Heart disease, also known as coronary artery disease, is caused by atherosclerosis, a process in which cholesterol plaques build up within the arteries that supply blood to the heart. These plaques can narrow blood vessels, reducing blood and oxygen supply to the heart (called ischemia) and causing symptoms such as chest pain. Plaques can also rupture and form blood clots, which can block oxygen supply and cause a myocardial infarction, or heart attack.
Your doctor may recommend diagnostic tests if you have symptoms such as chest pain or if your family history or other factors put you at higher risk for heart disease. In a graded exercise test (GXT) or “stress” test, a doctor, nurse, or exercise physiologist monitors your heart rate, blood pressure, and heart rhythm while increasing speed and incline, usually on a treadmill. Exercise by walking. Changes in these variables, as well as a person's exercise capacity, can be a sign of ischemia or cardiac dysfunction. GXT is often combined with another diagnostic technique, such as nuclear imaging, which shows areas of the heart that are not receiving adequate blood flow, or echocardiography, which uses ultrasound to show how the heart is beating and draining blood. Can be combined with
Based on the GXT results, your cardiologist may recommend angiography. This involves inserting a catheter into the coronary artery, injecting dye, and viewing the coronary arteries using x-ray images. This allows the cardiologist to see the degree of narrowing of the coronary arteries.
Heart disease can be diagnosed based on angiography results and the presence or absence of a heart attack. During the angiogram, the cardiologist can perform angioplasty, which involves inflating a balloon catheter to widen the narrowed artery. A mesh stent may be placed to keep the blood vessel open longer. In other cases, coronary artery bypass surgery may be indicated. Considered open-heart surgery, this procedure actually uses another blood vessel, often a vein in the leg, to bypass the narrowed portion of the coronary artery. Both angioplasty and bypass surgery restore adequate blood flow to the heart and can treat ischemia and heart attacks.
Many people think that once the heart attack is over and the angioplasty or bypass surgery is complete, treatment is complete. The truth is that long-term results are primarily based on what happens next. Traditionally, heart patients were told to rest and not put stress on their heart, and many people still believe this idea today. However, an exercise-based cardiac rehabilitation program is the key to improving heart health and preventing future complications.
Most cardiac rehabilitation programs include several stages. The Phase I program begins in the hospital and focuses on getting out of bed and doing self-care activities and walking. Phase II cardiac rehabilitation usually involves carefully monitored exercise for 12 weeks after a heart attack or surgery. Phase III includes longer exercise sessions with more independence and transitions to Phase IV, a lifelong exercise program. Education about exercise, nutrition, weight management, stress management, appropriate medication use, and psychosocial health are essential at all stages of cardiac rehabilitation.
The benefits of cardiac rehabilitation are well established through research and practice. In fact, many patients believe that cardiac rehabilitation saved their lives, even if they underwent bypass surgery. Despite this, less than one-third of patients eligible for cardiac rehabilitation actually participate in the program. If you or someone you know has had a heart attack or surgery, encourage them to ask their doctor about cardiac rehabilitation. This may be the best way to improve your quality of life and avoid future heart problems.
