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Cardiac Rehab after Septal Myectomy

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Elizabeth Find out more about Elizabeth
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  • Cardiac Rehab after Septal Myectomy

    First, Lisa, Doug says Hi!

    I just had a septal myectomy done at the mayo, and I'm starting to think about getting into cardiac rehab. I've read on this message board that you have to be careful to make sure the rehab people understand that this is for a myectomy, and not bypass or heart attach. But I haven't been able to find out (and the Mayo wasn't much help) what the differences should be. Can someone tell me how my rehab should be different than that of a bypass or heart attach patient?

    Thanks,

    Kathy

  • #2
    Re: Cardiac Rehab after Septal Myectomy

    I will ask Linda P. to please address this question in detail.
    Take it away Linda.
    Thank you!
    Lisa
    Knowledge is power ... Stay informed!
    YOU can make a difference - all you have to do is try!

    Dx age 12 current age 46 and counting!
    lost: 5 family members to HCM (SCD, Stroke, CHF)
    Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
    Therapy - ICD (implanted 97, 01, 04 and 11, medication
    Currently not obstructed
    Complications - unnecessary pacemaker and stroke (unrelated to each other)

    Comment


    • #3
      Re: Cardiac Rehab after Septal Myectomy

      This information as all info printed on this message board is not a substitute for the medical advice or supervision of your cardiologist or personal physician. No cardiac rehab exercise program should be entered into without supervision and direction of your physician.

      The concept of cardiac rehab was initiated 30 yrs ago, with a goal of achievement of optimal function for those recovering from a "heart attack", but has expanded to include other conditions. The program involves exercise, education, psychological, and emotional support and individualizes a plan for each participant. Each person must be evaluated according to medical history, functional abilities and limitations, risk factors, and potential optimum function. Adjustments are made with each session as indicated. Individuals with HCM can gain benefits from a structured cardiac rehab program, but must be aware of their unique limitations and risks. They apply mainly to the exercise portion of the program. The exercise is intended to increase in intensity as the individual progresses thru the program, usually 36 sessions of one hour each, about 3 times weekly. As a person exercises, they are conditioning and improving muscle function and oxygen consumption and usage. Based on target heart rate(determined by the supervising health provider), the exercise intensity will be increased as this conditioning, muscle function, and oxygen consumption improve. The target heart rate determination should be given careful consideration in the HCM patient as they are less able to tolerate high heart rates that will accompany exercise. The target heart rate of an HCM patient needs to be strictly adhered to and the cardiologist will most likely assign a target rate at a lower percentage of maximum heart rate than would be assigned a coronary artery disease(CAD) patient or other diagnosis. The patient must be informed immediately if they are approaching the top of target, and not allowed that 10 over, or whatever may be acceptable in that cardiac rehab unit. The intensity needs to be decreased quickly enough to keep the patient within that target range. Habitual exercise is essential to optimal health and musculoskeletal function. Physical activity plays a major role in maintaining bone health and can contribute toward prevention of adverse consequences of CAD. HCM patients can also develope CAD . Exercise training is characterized by an increase in the size of muscle fibers (hypertrophy) and may also increase the number of muscle fibers(hyperplasia). This applies not only to skeletal muscles, but myocardial or heart muscle as well and can increase the thickness of the already enlarged heart muscle, the classic presentation of HCM. HCM is characterized by structural defects in the heart tissue, making it less elastic and less able to tolerate high heart rates that will accompany exercise. Both metabolic and physiologic strains are greater with arm exercise than with leg exercise. The difference can be attributed to the smaller muscle mass of the upper body, the extra musculature required to stabilize the torso during arm exercise, and the more static muscular contractions usual with arm exercise. Therefore, walking or stationary bicycle exercises are more reasonable options than intense upper body exercises. Straining-type or isometric exercises such as weight lifting or sit-ups contribute to acute episodes of elevated arterial pressure, adding to the workload of the left ventricle that may already be compromised in HCM. It is imperative that the entire cardiac rehab team have a complete understanding of the disease process and possible complications of the condition. As it is estimated that only 0.5% of patients in the general practice of cardiology are affected with HCM, it cannot be assumed that staff members have had previous experience and knowledge of the condition. Inappropriate or excessive exercise compromises the safety of those affected with HCM. The cardiologist must provide a referral with very specific instructions and guidelines for any physical exercise to be undertaken.

      I know this has been a very wordy posting, but after having been witness to a few situations where the message just wasn't getting thru, I feel very strongly about making sure those in position of responsibility are aware of all details. I will just include a few "absolute contraindications" that are frequently seen in HCM(Adapted from Fardy, Franklyn, Porcari, & Verrill, 1998):

      Complex supraventricular or ventricular dysrhythmias at rest or dysrhythmias that worsen with exercise
      Uncompensated or symptomatic congestive heart failure
      Severely depressed left ventricular function
      Exertional hypotension or failure of BP to rise during graded exercise
      Significant exercise-induced ST-segment depression
      Recurrent/persistent ischemic symptoms
      Active or suspected myocarditis, pericarditis, or endocarditis
      Thrombophlebitis or intracardiac thrombi
      Selected structural cardiac abnormalities

      Hope this helps, now let's hear some first hand experiences from our members. Linda

      Comment


      • #4
        Re: Cardiac Rehab after Septal Myectomy

        I really enjoy going to cardiac rehab! My rehab nurses are extremly involved with all of my cardiologist in Boston as well as here in Florida. They strictly adhere to their instruction. I am one of those overachievers and am always being told to slow down. They understand my needs and limitations and it makes for a great experience. I've lost about ten pounds in the past few months and feel better from it. Just my two cents!

        Mary S.

        Comment


        • #5
          Re: Cardiac Rehab after Septal Myectomy

          Thank you Linda!
          Knowledge is power ... Stay informed!
          YOU can make a difference - all you have to do is try!

          Dx age 12 current age 46 and counting!
          lost: 5 family members to HCM (SCD, Stroke, CHF)
          Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
          Therapy - ICD (implanted 97, 01, 04 and 11, medication
          Currently not obstructed
          Complications - unnecessary pacemaker and stroke (unrelated to each other)

          Comment


          • #6
            Re: Cardiac Rehab after Septal Myectomy

            Thank you so much Linda for going into the detail about excercise and rehab. I am going to Cleveland and going thru two days of tests on 6-18-03. Any doubts I had to the importance of going to see the specialists has once and for all been pushed out of my mind.

            Diana

            Comment


            • #7
              Re: Cardiac Rehab after Septal Myectomy

              Dr. Lever at Cleveland is a big promoter of Cardiac Rehab in those affected with HCM. He will be able to help with guidelines when you are ready. I'm assuming you will be going to Cleveland and then home to the local hospital for rehab? Best wishes, Linda

              Comment


              • #8
                Re: Cardiac Rehab after Septal Myectomy

                Hi Elizabeth,

                Please see my response to your Shortness of Breath post as I covered both topics there.

                http://www.4hcm.org/phpBB2/viewtopic.php?p=6074#6074

                Hope it helps you out!
                Thanks, Lynn
                Lynn Stewart
                HOCM 4/2002
                Cleveland Myectomy Crew 8/2002

                Comment


                • #9
                  Re: Cardiac Rehab after Septal Myectomy

                  Wow Linda, you said it better than I could have, but I would not have used so many words.

                  When I went to meet the young woman who was handling my case. I immediatly could see that this facility was only handling those recovering from heart attacks. After explaining my unique situation, I requested that she contact Dr. Lever in Cleveland and discuss what my goals and guidelines should be. The two of them got together and a program was developed to meet my needs.

                  The easiest thing to do for those of you considering rehab after surgery is to get the rehab people in tough with your HCM specialist.

                  Bob
                  Cleveland Myectomy Crew
                  Member since November 2002

                  \"Chance favors the prepared mind!\"

                  Comment


                  • #10
                    Re: Cardiac Rehab after Septal Myectomy

                    Just a note. The day of check out at the Mayo in Rochester I went for the cardiac rehab intro. But the information being distributed was NOT for HOCM patients. The staff on hand didn't understand the difference as they said this is standard exercise for cardiac patients.
                    So my question is what would be the best source for me to contact to interact with the rehab team here?

                    Comment


                    • #11
                      Re: Cardiac Rehab after Septal Myectomy

                      Elizabeth, Bob's method seems like a good way to go. The other thing you can do is ask Kelly in the HCMA office to mail an information packet to the rehab unit. You are most likely speaking with an intake nurse or exercise physiologist as your contact person with the rehab unit. If you don't seem to be making progress with that person and there is reluctance to contact your HCM doctor, ask to speak to the medical director. Take a copy of these posts with you when you speak with someone. Show them that you are not asking for something that is unheard of, just that they may not have heard of it. Hope this helps a little. If anyone else has suggestions, let's hear them. Best of luck, and don't compromise your safety. Linda

                      Comment

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