Rehabilitation plan for ischemic heart disease. Therapeutic physical culture for coronary heart disease. Direct operations for ischemic heart disease

Social significance of coronary heart disease

The great social significance of IHD is due to the widespread prevalence of this disease, the severity of its course, the tendency to progression, the presence severe complications and significant economic losses.

IHD is a coronary circulatory failure caused by atherosclerosis of the coronary arteries (CA) or their temporary stenosis, which is caused by spasm or thrombosis of unchanged coronary arteries.

Characteristics of clinical forms of IHD

Three main clinical forms of ischemic heart disease:

1. Angina

1.1 Angina pectoris;

1.2. Spontaneous angina;

1.3. Not stable angina

2. Myocardial infarction

2.1. Large focal myocardial infarction

2.2. Small focal myocardial infarction

3. Post-infarction cardiosclerosis

Three main complications of IHD:

1. Sudden coronary death

2. Rhythm and conduction disturbances

3. Heart failure

Limitations of life activity due to coronary artery disease are caused by:

severity of functional disorders (CHN, CHF, arrhythmia syndrome, morpho-functional, structural disorders);

the nature of the course of IHD, including its clinical forms;

contraindicated factors at work.

Depending on:

stage and location of the rehabilitation course;

period of disease development;

level and severity of IHD;

rehabilitation potential;

There are clinical rehabilitation groups (CRGs).

KRG 1: early rehabilitation group.

acute manifestations of ischemic heart disease ( acute heart attack myocardium);

after surgical treatment IHD, regardless of the primary or recurrent myocardial infarction, surgical intervention, and the presence and severity of disability to the present case of the disease and surgical treatment.

These patients are being treated in “acute” hospitals (ICU, cardiac surgery, cardiology).

patients in the early phase of chronic ischemic heart disease (first-time exertional angina up to 1 month old)

SSN FC 1.2 (in the absence of indications for hospitalization);

newly diagnosed ischemic heart disease (up to 1 month old) in the absence or with mild consequences at the organ level.

These patients are undergoing outpatient treatment.

KRG:2: group of patients with chronic ischemic heart disease.

KRG2.1: patients with acute manifestations of coronary artery disease; after surgical treatment of coronary artery disease, located in the early medical rehabilitation department.

patients with chronic ischemic heart disease in the rehabilitation phase at the outpatient stage with manifestations of the consequences of the disease in the form of persistent limitations in life activity;

patients with myocardial infarction, after surgical treatment of coronary artery disease in the presence of contraindications to rehabilitation in the inpatient department of early medical rehabilitation.

KRG 3: recognized disabled people due to coronary artery disease.

KRG 3.1: patients with high rehabilitation potential.

KRG 3.2: patients with average rehabilitation potential.

KRG 3.3: patients with low rehabilitation potential.

Myocardial infarction remains one of the most common diseases in industrialized countries. Over the past 20 years, mortality due to myocardial infarction in men aged 35–44 years has increased by 60%. In the vast majority of cases (95%), acute myocardial infarction occurs as a result of thrombosis of the coronary artery in the area of atherosclerotic plaque.

pain syndrome;

changes in electrocardiography (ECG);

characteristic dynamics of serum markers.

In the case of cardiac rehabilitation, three main directions are defined in accordance with the 3 main phases of the rehabilitation process:

1. Inpatient (which includes the treatment and rehabilitation stage and the stage of early inpatient medical rehabilitation).

2.Early outpatient.

3. Long-term outpatient (outpatient or home rehabilitation stages).

Stages of rehabilitation of patients with myocardial infarction:

2-stage system rehabilitation is provided for patients who have contraindications for rehabilitation in the inpatient rehabilitation department, who refuse to undergo this stage in the inpatient rehabilitation department (inpatient, outpatient stage).

Hospital: 10-15 days

(10 days with 1 CT MI, 13 days with 2 CT MIs, 15 days with 3 CT MIs).

In case of complicated course – individually.

3 stage system is provided for patients who have reached the 3b level of activity, in the absence of contraindications for rehabilitation in the inpatient rehabilitation department:

hospital,

inpatient rehabilitation department,

outpatient stage.

Duration: hospital: 10-15 days (10 days for 1 CT MI, 13 days for 2 CT MI, 15 for 3 CT MI).

Inpatient rehabilitation department: 16 days.

Contraindications for referring patients with MI to an inpatient rehabilitation unit:

Stage III CHF (according to Strazhesko-Vasilenko).

Severe rhythm disturbances (ES of high gradations according to Lown, paroxysms), except for the constant form of MA.

Uncorrected complete AV block.

Recurrent thromboembolic complications.

Aneurysm of the heart and aorta with CHF above stage IIa (according to Strazhesko-Vasilenko).

Thrombophlebitis and other acute inflammatory diseases.

Principles and objectives of rehabilitation:

Quitting smoking and drinking alcohol.

Reducing body weight.

Normalization of blood pressure.

Improved lipid profile.

Increasing exercise tolerance.

Optimization of load conditions.

Improvement of psycho-emotional state.

Prevention of target organ damage and the development of clinical manifestations.

Maintaining social status.

Disability prevention.

The most complete return to work.

Chapter 2.0. Physical rehabilitation for atherosclerosis, coronary heart disease and myocardial infarction.

2.1 Atherosclerosis.

Atherosclerosis is a chronic pathological process that causes changes in arterial walls as a result of lipid deposition, subsequent formation of fibrous tissue and the formation of plaques that narrow the lumen of blood vessels.

Atherosclerosis is not considered an independent disease, since clinically it is manifested by general and local circulatory disorders, some of which are independent nosological forms (diseases). With atherosclerosis, cholesterol and triglycerides are deposited in the walls of the arteries. In blood plasma they are bound to proteins and are called lipoproteins. There are high-density lipoproteins (HDL) and low-density lipoproteins (LDL). As a rule, HDL does not contribute to the development of atherosclerosis and related diseases. On the contrary, there is a direct relationship between the content in blood LDL and the development of diseases such as coronary heart disease and others.

Etiology and pathogenesis. The disease develops slowly, is initially asymptomatic, and goes through several stages during which gradual narrowing lumen of blood vessels.

The causes leading to atherosclerosis include:

poor nutrition, containing excess fats and carbohydrates and lack of vitamin C;
psycho emotional stress;
diseases such as diabetes, obesity, decreased thyroid function;
disruption of the nervous regulation of blood vessels associated with infectious and allergic diseases;
physical inactivity;
smoking, etc.

These are the so-called risk factors that contribute to the development of the disease.

With atherosclerosis, blood circulation is impaired various organs depending on the localization of the process. When the coronary arteries of the heart are damaged, pain appears in the area of the heart and heart function is impaired (for more details, see the section “Coronary heart disease”). With atherosclerosis of the aorta, pain occurs in the chest. Atherosclerosis of cerebral vessels causes decreased performance, headaches, heaviness in the head, dizziness, memory impairment, and hearing loss. Atherosclerosis of the renal arteries leads to sclerotic changes in the kidneys and increased blood pressure. For arterial damage lower limbs pain occurs in the legs when walking (for more information about this, see the section on obliterating endarteritis).

Sclerotic vessels with reduced elasticity are more easily susceptible to rupture (especially with increased blood pressure due to hypertension) and cause hemorrhage. Loss of smoothness of the lining of the artery and ulceration of the plaque, combined with bleeding disorders, can cause a blood clot to form, which makes the vessel obstructed. Therefore, atherosclerosis can be accompanied by a number of complications: myocardial infarction, cerebral hemorrhage, gangrene of the lower extremities, etc.

Severe complications and lesions caused by atherosclerosis are difficult to treat. Therefore, it is advisable to start treatment as early as possible when initial manifestations diseases. Moreover, atherosclerosis usually develops gradually and can be almost asymptomatic for a long time, without causing deterioration in performance and well-being.

The therapeutic effect of physical exercise is primarily manifested in its positive effect on metabolism. Physical therapy exercises stimulate the activity of the nervous and endocrine systems regulating all types of metabolism. Animal studies provide convincing evidence that systematic exercise exercise have a normalizing effect on the content of lipids in the blood. Numerous observations of patients with atherosclerosis and elderly people also indicate the beneficial effects of various muscle activities. Thus, when cholesterol in the blood increases, a course of physical therapy often lowers it to normal values. The use of physical exercises that have a special therapeutic effect, for example, improving peripheral blood circulation, helps restore motor-visceral connections that are impaired due to the disease. As a result, the responses of the cardiovascular system become adequate, and the number of perverted reactions decreases. Special physical exercises improve blood circulation in the area or organ whose nutrition is impaired due to vascular damage. Systematic exercises develop collateral (roundabout) blood circulation. Excess weight is normalized under the influence of physical activity.

With initial signs of atherosclerosis and the presence of risk factors, in order to prevent further development of the disease, it is necessary to eliminate those that can be influenced. Therefore, physical exercise, a diet with a reduction in foods rich in fat (cholesterol) and carbohydrates, and quitting smoking are effective.

The main objectives of physical therapy are: activation of metabolism, improvement of nervous and endocrine regulation metabolic processes, increasing the functionality of the cardiovascular and other body systems.

The exercise therapy technique includes most physical exercises: long walks, gymnastic exercises, swimming, skiing, running, rowing, sports games. Particularly useful are physical exercises that are performed in an aerobic mode, when the oxygen demand of working muscles is fully satisfied.

Physical activity is dosed depending on functional state sick. Usually, they first correspond to the physical activity used for patients classified as functional class I (see coronary heart disease). Then classes should be continued in the “Health” group, in a fitness center, in a running club, or on your own. Such classes are held 3-4 times a week for 1-2 hours. They must continue constantly, since atherosclerosis occurs as a chronic disease, and physical exercise prevents its further development.

When atherosclerosis is pronounced, the therapeutic gymnast’s classes include exercises for all muscle groups. General tonic exercises alternate with exercises for small muscle groups and breathing. In case of cerebral circulatory insufficiency, movements associated with sudden changes in head position (rapid tilts and turns of the torso and head) are limited.

2.2. Coronary heart disease (CHD).

Coronary heart disease – acute or chronic damage to the heart muscle due to myocardial circulatory failurebecause of pathological processes in the coronary arteries. Clinical forms of IHD: atherosclerotic cardiosclerosis, angina pectoris and myocardial infarction.

IHD among diseases cardiovascular system has the greatest prevalence, is accompanied by large loss of ability to work and high mortality.

Risk factors contribute to the occurrence of this disease (see section “Atherosclerosis”). The presence of several risk factors at the same time is especially unfavorable. For example, a sedentary lifestyle and smoking increase the likelihood of the disease by 2-3 times. Atherosclerotic changes in the coronary arteries of the heart impair blood flow, which causes the proliferation of connective tissue and a decrease in the amount of muscle tissue, since the latter is very sensitive to lack of nutrition. Partial replacement of the muscular tissue of the heart with connective tissue in the form of scars is called cardiosclerosis. Atherosclerosis of the coronary arteries, atherosclerotic cardiosclerosis is reduced contractile function hearts, cause fatigue quickly during physical work, shortness of breath, palpitations. Pain appears behind the sternum and in the left half chest. Efficiency decreases.

Angina pectoris – clinical form ischemic disease, in which attacks of sudden chest pain occur due to acute circulatory failure of the heart muscle.

In most cases, angina is a consequence of atherosclerosis of the coronary arteries. The pain is localized behind the sternum or to the left of it, spreading to the left arm, left shoulder blade, neck and can be of a squeezing, pressing or burning nature.

Distinguish angina pectoris when attacks of pain occur during physical activity (walking, climbing stairs, carrying heavy objects), and angina at rest, in which an attack occurs without connection with physical effort, for example, during sleep.

Along the way, there are several variants (forms) of angina: rare attacks of angina, stable angina (attacks under the same conditions), unstable angina (increased attacks that occur at lower voltages than before), pre-infarction state (attacks increase in frequency, intensity and duration, resting angina appears).

In the treatment of angina, regulation of the motor regimen is important: it is necessary to avoid physical activity that leads to an attack; in case of unstable and pre-infarction angina, the regimen is limited to bed rest.

The diet should be limited in volume and caloric content of food. Medicines are needed to improve coronary circulation and eliminate emotional stress.

Objectives of exercise therapy for angina pectoris: stimulate neurohumoral regulatory mechanisms to restore normal vascular reactions during muscle work and improve the function of the cardiovascular system, activate metabolism (fight atherosclerotic processes), improve the emotional and mental state, ensure adaptation to physical activity.

In conditions inpatient treatment for unstable angina and pre-infarction condition, start exercising therapeutic exercises start after termination severe attacks on bed rest, with other types of angina in the ward mode. Gradual expansion is underway motor activity and passing all subsequent modes.

The exercise therapy technique is the same as for myocardial infarction. Transfer from mode to mode is carried out at an earlier date. New starting positions (sitting, standing) are included in classes immediately, without preliminary careful adaptation. Walking in the ward mode starts from 30-50 m and is increased to 200-300 m; in the free mode, the walking distance increases to 1-1.5 km. The pace of walking is slow with breaks for rest.

At the sanatorium or outpatient stage of rehabilitation treatment, the motor regimen is prescribed depending on the functional class to which the patient is classified. Therefore, it is advisable to consider a method for determining the functional class based on assessing the patients’ tolerance to physical activity.

Determination of exercise tolerance (PET) and functional class of a patient with coronary artery disease.

The study is carried out on a bicycle ergometer in a sitting position under electrocardiographic control. The patient performs 3–5 minute step-increasing physical activity, starting from 150 kgm/min: stage II – 300 kgm/min, stage III – 450 kgm/min, etc. – until the maximum load tolerated by the patient is determined.

When determining physical fitness, clinical and electrocardiographic criteria for stopping the load are used.

TO clinical criteria include: achieving a submaximal (75-80%) age-related heart rate, an attack of angina, a decrease in blood pressure by 20-30% or no increase in blood pressure with increasing load, a significant increase in blood pressure (230-130 mm Hg), an attack of suffocation, severe shortness of breath, sudden weakness, refusal of the patient further implementation samples.

TO electrocardiographic criteria include: a decrease or increase in the ST segment of the electrocardiogram by 1 mm or more, frequent electrosystoles and other disorders of myocardial excitability (paroxysmal tachycardia, atrial fibrillation), disturbance of atrioventricular or intraventricular conduction, sharp decline values of the R wave. The test is stopped when at least one of the above signs appears.

Stopping the test at the very beginning (1st - 2nd minute of the first stage of the load) indicates an extremely low functional reserve of the coronary circulation; it is typical for patients of functional class IV (150 kgm/min or less). Stopping the test within the range of 300-450 G kgm/min also indicates low reserves of coronary circulation - functional class III. The appearance of sample termination criteria within 600 kgm/min – functional class II, 750 kgm/min and more – functional class I.

In addition to the functional class, clinical data are also important in determining the functional class.

TO Ifunctional class include patients with rare attacks of angina pectoris that occur during excessive physical exertion with a well-compensated circulatory condition and higher than the specified functional level.

Co. second functional class These include patients with rare attacks of angina pectoris (for example, when climbing uphill, up stairs), with shortness of breath when walking quickly and TNF 600.

TO IIIfunctional class These include patients with frequent attacks of angina pectoris that occur during normal exercise (walking on level ground), circulatory insufficiency of degrees I and II A, heart rhythm disturbances, exercise capacity - 300-450 kgm/min.

TO IVfunctional class These include patients with frequent attacks of angina pectoris at rest or exertion, with circulatory insufficiency of degree II B, FN - 150 kgm/min or less.

Patients of functional class IV are not subject to rehabilitation in a sanatorium or clinic; they are indicated for treatment and rehabilitation in a hospital.

Methodology Exercise therapy for patients IHD at the sanatorium stage.

SickIfunctional class are engaged in a training regime program. In physical therapy classes, in addition to exercises of moderate intensity, 2-3 short-term loads of high intensity are allowed. Training in measured walking begins with walking 5 km, the distance gradually increases and is brought to 8-10 km, at a walking speed of 4-5 km/hour. While walking, accelerations are performed; sections of the route may have an elevation of 10-15. After patients have mastered the 10 km distance well, they can begin training by jogging alternating with walking. If there is a pool, classes are held in the pool, their duration gradually increases from 30 minutes to 45-60 minutes. Outdoor and sports games are also used - volleyball, table tennis, etc.

Heart rate during exercise can reach 140 beats per minute.

Patients of functional class II are engaged in a gentle training program. In physical therapy classes, moderate intensity loads are used, although short-term high-intensity physical activity is allowed.

Metered walking begins with a distance of 3 km and is gradually increased to 5-6 km. The walking speed is initially 3 km/h, then 4 km/h. Part of the route may have a rise of 5-10.

When exercising in the pool, the time spent in the water gradually increases, the duration of the entire lesson is increased to 30-45 minutes.

Skiing is done at a slow pace.

Maximum heart rate changes are up to 130 beats per minute.

Patients of functional class III are engaged in a gentle treatment program at the sanatorium. Training in measured walking begins with a distance of 500 m and increases daily by 200-500 m and gradually increases to 3 km, at a speed of 2-3 km/hour.

When swimming, the breaststroke method is used. Training in progress proper breathing with lengthening the exhalation into the water. Lesson duration 30 minutes. For any form of exercise, only low-intensity physical activity is used.

Maximum heart rate changes during exercise are up to 110 beats/min.

It should be noted that the means and methods of doing physical exercises in sanatoriums may differ significantly due to the characteristics of the conditions, equipment, and preparedness of the methodologists.

Many sanatoriums currently have various exercise equipment, primarily bicycle ergometers and treadmills, on which it is very easy to accurately dose loads with electrocardiographic control. The presence of a reservoir and boats allows you to successfully use dosed rowing. In winter, if you have skis and ski boots, an excellent means of rehabilitation is skiing, strictly dosed.

Until recently, physical therapy was practically not prescribed to patients with class IV coronary artery disease, since it was believed that it could cause complications. However, success drug therapy and rehabilitation patients with ischemic heart disease allowed us to develop special technique for this severe patient population.

Medical physical culture for patients with coronary heart disease of functional class IV.

The objectives of rehabilitation of patients with coronary artery disease of functional class IV are as follows:

achieve complete self-care for patients;
adapt patients to household stress of low and moderate intensity (washing dishes, cooking, walking on level ground, carrying small loads, climbing one floor);
reduce medication intake;
improve mental state.

Physical exercises should be carried out only in a cardiology hospital. Accurate individual dosage of loads should be carried out using a bicycle ergometer with electrocardiographic control.

The training methodology boils down to the following. First, the individual FN is determined. Usually in patients of functional class IV it does not exceed 200 kgm/min. Set the load level to 50%, i.e. in this case – 100 kgm/min. This load is a training load, the duration of work is 3 minutes at first. It is carried out under the supervision of an instructor 5 times a week.

With a consistently adequate response to this load, it is extended by 2-3 minutes and brought over a more or less long period to 30 minutes per session.

After 4 weeks, the FN determination is repeated. When it increases, a new 50% level is determined. Training duration is up to 8 weeks. Before or after training on an exercise bike, the patient does therapeutic exercises in the IP. sitting. The lesson includes exercises for small and medium muscle groups with repetitions of 10-12 and 4-6 times, respectively. The total number of exercises is 13-14.

Exercise on an exercise bike is stopped if one of the signs of deterioration in coronary circulation occurs, as discussed above.

To consolidate the achieved effect of inpatient training, home training in an accessible form is recommended for patients.

People who stop training at home experience a deterioration in their condition after 1-2 months.

At the outpatient stage of rehabilitation, the program of exercises for patients with coronary artery disease is very similar to the program of outpatient exercises for patients after myocardial infarction, but with a more bold increase in the volume and intensity of exercise.

2.3 Myocardial infarction.

(Myocardial infarction (MI) is ischemic necrosis of the heart muscle caused by coronary insufficiency. In most cases, the leading etiological cause of myocardial infarction is coronary atherosclerosis.

Along with the main factors acute failure coronary circulation (thrombosis, spasm, narrowing of the lumen, atherosclerotic changes in the coronary arteries), a major role in the development of myocardial infarction is played by insufficiency of collateral circulation in the coronary arteries, prolonged hypoxia, excess catecholamines, lack of potassium ions and excess sodium, causing prolonged cell ischemia.

Myocardial infarction is a polyetiological disease. Risk factors play an undoubted role in its occurrence: physical inactivity, excessive nutrition and increased weight, stress, etc.

The size and location of the myocardial infarction depend on the caliber and type of the blocked or narrowed artery.

There are:

A) extensive myocardial infarction– large-focal, involving the wall, septum, apex of the heart;

b) small focal infarction, affecting parts of the wall;

V) microinfarction, in which the foci of infarction are visible only under a microscope.

With intramural MI, necrosis affects the inner part of the muscle wall, and with transmural MI, the entire thickness of its wall. Necrotic muscle mass undergo resorption and replacement by granulation connective tissue, which gradually turns into scar. Resorption of necrotic masses and formation of scar tissue lasts 1.5-3 months.

The disease usually begins with the appearance of intense pain in the chest and in the heart area; the pain continues for hours, and sometimes for 1-3 days, subsides slowly and turns into a long-term dull pain. They are compressive, pressing, tearing in nature and sometimes are so intense that they cause shock, accompanied by a drop in blood pressure, severe pallor of the face, cold sweat and loss of consciousness. Following the pain, acute cardiovascular failure develops within half an hour (maximum 1-2 hours). On the 2-3rd day, an increase in temperature is noted, neutrophilic leukocytosis develops, and the erythrocyte sedimentation rate (ESR) increases. Already in the first hours of the development of myocardial infarction, characteristic changes in the electrocardiogram appear, which make it possible to clarify the diagnosis and localization of the infarction.

Drug treatment during this period is aimed primarily at controlling pain, combating cardiovascular failure, and also preventing recurrent coronary thrombosis (anticoagulants are used - drugs that reduce blood clotting).

Early motor activation of patients promotes the development of collateral circulation, has a beneficial effect on the physical and mental state of patients, shortens the period of hospitalization and does not increase the risk of death.

Treatment and rehabilitation of patients with MI is carried out in three stages: inpatient (hospital), sanatorium (or cardiac rehabilitation center) and outpatient.

2.3.1 Physical therapy for myocardial infarction at the inpatient stage of rehabilitation .

Physical exercises at this stage are of great importance not only for restoring the physical capabilities of patients with MI, but are also largely important as a means of psychological influence, instilling in the patient faith in recovery and the ability to return to work and society.

Therefore, the sooner, but taking into account individual characteristics diseases, the therapeutic exercises will be started, the better the overall effect will be.

Physical rehabilitation at the inpatient stage is aimed at achieving a level of physical activity for the patient at which he could serve himself, climb one floor of stairs and walk up to 2-3 km in 2-3 doses during the day without significant negative reactions .

The objectives of exercise therapy at the first stage are aimed at:

Prevention of complications associated with bed rest (thromboembolism, congestive pneumonia, intestinal atony, etc.)

Improving the functional state of the cardiovascular system (primarily training peripheral circulation with a gentle load on the myocardium);

Creation positive emotions and providing a tonic effect on the body;

Orthostatic stability training and restoration of simple motor skills.

At the inpatient stage of rehabilitation, depending on the severity of the disease, all patients with a heart attack are divided into 4 classes. This division of patients is based on various types of combinations, such basic indicators of the characteristics of the course of the disease as the extent and depth of MI, the presence and nature of complications, the severity of coronary insufficiency (see Table 2.1)

Table 2.1.

Severity classes of patients with myocardial infarction.

Activation of motor activity and the nature of exercise therapy depend on the severity class of the disease.

The physical rehabilitation program for patients with MI during the hospital phase is built taking into account the patient’s belonging to one of the 4 classes of severity of the condition.

The severity class is determined on the 2-3rd day of illness after the elimination of pain and complications such as cardiogenic shock, pulmonary edema, severe arrhythmias.

This program provides for the assignment of a particular type of household stress to the patient, a method of doing therapeutic exercises and an acceptable form of leisure time.

Depending on the severity of the MI, the hospital stage of rehabilitation is carried out within a period of three (for small-focal uncomplicated MI) to six (for extensive, transmural MI) weeks.

Numerous studies have shown that the best treatment results are achieved if therapeutic exercises begin early. Therapeutic exercises are prescribed after the cessation of a painful attack and the elimination of severe complications (heart failure, significant heart rhythm disturbances, etc.) on days 2-4 of illness, when the patient is on bed rest.

On bed rest, in the first lesson in a lying position, active movements are used in the small and medium joints of the limbs, static tension of the leg muscles, muscle relaxation exercises, exercises with the help of a physical therapy instructor for large joints of the limbs, breathing exercises without deepening breathing, elements of massage (stroking) of the lower extremities and back with passive turns of the patient on the right side. In the second lesson, active movements are added to large joints limbs. Leg movements are performed alternately, sliding movements along the bed. The patient is taught to economically, effortlessly turn onto the right side and lift the pelvis. After which you are allowed to independently turn onto your right side. All exercises are performed at a slow pace, the number of repetitions of exercises for small muscle groups is 4-6 times, for large muscle groups - 2-4 times. Between exercises, rest breaks are included. The duration of classes is up to 10-15 minutes.

After 1-2 days, during physical therapy classes, the patient is seated with his legs hanging with the help of a physical therapy instructor or nurse for 5-10 minutes, this is repeated 1-2 more times during the day.

LH classes are carried out in the starting positions lying on your back, on your right side and sitting. The number of exercises for small, medium and large muscle groups increases. Exercises for the legs with lifting them above the bed are performed alternately with the right and left legs. The amplitude of movements gradually increases. Breathing exercises are carried out with deepening and lengthening the exhalation. The pace of exercise is slow and medium. The duration of the lesson is 15-17 minutes.

The criteria for the adequacy of physical activity is an increase in heart rate, first by 10-12 beats/min, and then up to 15-20 beats/min. If the pulse increases in speed, then you need to pause for rest and perform static breathing exercises. It is permissible to increase systolic pressure by 20-40 mm Hg, and diastolic pressure by 10 mm Hg.

3-4 days after MI in case of MI severity class 1 and 2 and 5-6 and 7-8 days in case of severity class 3 and 4, the patient is transferred to the ward mode.

The objectives of this mode are: preventing the consequences of physical inactivity, gentle training of the cardiorespiratory wall, preparing the patient for walking along the corridor and everyday stress, and climbing stairs.

LH is carried out in the initial positions lying, sitting and standing, the number of exercises for the torso and legs increases and decreases for small muscle groups. Breathing exercises and muscle relaxation exercises are used to relax after difficult exercises. At the end of the main part of the lesson, walking is mastered. On the first day, the patient is lifted with a safety net and limited to adapting to the vertical position. From the second day, they are allowed to walk 5-10 meters, then every day the walking distance is increased by 5-10 meters. In the first part of the lesson, the starting positions are used, lying and sitting, in the second part of the lesson - sitting and standing, in the third part of the lesson - sitting. The duration of the lesson is 15-20 minutes.

When the patient masters walking 20-30 meters, a special dosed walking session begins. The walking dosage is small, but increases daily by 5-10 meters and reaches 50 meters.

In addition, patients do UGG, including individual exercises from the LH complex. Patients spend 30-50% of their time sitting and standing.

6-10 days after MI in the 1st class of MI severity, 8-13 days in the 2nd class, 9-15 days in the 3rd class and individually in the 4th class, patients are transferred to a free regimen.

The objectives of exercise therapy in this motor mode are the following: preparing the patient for full self-care and going out for a walk, for measured walking in a training mode.

Apply following forms Exercise therapy: UGG, LH, dosed walking, training for climbing stairs.

In therapeutic exercises and morning hygienic exercises, active physical exercises are used for all muscle groups. Includes exercises with light objects (gymnastic stick, clubs, ball), which are more complex in terms of coordination of movements. Just like in the previous mode, breathing exercises and muscle relaxation exercises are used. The number of exercises performed in a standing position increases. Lesson duration is 20-25 minutes.

Measured walking, first along the corridor, starts at 50 meters, at a pace of 50-60 steps per minute. The walking distance increases daily so that the patient can walk 150-200 meters along the corridor. Then the patient goes outside for a walk. By the end of his stay in the hospital, he should walk 2-3 km per day in 2-3 doses. The walking pace gradually increases, first 70-80 steps per minute, and then 90-100 steps per minute.

Stair climbing training is done very carefully. For the first time, climb 5-6 steps with a rest on each one. During rest, inhale; during ascent, exhale. In the second session, while exhaling, the patient walks 2 steps, and while inhaling, he rests. In subsequent classes, they switch to normal walking up the stairs with rest after completing the flight of stairs. By the end of the regimen, the patient masters climbing one floor.

The adequacy of physical activity to the patient’s capabilities is controlled by the heart rate response. On bed rest, the heart rate should not exceed 10-12 beats/min, and on ward and free rest, the heart rate should not exceed 100 beats/min.

2.3.2 Physical therapy for MI at the sanatorium stage of rehabilitation.

The objectives of exercise therapy at this stage are: restoration of the physical performance of patients, psychological readaptation of patients, preparation of patients for independent life and production activities.

Physical therapy classes begin with a gentle regimen, which largely replicates the free regimen program in the hospital and lasts 1-2 days if the patient completed it in the hospital. If the patient did not complete this program in the hospital or a lot of time has passed since discharge from the hospital, this regimen lasts 5-7 days.

Forms of exercise therapy in a gentle mode: UGG, LH, training walking, walks, training in climbing stairs. The PH technique differs little from the technique used in the free hospital setting. In classes, the number of exercises and the number of their repetitions gradually increases. The duration of LH classes increases from 20 to 40 minutes. The LH class includes simple and complicated walking (on toes with high knees), and various throwing movements. Training walking is carried out along a specially equipped route, starting from 500 m with a rest (3-5 minutes) in the middle, the walking pace is 70-90 steps per minute. The walking distance increases daily by 100-200 m and is increased to 1 km.

Walks start at 2 km and progress up to 4 km at a very relaxed, accessible pace. Training in climbing stairs is carried out daily, and climbing 2 floors is mastered.

When mastering this program, the patient is transferred to a gentle training regimen. Forms of exercise therapy are expanding by including games, lengthening training walking to 2 km per day and increasing the pace to 100-110 steps/min. Walking is 4-6 km per day and its pace increases from 60-70 to 80-90 steps/min. Climbing stairs to 2-3 floors.

LG classes use a variety of exercises without and with objects, as well as exercises on gymnastic apparatus and short-term running.

Only patients with MI severity classes I and II are transferred to the exercise therapy training regimen. In this mode, the difficulty of performing exercises in PH classes increases (use of weights, exercises with resistance, etc.), the number of repetitions of exercises and the duration of the entire lesson increases to 35-45 minutes. The training effect is achieved by performing long work moderate intensity. Training walking 2-3 km at a pace of 110-120 steps/min, walking 7-10 km per day, climbing 4-5 floors of stairs.

The exercise program in a sanatorium largely depends on its conditions and equipment. Nowadays, many sanatoriums are well equipped with exercise equipment: bicycle ergometers, treadmills, various strength training equipment, which allow you to monitor your heart rate (ECG, blood pressure) during physical activity. In addition, in winter it is possible to use skiing, and in summer - rowing.

You just need to focus on the permissible changes in heart rate: in a gentle mode, the peak heart rate is 100-110 beats/min; duration 2-3 minutes. on gentle training, the peak heart rate is 110-110 beats/min, the duration of the peak is up to 3-6 minutes. 4-6 times a day; in the training mode, peak heart rate is 110-120 beats/min, peak duration is 3-6 minutes, 4-6 times a day.

2.3.3 Physical therapy for MI at the outpatient stage.

Patients who have had an MI at the outpatient stage are individuals suffering from chronic ischemic heart disease with post-infarction cardiosclerosis. The tasks of exercise therapy at this stage are as follows:

Restoring the function of the cardiovascular system by including compensation mechanisms of a cardiac and extracardiac nature;

Increasing tolerance to physical activity;

Secondary prevention of coronary artery disease;

Restoration of working capacity and return to professional work, preservation of restored working capacity;

Possibility of partial or complete refusal of medications;

Improving the patient's quality of life.

At the outpatient stage, rehabilitation by a number of authors is divided into 3 periods: gentle, gentle-training and training. Some add a fourth - supportive.

The best form is long-term training loads. They are contraindicated only in case of: left ventricular aneurysm, frequent attacks of angina pectoris with little effort and rest, serious heart rhythm disturbances (atrial fibrillation, frequent polytopic or group extrasystole, paroxysmal tachycardia, arterial hypertension with steadily increased diastolic pressure(above 110 mm Hg), tendency to thromboembolic complications.

In case of myocardial infarction, long-term physical activity is allowed to begin 3-4 months after the MI.

According to functional capabilities, determined using bicycle ergometry, spiroergometry or clinical data, patients belong to functional classes 1-P - “strong group”, or to functional class III - “weak” group. If classes (group, individual) are conducted under the supervision of an exercise therapy instructor or medical personnel, then they are called controlled or partially controlled, conducted at home according to an individual plan.

Good results of physical rehabilitation after myocardial infarction at the outpatient stage are obtained by the technique developed by L.F. Nikolaeva, YES. Aronov and N.A. White. The course of long-term controlled training is divided into 2 periods: preparatory, lasting 2-2.5 months and main, lasting 9-10 months. The latter is divided into 3 subperiods.

During the preparatory period, classes are held group method in the gym 3 times a week for 30-60 minutes. The optimal number of patients in a group is 12-15 people. During classes, the methodologist must monitor the condition of the students: by external signs of fatigue, by subjective feelings, heart rate, breathing rate, etc.

At positive reactions Patients are transferred to the loads of the preparatory period into the main period, lasting 9-10 months. It consists of 3 stages.

The first stage of the main period lasts 2-2.5 months. Classes at this stage include:

1. Exercises in training mode with the number of repetitions of individual exercises 6-8 times, performed at an average pace.

2. Complicated walking (on toes, heels, on the inside and outside feet for 15-20 s).

3. Measured walking at an average pace in the introductory and final parts of the lesson; at a fast pace (120 steps per minute), twice in the main part (4 minutes).

4. Dosed running at a pace of 120-130 steps per minute. (1 min.) or complicated walking (“ski step”, walking with high knees for 1 min).

5. Training on a bicycle ergometer with dosing of physical activity by time (5-10 min.) and power (75% of the individual threshold power). If you don’t have a bicycle ergometer, you can prescribe climbing a step for the same duration.

6. Elements of sports games.

Heart rate during exercise can be 55-60% of the threshold in patients of functional class III (“weak group”) and 65-70% in patients of functional class I (“strong group”). In this case, the “peak” heart rate can reach 135 beats/min, with fluctuations from 120 to 155 beats/min,

During exercise, the “plateau” type heart rate can reach 100-105 per minute in the “weak” and 105-110 in the “strong” subgroups. The duration of the load on this pulse is 7-10 minutes.

At the second stage, lasting 5 months, the training program becomes more complicated, the severity and duration of the loads increases. Dosed running at a slow and medium pace (up to 3 minutes), work on a bicycle ergometer (up to 10 minutes) with a power of up to 90% of the individual threshold level, playing volleyball over a net (8-12 minutes) with the prohibition of jumping and a one-minute rest after every 4 minutes

Heart rate during “plateau” type loads reaches 75% of the threshold in the “weak” group and 85% in the “strong” group. “Peak” heart rate reaches 130-140 beats/min.

The role of LH decreases and the importance of cyclic exercises and games increases.

At the third stage, lasting 3 months, intensification of loads occurs not so much due to an increase in “peak” loads, but rather due to an extension of “plateau” type physical activity (up to 15-20 minutes). Heart rate at peak load reaches 135 beats/min in the “weak” and 145 in the “strong” subgroups; In this case, the increase in heart rate is more than 90% in relation to the resting heart rate and 95-100% in relation to the threshold heart rate.

Test questions and assignments

1. Give an idea about atherosclerosis and its factors
calling.

2. Diseases and complications of atheroxclerosis.

3. Mechanisms of the therapeutic effect of physical exercises in
atherosclerosis.

4. Methods of physical exercises for
initial stages of atherosclerosis development.

5. Define ischemic heart disease and the factors that cause it.
Name its clinical forms.

6. What is angina and its types, course options
angina pectoris?

7. Objectives and methods of exercise therapy for angina pectoris in hospital and
outpatient stages?

8. Determination of exercise tolerance and
functional class of the patient. Characteristics of functional
classes?

9. Physical rehabilitation of patients with IV functional coronary artery disease
class?

10. The concept of myocardial infarction, its etiology and pathogenesis.

11. Types and severity classes of myocardial infarction.

12. Describe the clinical picture of myocardial infarction.

13. Objectives and methods of physical rehabilitation for MI on
stationary stage.

14. Objectives and methods of physical rehabilitation for myocardial infarction
sanatorium stage.

15. Objectives and methods of physical rehabilitation for myocardial infarction
outpatient stage.

19
Chapter 2. Physical rehabilitation of patients diagnosed with coronary heart disease

2.1. Stages of rehabilitation of patients with coronary heart disease

Rehabilitation for ischemic heart disease is aimed at restoring the state of the cardiovascular system, strengthening general condition body and preparing the body for previous physical activity.

The first period of rehabilitation for ischemic heart disease is an adaptation. The patient must get used to new climatic conditions, even if the previous ones were worse. Acclimatization of the patient to new climatic conditions may take about several days. During this period, primary medical examination patient: doctors assess the patient’s health status, his readiness for physical activity (climbing stairs, gymnastics, therapeutic walking). Gradually, the patient's physical activity increases under the supervision of a physician. This is manifested in self-service, visits to the dining room and walks around the sanatorium.

The next stage of rehabilitation– this is the main stage. He milks for two to three weeks. During this period, physical activity, duration, and speed of therapeutic walking increase.

At the third and final stage rehabilitation, a final examination of the patient is carried out. At this time, the tolerability of therapeutic exercises, dosed walking and climbing stairs is assessed. The main thing in cardiac rehabilitation is dosed physical activity. This is due to the fact that it is physical activity that “trains” the heart muscle and prepares it for future stress during daily activity, work, etc. Moreover, it is currently reliably

Physical activity has been proven to reduce the risk of developing cardiovascular disease. Such therapeutic exercises can serve as a prevention for both the development of heart attacks and strokes, as well as for

restorative treatment.

Terrencourt– another excellent means of rehabilitation for heart diseases, incl. and IHD. A path is a walking ascent measured in distance, time and angle of inclination. Simply put, health path is a method of treatment by dosed walking along specially organized routes. The path path does not require any special equipment or tools. It would be a good slide. In addition, climbing stairs is also a path. Health path is effective remedy for training the heart affected by coronary artery disease. In addition, it is impossible to overdo it with a health path, since the load has already been calculated and dosed in advance.

However, modern simulators allow you to carry out a health path without slides and stairs. Instead of climbing a mountain, a special mechanical path with a changing angle of inclination can be used, and walking on stairs can be replaced by a step machine. Such simulators allow you to more accurately regulate the load, provide immediate control, feedback and, most importantly, do not depend on the vagaries of the weather.

Some may wonder how the stress on the heart and coronary artery disease can be combined? After all, it would seem that you need to spare the heart muscle in every possible way. However, this is not the case, and it is difficult to overestimate the benefits of physical exercise during rehabilitation after coronary artery disease.

First, physical activity helps reduce body weight and increase muscle strength and tone. During physical activity, the blood supply to all organs and tissues in the body improves, and the delivery of oxygen to all cells of the body is normalized. In addition, the heart itself trains a little bit and gets used to working under a slightly higher load, but at the same time, not

reaching the point of exhaustion. Thus, the heart “learns” to work under the same load as it would under normal conditions, at work, at home, etc.

It is also worth noting the fact that physical activity helps relieve

emotional stress and fight depression and stress.

After therapeutic exercises, as a rule, anxiety and restlessness disappear. And with regular exercises, insomnia and irritability disappear; the emotional component of IHD is an equally important factor. After all, according to experts, one of the reasons for the development of diseases of the cardiovascular system is neuro-emotional overload. And therapeutic exercises will help to cope with them.

An important point in therapeutic exercises is that not only the heart muscle is trained, but also blood vessels hearts ( coronary arteries). At the same time, the wall of blood vessels becomes stronger, and its ability to adapt to pressure changes improves.

Depending on the condition of the body, in addition to therapeutic exercises and walking, other types of physical activity can be used, for example, running, vigorous walking, cycling or exercise on an exercise bike, swimming, dancing, skating or skiing. But such types of exercise as tennis, volleyball, basketball, training on exercise machines are not suitable for the treatment and prevention of cardiovascular diseases; on the contrary, they are contraindicated, since long-term static loads cause increased blood pressure and heart pain.

2.2. Diet for coronary heart disease

In case of coronary artery disease, in order to reduce the load on the myocardium, the intake of water and sodium chloride (table salt) is limited in the diet. In addition, given the importance of atherosclerosis in the pathogenesis of IHD, much attention is paid to limiting foods that contribute to the progression of atherosclerosis. An important component treatment of coronary artery disease is the fight against obesity as a risk factor.

The following food groups should be limited, or if possible avoided.

Animal fats (lard, butter, fatty varieties meat)
Fried and smoked food.
Products containing large amounts of salt (salted cabbage, salted fish etc.)
Limit intake of high-calorie foods, especially quickly absorbed carbohydrates. (chocolate, sweets, cakes, pastry).

To correct body weight, it is especially important to monitor the ratio of energy coming from the food eaten and energy expenditure as a result of the body’s activities. For sustainable weight loss, the deficit must be at least 300 kilocalories daily. On average, a person not engaged in physical work spends 2000-2500 kilocalories per day.

2.3. Spa treatment for coronary heart disease

Sanitary treatment is an important stage in the rehabilitation of patients with chronic ischemic heart disease with post-infarction cardiosclerosis. The complex effect of rest, sanatorium treatment, climatic factors, and physical therapy allows one to obtain a pronounced positive integral effect.

An important criterion for transfer to a sanatorium is the level of activity of the patient achieved in the hospital. Contraindications for transfer to sanatorium treatment are: circulatory failure, cardiac asthma, tendency to hypertensive crises, significant heart rhythm disturbances, complete transverse heart block. At the same time, the presence in patients of such concomitant diseases complicating the condition as hypertension without frequent crises, compensated or subcompensated diabetes mellitus, deforming spondylosis, circulatory failure of the I-II degree, single extrasystoles, is not an obstacle to referral to a suburban sanatorium. Rehabilitation in a cardiological sanatorium should be divided into two stages. The first of them is a suburban sanatorium, the second is a sanatorium- spa treatment. Referral to sanatorium-resort treatment is becoming more realistic late dates. Patients who do not have the above contraindications are prescribed a gentle or gentle-training regimen, and then, after mastering, a training regimen. The method of physical therapy here is similar to the outpatient rehabilitation stage. Important has the correct medical selection for sanatorium-resort treatment, carried out strictly according to indications. The selection is carried out by doctors from clinics, medical units, dispensaries, etc. If there are indications, the patient is given a certificate indicating the type

the basis for obtaining a voucher for spa treatment at the trade union committee at the place of work or study. Before traveling to the resort, the attending physician issues the patient a sanatorium-resort card, which is presented at the medical institution upon arrival. At the resort, patients, as a rule, receive therapy, including a general sanatorium regimen, an active motor regimen, gas or mineral baths, daytime sleep in the open air, as well as vasodilators and coronary lytic drugs. Emerging attacks of angina pectoris are stopped by taking nitroglycerin or validol. Although the treatment of patients at this stage is complex, however, for example, drug therapy here has a more pronounced preventive focus - it is designed to ensure the normalization of metabolic processes in the myocardium, maintaining the basic functions of the cardiovascular system, water-salt metabolism etc.

2.4. Complex of therapeutic exercises for coronary heart disease

A valid method of preventing coronary heart disease, in addition to a balanced diet, is moderate physical exercise (walking, jogging, skiing, hiking, cycling, swimming) and hardening the body. At the same time, you should not get carried away with lifting weights (weights, large dumbbells, etc.) and do long (more than an hour) jogging, which causes severe fatigue.

Daily morning exercises, including the following set of exercises, are very useful:

Exercise 1: Starting position(ip.) - standing, hands on the belt. Move your arms to the sides - inhale; hands on the belt - exhale. 4-6 times. Breathing is uniform.

Exercise 2: I.p. - Same. Hands up - inhale; bend forward - exhale. 5-7 times. Tempo is average (t.s.).

Exercise 3: I.p. - standing, hands in front of the chest. Move your arms to the sides - inhale; return to IP - exhale. 4-6 times. The tempo is slow (tm).

Exercise 4: I.p. - sitting. Bend your right leg - clap; return to IP Same with the other leg. 3-5 times. T.s.

Exercise 5: I.p. - standing by the chair. Sit down - exhale; stand up - inhale. 5-7 times. T.m.

Exercise 6: I.p. - sitting on a chair. Sit in front of the chair; return to IP Do not hold your breath. 5-7 times. T.m.

Exercise 7: I.p. - the same, legs straightened, arms forward. Bend your knees, hands on your waist; return to IP 4-6 times. T.s.

Exercise 8: I.p. - standing, take your right leg back, arms up - inhale; return to IP - exhale. The same with the left leg. 4-6 times. T.m.

Exercise 9: I.p. - standing, hands on your belt. Tilts left and right. 3-5 times. T.m.

Exercise 10: I.p. - standing, hands in front of the chest. Move your arms to the sides - inhale; return to IP - exhale. 4-6 times. T.s.

Exercise 11: I.p. - standing. Move your right leg and arm forward. The same with the left leg. 3-5 times. T.s.

Exercise 12: I.p. - standing, hands up. sit down; return to IP 5-7 times. T.s. Breathing is uniform.

Exercise 13: I.p. - the same, arms up, hands “locked”. Torso rotation. 3-5 times. T.m. Do not hold your breath.

Exercise 14: I.p. - standing. Step forward with your left foot - arms up; return to IP The same with the right leg. 5-7 times. T.s.

Exercise 15: I.p. - standing, hands in front of the chest. Turns left and right with arms raised. 4-5 times. T.m.

Exercise 16: I.p. - standing, hands to shoulders. Take turns straightening your arms. 6-7 times. T.s.

Exercise 17: Walking in place or around the room - 30 s. Breathing is uniform.

Conclusion

The mortality rates of the population of the Russian Federation from coronary heart disease and cerebrovascular disease are 2-3 times higher than in economically developed countries (EDC). Russia occupies a “leading” position in the world in terms of mortality from strokes, the level of which exceeds the similar indicator among the population of the ER by approximately 8 times.

Considering the unfavorable socio-economic situation in the country, it can be assumed that in the coming years, mortality from this class of diseases will remain at a high level due to an increase in the number of elderly and senile people, an annual increase in the production and sales of alcohol, and the continued high level of chronic stress(rising prices, unemployment, decreased work motivation, high crime); lack of adequate growth in living standards, as well as the inaccessibility of modern medicines and new medical technologies for the poor.

Brief description

Rehabilitation therapy or rehabilitation of patients suffering from coronary heart disease is one of the partial sections of rehabilitation in medicine. It originated during the First World War, when the task of restoring the health and working capacity of war invalids first arose and began to be solved.

Table of contents

List of abbreviations................................................... ........................................... 3
Introduction………………………………………………………………………………. 4
Chapter 1. Review of literature on coronary disease
hearts……………………………………………………………………….. 5
1.1. Definition and classification of coronary heart disease.. 5
1.2. Etiology and pathogenesis of coronary heart disease........... 9
1.3. Clinical picture for coronary heart disease…..…16
Chapter 2. Physical rehabilitation of patients diagnosed with coronary heart disease……………….………………........................... ........................ 19
2.1 Stages of rehabilitation of patients with ischemic disease
hearts……………………………………………………………. 19
2.2 Diet for coronary heart disease……………………... 22
2.3 Sanitary spa treatment for coronary disease
hearts…………………………………………………………….. 23
2.4 Complex of therapeutic exercises for coronary artery disease
Hearts………………………………………………………. 25
Conclusion................................................. ........................................................ ..... 27
List of used literature......................................................... ............. 28

Rehabilitation for coronary artery disease is aimed at restoring the state of the cardiovascular system, strengthening the general condition of the body and preparing the body for previous physical activity.

The first period of rehabilitation for IHD is adaptation. The patient must get used to new climatic conditions, even if the previous ones were worse. Acclimatization of the patient to new climatic conditions may take about several days. During this period, a primary medical examination of the patient is carried out: doctors assess the patient’s health status, his readiness for physical activity (climbing stairs, gymnastics, therapeutic walking). Gradually, the patient's physical activity increases under the supervision of a physician. This is manifested in self-service, visits to the dining room and walks around the sanatorium.

The next stage of rehabilitation is the main stage. He milks for two to three weeks. During this period, physical activity, duration, and speed of therapeutic walking increase.

At the third and final stage of rehabilitation, a final examination of the patient is carried out. At this time, the tolerability of therapeutic exercises, dosed walking and climbing stairs is assessed.

So, as you already understand, the main thing in cardiac rehabilitation is dosed physical activity. This is due to the fact that it is physical activity that “trains” the heart muscle and prepares it for future stress during daily activity, work, etc.

In addition, it has now been reliably proven that physical activity reduces the risk of developing cardiovascular diseases. Such therapeutic exercises can serve as a prevention for both the development of heart attacks and strokes, as well as for rehabilitation treatment.

Health path is another excellent means of rehabilitation for heart diseases, incl. and IHD. A path is a walking ascent measured in distance, time and angle of inclination. Simply put, health path is a method of treatment by dosed walking along specially organized routes.

The path path does not require any special equipment or tools. It would be a good slide. In addition, climbing stairs is also a path. Health path is an effective means for training the heart affected by coronary artery disease. In addition, it is impossible to overdo it with a health path, since the load has already been calculated and dosed in advance.

It is important to remember that a health path is a dosed load. And you shouldn’t try to be the first to climb a steep mountain or climb the stairs the fastest. Health path is not a sport, but physical therapy!

In addition, the heart itself trains a little bit and gets used to working under a slightly higher load, but without reaching the point of exhaustion. Thus, the heart “learns” to work under such a load, which will be when normal conditions, at work, at home, etc.

It is also worth noting the fact that physical activity helps relieve emotional stress and fight depression and stress. After therapeutic exercises, as a rule, anxiety and restlessness disappear. And with regular exercises, insomnia and irritability disappear. And as you know, the emotional component in IHD is an equally important factor. After all, according to experts, one of the reasons for the development of diseases of the cardiovascular system is neuro-emotional overload. And therapeutic exercises will help to cope with them.

An important point in therapeutic exercises is that not only the heart muscle is trained, but also the blood vessels of the heart (coronary arteries). At the same time, the wall of blood vessels becomes stronger, and its ability to adapt to pressure changes improves.

Depending on the condition of the body, in addition to therapeutic exercises and walking, other types of physical activity can be used, for example, running, vigorous walking, cycling or exercise on an exercise bike, swimming, dancing, skating or skiing. But such types of exercise as tennis, volleyball, basketball, and training on exercise machines are not suitable for the treatment and prevention of cardiovascular diseases; on the contrary, they are contraindicated, since long-term static loads cause increased blood pressure and heart pain.

In addition to therapeutic exercises, which is undoubtedly the leading method of rehabilitation for patients with coronary artery disease, herbal medicine and aromatherapy are also used to restore patients after this disease. Phytotherapists select for each patient medical fees herbs The following plants have a beneficial effect on the cardiovascular system: astragalus fluffy-flowered, Sarepta mustard, lily of the valley, carrots, peppermint, viburnum, cardamom.

In addition, today for the rehabilitation of patients after coronary heart disease, such interesting method treatments like aromatherapy. Aromatherapy is a method of preventing and treating diseases using various aromas. This positive effect of smells on humans has been known since ancient times. It is known that not a single doctor Ancient Rome, China, Egypt or Greece could not do without medicinal aromatic oils. For some time, the use of medicinal oils in medical practice was undeservedly forgotten. However, modern medicine is returning to the experience accumulated over thousands of years in the use of aromas in the treatment of diseases. To restore normal functioning of the cardiovascular system, lemon oil, lemon balm oil, sage oil, lavender oil, and rosemary oil are used. The sanatorium has specially equipped rooms for aromatherapy.

Work with a psychologist is carried out if it is required. If you suffer from depression or have suffered stress, then psychological rehabilitation, along with physical therapy, is undoubtedly important. Remember that stress can aggravate the course of the disease and lead to exacerbation. This is why proper psychological rehabilitation is so important.

Diet is another one important aspect rehabilitation. Proper diet important for the prevention of atherosclerosis, the main cause of coronary artery disease. A nutritionist will develop a diet especially for you, taking into account your taste preferences. Of course, you will have to give up certain foods. Eat less salt and fat, and more vegetables and fruits. This is important, since if excess cholesterol continues to enter the body, physical therapy will be ineffective.

Rehabilitation of coronary heart disease

Rehabilitation of coronary heart disease involves sanatorium-resort treatment. However, you should avoid traveling to resorts with a contrasting climate or during the cold season (sharp weather fluctuations are possible), because Patients with coronary heart disease have increased meteosensitivity.

The approved standard for the rehabilitation of coronary heart disease is the prescription of diet therapy, various baths (contrast, dry air, radon, mineral), therapeutic showers, manual therapy, massage. Exposure to sinusoidal modulated currents (SMC), diademic currents, and low-intensity laser radiation is also used. Electrosleep and reflexology are used.

The beneficial effects of climate help improve the functioning of the body's cardiovascular system. Mountain resorts are most suitable for the rehabilitation of coronary heart disease, because... staying in conditions of natural hypoxia ( reduced content oxygen in the air) trains the body, promotes the mobilization of protective factors, which increases the body’s overall resistance to oxygen deficiency.

But sunbathing and swimming in sea water must be strictly dosed, because contribute to thrombus formation, increased blood pressure and stress on the heart.

Cardiac training can be carried out not only on specialized simulators, but also during walking along special routes (terrenkur). The paths are designed in such a way that the effect is a combination of the length of the route, ascents, and number of stops. In addition, the surrounding nature has a beneficial effect on the body, which helps to relax and relieve psycho-emotional stress.

Application various types baths, exposure to currents (SMT, DDT), low-intensity laser radiation promotes excitation of nerve and muscle fibers, improvement of microcirculation in ischemic areas of the myocardium, increased pain threshold. In addition, procedures such as shock wave therapy and gravity therapy.

Rehabilitation of coronary artery disease using these methods is achieved through the growth of microvessels into the area of ischemia, the development of a wide network of collateral vessels, which improves myocardial trophism and increases its stability in conditions of insufficient oxygen supply to the body (during physical and psycho-emotional stress).

An individual rehabilitation program is developed taking into account all the individual characteristics of the patient.

Rehabilitation for coronary artery disease

The term "rehabilitation" translated from Latin means restoration of ability.

Rehabilitation is currently understood as a set of therapeutic and socio-economic measures designed to provide people with impairments of various functions that have developed as a result of illness, such a physical, mental and social state that would allow them to re-enter life and take a position in life that corresponds to their capabilities. society.

The scientific foundations for restoring the ability to work of patients with diseases of the cardiovascular system were laid in our country in the thirties by the outstanding Soviet therapist G. F. Lang. IN recent years The problem of rehabilitation of these patients is being actively developed in all countries of the world.

What determines such great interest in this problem? First of all, its great practical significance. Thanks to advances in the rehabilitative treatment of patients with coronary artery disease, including those who have suffered a myocardial infarction, the attitude of doctors and society towards them has radically changed: pessimism has been replaced by reasonable, albeit restrained optimism. Numerous examples from the experience of cardiologists indicate that thousands of patients whose lives could not be saved by medicine several years ago are now living and have every opportunity to improve their health so much that they can return to active and productive work, remaining a full-fledged member of society.

Considering the high social significance rehabilitation and experience of leading medical institutions country, several years ago a decision was made to organize a state step-by-step rehabilitation patients who have had myocardial infarction. This system is currently being implemented.

It is three-stage and provides for the sequential implementation of rehabilitation measures in a hospital (mainly in the cardiology department), in the rehabilitation department of a local cardiology sanatorium and in a district clinic by a cardiology doctor or a local therapist, with the involvement of other specialists if necessary.

During the first period of rehabilitation the main tasks of treating the acute period of a heart attack are solved: to promote rapid scarring of the necrosis focus, prevent complications, increase the patient’s physical activity to a certain extent, and correct psychological disorders.

Second rehabilitation period- very responsible in the patient’s life, since it is the boundary between the time when a person is in a sick position and the time when he returns to his usual life environment. The main goal is to identify the compensatory capabilities of the heart and their development. At this time, patients should engage in the fight against risk factors for coronary artery disease.

Before the third period The following tasks are set:

prevention of exacerbations of coronary artery disease through the implementation of secondary prevention measures;
maintaining the achieved level of physical activity (for some patients and increasing it);
completion of psychological rehabilitation;
carrying out examinations of the ability to work and employment of patients.

The diversity of rehabilitation tasks determines its division into so-called types, or aspects: medical, psychological, socio-economic, professional. The solution to the problems of each type of rehabilitation is achieved by its own means.

Patients of functional class I are engaged in a training regime program. In PH classes, in addition to exercises of moderate intensity, 2-3 short-term loads of high intensity are allowed.

Dosed walking training starts at 5 km and progresses to 8-10 km at a walking speed of 4-5 km/hour. While walking, accelerations are performed; sections of the route may have an incline of 10-17. After patients have mastered the 10 km distance well, they can begin training by jogging alternating with walking. If there is a pool, classes are held in the pool, their duration gradually increases from 30 to 45-60 minutes.

Patients of the II functional cash desk They are engaged in a gentle training program. The classes use loads of moderate intensity. Metered walking begins with a distance of 3 km and gradually increases to 5-6.

The walking speed at the beginning is 3 km/hour, then 4., part of the route may have an ascent of 5-10. When exercising in the pool, the time spent in the water gradually increases, and the duration of the entire lesson is increased to 30 - 45 minutes. Maximum changes in heart rate - up to 130 beats/min.

Patients of the III functional cash desk are engaged in the sanatorium's gentle treatment program. Training in measured walking begins with a distance of 500 m, increases daily by 200 - 500 m and is gradually increased to 3 km at a speed of 2-3 km/hour. For any form of exercise, only low-intensity physical activity is used. Maximum heart rate changes during exercise are up to 110 beats/min.

Physical rehabilitation of patients with coronary artery disease of the functional class

Tasks:

Achieve complete self-care for patients;

Introduce patients to household activities of low and moderate intensity);

Reduce medication intake;

Improve mental state.

The physical exercise program should have the following features:

Physical exercises are carried out only in a cardiology hospital;

Precise individual dosage of loads is carried out using a bicycle ergometer with electrocardiographic control;

Low intensity loads are used;

The lesson includes exercises for small and medium muscle groups with repetitions of 10-12 and 4-6 times, respectively. The total number of exercises is 13-14.

At the outpatient stage, rehabilitation of patients and coronary artery disease is divided into 3 periods: gentle, gentle - training, training. The best form is long-term training loads.

They are contraindicated only in case of frequent attacks of angina pectoris or serious heart rhythm disturbances.

Exercise therapy classes take place in 2 stages.

The first stage of the main period lasts 2-2.5 months. Classes at this stage include:

1.exercises in training mode with the number of repetitions of individual
exercises up to 6-8 times, performed at an average pace;

2.complicated walking (on toes, heels, on the inside and outside
feet for 15-20 seconds);

3. dosed walking at an average pace in the introductory and final parts of the lesson; at a fast pace (120 steps per minute), twice in the main part (4 minutes);

4. dosed running at a pace of 120-130 steps per minute or complicated walking (walking with high knees for 1 minute);

5.training on a bicycle ergometer with dosing of physical activity by time (15-10 minutes) and power (75% of the individual threshold power).

At the second stage (duration 5 months) the training program becomes more complicated, the severity and duration of the loads increase. Dosed running at a slow and medium pace (up to 3 minutes) and work on a bicycle ergometer (up to 10 minutes) are used.

MYOCARDIAL INFARCTION

Myocardial infarction- a focus of ischemic necrosis in the heart muscle, caused by acute insufficiency of its blood supply.

The main factor in acute failure is obstruction of the coronary arteries (thrombosis, prolonged spasm of a narrowed artery).

Acute (rapid) blockage of the lumen of the coronary artery usually leads to macrofocal necrosis or massive heart attack(covers the wall, septum, apex of the heart); narrowing of the artery - to small focal necrosis or microinfarction(affects part of the wall) .

Severe heart damage is transmural myocardial infarction, in which necrosis affects the entire thickness of the muscle.

The site of necrosis is replaced by connective tissue, which gradually turns into scar tissue. Resorption of necrotic masses and formation of scar tissue lasts 1.5-3 months.

Myocardial infarction

Clinic:

1st period - painful or ischemic: most often, myocardial infarction begins with increasing pain in the chest, often of a pulsating nature.

Characterized by extensive irradiation of pain - in the arms, back, stomach, head, etc. Signs of heart and vascular failure are often present - cold extremities, sticky sweat etc. The pain syndrome is long-lasting and cannot be relieved by nitroglycerin. Various heart rhythm disorders and a drop in blood pressure occur. The duration of 1 period is from several hours to 2 days.

2nd period - acute(inflammatory): characterized by the occurrence of necrosis of the heart muscle at the site of ischemia. The pain usually goes away. The duration of the acute period is up to 2 weeks. The patient's well-being gradually improves, but general weakness, malaise, and tachycardia persist. Heart sounds are muffled. The increase in body temperature caused by the inflammatory process in the myocardium, usually small, up to 38°C, usually appears on the 3rd day of the disease. By the end of the first week, the temperature usually returns to normal.

3rd period - (subacute or scarring period): lasts 4-6 weeks, body temperature normalizes and all other signs of the acute process disappear: a connective tissue scar develops at the site of necrosis. Subjectively, the patient feels healthy.

4th period - (rehabilitation period, recovery): lasts from 6
months to 1 year. Clinically there are no signs. Happening
gradual restoration of myocardial function.

Physical rehabilitation:

Contraindications to exercise therapy: frequent attacks of angina, angina at rest, unstable angina, severe cardiac arrhythmias (frequent extrasystole, paroxysmal tachycardia, atrial fibrillation), circulatory failure of the PB (and higher) stage, persistent arterial hypertension over 170/110 mm Hg. Art., concomitant severe diabetes mellitus.