The Benefit Of Exercises In Cardiac Rehabilitation

The Benefit Of Exercises In Cardiac Rehabilitation Custom Nursing Essay

After a Myocardial Infarction, the heart is so severally damaged that it is unable to generate sufficient force, to pump enough blood to keep the body alive, & as a result the patient goes into cardiogenetic shock. Whenever the left ventricle becomes dysfunctional, the heart becomes progressively weaker. Myocardial Infarction is by far, the most common cause of left ventricular dysfunction, & as a result the ejection fraction, is reduced to less than 50%. Other causes of this include: Chronic Hypertension, Valve diseases, school abuse and cardiomyopathy.

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Following myocardial infarction, the reduction in stroke volume is due to impairment of both the filling and emptying phases of the left ventricle. Filling is reduced because damage to the left ventricle makes it less compliant and, consequently cannot accommodate the same volume of blood that a healthy heart can. This results in reduced preload and therefore, a reduction in stroke volume. Emptying is impaired because the loss of cardiac muscle mass (as a result of the infarction) reduces contractility and, consequently, a lower percentage of blood is ejected.

If the infarct is extensive or the site of the myocardial infarction is anterior, then the left ventricle becomes bigger and thicker (a process known as remodelling) which initially helps to maintain cardiac output. Nevertheless, such compensatory mechanisms, although designed to support cardiac function, will over time, actually increase the work of the heart. For example, increased sympathetic activity raises blood pressure, which means the heart has to work harder in order to eject blood into the systemic circulation.

Once the compensatory mechanisms cease to be effective, left ventricle dysfunction typically progresses to a situation in which symptoms of heart failure becomes apparent.

Heart Failure occurs when the left ventricle is unable to maintain a cardiac output that is adequate to meet the oxygen demands of the body. Clinically heart failure is a syndrome in which patients have symptoms of breathlessness or fatigue, either at rest or during exertion. They may also experience ankle swelling.

The right ventricle therefore ejects less blood causing blood to back up in the systemic circulation phase which in turn increases the pressure in the systemic capillaries. The result is, fluid leaks from the circulation into the tissues resulting in pitting oedema (swollen tissue in which indentation can be made, usually seen as swollen ankles). When the left-side fails, the reduced ejection fraction of the left ventricle causes blood to back up in the pulmonary capillaries. The result is, fluid leaks from the circulation into the tissues, hindering the gaseous exchange process, particularly on exertion.

Patients complain of fatigue, their exercise capacity is reduced and usually they notice deterioration, in quality of life. The degree of the left ventricular impairment has an effect on the survival rate; the worse the impairment, the lower the survival. The chances of heart failure, increase, with the average age being 75years. Half of all patients diagnosed with heart failure, will die within 4 years, and over 50% of those patients with severe heart failure will die within 1 year…………………………..