Cardiac Rehabilitation
Case Research of a Affected person That Sustained a Myocardial Infarction and Subsequent Congestive Coronary heart Failure
by John Petrizzo, DPT, SSC and Alexander Pisanello, DPT
| September 25, 2025
The topic of this case examine is a 76-year-old male that sustained a
myocardial infarction and underwent a left anterior descending artery
bypass graft on January 5, 2025. On account of the infarction and
subsequent surgical process, he had a left ventricular ejection
fraction of 25%.
For individuals who could also be
unfamiliar with that time period, a traditional ejection fraction is roughly
50-70%. Because of this in a wholesome particular person, 50-70% of the blood
that’s of their left ventricle is ejected from the guts with every
contraction. The left ventricle of the guts is the chamber that’s
liable for pumping oxygen-rich blood to the remainder of the physique. An ejection fraction under 30% is
thought of to be severely irregular.
The indicators and signs the affected person offered with, together with, however not
restricted to, ventricular pump dysfunction, pulmonary edema, nocturnal
dyspnea (shortness of breath), bilateral pitting edema, orthopnea
(dyspnea whereas mendacity down), and dyspnea, are a medical presentation
that’s in keeping with congestive coronary heart failure, which is a
situation that arises when the guts can’t pump sufficient blood to satisfy
the physique’s wants.
The affected person’s
doctor, who’s a good friend and colleague of mine, referred the
affected person to me for cardiac rehabilitation. Happily, this doctor
is properly conscious that I make the most of resistance coaching within the type of
correctly titrated and dosed squats, deadlifts, overhead presses, and
bench presses as a cornerstone for remedy with the affected person
inhabitants that I at present serve. Equally, I handled this affected person
at my clinic, the place the proprietor encourages the Beginning Energy technique
of energy coaching, and permits me to see sufferers one-on-one for a
affordable time frame.
I really feel lucky that I
have been given the liberty to make the most of barbell workout routines in my
remedy packages for my sufferers, as I notice the unfavourable
connotation that’s nonetheless related to these workout routines by many in
the rehabilitative discipline.
The rules for
cardiac rehabilitation state particularly that this affected person
inhabitants advantages from incrementally rising progressive
energy coaching and cardio conditioning. Nevertheless, there are
particular standards for the initiation, modification, and termination
of train when working with this affected person inhabitants. Cardiac
rehabilitation is reserved for medical professionals which are
licensed, competent, and capable of persistently monitor for indicators and
signs requiring the modification and or termination of train.
I at present educate
Cardiac Rehabilitation at Quinnipiac College, Anderson College,
and Wheeling College, and have actively taught it at many
universities nationwide for Nationwide Bodily Remedy licensing examination
functions. I even have applied cardiac and pulmonary
rehabilitation for a various affected person inhabitants over the course of
the final 5 years.
I evaluated and commenced
treating the affected person on February 12, 2025. He was taking a number of
drugs that influence coronary heart perform on the time he started working
with me. These drugs included a beta-adrenergic antagonist, a
diuretic, and natural nitrates, to call a number of. At baseline, the
affected person was unable to get out of a 17-inch chair with out using
his arms, and will solely stroll 350 toes with out gasping for air,
requiring him to take a seat down. His chief criticism was that he was weak,
deconditioned, and unable to rise up the steps in his house, with the
use of a handrail and turning into wanting breath. The affected person’s
impairments negatively impacted the efficiency of instrumental
actions of day by day residing, leisure actions, and occupational
duties. Bodily remedy companies have been really useful to scale back signs
of dyspnea, enhance train tolerance and cardio capability, improve
energy, and optimize locomotion, the efficiency of instrumental
actions of day by day residing, and leisure actions.
I started by instructing the
affected person how you can squat, deadlift, and overhead press, as outlined in
Beginning Energy: Fundamental Barbell Coaching third version.
Nevertheless, his poor bodily situation on the time of his analysis
necessitated important modification in comparison with that of a wholesome
particular person. At this primary session, he was capable of deadlift a 5-pound
kettlebell for 1 set of 5 repetitions, and his overhead press was two
3-pound dumbbells for 1 set of 5 repetitions. I taught him
applicable squat mechanics, and he was capable of do 1 set of 5
repetitions ranging from a 17-inch assist floor with out utilizing his
arms. We did some mild intervals on the air bike for conditioning
after his resistance coaching.
I discharged the
affected person for the primary time on 03/31/25, about 6 weeks later. I used to be
seeing him as soon as every week within the clinic on the time of discharge. Prior
to his discharge, he goblet squatted 30 kilos for 3 units of 5, did a
standing dumbbell overhead press for 3 units of 8 with 20 kilos, and
he carried out a dumbbell deadlift for 3 units of 5 with 30 kilos. I
additionally noticed him climb 15 flights of stairs within the clinic with no
downside. His 6-minute stroll check distance was over 1500 meters. Whereas
no person within the Beginning Energy group would essentially take into account
the affected person to be “sturdy” on the time of his preliminary discharge,
it was wonderful to see how profoundly a modest acquire in energy
impacted his general perform. It’s apparent that the affected person might
have gotten considerably stronger and extra aerobically conditioned;
nevertheless, he was very proud of the outcomes and requested to be
discharged at the moment.
He returned for six extra
classes, commencing on 05/29/25 and ending on 06/20/25. When he was
discharged the second time on 06/20/25, he might excessive bar squat with
30 kilos under parallel for 3 units of 5 with a field, overhead press
32.5 kilos for 3 units of 5, and he might deadlift 95 kilos from the
flooring for 1 set of 5. As soon as once more, he was happy with the outcomes
he acquired beneath the bar and determined to finish bodily remedy at that
time.
This case examine is
proof that when rigorously monitored and correctly titrated and
dosed, the essential barbell workout routines may be extraordinarily helpful for
even probably the most sick and frail amongst us.
