Preparing for Cardiac Surgery and Cardiac Rehabilitation

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

While many of you who regularly visit are looking to prevent heart disease in the future, some of you have already been diagnosed with some form of arteriosclerosis. Maybe you have symptoms on exertion (angina) or you’ve had a heart attack (myocardial infarction or MI). Perhaps you have had, or will have, an intervention such as an angioplasty (percutaneous coronary angioplasty, or PTCA) or a placement of stent to hold arteries open.

Just know – as frightening as it is to be diagnosed with heart disease, it is not a death sentence.

Life can begin anew after a heart attack, or interventional procedure, if you can take the initiative to make simple changes in your life, and build on your successes.

The idea of cardiac surgery and procedures may seem scary and overwhelming, but sitting down and planning things out can give you a sense of control. It can also be of some comfort to know what to expect, and then plan for it. Preparation can lessen anxiety for you and your family.

This 2-part cardiac rehab series is about helping people—and their families—learn to live with heart disease. We hope it will assuage fears and offer you solutions.

Discovering You Need a Cardiac Surgery or Procedure Is an Opportunity to Plan Ahead

So, you’ve agreed to have a coronary bypass operation or other cardiac intervention, and your mind may be spinning…

Actually, if you are having an elective surgery or other procedure, you are among the lucky ones who can plan ahead. All too many find themselves on the table under emergency conditions, and are headed for stent, angioplasty, or emergent surgery in order to prevent or limit damage to their hearts.

However, even those who cannot prepare are so fortunate! We can easily take for granted the resuscitation techniques we have, as well as all the technological advances that have only been available very recently. Defibrillators only went mainstream in the mid-1980’s, and more invasive intervention like pacemakers, coronary artery bypass grafting/surgery (CABG/CABS), percutaneous balloon angioplasty, and stents have joined the scene over the last decades. So, going into formal cardiac rehab programs is something our great-grandparents never even had as an option. Similar advances have been made from everything to treating cardiac arrhythmia and replacing hearts valves, to heart transplantation and future stem cell therapies.

Before we look at what you can expect pre and post CABS (we’ll cover this soon through part 2 of this series: How to Prepare for Cardiac Surgery), let’s take a brief look at what cardiac rehab is for all those with heart disease who can take advantage of this wonderful program…

What is Cardiac Rehab?

“Cardiac Rehab”—as it is so often referred to—is a structured, professionally supervised program for people of all ages who are recovering from cardiac events, or learning to live with angina. These programs are usually hospital-based initially, and may be conducted in community centers after the initial months of healing and stabilization have occurred.

I was a former director of our community hospital’s “Cardiac Rehab” for several years. And my wife, Jan, enjoyed her many years as cardiac rehab nurse. Our cardiac patients have always been—and continue to be– very near and dear to our own hearts.

When in hospital practice, we offered support and guidance over the many months of recovery. We also received some of the most incredible gratitude—and learned so many valuable lessons from those in our care.

In general, cardiac rehab programs include counseling and education, as well as supervised exercise. The team of specialists includes a Medical Director, usually an MD, as well as registered nurses, physical therapist, exercise physiologists, nutritionists and other healthcare professionals.  The goal of cardiac rehab is to assist cardiac patients to gradually increase their physical fitness over the healing period. Generally, this is approximately three months after a heart attack or cardiac surgery, and may be shorter for invasive procedures like angioplasty and stent placement.

You’ll get educated about your specific heart condition, how to reduce any symptoms you may have, and your risk factors. You’ll also learn behavioral strategies such as dietary modification, smoking cessation, weight management, and stress reduction techniques to offset those risks.

Cardiac Rehab Phases

Phase I of cardiac rehabilitation starts at the bedside during your hospital stay. In some locations, trained staff will assist you as you go through early stages of mobility, usually walking in the hallway. Commonly, a low level treadmill exercise stress test is performed before discharge to enable your cardiologist to assess your progress, and give you instructions for activity limitations at home. You may be given instructions on how to safely increase your activity level as tolerated.

Phase II most often begins a few weeks after discharge. Your rehab team will develop what is called an “exercise prescription” based on your most recent stress test. You will be taught about “target heart rate”(THR), or the heart rate it is safe for you to achieve during exercise sessions. You are medically supervised to be sure you do not have symptoms within your THR range. If you do, your exercise prescription can be modified, and then progressed again accordingly. As you engage in your exercise sessions two to three times a week, you will learn safe parameters—such as walking speed and any hill incline; bicycle RPMs and resistance;  and so on— so that you can exercise at the same level safely at home. One of the first agendas is learning to take your own pulse. You will also become familiar with terms such as “MET”, or metabolic equivalent. For instance, sitting at rest is equal to 1 MET. Whatever MET level you are able to do during an exercise session should translate into other daily activities that are safe for you.

One goal of cardiac rehab is to help you be more in touch with your body, so that you more easily recognize signs that you may be overdoing it, and acquire confidence with what you can do safely. Depending on your insurance carrier and your diagnosis, your personal rehabilitation program may last a few weeks or a few months.

Physical activity is engaging and uplifting. You can collaborate with your rehab team to set reasonable goals. You will also have opportunities to discuss your emotional and spiritual recovery. Our patients used to bring in copies of their latest medical reports for their charts—a positive reinforcement that healing was progressing. Should any complications develop along the way, we could intercept quickly to get them back on track.

Phase III at our hospital was an open-ended self-pay program for those who had “graduated” from Phase II. Many had formed close bonds with “classmates”, and wished to continue “working out” together. Some just appreciated the “safe” feeling of exercising in medically supervised environment. Others were intimidated to return to the gym. Close monitoring was no longer required in Phase III, and people could self-select how many times a week to attend in order to supplement their exercise program at home.

Things to Consider When Choosing A Cardiac Rehab Program

Your primary physician or cardiologist will need to give you and your insurance company a referral order for cardiac rehabilitation. He or she can familiarize you with the options you have in your particular area. Obviously, large urban areas may have more options at a variety of medical centers. If you were hospitalized while traveling away from home, you can locate a cardiac rehabilitation program near your residence after discharge. Things to consider are location and a time of day that are accessible and convenient for you; insurance coverage, pricing and affordability; setting—at-home vs hospital-based; and whether cardiac rehab is offered as a group program or individually (more rural locations may offer primarily home-based opportunities).

Having worked in a group setting, I highly recommend cardiac rehab if possible. Our classes were limited to 12 people, due to space, equipment availability, and staffing. People wore cardiac monitors for Phase II, so we could easily watch for heart rate response, irregular heartbeats, and any signs of ischemia. I have to say that the most important aspect that I enjoyed observing during rehab classes was the close bonds people there formed with one another. The willingness to reassure each other; offer “pep talks” to new people when needed; and to lighten the load by finding the humor that’s so easy to forget along the way.  There was even a special wall to post cartoons we all found that were relevant– even the one of the overbearing, overweight nurse intimidating a fellow on a treadmill. Those cartoons kept us all laughing at ourselves along the way to health and recovery.

Cardiac rehabilitation: we can’t imagine getting back to restored health and happiness without it.

Be on the lookout for part 2 of this series: How to Prepare for Cardiac Surgery… coming soon!

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