1. High Risk Case Study Sudbury Regional Hospital Cardiac Rehabilitation

2. High Risk Case Study n 66 year old male n MI 16 years ago and 2 months ago n CABG 6 years ago n Cardiac Arrest during recent Angiogram

3. High Risk Case Study n Left Ventricle Ejection Fraction Grade 4 ( less than 20%) n Congestive Heart Failure( NYHA Class II) n TIA n PVD n Osteoarthritis

4. CORONARY RISK FACTORS n Hypertension n Dyslipidemia n Obesity n Stress n Diabetes n Inactivity n Family History

5. MEDICATIONS n Digoxin n Coumadin n Aldactone n Enteric Coated ASA n Nitrong n Accupril n Lasix n Carvedilol n Insulin n Ativan n Slow K Mr..H. Nitrong SR 2.6mg

6. FUNCTIONAL CAPACITY n 3.5 - 4 Mets (metabolic equivalents) n Moderate Dyspnea with ADL n Walked 550 feet on 6 min. walk test

7. RISK STRATIFICATION SCORE n Total Score from both Risk of Disease Progression and Acute Event = 84.3

8. HYPERTENSION n Medication n Control weight n Reduce sodium - less than 3 gm/day

9. DYSLIPIDEMIA n Medication n Low fat diet n Exercise

10. OBESITY n Exercise to expend 200 cal/session n BMI 20-25/ WHR <1 n 1500-1800 caloric intake daily n Low fat, low sodium diet n Referral to dietician

11. INACTIVITY n Balance activity with rest n Combination wt./ non-wt.bearing exercise n Must be stable (NYHA I-II) n Exercise capacity of > 3 METS n 500 feet on 6 min. walk test

12. F.I.T.T. PRINCIPAL FREQUENCY n 3-5 Times per week n Can try shorter bouts( 5-10min.) of 2-3 sessions per day

13. F.I.T.T. PRINCIPAL INTENSITY n Based on treadmill test and/or 6 min. walk test n 40-75% Vo2max n Karvonen’s formula n RPE and Dyspnea scale

14. F.I.T.T. PRINCIPAL TYPE n Aerobic activities recommended n Resistance training -high rep, low wt.

15. F.I.T.T. PRINCIPAL TIME n Brief initially: 2-5 min. per session, increasing this by total of 5 min. per week n Rest periods between intervals n Progressively increase time to 20-30 min. total as patient’s tolerance improves

16. STRESS n Medication to reduce anxiety n Regular exercise n BDI46 n Stress management n Assess social and family support n Quality of Life Assessment tool

17. DIABETES n Regular exercise n Medication n Diabetes Educator