Cardiac Rehab Education and Exercise Program is a medically supervised program for people who have had either a heart attack, heart failure, heart valve surgery or a coronary artery bypass.
Guidelines for Taking Medications
Each medication for your heart has a specific expected effect, so it is important that you take your medications exactly as prescribed by your doctor. Here are a few basic guidelines about taking medications.
- Learn the names of the medications you are taking. Do your best to understand why you are taking them.
- Take your medication in the amount and the times ordered by your doctor.
- Do not stop taking a medication that has been prescribed for you without first consulting your doctor.
- Check with your doctor before taking any medication that has not been prescribed.
- Do not take someone else’s pills, even if his medication is the same name.
- Contact your doctor if you have any unexpected reaction to a medication such as fever, nausea, vomiting, diarrhea, impotence.
- Keep each medication in its own labeled container. Store your medications in a cool dry place.
- If you forget to take your medication or are unsure whether you took it, do not take another (do not double your dose). Wait until the next time on your medication schedule.
- Carry a list of all the medications that you take with you at all times.
- Keep your medications out of reach of small children.
- Refill your prescriptions on time.
- Some medications lose their strength. Check expiration dates. Ask your Pharmacist to be sure how long you can safely store your medication.
Breathing Exercises after Open Heart Surgery
Breathing exercises after open-heart surgery are essential in expanding your lungs and providing adequate amounts of oxygen to your bloodstream. They also help loosen mucus secretions that accumulate during surgery, which may obstruct the tiny air sacs in your lungs and cause them to collapse. This condition, called ATELECTASIS, often causes fever and may prolong your recovery. Therefore, it is important that you practice your breathing exercises daily. Try to perform the exercises 5 times each 3-4 times a day for the first month after you go home. You may do them in any comfortable position like lying on your back, sitting or standing. Follow your breathing exercises with coughing.
Diaphragmatic (Abdominal) Breathing
- Step 1 – Place your hands over your upper abdomen just below your breast bone.
- Step 2 – Inhale gently and deeply through your nose, and allow your abdomen to expand against your hands while keeping your upper chest relaxed.
- Step 3 – Exhale slowly through your mouth, and fell your abdomen pulling inward, helping to push the air out.
Lateral Costal (Chest Expansion) Breathing
- Step 1 – Place your hands on both sides of your rib cage.
- Step 2 – Inhale gently through your nose and allow your ribcage to expand against your hands
- Step 3 – Exhale slowly through your mouth while pressing your ribs inward to push the air out.
- Step 1 – Inhale deeply and quickly through your mouth.
- Step 2 – With both hands, place your splints pillow over your chest incision and grasp it tightly against your chest.
- Step 3 – Cough twice.
Home Exercise Guidelines
Exercise is very important for the health of your cardiovascular system. Benefits of regular exercise include improved pumping efficiency of your heart, decreased effort to perform activities, better muscle tone, and joint flexibility, decreased blood pressure and cholesterol levels, decreased stress and improve the sense of well-being, and weight loss. Before leaving the hospital, you will receive a home exercise prescription which will indicate the type, duration, frequency, and intensity of exercises you are to do. The following guidelines are intended to make your exercise session as comfortable and as safe as possible.
- Exercise Only When You Are Rested. Avoid exercise if you are tired. Try to exercise at the same time every day.
- Exercise Only When You Feel Well. Illnesses such as colds or flu reduce the capacity of your heart and muscles to perform physical work. Wait until you are completely recovered from any illness before returning to your exercise program.
- Exercise In Comfortable Climate Conditions. Avoid exercising in extremes of temperature. If the weather is hot and humid, exercise indoors in an air-conditioned or well-ventilated room. If cold, exercise at midday. Wear comfortable clothing, appropriate for the weather.
- Wait 1-1/2 to 2 Hours After Eating A Meal Before Exercising. After you eat, your heart is busy pumping blood to your digestive system.
- When Exercising, Breathe Deeply And Slowly. Breathing deeply during exercise helps avoid a strain on your heart. Never hold your breath.
- Exercise On Level Ground. Hills increase the work of your heart. Indoor tracks and shopping malls are good places to exercise.
- Decrease Your Exercise As Necessary. Decrease repetition on length of time of exercise if you experience muscle soreness or become excessively fatigued. If you have had open-heart surgery, stop any exercise that causes clicking in your sternum (breastbone). If your incision becomes inflamed or if you have a past injury that flares up, consult your doctor.
- Know The Symptoms Of Exercise Intolerance. If while exercising you experience angina, excessive sweating, shortness of breath, faintness, nausea, or palpitations, slow down your pace and stop. If your symptoms subside immediately, resume exercise at a slower pace. If the discomfort recurs, contact your doctor. If the doctor has prescribed nitroglycerin and symptoms were not relieved by slowing down or stopping, take nitroglycerin as instructed by your doctor. If then your discomfort persists, call an ambulance and get immediately to a hospital.
Home Exercise Program – Heart Attack
Start your exercise session by performing your sitting and standing exercises at a comfortable pace in the specific order indicated on your exercise list. Begin with _______ repetitions of each exercise. Increase by ______ repetitions every _______ day/s until you reach a total of ______ repetitions for each exercise.
A walking program is an excellent way to improve cardiovascular fitness. After you complete your warm-up, begin your walk. Move at a comfortable pace which you can maintain without having to stop and rest. Swing your arms and stride along at an even rhythmic pace. Do not stroll or stop unless necessary. Start with _______ minutes of continuous walking. Increase the duration of your walk by _______ minutes every _______ day/s until you reach a total of _______ minutes of continuous walking.
To help you evaluate your progress, record your resting pulse, warm-up pulse and walking pulse (or perceived exertion scores) on your exercise log during each session. Your pulse should not exceed 20 beats above resting value (or a perceived exertion score of more than 13). If it does, then slow down your pace.
Going Home After Open Heart Surgery or Heart Attack Activity Guidelines for the First Few Weeks
- Stair Climbing – If necessary for you to climb stairs, walk up and down 1-2 times a day. Don’t combine stairs with carrying a load such as groceries or laundry. Go one step at a time, slowly.
- Driving – If your doctor agrees, you may resume driving short distances (20-25 miles/week) 7-8 weeks after going home. Avoid heavy traffic and bad weather conditions. Don’t attempt roadside repairs.
- Shopping – If your doctor agrees, you may take short shopping trips a few weeks after going home. Don’t lift bags greater than 10lbs. Get help.
- Traveling – If your doctor agrees, short trips such as visits to friends, neighbors, movies, or restaurants are permitted soon after you go home. Check with your doctor before traveling by plane.
- Activities of Daily Living, Occupational and Leisure
First 2-4 Weeks at home (Mild Activities)
- Self-care (dressing, washing, bathing, showering)
- Light meal preparation
- Setting/Clearing table
- Watering plants
- Hand washing small clothes
- Washing a few dishes
- Light floor sweeping
- Light cleaning (dusting, picking up, wiping counters)
- Bed-making (no changing sheets)
- Computer operation
- Desk work
- Electrical calculating
- Repairing small items
- Playing cards
- Watching TV
- Table games
- Knitting, crocheting, needlework
8 Weeks after going home (Moderate activities)
- Changing sheets
- Laundry (light loads)
- Light gardening
- Light home repairs
- Full meal preparation
- Hanging wash (not overhead)
- Stoking shelves (light objects)
- TV repair
- Light woodworking
- Golf (light)
- Dancing (ballroom)
- Rug hooking
- Sailing (small boats)
- Fly fishing
- Playing a musical instrument
- Horseback riding
Stretching Exercises – Open Heart Surgery
The following exercises consist of stretches and relaxation techniques which will help relieve muscular tension and discomfort, enhance your circulation and improve your posture. Perform these exercises in the listed order, 5 times each, once or twice a day.
- Neck Glides – Slowly press your chin inward and backward while keeping your head straight and eyes facing forward. Hold the stretch 5 seconds and relax.
- Neck Stretches – Slowly bring your right ear toward your right shoulder. Hold the stretch for 5 seconds. Return to starting position. Repeat in the opposite direction.
- Shoulder Shrugs – Lift both shoulders slowly upward. Hold the stretch for 5 seconds, and then press your shoulders down slowly.
- Shoulder Circles – Lift both shoulders slowly upward and circle completely around in a forward direction. Repeat in a backward direction.
- Back Arch – Gently and slowly push your shoulders backward while arching your back. Hold the stretch for 5 seconds.
- Taking Your Pulse – Your pulse is a sensation created by the pumping action of your heart as it pushes blood through your arteries. You can determine the number of times per minute that your heart beats by counting your pulse. The most common location to take your pulse is at the wrist.
To Find Your Pulse
- Place the tips of your index and middle fingers on the palm side of your opposite hand just below your thumb.
- Slide your two fingers down to your wrist. Your fingers will lie in a fleshy space between a bone and a tendon.
- At this point, your radial artery runs over your wrist bone. You should be able to feel a throbbing vibration with each heartbeat.
- If you can’t find your pulse, explore the area carefully. Try altering the amount of pressure you exert. If you press too hard or too lightly, you may not be able to feel your pulse. Be patient. It takes practice.
Counting Your Pulse
- Once you have located your pulse, count it while observing the second hand of a watch. Initially, try counting it for a full minute. Once you can do this easily, try counting it for 15 seconds and multiply by 4 to obtain your heart rate.
- After physical activity, your heart rate immediately begins to decrease when you stop the activity, so if you count your pulse for longer than 15 seconds, you may not obtain an accurate heart rate.
- Your heart rate should not exceed ________ beats per minute.