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Chapter 45: Rehabilitation of the Patient with Coronary Heart Disease

Which of the following is not a benefit of cardiac rehabilitation (CR)?

A. Improved heart rate recovery

B. Decreased levels of high-density lipoprotein (HDL) cholesterol

C. Dose-dependent reduction in mortality

D. Improved left ventricular (LV) function

E. Decreased depression symptoms

The answer is B. (Hurst’s The Heart, 14th Edition, Chap. 45) Clinical trials have demonstrated many clinical benefits of exercise-based CR.1 A number of mechanistic effects seem to contribute to this clinical benefit. For example, exercise has anti-inflammatory effects by increasing HDL cholesterol levels (option B). Heart rate recovery is an indicator of cardiovascular (CV) health, and impaired heart rate recovery predicts mortality. In a study of patients with abnormal heart rate recovery prior to starting CR, the exercise program resulted in a 41% improvement in heart rate recovery (option A).2 Following MI, exercise training has proven benefits on LV function and remodeling (option D), and the effects were greatest when the exercise training was started 1 week after MI and lasted longer than 12 weeks.3 It has been estimated that 20% to 45% of patients demonstrate depression following MI.4 Improved fitness was associated with decreased depressive symptoms and decreased mortality (option E).5 Furthermore, the relationship between the number of CR sessions completed in older patients and improved outcomes found a dose-dependent reduction in mortality and recurrent MI (option C).

A 54-year-old man recovering from a cardiovascular event is referred to you for medical evaluation prior to initiating CR. Which of the following is a contraindication to enrollment in a CR program?

A. Hypertension

B. Coronary artery bypass graft (CABG) surgery

C. Myocardial infarction (MI)

D. Unstable angina

E. All of the above

The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 45) To establish a safe and effective program of comprehensive CV disease risk reduction and rehabilitation, each patient should undergo a careful medical evaluation and exercise test before participating in an outpatient CR/SP program. CR was initially implemented to reduce hospitalizations after MI (option C), but given the benefits for CV health, the concept was expanded to include patients with several conditions. This includes patients undergoing cardiac surgery and coronary interventions (option B), and those with a high cardiovascular risk, namely hypertensives (option A). Nevertheless, there are absolute contraindications to CR, including all conditions where physical exercise carries a significant risk of adverse effect, ...

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