Living withCardiovascular Disease Cardiac Rehabilitation Education Program St. Mary’s General Hospital
StatisticsAlthough 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 works What is Coronary Artery Disease Recognize the Signs and Symptoms Know the difference between Angina and Heart Attack Understand the Risk Factors Manage the Risk Factors
QuestionsWhat 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 ofthe chest cavity behind thebreast bone.A pump with a big job todo!
The Heart and How It WorksThe heart pumps blood into the lungs to pick up oxygenThe 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
Coronary Arteries • 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 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.
AnginaAngina is the signal of an imbalance in the demand of the heart muscle for oxygenIt 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 Angina5 “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 muscleOnset 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: TheHealing ProcessIt takes 6-8 weeks for the damaged muscle to form a scarThis 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 AttackAngina Heart AttackNo heart muscle Part of the heart damage muscle diesPain lasts < 15 min. Pain lasts > 15 minRelieved with rest Is not relieved with and nitroglycerin nitro and rest Time to treatment crucial.
Treatment of HeartDiseaseMedicationCoronary 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
Valve SurgeryValve 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
Risk FactorsName some risk factors for heart disease?Name some risk factors that we cannot change?
SmokingMost preventable cause of Coronary Artery DiseaseSmoking increases the risk of developing coronary artery disease and also the risk of dying from itSmoking 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 pressureCarbon monoxide in smoke decreases the amount of oxygen being supplied to the heart.
Managing SmokingIt 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 PressureThe target blood pressure we are aiming for is a blood pressure less than 140/90Blood vessels are under more stress damaging the walls of the coronary arteries and making them more susceptible to plaque formation
Managing Blood PressureBlood pressure will be monitored weekly prior to exercise sessionsIf elevated over time 24 hour monitoring may be recommended to contribute to improved management Group Education and individualized counseling – Heart Healthy Diet - Medication - Exercise
High CholesterolAn abnormal blood lipid profile has been a major risk factor for cardiovascular diseaseManaging 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 CholesterolReview of lipid profileUnderstand the numbersSet goals to lower your risk Group education and individualized counseling Heart Healthy Diet Medication Exercise
DiabetesIn 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 DiabetesReduce diabetes complications by keeping your blood sugar in your recommended target range and blood pressure<130/80Monitor and record your blood glucose levels dailyBring 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 pinch3. Wash and dry your feet (Especially between your toes) thoroughly4. Wear fresh clean socks everyday5. Inspect your feet carefully every day6. Clean cuts or scratches with mild soap and water
Excess Body WeightExcess body weight – adds strain on the heart - increases the workload of the heartExcess body weight also increases blood pressure and blood cholesterol
Managing Ideal BodyWeightStudies 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 InactivityPhysical inactivity is a major risk factor for many cardiovascular diseases including coronary artery diseasePhysical 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,AnxietyEstablished as predictors of coronary artery disease and can lead to a heart attackDepression found to complicate recovery from cardiovascular events as well as an increase in 1 year mortality after heart attackIncrease susceptibility to other risk factors i.e. smoking, inactivity.
Managing Stress,Depressionand AnxietyAcknowledge and discuss emotions and reactions that accompany a change in health. Many are normal and a necessary part of recoveryLearning 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