>Hi Juliana,
>Actually, my name is Kate, not Steven (my surname is Stevens)!
Really sorry about that *sheepish smile*. :)
>When surgeons do a heart transplant they don't reconnect the nerves to the
>heart. As Nancy Howes explains in her reply, this increases the resting
>heart rate. This is because there is no sympathetic nerve inhibition of the
>heart rate. Also, the heart rate responds slowly to exercise, with less
>increase in heart rate than normal. For example, if you had to get up from
>your computer and sprint across the room, your heart rate would increase
>immediatly. If you had had a heart transplant, it might not change at all,
>or perhaps only increase a few minutes later, and it would not increase by
>as much. The response depends on how long ago the surgery was done as the
>heart seems to respond more quickly as time goes by. Exercise is still
>possible because the stroke volume increases, thereby increasing cardiac
>output.
>I agree with Nancy's comments on the use of the Borg Rating of Perceived
>Exertion Score, you should be able to find info on this quite easily as it
>is widely used in rehabilitation (pulmonary and cardiac). It is a
>subjective measure of how hard the patient feels they are working
>(including their breathing, and how their muscles are feeling). We explain
>this score to our patient at their first visit to the gym, telling them
>that they should be working at 'fairly hard' (12-14 score on the 6 - 20
>scale we use) level, ie mildly short of breath but able to talk, warm but
>not pouring sweat. On their first few visits to the gym we regularly will
>ask them whether the exercise we have set them makes them work at the right
>level. If not, we will make it easier or harder as necessary. The patients
>quickly become used to adapting their level of exertion independently. This
>method is also useful for cardiac rehab patients who are in Atrial
>Fibrillation and therefore find it difficult to work to a target heart
>rate.
Please forgive me for my ignorance but just to confirm that I understand
what you are saying - using the RPE Borg's scale is a better measurement of
how hard they (heart transplant patients) are working rather than the heart
rate, contrary to that of CABG patients, because of the denervation, right?
What's the difference between the 6-20 and the 0-10 scale? The center I am
at uses the 6-20 scale. If I am not mistaken, Nancy uses the 0-10 scale.
>Do you have transplant patients mixed with CABG patients in your cardiac
>rehab group?
No, only heart transplant.
Another issue to mention for transplant patients is that they tend to suffer
from hypertension and raised cholesterol as side effects of their
immunosupressive medication. In fact the drugs they have to take can have
lots and lots of different side effects, but the patients should usually be
very well-educated about these problems.
>I hope I haven't overloaded you with too much information!
Not at all. On the contrary, I am learning a lot.
Just want to know your opinion: I have this patient who joined the cardiac
rehab group after a recent transplant. He is the "gung-ho" type who is
stubborn and will increase his own workload on the treadmill. We have tried
to explain to him many times the dangers in doing that. Have you
encountered this kind of patients and how do you actually handle them.
Another question: I have patients coming to me post-CABG, complaining of
hypersensitivity in pain over their chest. Why? Wearing a very thin
t-shirt for them is agony. Can we do anything to help them?
Regards,
Juliana Kok
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