Cardiovascular Medicine Book

Electrocardiogram

Myocardial Infarction

Symptoms

Circulatory Disorders

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Cardiac Rehabilitation

Aka: Cardiac Rehabilitation, Activity after Myocardial Infarction
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  1. Background
    1. Cardiac Rehabilitation is under-utilized by Medicare-eligible indications (only 14-31% participation)
    2. Cardiac Rehabilitation has great efficacy as a secondary prevention tool
  2. Indications
    1. Medicare reimbursed indications (3 sesssions per week for 3 months)
      1. Following acute Myocardial Infarction (STEMI or non-STEMI)
      2. Status-post Coronary Artery Bypass Graft (CABG)
      3. Status-post Percutaneous Coronary Intervention (PCI)
      4. Stable Angina Pectoris
      5. Status-post Vascular Surgery
      6. Status-post Heart Transplantation
      7. Status-post Heart Valve Repair or Replacement
    2. Other indications
      1. Stable Congestive Heart Failure
      2. Peripheral Arterial Disease
      3. Status-post ventricular assist device placement
  3. Protocol: Cardiac Rehabilitation Phases
    1. Phase I Cardiac Rehabilitation (during hospitalization for acute event or procedure)
      1. Supervised, structured early Physical Activity
      2. Patient Education
      3. Risk stratification (low level, graded, Exercise tolerance testing)
    2. Phase II Cardiac Rehabilitation (Early Outpatient)
      1. Supervised Physical Activity program
        1. Reassess symptom-limited Exercise tolerance
        2. Custom tailored Exercise Prescription for 30 minutes daily and 5 days weekly
      2. Monitoring of Blood Pressure, pulse, cardiac rhythm
        1. Maintain Blood Pressure <140/90 mmHg
      3. Nutrition counseling
        1. Diabetes Mellitus Type II control with Hemoglobin A1C <8%
        2. LDL Cholesterol <100 mg/dl (preferable <70 mg/dl)
        3. Body Mass Index reduction towards goal of <27 kg/m2 (ideally <25 kg/m2)
      4. Cardiac Risk Factor modification
        1. Tobacco Cessation
      5. Reassess cardiac symptoms at rest and with activity
      6. Psychosocial support to screen for and manage Major Depression
    3. Phase III Cardiac Rehabilitation (Late Outpatient)
      1. Maintain and reinforce phase I and II management
      2. Reinforce medication use, Patient Education
  4. Protocol: Activity restrictions following acute Myocardial Infarction
    1. Gradually increase activity over 6-8 weeks following MI
    2. Return to work by 8 weeks after MI
    3. Activity program may start by 3-4 weeks after MI
    4. Sexual activity restarted at 4-6 weeks after MI
      1. See Sexual Intercourse after Myocardial Infarction
  5. Efficacy
    1. Reduced Angina, Dyspnea, and Fatigue
    2. Reduced Major Depression after acute coronary event
    3. Exercise performance improved
    4. Activities of Daily Living (ADL) performance improved
    5. Quality of life improved
    6. Decreased re-hospitalization rate
    7. Decreased work absence
    8. Reduced age-adjusted cardiovascular mortality by 50%
    9. References
      1. Bondestam (1995) Am J Cardiol 75:767-71
      2. Milani (2007) Am J Med 120(9): 799-806
  6. References
    1. Leon (2005) Circulation 111(3): 369-76
    2. Stephens (2009) Am Fam Physician 80(9): 955-60
    3. Wenger (2008) J Am Coll Cardiol 51(17): 1619-31

Cardiac rehabilitation (C0700431)

Definition (MEDLINEPLUS)

Cardiac rehabilitation (rehab) is a medically supervised program to help people who have

  • A heart attack
  • Angioplasty or coronary artery bypass grafting for coronary heart disease
  • A heart valve repair or replacement
  • A heart transplant or a lung transplant
  • Angina
  • Heart failure

The goal is to help you return to an active life, and to reduce the risk of further heart problems. A team of specialists will create a plan for you that includes exercise training, education on heart healthy living, and counseling. You will learn how to reduce your risk factors. These may include disorders such as high blood pressure, high blood cholesterol, overweight or obesity, diabetes. Smoking, lack of physical activity, and depression are other risk factors.

NIH: National Heart, Lung, and Blood Institute
Definition (HHC) Actions performed to restore cardiac health.
Definition (NIC) Promotion of maximum functional activity level for a patient who has experienced an episode of impaired cardiac function that resulted from an imbalance between myocardial oxygen supply and demand
Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 183378000, 151613007, 313395003
English Cardiac Rehabilitation, Cardiac rehabilitation, Cardiac Care: Rehabilitative, cardiac rehabilitation, cardiac rehabilitation (treatment), CARDIAC REHABILITATION, rnrx cardiac rehabilitation (treatment), rnrx cardiac rehabilitation, Cardiac rehabilitation treatment, rehabilitation cardiac, cardiac rehabilitation therapy, therapy cardiac rehabilitation, cardiac rehabilitation treatments, Heart Diseases--Rehabilitation, Cardiac rehabilitation therapy, Cardiac care: rehabilitative, Cardiac rehabilitation (regime/therapy), Cardiac rehabilitation (procedure)
Italian Terapia di riabilitazione cardiaca
Japanese 心リハビリテーション療法, ｼﾝﾘﾊﾋﾞﾘﾃｰｼｮﾝﾘｮｳﾎｳ
Spanish Cardiac rehabilitation, rehabilitación cardíaca (procedimiento), rehabilitación cardíaca (régimen/tratamiento), rehabilitación cardíaca, Terapia de rehabilitación cardiaca
Czech Rehabilitace při onemocnění srdce
Hungarian Cardialis rehabilitációs kezelés
Portuguese Terapia de reabilitação cardíaca
Dutch hartrehabilitatietherapie
French Réadaptation fonctionnelle cardiaque
German Herzrehabilitationstherapie
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Myocardial Infarction (C0027051)

Definition (NCI) A disorder characterized by gross necrosis of the myocardium; this is due to an interruption of blood supply to the area.
Definition (NCI) Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis.
Definition (MEDLINEPLUS)

Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don't get help immediately. It's important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include

  • Chest discomfort - pressure, squeezing, or pain
  • Shortness of breath
  • Discomfort in the upper body - arms, shoulder, neck, back
  • Nausea, vomiting, dizziness, lightheadedness, sweating

These symptoms can sometimes be different in women.

What exactly is a heart attack? Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat – called an arrhythmia - that causes a severe decrease in the pumping function of the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die.

NIH: National Heart, Lung, and Blood Institute
Definition (CSP) gross necrosis of the myocardium, as a result of interruption of the blood supply to the area.
Definition (NCI) Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area, as in coronary thrombosis.
Definition (MSH) NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION).
Concepts Disease or Syndrome (T047)
MSH D009203
ICD10 I22, I21
SnomedCT 233824008, 22298006, 155304006, 266288001, 66514008, 194796000
English Myocardial Infarct, Infarctions, Myocardial, Myocardial Infarction, Myocardial Infarctions, Infarcts, Myocardial, Myocardial Infarcts, HEART ATTACK, HEART INFARCTION, INFARCT MYOCARDIAL, Infarct, Myocardial, Infarction, Myocardial, MYOCARDIAL INFARCT, MYOCARDIAL INFARCTION, Cardiac infarction, NOS, Heart attack, NOS, Infarction of heart, NOS, Myocardial infarction, NOS, MI, ATTACK CORONARY, ATTACK HEART (NOS), Myocardial infarction syndrome, Myocardial infarction (MI), mi, Attack heart (NOS), Infarct myocardial, Heart Attack, INFARCTION (MI), MYOCARDIAL, MYOCARDIAL INFARCTION, (MI), MI, MYOCARDIAL INFARCTION, cardiac infarction, Myocardial Infarction [Disease/Finding], AMI, attacking heart, heart attacks, attack hearts, infarctions myocardial, infarcts myocardial, myocardial infarctions, Infarction;heart, myocardial infarcts, Infarction;myocardial, attacks coronary, attacks hearts, coronary attack, disorder infarction myocardial, mied, myocardial necrosis, syndrome myocardial infarction, mies, Myocardial infarct, Myocardial infarction, Heart attack, MI - Myocardial infarction, Cardiac infarction, Infarction of heart, Myocardial infarction (disorder), cardiac; infarction, infarction; myocardial, Attack - heart, Heart Attacks, Infarctions (Myocardial), Myocardial infarction NOS, Attack coronary, myocardial infarction, heart attack, heart infarction
German MYOKARDINFARKT, Koronarattacke, Herzanfall, MI, Herzanfall (NNB), HERZANFALL, Herzinfarkt, Myokardinfarkt
Dutch hartaanval, hartinfarct, hartaanval (NAO), MI, cardiaal; infarct, infarct; myocard, myocardinfarct, Hartinfarct, Infarct, myocard-, Myocardinfarct
French Crise coronaire, IM, Crise cardiaque SAI, Crise cardiaque, CRISE CARDIAQUE, INFARCTUS DU MYOCARDE, IDM (Infarctus Du Myocarde), Infarctus du myocarde, Infarctus myocardique
Italian MI, Attacco cardiaco, Attacco coronarico, Attacco cardiaco (NAS), Infarto del miocardio, Infarto miocardico
Portuguese Ataque coronário, Ataque do coração, Ataque cardíaco NE, EM, ATAQUE CARDIACO, ENFARTO DO MIOCARDIO, Enfarte do miocárdio, Infarto do Miocárdio
Spanish IM, Crisis coronaria, Ataque al corazón, Ataque al corazón (NEOM), Infarto miocárdico, Heart attack, Attack - heart, Myocardial infarct, Myocardial infarction, ATAQUE CARDIACO, INFARTO DE MIOCARDIO, Infarto al Miocardio, ataque al corazón, infarto cardíaco, infarto de corazón, infarto de miocardio (trastorno), infarto de miocardio, Infarto de miocardio, Infarto del Miocardio
Japanese 心臓発作（ＮＯＳ）, 冠発作, 心臓発作, ｶﾝﾎｯｻ, ｼﾝｿﾞｳﾎｯｻNOS, ｼﾝｿﾞｳﾎｯｻ, ｼﾝｷﾝｺｳｿｸ, 冠状動脈梗塞, 心筋梗塞, 冠動脈梗塞, 心筋梗塞症
Swedish Hjärtinfarkt
Czech infarkt myokardu, Srdeční záchvat, Srdeční záchvat (NOS), IM, Koronární záchvat, Infarkt myokardu
Finnish Sydäninfarkti
Russian INFARKT MIOKARDA, ИНФАРКТ МИОКАРДА
Croatian SRČANI INFARKT
Polish Świeży zawał serca, Zawał serca świeży, Zawał mięśnia sercowego, Zawał serca
Hungarian Coronaria roham, Szívroham (k.m.n.), Szívroham, Infarctus myocardii, Szívizom infarctus, MI
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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