quence of MYOCARDIAL INFARCTION, cannot increase
the force of its contractions, limiting cardiac out-
put. Severe damage can result in cardiac output
that is less than the body’s needs even at rest.
Medications to strengthen the heart and focus the
efforts of its contractions can often improve car-
diac efficiency, though only mediating the under-
lying cause can restore adequate cardiac output.
People who have a high AEROBIC FITNESSlevel,
such as athletes and those who regularly engage
in AEROBIC EXERCISE, can significantly increase their
cardiac output to send more blood to their mus-
cles. During intense aerobic activity, 60 percent or
more of the cardiac output may go to the skeletal
muscles. High cardiac output is essential to get
enough blood and oxygen to vital organs at the
same time.
See also CARDIAC CAPACITY; LEFT VENTRICULAR EJEC-
TION FRACTION(LVEF).
cardiac rehabilitation Planned activities, course
of recovery, or structured program for improving
cardiovascular health after HEART ATTACK, CORONARY
ARTERY BYPASS GRAFT(CABG), HEART TRANSPLANTATION,
and other major cardiovascular events or opera-
tions. Many people, after such events, need to
make significant lifestyle changes. A structured
cardiac rehabilitation program helps people to
define their needs and goals and establish realistic
steps to move progressively toward meeting them.
Most people benefit from assistance with meal
planning and nutrition, exercise, and SMOKING CES-
SATION. Structured programs also offer social inter-
action with other people who have similar
experiences, and may include organized SUPPORT
GROUPSfor people to share their feelings, percep-
tions, and suggestions.
Many factors influence a person’s ability to par-
ticipate in physical activity. Many hospitals and
medical centers offer physician-supervised cardiac
rehabilitation programs that feature defined yet
individualized activities, some of which may take
place at a facility such as a rehabilitation center
and others designed for the person to do at home.
Some medically supervised cardiac rehabilitation
programs incorporate ambulatory ELECTROCARDIO-
GRAM(ECG) so people can use the telephone to
send their ECG readings to cardiologists who can
then determine whether physical exercise is
within therapeutic range and provide assurance
that the HEARTis functioning satisfactorily.
Programs such as those health clubs and organ-
izations such as the YMCA offer are less compre-
hensive and not under a physician’s direction.
They primarily provide classes in aerobic and
resistance exercises as well as access to facilities
and equipment. A nutritional counselor separately
provides dietary guidance including instruction for
WEIGHT LOSS AND WEIGHT MANAGEMENT. People who
have health conditions other than cardiovascular,
such as DIABETESor chronic OSTEOARTHRITIS, may
need additional consultations or professional guid-
ance to accommodate all of their health needs.
Current medical practice emphasizes a return
to regular activities as quickly as possible following
heart attack or major heart surgery. This reduces
the risk of BLOOD clots that can cause STROKE,
another heart attack, or PULMONARY EMBOLISM
(blood clot in the LUNG). It also expedites HEALING
and counters the emotional swings, especially
DEPRESSION and anxiety, that are common with
serious CARDIOVASCULAR DISEASE (CVD). Research
studies have conclusively demonstrated that peo-
ple who engage in cardiac rehabilitation and
maintain heart-healthy lifestyle changes are much
less likely to experience additional cardiovascular
events and may even halt or reverse cardiovascu-
lar conditions such as ATHEROSCLEROSISand HYPER-
TENSION(highBLOOD PRESSURE).BENEFITS OF CARDIAC REHABILITATION
decreasedCHOLESTEROL faster return to work and
BLOOD LEVELS other activities
fewer cardiovascular symptoms improvedAEROBIC FITNESS
improvedATHEROSCLEROSIS improved INSULINsensitivity
improved nutritious eating habits improvedQUALITY OF LIFE
loweredBLOOD PRESSURE reduced postoperative
reduced risk of health problems discomfort
related to smoking stress reduction
WEIGHT LOSS AND WEIGHT MANAGEMENTHeart attack or major heart surgery is a signifi-
cant trauma for an individual to experience, with
both physical and emotional components. Many
people are fearful about the level of physical activ-
ity their bodies, and especially hearts, can tolerate.
Some people respond with reluctance to do any-
thing and others leap into action with a fervor30 The Cardiovascular System