Question

Sherman is a 65-year-old, sedentary male with Heart Failure (HF). He weighs 200 lb, is 5’8” tall. He has a cardiac output of 4.0 L/min and his left ventricular ejection fraction (LVEF) is 40%. He is referred to you by his cardiologist who would like him to begin exercising in your cardiac rehabilitation facility. Discuss how heart failure affects Sherman’s physiology and the compensatory mechanisms to maintain circulation. How will this limit his ability to exercise?   

As his clinician you need to design an 8-week exercise program for Sherman. Before you develop an exercise program, you evaluate his VO2max, which is 20 mL/kg/min. Specify the optimal training program including intensity and duration that would yield the greatest improvement in his cardiovascular function and explain why. Outline Sherman’s expected cardiovascular (central and peripheral) and pulmonary adaptations to exercise. How would you evaluate his cardiopulmonary performance before and after the 8-week exercise program to determine if the program was successful?

Answer 1

The hearts goal in heart failure is to maintain the stroke volume and cardiac output.As the body fails to compensate in heart failure it reflects 2 types of symptoms which include:

• Congestive symptoms ( back flow of blood into lungs resulting in Shortness of breath and swellings in ankle and abdomen)
• low output symptoms( decreased blood flow to brain and other vital organs resulting in lightheadedness, fatigue and low urine output result in damaging organs especially kidney)

when the cardiac output is less the brain signals the heart to pump faster, adrenal gland release adrenaline to blood stream that stimulate the heart to beat faster.

To increase stroke volume means to get adequate blood to heart and to pump harder by thickening of heart muscles to help heart muscle to pump harder to and by increasing the size of the ventricles, thus increase stroke volume.

Cardiac rehabilitaion exercise program include:

• warm up, stretching exercise
• aerobic Exercise for 30 to 45 minute- walking , jogging , swimming, cycling
• treadmill exercise
• stationary cycle exercise
• rowing machine exercise
• resistance exercise

After exercise assessment made by ECG and vitals monitored regularly .

The normal Vo2 max for a normal individual is 35-40 ml/kg/min. As per the question Mr. Sherman has a Vo2 max of 20ml/kg/min which is very poor. So as per the physique and age of the patient the exercise schedule is planned as:

walk fast for 1 minute ------> jog for 2 minute -------> cycle on stationary cycle for 1 minute ------> jog for 2 minute and so for 20 minute. gradually the timing will be increased over the weak as Mr.Sherman adjust to the routine without any issues.

Before and after the completion of 8 weeks , plan for  CPET ( cardio pulmonary exercise test) which helps to assess exercise responses on pulmonary, cardiovascular, haematological , neuropsychological, and skeletal muscle system that cannot be identified by a normal organs function tests.PCET assessment include:

• Lung Function: Flow volume loops

• Oxygen Consumption during exercise (VO2 max)

• Anaerobic Threshold

• Heart performance during exercise

• Blood gas measurement from blood sample taken from the earlobe

• Exercise 12 lead ECG