Question

Philip is a 65-year-old retired salesman with a 20-year history of heart disease that includes 2 myocardial infarctions, each followed by a bypass operation. The most recent bypass was last year. He has decided to begin an exercise program, but is experiencing shortness of breath. His physician conducted an exercise stress test using the Bruce protocol. He had to terminate the test after 5 minutes because of shortness of breath. An echocardiogram revealed a 30% ejection fraction. He was diagnosed with CHF and prescribed a Beta Blocker, diuretic, an ACE inhibitor, and a potassium supplement. The exercise test revealed a maximal heart rate of 115 bpm, resting heart rate of 85 bpm, peak blood pressure of 150/90 mmHg, resting BP of 100/80 mmHg, and a VO2 max of 12 ml/kg/min.

Identify frequency, intensity, time, and type of exercise. How would you monitor intensity? What special precautions do you think you need to take?

this is all the information I got as well

Answer 1

Step 1

Acute myocardial infarction is a life-threatening condition which is also called a heart attack. Coronary arteries supply oxygen-rich blood to heart muscles. When one or more coronary arteries blocked or narrowed due to plaque which is made of fat, cholesterol, and cellular waste products that can decrease or stops blood flow to heart muscles that result in damaged tissues. This in turn results in a heart attack.

Step 2

The Cardiopulmonary Stress Test is performed to know how well lungs and heart are functioning during exercise. The patient performs a mild exercise on an upright bicycle while breathing through a mouthpiece. Each breath is measured to assess the bodys function. The capacity and strength of the lungs are measured before and after exercise. Echocardiography is a test that is used to monitor the heart and its valve functioning. This test uses sound waves to produce live images of the heart. This image is called an echocardiogram which uses electrodes to check heart rhythm and ultrasound technology to see how blood moves through the heart. The results of the tests are as follows.
ECG: old myocardial infarctions (significant Q-wave present)
Maximum Heart Rate: 115 beats per minute (test stopped due to dyspnea)
Resting Heart Rate: 85 bpm
Peak Blood Pressure: 150/90 mm Hg
Resting Blood Pressure: 100/80 mm Hg
Vo2max: 12 ml.min-1.kg-1

Step 3

While performing the stress test shortness of breath is observed in five minutes. This is an indication that there are high chances of heart failure and there are more chances for immediate heart attack. An echocardiogram revealed a 30% ejection fraction which is the low ejection rate indicating the immediate intervention. Therefore he should diagnose with a diuretic, an ACE inhibitor which is already done hence it clear from a medical point of view. After which we need to check any heart block is present. If present then it is checked for at what degree block is present and for a better purpose surgery is performed if requires. Then the type of heart block is analyzed using a coronary angiogram. After this analysis to ensure the health of the heart positive surgeries such as coronary angioplasty or PTCA or a bypass should be performed. Based on overall health condition second surgery is performed and based on tolerance capacity third surgery is recommended.

Step 4

Try to exercise at the same time every day to develop a habit and avoid variables that impact exercise. Mostly weight lifting exercise should be avoided if require performed under the guidance of a doctor. Walking, stationary cycling, rowing, water aerobics are some of the regular exercises to perform with the advice of a doctor. Cardiac rehabilitation also recommended.

Exercise therapy improves behavioral risk factors which help to promote exercise capacity, and elevates Quality of life. Short-term exercise is safe. In the early stages moderate exercise best choice to improve patients' health conditions which decreases total cholesterol and body mass index. Then high-intensity exercise increases peak aerobic capacity and increases peak difference arteriovenous oxygen at peak exercise.

Stop smoking, stop consuming alcohol, maintain a proper diet, maintain blood pressure, regular exercise, avoid traveling, etc are the precautions to take.