Chronicle of My Husband's Heart Attack

My husband, a 57 year old cardiac patient and heart attack survivor, finished 36 sessions of cardiac rehab last week.
The cardiac rehab staff gave him a fitness program to follow at home. (Jim will attend cardiac rehab once/month on a maintenance program though.) Part of the at home fitness program is to exercise at an aerobic
heart rate training zone. To do that, he was told to calculate his target heart rate using the Karvonen formula. So what is the Karvonen formula? I had no idea, until I found this web page that defines it as:

The Karvonen Formula is a method that uses your age and fitness level to determine your target heart rate training zones. Developed by Dr. M Karvonen, the Karvonen Formula offers a more personalized number than the standard equation and is considered the most accurate means of determining heart rate.

The formula is: (MHR – RHR x (.60 & .80) +RHR) where MHR is your maximum heart rate and RHR is your resting heart rate.

The resting heart rate is calculated by measuring your heart rate before getting out of bed in the morning, each day, for 3 days. Add the 3 resting heart rates together and divide that sum by 3 so that you have your average resting heart rate. (As fitness improves the resting heart rate usually goes down.)

The maximum heart rate can be determined by a stress test, or by subtracting your age from 220.

For example, if an individual has a resting heart rate of 63 and is 45 years old then their maximum heart rate is 220-45=175. Using the Karvonen Formula to calculate their 60% target heart rate:
(175 – 63 x .60) + 63 = 130

and, using the same formula to calculate their 80% target heart rate:
(175 – 63 x .80) + 63 = 152

So that person’s target heart rate would be 130-152.

UPDATE: Let’s apply the Karvonen Formula to Jim, specifically. Jim’s average resting heart rate is 67 bpm. His maximum heart rate is 165 bpm (from a stress test he passed in June).

So Jim’s 60% target heart rate formula is:
(165-67x.60) + 67 = 125.8

And Jim’s 80% target heart rate formula is:
(165-67x.80) + 67 =
145.4

Therefore, Jim stregthens his heart when he exercises with a heart rate between 125.8 and 145.4.

vadkins

These are the home exercise guidelines that the cardiac rehab program gave my husband after his last rehab session:

Prepare yourself with proper diet, clothing, equipment and workout conditions.

1. Diet
   -Wait at least 2 hours after a heavy meal before exercising vigorously. The reason for this is that for at least 1 1/2 hours following a meal, blood is diverted from different parts of the body to the stomach to aid in digestion.
   -Replace fluids lost during exercise due to seating, and avoid ice-cold drinks immediately after exercise. Drink plenty of cool water before, during, and after your workout.
2. Clothing
   -2 pair of socks may help avoid blisters.
   -There are many types of shoes for different physical activities. Be choosey, and get some expert advice on shoes. Correct, well-fitting shoes can prevent strains, blisters, sprains and sore legs and ankles. Good shoes may mean the difference between enjoying your program and dropping out.
   -If your legs chafe around the thighs, rub vaseline on them prior to workout.
   -Most women find it more comfortable to wear a good supportive bra during exercise. Sports bras are excellent
   -Wear some form of identification, in case of accident or illness while exercising.
   -If you are outdoors and it is cold, wear a hooded sweatshirt or cap that comes over the ears.
   -Do not put on too many clothes. They will hamper your movements and cause you to perspire excessively, making it hard to avoid chilling after exercise.
3. Equipment: Make sure the equipment you are using is in proper working order. The use of poorly maintained equipment may cause injury.
4. Workout Conditions
   -If the temperature is above 90 degrees with 60 percent humidity, do not exercise strenuously. Morning or evening workouts may be the solution for the extreme heat, or you may want to swim for your exercise. Walking in a shopping mall or cycling on an exercise bike at home are other alternatives.
   -When it is extremely cold, below zero degrees, a mask or scarf can be worn over the face.

Exercise Prescription: Your exercise prescription is based on the F.I.T. principle, consisting of 3 main things:

1. F – Frequency:  How often you are to exercise.
2. I – Intensity:  How fast to walk or how much resistance to use on the bicycle. (In order to measure the intensity at which you are exercising, you may rely on your rate of perceived exertion (RPE), the “talk test,” and your heart rate. Your RPE should be no higher than 5/10, or moderately strong. The “talk test” is simply done by talking as you exercise. If you are too breathless to talk, SLOW DOWN. Finally, your heart rate can be measured by checking your pulse and keeping it within your target heart rate range.)
3. T – Time: The length of time for an individual exercise session.

Target Heart Rate:  At the completion of the rehabilitation, you will know the target heart rate range you should be within while exercising. Your pulse should be taken before, during, and after exercise and recorded in your exercise diary.

Your Pulse.

1. Get a wristwatch with a second hand and place it where you can easily see it.
2. With a mild to moderate pressure find your pulse on your neck or wrist. Count the pulse beats for 10 seconds, starting the count with 0, then multiply by six.
3. Record the rate in terms of how many times your heart beats in one minute.

Warm Up:  A warm up should be thorough, adequate, and precede every type of workout. A combination of flexibility and stretching exercises can prevent cramps, strains, sprains, and even heart problems. Slow whole-body activities should also be included in the warm-up to allow the body to adjust from resting to exercise conditions. Follow the routine that you learned in the rehabilitation program. These exercises should be done slowly and gently. Do not bounce with stretching exercises.

Signs of Overexertion

1. Do not push yourself into trouble. A little enthusiasm and drive is needed, but too much, too soon, will only lead to sore muscle and discouragement.
2. Here are some immediate signs of overexertion to look for during and after exercise:
   -Tightness or pain in the chest, severe breathlessness, light-headedness, dizziness, loss of muscle control and nausea. When you experience any of these symptoms, STOP EXERCISING IMMEDIATELY. If the symptoms do not subside, consult your physician.
3. If you find yourself over fatigued during the day after exercising, if may be that you are exercising too hard.
4. Ten (10) minutes after you stop exercising, if you are still short of breath you are overdoing it.

Cool Down

1. Strenuous exercise causes the muscles to demand large amounts of oxygen. The heart responds by beating harder and faster and by sending greater volumes of oxygen-carrying blood to those hard working muscles, especially the thigh and calf muscles. The squeezing action of those muscles and one way valves in the leg veins shunt the used blood back to the heart. If strenuous exercise is suddenly stopped, the squeezing action of the muscles also stops and blood tends to pool in the legs. This pooling causes the brain and heart to be deprived of blood and the much needed oxygen. When this happens, fainting and serious heart problems can result. This problem is further complicated if the exerciser enters a hot shower or sauna without a cool down period. Heat opens up (dilates) the skin’s small vessels and allows blood to flow to the skin’s surface in an effort to cool down the body. This creates an additional lack of surface in an effort to cool down the body. This creates an additional lack of blood to the vital centers with sometimes serious consequences.
   As you can see, a cool down period is very important. It allows your body to maintain an adequate blood and oxygen supply to the vital organs and to gradually adjust to a resting or non-exercising state. Your minimum cool down time should be 8-10 minutes.
   A cool down will contain a slow aerobic activity. Whatever activity you have chosen, the important thing is TAPER OFF GRADUALLY; do not suddenly stop. Follow this slow aerobic activity with a series of stretching exercises which may prevent sore muscles and increase flexibility. The same series of exercises prescribed for the “warm-up” period is ideal for the “cool-down” period.

vadkins

My husband had a stent placed in his major coronary artery the day after the heart attack on January 8, 2008. He is now doing very well. Since his heart attack we are always looking for information as to what to look for as far as possible problems/complications are concerned. During the course of our research, we have noticed some reports restenosis of stents (). Today I came across this article on a medhelp.com forum that asks some questions that Jim and I have wondered about, that sounds similar to Jim’s case. The questions that are asked at this forum are answered by doctors at the Cleveland Clinic.

The forum questioner asks in part:

…the need to perform another PTCA on the lesion due to restenosis is about 10-15% by 6 months. When and how would restenosis be noticeable to me? What tests could my cardiologist run to determine if restenosis is happening? Finally, is there anything I should be doing or taking, medication or supplement, to help myself and reduce the risk of complication?

The doctor’s reply is:

Restenosis within a stent is caused by proliferation of the intimal cells which line the inside wall of the artery. This process occurs in approximately 15% of patients and is usually identified by a recurrence of angina or the presence of ischemia on a stress test. Routine stress tests after a stent procedure are not recommended but many cardiologists prefer to perform such a test 3-6 months after the procedure to ensure that restenosis hasn’t occurred. Many different therapies have been tested to prevent restensosis, but there are no medications that you could take that have been shown to be effective. However, to prevent the progression of atherosclerosis in areas other than the stented segment, you should exercise daily, eat a low-fat and low-cholesterol diet, and avoid tobacco.

vadkins

This post expands on my previous post which summarized the advice that a dietician gave us during one of my husband’s cardiac rehab sessions.

During my husband’s recovery from a heart attack in January, one of the facts that was repeatedly pounded into our heads by the cardiology staff at the Boston Medical Center, was that trans fats are really really bad for us. Eating trans fats is like injecting plaque plugs directly into our arteries. I’ve often wondered since then, why the medical staff made such a point of it though, because I have yet to find one food for sale that lists any trans fat content.

Well the dietician told us that a food manufacturer can put trans fats in a food product, but not be required to list it in the nutritional labeling. If a food has less than .5 grams in a serving, then that item does not have to be listed on the nutritional labeling list. That means that a food can contain .4 grams of trans fats, can say on the label Trans Fats: 0.

The rub in this is that, according to the dietician, people should not consume more than 2 grams of trans fats per day. The limit is so low because it is so dangerous for us. So, if we eat 6 servings a day of foods that each contain .4 grams of trans fats, then we are exceeding the amount of trans fats that we can safely ingest.

So the dietician recommends that we do what she does: always read the list of ingredients in a food. If the list contains anything that says “hydrogenated”, don’t eat it.

Here’s what the FDA has on their web site about trans fats:

Q: Is it possible for a food product to list the amount of trans fat as 0 g on the Nutrition Facts panel if the ingredient list indicates that it contains “partially hydrogenated vegetable oil?”

A: Yes. Food manufacturers are allowed to list amounts of trans fat with less than 0.5 gram (1/2 g) as 0 (zero) on the Nutrition Facts panel. As a result, consumers may see a few products that list 0 gram trans fat on the label, while the ingredient list will have “shortening” or “partially hydrogenated vegetable oil” on it. This means the food contains very small amounts (less than 0.5 g) of trans fat per serving.

vadkins