Limiting factors of early physiotherapy followingheartsurgeries

Overview

Limiting factors of early physiotherapy after cardiac surgeries are, besides various risks of circulatorycomplications, set by general deconditioning of patients with multiple illnesses, syndrome of painfulthoracic armour and problems with unhealed operation wounds (longitudinal sternotomy, thoracostomy,sutures in graft donor sites in extremities). Significant non-cardiac pain dominates in the areaof sternotomy, associated with respiratory insufficiency and risk of unstable sternum. Patients canalso experience esophagus pain (GERD), segmental visceral pain with segmental propagation (Th4-11), as well as vertebral inter- and peri-scapular pain and acral paresthesias in the upperextremities. Ergometry is, because of risk of sutures dehiscence and misinterpretation of resultssecondary to non-cardiac factors, possible only after surgery sites heal. The goals of physiotherapyare to achieve good activity tolerance in the level of activities of daily living and to teach patientssimple technique of determination of appropriate preventative exercise. To set individually theadequate exercise level, we can use the ”speak, sing, and breathe heavily” method, set the trainingheart rate (THR) and limit heart rate according to approximate formula THR= (220 – age) * 0.75 oruse so called Corridor walking test (CWT) and correlation between CWT/6 min and spirometricmaximal O2 consumption.

Key words:
coronary revascularization, longitudinal sternotomy, prevention of unstablesternum, irritable esophagus, respiratory physiotherapy, training heart rate, Corridor walkingtest, Nordic walk