Phase 2
Cardiac Rehabilitation
Phase 3 Cardiac Rehabilitation
Stress Testing
(regular, nuclear, pharmacologic)
Echocardiography
24 hour holter
monitoring
EKG
Electrocardiogram
EEG Electroencephalogram
24-hour Ambulatory Blood
Pressure Monitoring
Non-invasive Hemodynamic Monitoring (ICG or BIO-Z)
Phase 2
Pulmonary Rehabilitation
Phase 3 Pulmonary Rehabilitation
Pulmonary
Function Testing
For more information on this program or hours of
operation,
please call 786-8940, ext. 4552
Phase 2 Cardiac Rehabilitation
is an exercise and education program designed to assist individuals in their
recovery from heart ailments such as stable angina, a heart attack,
angioplasty, stents, bypass surgery, congestive heart failure or heart valve
repair or replacement. Besides the monitored exercise program, we provide
patient/family education and counseling on diet, risk factor modification
and the importance of change. Change can lead to your feeling better,
gaining strength, reducing stress, returning to work or retirement
activities faster and, maintaining less risk of a reoccurring incident or
future heart problems. Program length varies for each participant
(determined by your insurance coverage) but generally is for three days a
week for twelve weeks. The exercise classes themselves last for about an
hour with additional time slotted for the education portion. We strongly
recommend your family and/or friends attend the educational classes along
with you in order to help provide the ongoing support you are going to need
to make a full recovery. Class hours are 8AM to 3PM , Mondays,Wednesdays,
and Fridays. A written referral from your family doctor or cardiologist is
required for admission to the program as well as a low level stress test to
assure your safety for exercise. Most insurances cover this phase of rehab
but we ask that you check with your provider to be sure of the exact
coverage. Advanced Cardiac Life Support(ACLS) trained staff are always in
attendance during these classes.
During the program your heart rhythm
will be continuously monitored to detect any abnormal rhythms. Your blood
pressure and pulse will also be monitored. Your well being and safety are
always our first priority during this program. Please understand that
whatever intervention(s) you previously underwent was not a cure; it just
mended the problem and gave you time to make the appropriate lifestyle
changes that the Cardiac Rehab program can help you achieve.
Phase 3
Cardiac Rehabilitation is the maintenance portion of Cardiac Rehabilitation.
After completion of the Phase 2 program patients enroll in this phase.
Patients attend as long as they wish with many making it a lifelong
commitment. It is a self pay program with a modest fee charged per class or
per month as the patient wishes. A daily blood pressure is recorded along
with a monthly cardiac rhythm strip. Patients maintain their own worksheets
and record their own pulses with exercise. Basic Life Support trained staff
are always available. Progress reports are sent twice a year to the family
physician. Class hours are 7AM to 3PM, Mondays, Wednesdays, and Fridays.
Patients with
coronary artery blockages may have minimal symptoms and an unremarkable EKG
while at rest. However, signs and symptoms of heart disease (such as chest
pain, chest pressure or chest tightness, arm or jaw discomfort, dizziness,
lightheadedness, shortness of breath, irregular heart rhythms, changes on
the EKG ) may be unveiled when the patient is exposed to stress on their
heart by the use of exercise or medications. It is normal for your heart
rate, blood pressure, breathing rate and perspiration to increase during the
test. The cardiac staff will observe you for any excessive symptoms or
changes that may indicate the test should be stopped. Normally, with
exercise, healthy coronary arteries dilate to provide more blood to the
“stressed” heart while blocked or partially blocked arteries can not provide
the increased blood flow needed so symptoms like chest pain, pressure, or
EKG changes develop that indicate the patient needs further cardiac studies.
WCCHS presently offers three types of stress test—Regular ,
Nuclear, or Persantine.
***NO caffeine for 24 hours prior to any
type of stress test***
The patient walks on
the treadmill while their EKG and blood pressure are being continuously
monitored. Depending on the protocol chosen by the testing physician, the
treadmill speed and incline increase every two-three minutes. The patient
walks until a predetermined heart rate is achieved, EKG changes occur, signs
or symptoms occur, or the patient fatigues. A regular stress test is heavily
dependent upon the interpretation of EKG changes produced by exercise. The
reliability drops drastically if there are significant resting changes
already present. A report will be forwarded to your physician.
The patient walks on the treadmill while their EKG and
blood pressure are being continuously monitored. In addition, IV access is
obtained prior to the start of the test so that the Cardiolite can be
injected as the patient reaches their peak exertion on the treadmill. The
Cardiolite is extracted by the heart muscle in proportion to the flow of
blood. The amount of tracer uptake helps differentiate normal muscle (which
receives more of the Cardiolite) from the reduced uptake found in the muscle
that is supplied by a narrowed coronary artery. After completion of the
treadmill portion, the patient goes to the nuclear medicine department to be
scanned. The patient must return within seven days to the nuclear medicine
department to have resting images taken which requires the patient to again
be injected with the Cardiolite isotope. Resting images are compared to
images taken after the treadmill to determine if a possible blockage exists.
A treadmill report along with a nuclear medicine department report will be
forwarded to your physician.
Instead of
walking on the treadmill the patient lies on the stretcher while their EKG
and blood pressure are continuously monitored. In addition, IV access is
obtained prior to the start of the test so that Persantine, Cardiolite, and
Aminophylline can be administered. This test is used for patient’s that are
unable to walk on the treadmill adequately due to physical limitations,
respiratory status, presence of left bundle branch block pattern, and
certain people with pacemakers. IV Persantine is administered over 4 minutes
( the Persantine expands the coronary arteries similar to the effects of
exercise) while the EKG and BP are continuously monitored, 2 minutes later
the Cardiolite isotope is injected, and 2 minutes later IV Aminophylline is
administered to reverse the effects of the Persantine. The patient then goes
to the nuclear medicine lab for imaging. The patient must return within
seven days to the nuclear medicine department to have resting images taken
which requires the patient to again be injected with the Cardiolite isotope.
Resting images are compared to images taken after the Persantine was given
to determine if a possible blockage exists.
**Patients on xanthine
medications (examples are aminophylline or theophylline) may have to have
medications held for 24-48 hours
A report will be forwarded to your
physician along with a report from the nuclear medicine department.
An echocardiogram
uses high frequency sound waves called ultrasound to reveal images of your
hearts valves and chambers as well as evaluate the pumping action of your
heart. The sonographer will place a hand held wand on your chest and record
your hearts images for the cardiologist to interpret. A report will be
forwarded to your physician.
A holter monitor is a small portable ECG recorder that
records all your heartbeats during a 24 hour
period. Ten small
electrodes (sticky patches) are attached to the front of your chest and
connected to a small recording device. It is worn continuously, even during
sleep. You will return to the clinic the following day to have the
electrodes and recorder removed. No bathing or showering is allowed while
wearing the monitor as the monitor and electrodes must stay dry and in place
for the entire recording. In some cases the monitor may be worn for 48
hours. It is used to diagnose abnormal heart rhythms or heart beats: what
kind they are, how long they last, and what may cause them or may be used to
correlate your symptoms with your heart rhythm. A report will be forwarded
to your physician.
When your doctor writes a prescription for an EKG or Electrocardiogram,
you will need to register in the outpatient department and the EKG
technician will come to you and take you to a private room for the
procedure. It is really a very fast and simple procedure. When we do an EKG
we are looking at how your heart is functioning electrically. We put six
electrodes across your chest and one on each limb. You are then connected to
the EKG machine and the test is run. The entire procedure takes about five
minutes. The EKG is then set up for the physician to read and a report is
sent to your physician for your office record.
When your
doctor writes a prescription for an EEG or Electroencephalogram, you will
need to register in the outpatient department and the technician will come
to you and take you to the EEG room which is located on the second floor.
Only the technician and the patient will be allowed in the room for the
procedure. When we do an EEG we are looking at the electrical activity of
the brain. Depending on the reason for the test or the age of the patient we
may request the patient to be sleep deprived for a particular number of
hours. We will discuss these issues with you when we schedule your
appointment. No caffeine for 24 hours prior to the test. You are allowed to
eat breakfast and take your morning medications. We request that you wash
and thoroughly dry your hair before coming for the test-DO NOT USE any hair
products after washing. The EEG is done for patients who may be possibly
have a seizure disorder, a possible stroke, or a syncopal (fainting or near
fainting) episode. When the test is performed the technician will put
twenty-two electrodes on the scalp and the patient will lie on a bed with
their eyes closed for about twenty minutes, while the machine runs the test.
The test is then sent to our Neurologist for interpretation. The report is
then sent to the ordering physician. The entire exam lasts approximately an
hour.
This test is used primarily to prove or disprove
the presence of “white coat hypertension” in patients who tend to have high
blood pressures whenever they are checked in a hospital or clinic setting or
by staff garbed in medical attire. It requires you to wear a blood pressure
cuff and monitor that will record your blood pressure every 30 minutes
during the day and every hour throughout the night. You will return to the
clinic the following day to have it removed. It must stay in place for the
24 hours to detect trends and record accurate blood pressures. A complete
report is downloaded from the monitor and sent to your physician for
interpretation.
This test is used to determine hemodynamic parameters using four dual
sensors on your neck and your chest. Hemodynamics is defined as the forces
affecting the flow of blood throughout the body. Your physician may use this
to determine if your heart is pumping well enough, if you are having a
respiratory or cardiac problem, or to see if your medications are working
adequately ( especially blood pressure medications or diuretics). The test
takes approximately 20 minutes. A report is then sent to your physician.
ACLS (Advanced
Cardiac Life Support)- Advanced training that teaches providers how to treat
life threatening cardiac events.
Angina- A term for chest pain
due to lack of blood flow to the heart. Generally occurs with increased
activity or exercise and is relieved with rest and /or Nitroglycerine
tablets
Angioplasty-A procedure in which a catheter with a
deflated balloon on its tip is passed into a narrowed artery segment. As the
balloon is inflated, the narrowed segment is widened and blood flow through
the vessel is restored.
Arrhythmias-An abnormal rhythm of the
heart due to a disruption in the electrical impulses that regulate
heartbeat, causing a slower or faster beat. Some people may complain of
palpitations or a “racing heart”.
Atherosclerosis- Due to
deposits of fat and cholesterol in the inner layers of artery walls they
become thickened resulting in the restriction of blood flow and oxygen in
that artery. Atherosclerosis results in heart disease that may lead to a
heart attack if not treated appropriately.
BLS (Basic life
Support)- Basic training that teaches providers how to treat respiratory
and cardiac emergencies. Training includes CPR ( Cardiopulmonary
Resuscitation) , managing foreign body airway obstructions, and use of an
AED.
Coronary Artery Bypass Surgery (CABG)- A procedure used
to improve the blood supply to the heart. A blood vessel (generally a
mammery artery or leg vein) is used to re-route the blood supply of the
heart above and below a blockage to restore the blood flow to that area.
Cholesterol-A fat like substance that can build up on artery
walls and cause atherosclerosis. It is carried through the bloodstream in
two types of lipoproteins-HDL and LDL. High density lipoproteins (HDL’s) are
the “good cholesterols”-they carry cholesterol away from the tissues to the
liver where it is passed out of the body. Low density lipoproteins (LDL’s)
are the “bad cholesterols”- tend to build up on the artery walls , slowing
or obstructing the flow of blood and oxygen to the heart.
Electrocardiogram (EKG) - A graphic record of the electrical activity of
the heart.
Heart Attack (Also called MI or Myocardial Infarction)-A
heart attack occurs when an artery that supplies blood to the heart becomes
blocked, depriving the heart muscle of oxygen rich blood and causing it to
die. The blockage results when an artery narrows over time due to deposits
of fat and cholesterol. A clot then becomes trapped in this narrowed area
resulting in a complete occlusion and death to the tissue supplied by that
artery. Early treatment with thrombolytics, angioplasty or stents can help
salvage the damaged areas.
Hypertension (High Blood Pressure)-
A blood pressure reading is the measurement of two forces – the top number
(Systolic reading) is the force exerted as the heart pumps blood; the bottom
number (Diastolic reading) is the force exerted as the heart rests. These
two forces are measured in millimeters of mercury(mmHg). The ideal blood
pressure is less than 120/80. Blood pressures above these numbers put strain
on the heart and arteries and can contribute to heart attacks, strokes, and
kidney failure. Hypertension can be controlled with prescription medications
and lifestyle changes such as diet modifications and exercise.
Stents- Metal implants that are used to reopen clogged arteries in heart
patients.
Stroke (acute ischemic stroke or “brain attack”)-
occurs when a blood vessel leading to or in the brain becomes blocked
(ischemic), or ruptures (hemmorhagic), causing brain tissue to die. Stroke
symptoms include numbness or weakness on one side of the face or body,
difficulty speaking or understanding, blurred vision, sudden, severe or
unexplained headaches or loss of balance.
Thrombolytics (clot
busters or clot dissolvers)-Medication that dissolves the blood clot
formed in an artery in the heart (heart attack) or in the brain (acute
ischemic stroke), restoring blood flow to the respective areas.
Thrombolytics must be given within hours of symptom onset to be effective.
***STROKE SYMPTOMS***
• Sudden numbness or weakness of
the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, or loss of
balance or coordination
•
Sudden, severe headache with no known cause
If you have one or more stroke symptoms that last more
than a few minutes, don’t delay! Immediately call 911 so an ambulance can
quickly be sent for you.
***HEART
ATTACK SYMPTOMS***
• CHEST
DISCOMFORT: May be described as chest pain, chest pressure, chest
discomfort, tightness, fullness or squeezing
• DISCOMFORT IN OTHER AREAS OF THE UPPER BODY: Can
include pain or discomfort in one or both arms, the back, shoulder blades,
neck, jaw, or stomach.
•
SHORTNESS OF BREATH: May occur with or without chest discomfort.
• OTHER SIGNS: May include breaking out in a cold
sweat, nausea or lightheadedness.
REMEMBER, IF
YOU OR A LOVED ONE EXPERIENCE ANY OF THE SYMPTOMS OF A HEART ATTACK OR A
STROKE –DON’T WAIT-