Living with Cardiovascular Disease

Cardiac Rehabilitation

Education Program

St. Mary’s General Hospital

Statistics

Although cardiovascular disease remains the leading cause of death in Canada,mortality rates have dropped significantly since the early 1950’s.

Cardiac Rehabilitation programs emphasize prevention strategies targeted at reducing the major risk factors associated with heart disease, lowering the risk of death by 20-25%.

Learning Session Objectives

Understand how the heart worksWhat is Coronary Artery DiseaseRecognize the Signs and SymptomsKnow the difference between Angina

and Heart AttackUnderstand the Risk FactorsManage the Risk Factors

Questions

What is the function of the heart?What are the coronaries?What is Coronary Artery Disease?What is Angina?What is a Heart Attack?What is the difference between a

Heart Attack?

The Heart and How It Works

• Hollow Muscular Organ • Size of a clenched fist • Located in the center of

the chest cavity behind the breast bone.

A pump with a big job to do!

The heart pumps blood into the lungs to pick up oxygen

The blood returns to the heart and is then pumped into arteries and capillaries that carry blood rich in oxygen and nutrients to every cell of the body

The Heart and How It Works

•  The Heart as a muscle requires oxygen and nutrients and has its own network of 3 coronary arteries to feed the heart muscle

• These arteries curl around the surface of the heart and plunge into the muscle bed where they divide like branches of a tree to reach every fiber in the heart

Coronary Arteries

Coronary Artery Disease

•  A condition in which the arteries that supply the heart muscle with blood containing oxygen and nutrients become narrowed or blocked

• Fatty streaks line the inner blood vessel and build up into “plaques” small clumps of irregular shapes and sizes that project out from the wall of the artery causing the narrowing

Signs And Symptoms… When arteries are narrowed the blood cannot

flow freely through them which reduces the supply of oxygen to the heart muscle

The heart sends out a signal or warning sign called angina *angina pectoris or “chest pain”

A tightness, a pressure, or a squeezing sensation in the middle of the chest

It may radiate into the neck, jaw, throat, elbows. It can present as shortness of breath or

heartburn.

Angina

Angina is the signal of an imbalance in the demand of the heart muscle for oxygen

It is typically brought on with exertion and relieved with rest.

It is temporary and causes no muscle damageNitroglycerin sublingually relaxes the tone in the

walls of the arteries and improves the supply of oxygen rich blood to relieve the discomfort

Factors that may cause Angina

5 “E’s” and Smoking: 1. Exercise2. Exertion3. Emotion4. Eating5. Exposure6. Smoking

Heart AttackBlood flow through the coronary artery is

completely blocked, no blood and oxygen can get beyond the blocked artery and results in permanent damage to heart muscle

Onset not associated with activitySymptoms include:

Pressure, burning, tightness, heaviness or squeezing that persists for > 15 min and is not relieved with rest and nitroglycerin

Nausea, indigestion and/or vomiting Sweaty, clammy skin. Sense that something is very wrong

After a Heart Attack: The Healing Process

It takes 6-8 weeks for the damaged muscle to form a scar

This strengthens the area of damage.New, smaller blood vessels can form to

supply the area around the damage with blood (collateral circulation).

Angina vs. Heart Attack

AnginaNo heart muscle

damagePain lasts < 15

min.Relieved with rest

and nitroglycerin

Heart AttackPart of the heart

muscle diesPain lasts > 15 minIs not relieved with

nitro and restTime to treatment

crucial.

Treatment of Heart Disease

MedicationCoronary AngioplastyCoronary Artery Bypass Graft Surgery

(CABG)Cardiac Rehabilitation Program

Cardiac Investigations

Cardiac Catheterization: A catheter is passed from femoral or brachial artery (groin or wrist) and dye injected into each coronary artery to determine narrowing or blockages and confirm diagnosis

Balloon Angioplasty

Angioplasty with Stent

•

                                                                                                                                                    

Angioplasty (PTCA)

Before After

Angioplasty (PTCA)

Before 5-years later

Coronary Artery Bypass Graft

Valve Surgery

Valve surgery but have clean arteriesExercise to help in re-conditioning

the heart and strengthen the heartYou may have been very short of

breath before surgeryExercise with help build up your

strength again

Name some risk factors for heart disease?

Name some risk factors that we cannot change?

Risk Factors

Risk Factors for Heart Disease

Modifiable:SmokingHigh Blood

PressureHigh CholesterolDiabetesObesityPhysical InactivityStress

Non-Modifiable:AgeRaceGenderFamily History

SmokingMost preventable cause of Coronary Artery Disease

Smoking increases the risk of developing coronary artery disease and also the risk of dying from it

Smoking increases the risk of in-stent blockageSmoking negatively affect bypass graftsNicotine contributes to build-up of fatty plaques

in your arteries, and increases the workload of the heart by increasing the heart rate and blood pressure

Carbon monoxide in smoke decreases the amount of oxygen being supplied to the heart.

Managing Smoking

It is never too late to quit smokingHealth Benefits begin as soon as 20 minutes

from the time of the last cigaretteBlood pressure and heart rate return to normalBlood carbon monoxide levels to normal within

8-12 hrs, improving oxygen levels

Cardiac Rehab Program can Assist you in this process with group support sessions for “Preparing to Quit Smoking”

High Blood Pressure

The target blood pressure we are aiming for is a blood pressure less than 140/90

Blood vessels are under more stress damaging the walls of the coronary arteries and making them more susceptible to plaque formation

Managing Blood Pressure

Blood pressure will be monitored weekly prior to exercise sessions

If elevated over time 24 hour monitoring may be recommended to contribute to improved managementGroup Education and individualized counseling – Heart Healthy Diet

- Medication - Exercise

High Cholesterol

An abnormal blood lipid profile has been a major risk factor for cardiovascular disease

Managing the levels to recommended target range has been shown to decrease cardiac events by slowing disease progression stabilizing the plaque and improving the function of the lining of the arteries

Managing Cholesterol

Review of lipid profile Understand the numbersSet goals to lower your risk

Group education and individualized counseling Heart Healthy Diet Medication Exercise

Diabetes

In Type 2 diabetes the body either does not use the insulin it makes or it doesn’t make enough insulin causing high levels of glucose or “sugar” in the bloodstream.

Poorly controlled blood sugars accelerates the process of plaque build up causing damage to blood vessels and nerve endings

Managing Diabetes

Reduce diabetes complications by keeping your blood sugar in your recommended target range and blood pressure<130/80

Monitor and record your blood glucose levels daily

Bring your glucometer to exercise sessions. <14 & >4 for safe exercise

Diabetes Education as required

Managing Diabetes cont’d

Foot Care Rules:1. Never go barefoot, even indoors2. Wear shoes that fit properly. They

should be supportive, and should not rub or pinch

3. Wash and dry your feet (Especially between your toes) thoroughly

4. Wear fresh clean socks everyday5. Inspect your feet carefully every day6. Clean cuts or scratches with mild soap

and water

Excess Body Weight

Excess body weight – adds strain on the heart

- increases the workload of the heart

Excess body weight also increases blood pressure and blood cholesterol

Managing Ideal Body Weight

Studies have demonstrated significant heart health benefit associated with a 10% decrease in weight

Cardiac rehab offers counseling and support to assist you to achieve your target weight range Body Composition Analysis Heart Healthy nutrition education in group setting Individualized nutrition counseling

Managing Physical Inactivity

Physical inactivity is a major risk factor for many cardiovascular diseases including coronary artery disease

Physical Activity Guideline, From Health Canada recommends a target of 30-60 minutes of moderate intensity physical activity 4-5 days of the week

Cardiac rehab offers education sessions about the heart health benefits of daily exercise and active living

Supervised exercise program and support in determining goals for independent exercise

Stress,Depression,Anxiety

Established as predictors of coronary artery disease and can lead to a heart attack

Depression found to complicate recovery from cardiovascular events as well as an increase in 1 year mortality after heart attack

Increase susceptibility to other risk factors i.e. smoking, inactivity.

Managing Stress,Depression and Anxiety

Acknowledge and discuss emotions and reactions that accompany a change in health. Many are normal and a necessary part of recovery

Learning and support may occur through shared experiences and emotions related to coping with heart disease as well as group education to assist in recognizing signs of poor coping

Individual counseling with Social Work

Welcome to Cardiac Rehab

Looking forward to a great 4 months getting to know you better. Your nursing team:Linda Tammaro R.N.Christine Martin R.N.Marilyn Wilk R.N.CCN(C)BScN