PT Weekly: Physiotherapy intervention in myocardial infarction
Cardiovascular disease refers to a number of different conditions that affect the heart and circulatory system. These conditions include heart disease, peripheral vascular disease, strokes, congenital heart disease. Cardiovascular disease has become one of the leading causes of death worldwide. If left untreated, those who show signs of cardiac diseases or have previously suffered from this disease are at a very high risk of developing more serious conditions or ultimately, death. However, by addressing behavioural risk factors such as an unhealthy diet, obesity, physical inactivity and harmful use of alcohol, many cardiovascular diseases can be prevented or managed.
Heart disease is no longer considered a disease that affects just men. In the past, women usually received less aggressive treatment for heart disease and were not referred for diagnostic tests as often. As a result, when many women were finally diagnosed with heart disease, they usually had more advanced disease and their prognosis was poorer.
Myocardial infarction or Ischaemic Heart Disease
Acute myocardial infarction (AMI), commonly known as a heart attack, is the interruption of blood supply to a part of the heart, causing heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (fatty acids) and white blood cells in the wall of an artery.
The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death of heart muscle tissue.
The most frequent cause of myocardial infarction (MI) is rupture of an atherosclerotic plaque within a coronary artery with subsequent arterial spasm and thrombus formation.
Other causes include the following:
- Coronary artery vasospasm.
- Ventricular hypertrophy.
- Hypoxia due to carbon monoxide poisoning or acute pulmonary diseases.
- Coronary artery emboli, secondary to cholesterol, air, or the products of sepsis.
- Cocaine, amphetamines.
- Arteritis ,aneurysms of the coronary arteries.
- Aortic dissection.
Heart attack symptoms in women may be different from those experienced by men. Many women who have a heart attack do not know it. Women tend to feel a burning sensation in their upper abdomen and may experience lightheadedness, an upset stomach, and sweating. Because they may not feel the typical pain in the left half of their chest, many women may ignore symptoms that indicate they are having a heart attack.
Other symptoms may include:
- sudden chest pain (typically radiating to the left arm or left side of the neck).
- shortness of breath.
- and anxiety.
Risk factors for myocardial infarction
Studies have shown that after menopause, women experience an increased risk of heart disease. This was connected to decreasing levels of the female hormone estrogen during menopause—a process that begins around age 50. Estrogen is associated with higher levels of high-density lipoprotein (HDL or “good cholesterol”) and lower levels of low-density lipoprotein (LDL or “bad cholesterol”). Withdrawal of the natural estrogen that occurs in menopause leads to lower “good cholesterol” and higher “bad cholesterol” thus increasing the risk of heart disease.
- Diabetes (with or without insulin resistance) – the single most important risk factor for ischaemic heart disease (IHD).
- Tobacco smoking.
- Low HDL.
- High Triglycerides.
- High blood pressure.
- Family history of ischaemic heart disease (IHD).
- Age: Men acquire an independent risk factor at age 45, Women acquire an independent risk factor at age 55.
- Sedentary life style / physical inactivity
- Alcohol Studies show that prolonged exposure to high quantities of alcohol can increase the risk of heart attack Males are more at risk than females.
Physiotherapy play a major role in the treatment of those with myocardial infarction . The recommended form of treatment is a supervised exercise programme that is specially created and supervised by a physiotherapist to meet and treat your needs. Due to the nature of cardiac diseases, each patient’s symptoms will be different therefore; it is essential that prior to physiotherapy, a medical/ proper physical assessment be carried out so that an appropriate exercise program will be designed.
Physiotherapy Intervention is in stages which is also a factor of patients’ response to medical treatment. An exercise programme will be design from admission to when he/she will be discharged.
- Complete bed rest:
Aims of physiotherapy :
- To prevent accumulation of secretion in the lungs.
- To prevent deep vein thrombosis.
- To prevent pressure sores.
- To teach and encourage relaxation.
- To explain the purpose of an active rehabilitation programme
- Partial bed rest:
The patient is up to sit for 1-2hours per day. Feeding, washing are allowed.
Aims of physiotherapy:
- To maintain clear lung fields.
- To increase the load on the heart such that there is hypertrophy of the myocardium.
- To educate the patient to recognize signs and symptoms of excess exercise.
- To begin rebuilding the patients confidence.
- To train postural awareness.
- To strengthen leg and trunk exercises.
- Up and about in hospital:
The patient is allowed to wash, feed, go to the toilet and have a bath-with supervision.
Aims of physiotherapy:
- To continue promoting hypertrophy of the heart muscle to strengthen trunk and leg muscles.
- To continue rebuilding patient confidence.
- To improve exercise tolerance to teach awareness of exercise capacity.
- After discharge from hospital:
Home management will be given before leaving from the hospital. The patient is advised and encouraged to come on an out-patient basis.
Out-patient follow-up treatment plan
This is usually taken in gymnasium. Patients benefit from meeting fellow patients in group.
Aims of physiotherapy:
- To increase exercise tolerance.
- To maintain or improve confidence.
- To provide support and encouragement.
- To help reduce risk factors and thereby reduce recurrence.
For more information or to arrange an appointment, you can reach out to Physio Centers of Africa on 0813 028 0496!