Myocardial Infarction Case Study

Myocardial Infarction Case Study Bree Dela Rosa Case Study #1 M.I. Soon is a construction worker and is 44 years old. He has a family history of heart diseases and is trying to stop smoking. He had his first myocardial infarction, and his physician prescribed him a medication called a beta blocker. He completes the inpatient cardiac rehabilitation a little over a week ago, and the doctor and wife are recommending that M.I. Soon to seek a fitness facility. His resting heart rate (RHR) is 78 beats per minute (bpm) with a max heart rate of 132 and blood pressure of 136/82 mmHg. M.I. Soon has never exercised before and he regularly eats fast food such as McDonalds, Burger King, etc. for lunch. He believes he has enough exercise from working, as he states, Hey, I work hard all day, isnt that enough!. M.I. Soon regularly stops on the way home to the tavern with some friends to grab a couple of drinks. Introduction Myocardial Infarction (MI) is one of the common heart disorders considered to be severely fatal. In many cases, this condition requires control and prevention of atheroma as a way of preventing MI. Development of coronary occlusion is the initial presentation of atheroma, which leads to myocardial infarction. Early diagnosis has helped many patients avoid severe consequences of the condition. The initial management is to restore the perfusion in the affected myocardium. To accomplish this, various approaches must be instituted as discussed below. As such, public education is necessary for making people understand the need for early diagnosis. Goals Short Term (1-4 weeks) Go for a 30-minute walk in the morning before work or with his wife or after his lunch once once a day for 2 weeks. Educate him to reduce the number of cigarettes smoked per day as well as the number of cold ones. Exercise to lose a pound weekly with a combination of moderate intensity exercise and strength training. Long Term (3months-6months) Maintain an optimal blood pressure of 120/80 mmHg. To increase the strength and intensity of the exercise as time goes, METs > 8. Burn between 1,800 2,000 kcals each week after the training period and eating less high saturated food, which will help lower blood pressure and improve cholesterol and blood sugar. Recommendations for Fitting Workouts into schedule This exercise will be incorporated into the schedule during the day. The patient will do the workout in the morning before any activity. Exercise shall be done in parts whenever there is time constraint such as 10 minutes of the stationary bike or treadmill in the morning before work and 15 minutes after work. It is advisable to create time for the gym every day. Reasons for frequency of aerobic Everyday exercise is best because the patient has a lot of free time. Due to the state of cardiovascular, aerobic exercise is more important than resistance training. Reasons for frequency In the initial two weeks, two bouts of resistance training will help in improving muscle strength in the patient. Two sessions will help him keep normal muscle strength and to avoid soreness during aerobic exercise. Static stretches done every day during cool down exercises will help in maintaining flexibility. Exercise Prescription and Justifications Week 1 Monday Warm up exercise (5 mins / 5.0 METS) Myocardial infarction patients should start their regular exercises with warm up exercises to make themselves used to exercise. This must be done on the treadmill at a gradient of 0 degrees and a low speed of 2 mph. Reason This exercise helps in increasing the body temperature and especially of the muscle in preparation for better performance in following exercises. The warm up exercise also excites the sympathetic nervous system, which improves the performance during the exercise. Treadmill exercise (30 min / 8.0 METS) This exercise is slightly moderate 20-minute walks at a speed of 2.5 mph at a gradient of 3 degrees. Remember to slow down between the two bouts for 5 minutes. Reasons Since its the first treadmill exercise for him, the patient must complete the exercise to develop the habit and to keep him out of undesirable habits such as drinking. Cooldown Exercise (8 mins / 5.0 METs) The gradient will be set back to 0 degrees and a speed of 2 mph for 8 minutes before stepping out of the treadmill. Additionally, the patient will have to sit at a V shape and stretch in the middle from left to right. Reasons This exercise will facilitate the transition from active sympathetic nervous system to parasympathetic for recovery from the strenuous exercise for 4 minutes. Butterfly Stretch (2 Minutes / 2.5 METs) Sit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds. Reasons This cooldown exercise will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness. Wednesday Warm up exercise (10 mins / 5.0 METS) Put the treadmill at a gradient of 0 degrees and a low speed of 1.9 mph. Reasons: This exercise helps in increasing the body temperature and especially of the muscle in preparation for better performance in following exercises. The warm up exercise also excites the sympathetic nervous system, which improves the performance during the training. Exercises Leg Swings (10 Min / 3.0 METS) Swing the leg horizontally at 90 degrees while keeping the torso straight. Do this ten times then changing to another leg for ten minutes. Simply make yourself stable and swing your legs until the end of 10 minutes as demonstrated in the image below. Reasons This exercise will help stretch and warm the leg muscles in preparedness for following exercises. Will warm up the muscle in preparation for further exercise. Walking Knee Hugs (10 min / 4.0 METS) This exercise will require stepping and lift the knee closer to the chest while keeping the back straight. Do both legs and monitor time with your phone, stopwatch, and or clock until the end of ten minutes while maintaining the balance as shown in the picture below. Reason To help the patient with balance during exercise. This will also assist in warming up the muscles before the following training. Cooldown Exercise (8 mins / 5.0 METs) Side Lunge (4 Minutes / 3.0 METS) Stand up straight with your feet shoulder width apart. Have your hands placed on your waist. Step out to one side to push your thigh until you feel a pull on your muscle, hold for 30 seconds each side. Reason This will help the patient warm up his muscles and gain balance on both feet increase body temperature and raise the level of intensity in exercise performance. The patient will also be able to stretch his muscles moderately. Hip flexor stretch (3 minutes / 2.5 METs) Do the exercise with one knee on the ground and the other knee raised with foot on the ground. Make sure you slightly shift weight to the front leg while keeping torso straight and arm of down knee extended upwards as shown below. Hold each side for 30 seconds and do two sets each. Reasons To facilitate the active transition exercise to recovery. To promote removal of lactate to decrease immediate muscle soreness. Butterfly Stretch (2 minutes / 2.5 METs) Sit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds. Reasons This cooldown exercise will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness. Hamstring Stretch (3 minutes / 2.5 METs) Lying on your back in an 180-degree angle and keep your back straight. Your hips should be level with your lower back on the floor. Slowly bend your knees towards your chest, and keep your left leg extended on the floor. Reasons Slowly bending your knees towards your chest, keep your dominant leg extended until you feel a mild discomfort from the stretch. Friday Warm up exercise (10 mins / 5.0 METS) Treadmill at a gradient of 0 degrees and a low speed of 2 mph. Reasons This exercise helps in increasing the body temperature and especially of the muscle in preparation for better performance in following exercises. The warm up exercise also excites the sympathetic nervous system, which improves the performance during the exercise. Exercise Treadmill Walking (40 minutes / 8.0 METS) Walk on the treadmill for two bouts of 15 minutes at 2.5 mph at 3% grade. Between bouts remove back to 0% grade and walk at a comfortable rate at 2 mph for 5 minutes. Reasons for duration I gave him two 15 minute bouts because it is her first day of the exercise program and I wanted her to be able to complete the task to increase confidence. The 5-minute rest between bouts I believe is sufficient to make sure he can complete the full duration of exercise. Reasons for mode The treadmill is very easy to adjust so that the client can set it to the particular speed and grade I have instructed to work at. I want her mode of exercise to require little thought since she may already feel uncomfortable in a gym setting because of her inexperience. The treadmill is a type An exercise, so it does not require much skill to use for someone inexperienced with exercise. Reasons for intensity (RPE) The Relative Perceived Exertion (RPE) for M.I. Soon should be For the exercise to be effective it should be a routine; whereby, every day he should take 30 minutes to do the exercise. This is done to increase the level of calories lost within a week and help the individual adapt to the exercises as a lifestyle. Cooldown (8 mins) Treadmill (6 minutes / 5.0 METs) The gradient will be set back to 0 degrees and a speed of 1.9 mph for 8 minutes before stepping out of the treadmill. Additionally, the patient will have to sit at a V shape and stretch in the middle from left to right. Reasons This exercise will facilitate the transition from active sympathetic nervous system to parasympathetic for recovery from the strenuous exercise for 4 minutes. Butterfly Stretch (2 Minutes / 2.5 METs) Reasons Sit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds. This cooldown exercise will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness. WEEK 2 Monday Warm up (10 minutes / 5.0 METS) Stationary bike with zero resistance at comfortable speed for 5 minutes. Reasons To increase the temperature of muscle to perform better during exercise. To activate the sympathetic nervous system to improve exercise performance. Exercise (35min / 7.0 METS): Use the stationary bike for two bouts of 15 minutes with a resistance of between 284kgm/min (50 Watts) and 406kgm/min (68 Watts). Between bouts, remove resistance and pedal at a comfortable pace for 5 minutes before beginning next bout. Reasons for duration Transitioning from the treadmill from week one to a stationary bike I am starting M.I. soon with 15 minute bouts to adjust and complete the exercise with confidence. I want to give him 5 minute rests in-between to make sure there is not a lot of stress and that he receives enough intake of water so he can complete the exercise. Reasons for mode I chose the stationary bike for his form of exercise since it safe for a sedentary and obese individual with little or no experience of exercise. The stationary bike is effective and useful for people who have never exercised before or who exercise a little. Reasons for intensity (RPE) The Relative Perceived Exertion (RPE) for M.I. Soon should be For the exercise to be effective it should be a routine; whereby, every day he should take 30 minutes to do the exercise. This is done to increase the level of calories lost within a week and help the individual adapt to the exercises as a lifestyle. Cooldown (8 mins) Stationary Bike (5 minutes) With no resistance peddle for around 5 minutes and then get off to proceed to stretches. Hamstring Stretch (3 minutes / 2.5 METs) Lie on your back with your legs extended in an 180-degree angle and keep your back straight. Your hips should be level with your lower back on the floor. Slowly bend your knees towards your chest, and keep your left leg extended on the floor. Reasons Stretch to the point of mild discomfort but not to the point of feeling discomfort or pain. Wednesday Warm Up Warm up (10 minutes / 5.0 METS) Stationary bike with zero resistance at a comfortable speed for 5 minutes. Reasons To increase the temperature of muscle to perform better during exercise. To activate the sympathetic nervous system to improve exercise performance. Exercise (35 Minutes / 8.0 METS) Use the stationary bike for two bouts of 15 minutes with a resistance of between 284kgm/min (50 Watts) and 406kgm/min (68 Watts). Between bouts, remove resistance and pedal at a comfortable pace for 5 minutes before beginning next bout. Reasons Less stress on joints Help reduce the mechanical stress, on back, hips, and ankles even when compared to walking.You can indulge in daily exercise with a lower risk of injury. Cool Down (8 minutes) Stationary Bike (6 minutes / 5.0 METs) Remove resistance and peddle for around 6 minutes and then get off to proceed to stretches. Butterfly Stretch (2 Minutes / 2.5 METs) Sit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds. Reasons This cooldown exercise will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness. Day 3Â  Friday Warm up exercise (5 mins / 5.0 METS) Myocardial infarction patients should start their regular exercises with warm up exercises to make themselves used to exercise. This must be done on the treadmill at a gradient of 0 degrees and a low speed of 1.9 2 mph. Reason This exercise helps in increasing the body temperature and especially of the muscle in preparation for better performance in following exercises. The warm up exercise also excites the sympathetic nervous system, which improves the performance during the exercise. Treadmill exercise (30 min / 7.0 METS) This exercise is slightly strenuous as it takes 20 separate 20-minute walks at a speed of 2.5 mph at a gradient of 3 degrees. Remember to slow down between the two bouts for 5 minutes. Reasons Since its the first treadmill exercise for him, the patient must complete the exercise to develop the habit and to keep him out of undesirable habits such as drinking. Cooldown (8 Minutes) Treadmill (6 minutes / 5.0 METs) The gradient will be set back to 0 degrees and a speed of 1.9 mph for 8 minutes before stepping out of the treadmill. Additionally, the patient must sit at a V shape and stretch in the middle from left to right. Reasons This exercise will facilitate the transition from active sympathetic nervous system to parasympathetic for recovery from the strenuous exercise for 4 minutes. Hip flexor stretch (2minutes / 2.5 METs) Do the exercise with one knee on the ground and the other knee raised with foot on the ground. Make sure you slightly shift weight to the front leg while keeping torso straight and arm of down knee extended upwards as shown below. Hold each side for 30 seconds and do two sets each. Reasons To facilitate the active transition exercise to recovery. To promote removal of lactate to decrease immediate muscle soreness. Strength and Conditioning Week 1 (Repeat the following week) Monday, Wednesday, Friday Lat pull downs (5 minutes / 3.0 METs) Ten repetitions of 25 pounds the first week, then the second week increase the weights by 5 pounds with a weight that is equivalent to a 3 or 4 rating on the RPE scale. Pull with arms starting fully extended until the bar is just below neck height in a controlled rhythm. When you begin this, take it slow. If you are feeling chest pain, stop the exercise as with all the strength exercises provided. Lateral Band Walk (5 Minutes / 3.0 METs) Place your feet shoulder width apart to create tension inbetween the bands. Form a 60 degree squat position, and shift your weight to the right side, steping sideways take 10-12 steps before heading back to the start postion and do the same on the left side. Shoulder Press (5 Minutes / 4.0 METs) Hold a 10 lb (this is the start) dumbbell in each hand and sit on a bench with back support, plant both feet on the ground, bend your elbows down to your ear and lift back up. Remember not to hold your breath when performing this exercise, take it slow and go at your pace. Leg Press (5 Minutes / 3.0 METs) Set the leg press weight at 50 lbs. Leg and torso should be at a 90-degree angle. As you go down breathe in and out slowly push down until your legs make another 90-degree angle and push back up in start position. Reasons for exercises These exercises are a combination of lower body and upper body that are doable that can be done with inexpensive equipment at home or the gym facility. These are appropriate exercises for someone who is not used to strength training, regardless of job description, these are easy to follow, and they are not confusing or difficult for someone who is inexperienced These exercises also target large and small muscle groups that will help with his balance. Reasons for repetitions Lifting in a rhythmic and full range in motion I chose for the exercises to be ten repetitions of lighter weights for M.I. to adjust to the movement and patterns to develop technique and consistency. He will gain muscular strength, lean body mass, endurance, and insulin sensitivity. I highly remind and advise him each exercise session to not hold his breath while he is performing any of the strength exercises since it will increase the pressure in his chest by placing a greater workload on his heart. Reasons for Strength or Resistance. I chose a moderate level of intensity because I want M.I. Soon to adapt to the strength and conditioning training and not make him too sore. 5 minutes for each exercise will allow M.I. Soon to finish all the reps I suggested. I do not want him to feel in denial with the exercise demand, but I want him to accept the purpose of exercise and the benefits. Cooldown (8 Minutes) Treadmill (6 minutes / 5.0 METs) The gradient will be set to 0 degrees and a speed of 2 mph for 6 minutes before stepping out of the treadmill. Butterfly Stretch (2 Minutes / 2.5 METs) Sit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds. Quad stretch on side (2 minutes / 2.5 METs) Standing up grab or chair or find a pole to stand next to and lift your left leg back until you feel this pull in the muscle, and repeat for the right leg. Reasons for Cooldown: This cooldown exercises will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness. This exercise will facilitate the transition from active sympathetic nervous system to parasympathetic for recovery from the strenuous exercise. Education and Risk Factor Management It is important for you to understand that the type of diet you take determines your risk of exposure to further heart complications. The point is, different food contents have different nutrients. Always remember that fast food may be affordable and presumably convenient, but it contains a lot of saturated fat, calories, and sodium. For this reason, with the Myocardial infarction, you should modify your frequency of fast food consumption. There may not be specific patterns on how to take fast food, but I recommend that you dont eat it very often. Alcohol, on the other hand, may be recommended by researchers but the exact amount has not been agreed on yet (Frederico et al., 2009). Therefore, my recommendation is that you take not more that 14 alcohol units in one week and the units should not exceed four in a single day. Also, please ensure that you have at least two days that you do not consume it. The bottom line is that moderate and habitual alcohol consumption lowers the risk of heart-related disorders. However, sometimes the short-term consequence is that it may cause sudden cardiac death. I recommend that you refrain from smoking because it increases the chances of heart diseases infections. This is because it contributes to the fatty conditions in the coronary system. Also, be informed that the tobacco chemicals will damage your heart cells and expose you to atherosclerosis, a condition that affects the functioning of the heart and blood cells in the body (Antman, 2007). With your MI, smoking cigarettes will worsen your condition because the tobacco chemicals have the ability to weaken the resilience of the cardiovascular system and thus heighten the chances of succumbing. You should, therefore, avoid smoking at all costs to reduce the likelihood of recurring and causing more damage to the heart and other cardiovascular organs and vessels. If you find it hard to stop smoking, it would be wise to see a doctor or a practice nurse. By doing so, you will get help and advice on the how to make use of the nicotine replacement therapy. The best medication to improve your health is the Beta-blocker due to the following reasons. First, they are drugs that will enhance your outlook. These drugs are believed to prevent vertical hemorrhage in patients who have cirrhosis and heart conditions. It is worth noting that the body has a way of responding to increased stress caused by heart attack or unstable angina. What it does is, it increases the heart rate as well as the blood pressure. Therefore, beta-blockers are good for you because they will reduce both the heart rate and its workload. You should take these drugs as soon as you your heart condition are identified. However, to increase efficiency, they can be taken together with an ACE inhibitor and sometimes a statin. The American Heart Association has recommended treatment using Beta-blockers. It has been shown to reduce morbidity and mortality as compared to other therapies. Moreover, the management of obesity would be useful in preventing the reoccurrence of myocard ial infarction (Ades, Savage Harvey, 2009). It is, therefore, important that you visit a pharmacist or a cardiologist for prescription and further directions on how to use this medication. According the American Family Physician website, AHA (American Heart Association) standards state that they highly recommend that each patient who suffers from a heart attack must monitor your cardiac risk factor of a blood pressure lower than 140/90 mmHg. The waist circumference less than 35 inches for womens and 40 for men, a body mass index (BMI) of 18.5 and 24.9, blood cholesterol under 180 mg/dl, and blood glucose under 100 mg/dL. Our goal as we work together is to reduce your blood pressure of 136/82 down to 120/80, when performing the exercises I prescribed you, make sure to breath after each repetition and walking on a treadmill, if you do not, your blood pressure will increase. If you are experiencing high blood pressure, seek medical attention right away, and seek your primary care provider immediately. Myocardial Infarction, Cardiac infarction, and coronary thrombosis are other terms also know a heart attack. Infarction means that there is