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Cardiac rehabilitation: It’s the heart of the matter

Robert Malkin, M.D. [August 20 2010]

You're in the intensive cardiac care unit when you realize how lucky you are: You've survived a heart attack! But soon, your thoughts race to what's ahead — months out of work, recuperation, perhaps more heart trouble?

Not necessarily. The fact is, many patients can avoid more cardiac trouble and return to usual activities in about six to 12 weeks. How? By participating in cardiac rehabilitation — a program of closely monitored exercises, lifestyle education, and support. In many cases rehab begins in the hospital within 48 hours of the attack itself.

Exercise right after a heart attack? Absolutely. Although it may sound counterintuitive, cardiologists know that cardiac rehab significantly reduces your chance of suffering another heart-related episode.
The importance of exercise

The day after a heart attack, cardiac rehab staff typically have patients sitting up, standing and walking the halls. Within a day or two, while you're still in the hospital, you may undergo a treadmill stress test to evaluate how you respond to increasing physical activity.

Using the stress test results as a guide, the cardiac rehab staff, along with your cardiologist, will prescribe various exercises for your recovery. Exercise levels will start off slowly and comfortably and will gradually progress as you are able to tolerate more (while always remaining comfortable). Generally, rehab programs are designed to provide exercise supervision three days a week and will include treadmill walking, bicycling, or other forms of cardiovascular exercises. Regular exercise over several months will help you slowly rebuild your stamina, strengthen your heart, and greatly reduce your risks of experiencing another cardiac event.

Weight lifting is another important part of the rehab program with the goal of strengthening your muscles so you can more comfortably return to work, recreation, and your daily tasks.

As you become more comfortable with exercise and are able to manage your workloads and symptoms, you will be encouraged to begin exercising at home during the days you do not attend rehab.

Exercise is just one aspect of cardiac rehabilitation. Early on you'll receive direction and support on making lifestyle changes; overcoming the stress and anxiety of dealing with your heart condition; managing your symptoms; and eating healthier. A dietitian can help design an eating plan that is right for you.

Medicines that aid recovery

Your doctor will likely prescribe medications to help you better manage your heart disease. Among the most commonly prescribed drugs are:

• Aspirin. This over-the-counter drug has powerful anti-clotting properties that may help reduce the risk of a second heart attack or stroke.

• Beta blockers. This classification of drugs lowers the heart rate and blood pressure to reduce strain on the heart.

• ACE inhibitors. These drugs relax the blood vessels, thereby enhancing circulation and lowering blood pressure.

• Statins. These drugs help lower high levels of low-density lipoprotein (“bad”) cholesterol in the blood right after a heart attack.

Your doctor will know what medications are best for you.

The bottom line:Getting involved early in a cardiac rehab program is the safest and surest way to recover from a heart attack and return back confidently to your life!

Robert Malkin, M.D., is a cardiologist at The Hospital of Central Connecticut and medical director of the hospital's cardiac rehab program. Learn more about cardiac rehabilitation the hospital