General Management of the
Cardiac Patient

The majority of patients suffering from cardiac disease are afflicted by a chronic, often lifelong problem. Consequently, their medical management goes beyond conventional treatment and involves recommendations concerning life-style. Patients with milder varieties of heart disease are often permitted to lead a normal, totally unrestricted life, except for such minor interventions as administering an antibiotic drug before dental extractions as a precaution against infection. Children with heart disease may require specific instructions concerning physical education and recreational activities as well as vocational guidance. Patients whose disease have progressed to a point of some disability may need a detailed program regulating their activities and diet and may be counseled regarding some occupational and environmental factors.

The most detailed set of regulations applies to patients recovering from heart operations or from an acute myocardial infarction. Here a specially trained team may take charge of cardiac rehabilitation. The goal is to guide and facilitate the transition from acute hospital care to as normal a life as possible, while emphasizing secondary prevention of further heart damage. Cardiac rehabilitation is usually divided

into three stages: stage 1 involves in-hospital treatment; stage 2, immediate convalescence; and stage 3, long-term support. During the first stage the patient is guided toward resuming activities at a gradual pace often by physical therapists and occupational therapists, in combination with psychological support. On leaving the hospital, the patient usually receives individual instruction regarding an exercise program, based on treadmill tests, as well as other advice regarding life-style. Exercise is often performed in organized rehabilitation units under medical supervision. The third stage is important for those patients who have some residual disability and may benefit from constant supervision.