Cardiac Rehabilitation Can Do Your Heart Good
At age 52, Veronica Vicente led a very active lifestyle, working as a dental assistant and following a regular exercise routine. For nearly a year, however, she had been experiencing intermittent chest pains and shortness of breath. Occasionally, her jaw would lock up when she exercised.
"I had been seeing my regular doctor for routine checkups, monitoring my blood pressure and cholesterol," she recalls. "When I told him about the chest pain, he thought at first that perhaps it was due to stress and anxiety."
When her pains kept getting worse, though, the doctor ordered an electrocardiogram (EKG), a test that records the heart's electrical activity to help find the cause of unexplained chest pain.
"The EKG showed my heart rhythm was normal, but the chest pains continued to get worse," she explains. "Then on my birthday last October, I was walking uphill with a friend and had extreme shortness of breath, so I asked my doctor to refer me to a specialist."
The specialist, Dr. Timothy Tsoi, was a cardiologist on the medical staff at Washington Hospital. After examining Mrs. Vicente and ordering another EKG, he scheduled an echocardiogram (a sonogram of the heart) for the next week, followed by a stress test a few days later.
"I had forgotten to tell Dr. Tsoi about the locking of my jaw before I had the stress test," she notes. "When I told him about that odd symptom, he decided to order a nuclear medicine imaging exam that showed possible blockage of an artery, and then he scheduled an angiogram for November 27."
Dr. Tsoi had recognized that pain in the jaw could be associated with cardiovascular disease. The nuclear imaging results and angiogram (a test that uses contrast dye and special X-rays to view the insides of coronary arteries) would help diagnose the cause of her various symptoms. When she came out of anesthesia following the angiogram, Dr. Shashank Jolly, a cardiothoracic surgeon at Washington Hospital, was at her bedside to explain the results.
"Mrs. Vicente's left main coronary artery had close to 99 percent stenosis, a narrowing or constriction of the inner surface of the artery," Dr. Jolly explains. "This is the main artery that supplies blood to the heart, and any stenosis above 50 percent is considered very serious. In essence, her "life line" was blocked, and her life was hanging by a thread. Using a stent or balloon angioplasty to open up the artery were not viable options. She needed emergency bypass surgery.
"We realize that learning you need to have emergency heart surgery can be quite upsetting, so we explained the situation carefully, showing compassion for the patient and family," he adds. "I also spoke with Mrs. Vicente's sister, who is a doctor in the Philippines, to answer all her questions and reassure her, too."
"My husband was with me when Dr. Jolly explained the need for emergency heart surgery," Mrs. Vicente says. "We were really surprised because we had thought they might perform angioplasty or insert a stent if the angiogram showed blockage. The angiogram results were much worse than expected, though, and there was no other option. They put me back under anesthesia and performed the surgery right away."
Following her surgery, Mrs. Vicente spent five days in the hospital, including one day in the cardiac care unit (CCU).
"Dr. Jolly did a great job on my surgery, and I received excellent care from the nurses and other staff members in the hospital," she says. "A dietitian came in to provide me with guidance on following a diet that includes more fruits and vegetables and is lower in fats, cholesterol and salt. I also met a woman from the Mended Hearts program. They are former heart patients who volunteer to visit heart patients in the hospital. It was encouraging to know that other people have gone through the same experience I did and have recovered."
On her last day in the hospital, Mrs. Vicente met with Washington Hospital's Cardiac Rehabilitation Program Manager Lani dela Rama, RN, MSN, who explained how the program could help her return to her previous active lifestyle.
The Cardiac Rehabilitation Program offers one-hour exercise sessions under the close supervision of an exercise physiologist and a registered nurse. Patients learn how to use a wide range of exercise equipment, such as treadmills, stair-masters, bikes, recumbent bikes and elliptical equipment. During exercises, the patient is connected to portable electronic equipment to monitor the heart rate and blood pressure.
In addition to the exercise sessions, registered dietitians from Washington Hospital meet with program participants to provide counseling in heart-healthy diets and for managing diabetes, which can be a contributing factor in heart disease. A cardiologist who serves as medical advisor also is available as needed.
"The goal of the program is to help patients regain their physical strength and their confidence," says Ms. dela Rama. "Heart patients are sometimes afraid to go back to exercising after a heart attack or surgery, especially if it's an emergency surgery like Mrs. Vicente's. Taking part in the exercise sessions helps them feel they have control of their lives again, and the socialization with other heart patients helps their mental outlook, too."
Patients usually participate in three sessions a week on Monday, Wednesday and Friday at various times throughout the day. Most insurance providers, including Medicare, will cover up to 36 sessions following an acute cardiac event. The program offers the option of continuing after insurance coverage has expired, for a nominal fee of $8.50 per visit.
Mrs. Vicente started attending the exercise sessions the third week of January, once she was able to drive herself to the hospital.
"I started out on the treadmill and elliptical equipment, going slowly at first," she says. "I had been working out for eight years, so the equipment was familiar. The exercise physiologist is very helpful in explaining things, and everyone there is very nice. I also appreciate the emphasis on exercising safely, with the staff monitoring me electronically while I exercise."
Ms. dela Rama notes, "We really enjoy seeing our patients improve over the course of their journey from hospitalization through rehabilitation. The exercise sessions last an hour, and the level of exertion varies, depending on the patient's age and condition. We start them out slowly at first, and we don't push too hard, but we do encourage them to increase the intensity of their workouts over time."
For Mrs. Vicente, the results of participating in the Cardiac Rehabilitation Program have been encouraging.
"I have regained my confidence, and I know I'm getting stronger; that's the most important thing," she says. "I plan to resume my normal exercise routine, and I hope to go back to work soon as a dental assistant. I'm also hoping that later this year I can take the trip to visit my relatives in the Philippines that I had to cancel in December. I feel motivated to keep improving."
Her reasons for going public with her story go beyond just sharing her personal experience.
"This is also a good opportunity to share the lessons I've learned and to help others by pointing out the importance of living well for our loved ones," she explains. "We really need to be conscious about how we feel physically and persistent in seeking good medical care that can save our lives. I also hope my story will encourage people to live healthier lives and encourage those who have experienced heart problems to get back to a normal life again by taking part in a cardiac rehabilitation program. I would definitely recommend Dr. Jolly and the Washington Hospital Cardiac Rehabilitation Program to family members or friends who are experiencing heart problems."
Find a Physician Near You
If you are concerned about your risks for a heart attack, consult your regular physician. To find a cardiologist near you, visit Washington Hospital's website at www.whhs.com and click on "Find My Physician." To learn more about Washington Hospital's Cardiac Rehabilitation Program visit www.whhs.com/heart or call (510) 494-7022.