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Aim of Cardiac Rehabilitation.

1. Maximize the physical psychological and social recovery so that patient can
achieve a lifestyle that is productive and personally satisfying as possible.
2. Encourage the adaptation of lifestyle that limits the progress of atherosclerosis
and minimize the risk of further cardiac event.
3. Assist patient to become physically active at the level which is compatible with
the functional capacity of their cardiovascular system.
4. Promote self responsibility to patient and encourage them to use appropriate
health and community services.
Health Education.
1. Start as soon as possible after stabilize in CRW to achieve the best result.
2. Explain regarding myocardial infarction in terms the patient can understand. Use
appropriate teaching aims example give pamphlet and the heart disease
magazine.
3. Inform patient that it takes approximately 6-8 weeks for heart to heal after
myocardial infarction and may be re infarction.
4. Explain signs and symptoms of extending myocardial infarction such as chest
pain, SOB, weakness and not relieved by taking the medication and the chest
pain longer than 20 minute.
Risk Factors.
1. Explain to patient that modifiable risk factor :
- Smoking, hypertension, dyslipidaemia, diabetes mellitus, obesity, stressfull
lifestyle.
Diet.
1. Teach the patient and family member in planning low fat sodium diet.
2. Reduction of high cholesterol and sodium food will help to control
atherosclerosis, hyperlipidemia, fluid retention and effect of coronary blood flow.
3. Take less than 3 mg of salt per day.
4. Consult dietician in order to assist patient in planning meals that will meet the
prescribed limitation of sodium, saturated fat and cholesterol.
Medication.
1. Explain the rational for side effect and important of compliance of the medication
prescribed.
2. Take according prescription at correct time and dosage.
Smoking.
1. Explain to patient risk of smoking.
2. Nicotine in the cigarette causes an increased catecholamine (epinephrine and
norepinephrine) release which causes an increased heart rate, peripheral
vasoconstriction and increased blood pressure.
3. Stop smoking reduce the heart rate, increased oxygen absorption and reduction
of heart rate.
4. After 15 years, the risk of CAD is same with non smoker.
Activity.
1. Reduce risk CAD 30 40%.
2. Instruct patient gradually increase activity tolerance by adhering to a regular
exercise programmed.
3. Take frequent rest periods for about 4-8 weeks after discharge.
4. Avoid physical conditioning programs such as jogging and aerobic dancing until
advice by doctor.
5. Stop any activity that cause chest pain, SOB, palpitation or dizziness.
6. Avoid activity immediately after meals and in extreme heat or cold.
7. Sexual activity with usual as a passive partner, not the active partner. If during
doing do the sexual activity, stop it immediately.
Follow up.
1. Explain the important to follow up to check on his progress.
2. Instruct patient to report :
- Chest pain, arm , neck, and jaw pain unrelieved by S/L GTN.
- SOB.
- Significant weight gain or swelling of foot and ankle.
- Irregular pulse or unexpected change the pulse rate.
- Inability to tolerate activity.
- Reinforce the importance of keeping follow up appointment with doctor and
for stress testing.
Cardiac Rehabilitation for Mr, M.
Mr M was referred to cardiac rehab programmed in Hospital Pulau Pinang. Health
education was given to Mr M regarding his modifiable risk factors and the importance to
practice healthy life style before he discharge from the Hospital. Reinforcement is given
during phone Mr M.