Thank you very much for your reply.
I am doing my rotation at the National Heart Center in Singapore.
Regards,
Juliana
>Hi Juliana
>Yes, you need to use the RPE scale for heart transplants patients. I think
>you're right about Nancy using the RPE 0-10 scale. The original Borg Score
>had numerical values from 6 to 20 with descriptions from very, very light
>to very, very hard placed against 7 of these numbers (this is the one you
>and I use). The modified borg score (1982) is used to assess perceived
>breathlessness in response to an intervention such as exercise. Words range
>from 'nothing at all' to 'maximal' and are next to values 0-10. (ref
>Practical Pulmonary Rehabilitation by Mike Morgan and Sally Singh .... the
>only text book I happened to have on my desk at the time).I don't know much
>more about the differences between the 2 scores but I guess this would be a
>good area to read up on. I think a fair bit of research has been done on
>the correlation between physiological response and RPE score.
>I think hypersensitivity over the scar is quite common, especially in
>patients who have had the left internal mammary artery used..... don't
>quote me on that, I'm not a cardiac rehab specialist. Perhaps our
>musculo-skeletal physio colleagues will have some tips on how to treat
>that.
>Your 'gung-ho' type: yes, I have had such transplant patients. I suppose
>you can only advise them, gently at first and then more strongly. Make a
>point of explaining to him that his heart rate cannot increase to meet the
>demand he is putting on it and that is why he gets very breathless when he
>pushes himself too hard.
>How long post transplant is he? We do let our more responsible patients
>increase their own work-load on the treadmill, as long as they understand
>how hard they should be working and how to progress their exercise. Don't
>forget that (unlike you M.I. patients), he has gone from having a failing
>heart to a strong new one, so he should be increasing his fitness more
>rapidly than your M.I. patients unless there have been problems with the
>new heart. If you feel that he is really being irresponsible and doing too
>much you could voice your concerns to his transplant cardiology consultant,
>or if worst comes to worst, tell him you are not willing to take
>responsibility for his exercising in the gym under your care if he will not
>abide by your guidance.
>I'm curious as to which hospital you work at in which country?
>Kate Stevens
>
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