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Table 2: Comprehensive Risk Reduction Guidelines for Patients with CHD. (Adapted from Ref 18,19)
Lipid management
Evaluation:
Goal:
Intervention:
Hypertension management
Evaluation:
Goal:
Intervention:
Diabetes management:
Evaluation:
Goal:
Intervention:
Smoking / Tobacco:
Evaluation
Goal:
Intervention:
Weight management
Evaluation:
Goal:
Intervention:
Obtain fasting plasma glucose measurements in all patients and HbA1C in diabetic patients to monitor therapy.
Near normal fasting plasma glucose(< 100 mg/dl)and near normal HbA1C (<7)
Appropriate hypoglycemic therapy (including weight control, exercise, and if needed oral hypoglycemic agents
and/or insulin).
Monitor glucose levels before and / or after exercise sessions. Instruct patient regarding identification and
treatment of post exercise hypoglycaemia. Exercise with caution if blood glucose > 300 mg/dl (evaluate for urine
ketones as well), after consulting with a physician.
Document smoking and / or tobacco consumption habits in detail, including amount and duration.
Assess the readiness to change on the part of the patient.
Complete cessation.
Provide individual education and counselling. Encourage patient to quit at each and every visit.
Provide nicotine replacement and pharmacological therapy as appropriate.
Measure weight, height, and waist circumference. Calculate body mass index (BMI).
BMI 21-25 kg/m2, waist < 35 inches in men and < 31 inches in women.
For patients who do not meet the goal criteria, advice a reduction in total caloric intake, and increase in energy
expenditure through a combined program of diet, and exercise.
The initial goal of weight loss therapy should be to reduce body weight by approximately 10% from baseline. With
success, further weight loss can be attempted , if indicated.
Psychosocial management
Evaluation
Identify patients with clinically significant depression, anxiety, anger, and substance abuse.
Goal:
To minimize the patients psychosocial distress.
Intervention:
Stress management and individual or group education to help the patient adjust to his/her disease.
When needed, refer the patient to appropriate mental health specialists for further treatment.
Unstable angina
2.
3.
4.
5.
6.
7.
8.
Uncompensated CHF.
9.
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Aerobic Resistance
Exercise Exercise
Muscle strength
0
Glucose metabolism
Insulin response to glucose challenge
Insulin sensitivity
0
Cardiovascular dynamics
Resting heart rate
0
SBP at rest
0
0
DBP at rest
0
0
Vo 2max
0
Submaximal and maximal endurance time
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Nutrition Counselling
Psycho-Social Rehabilitation
After an MI, some of the common psychological reactions
that patients may experience are: low mood, tearfulness, sleep
disturbance, irritability, anxiety, acute awareness of minor
somatic sensations or pains, poor concentration and memory.
References
1. Reddy K S. India Wakes Up to the Threat of Cardiovascular
Diseases. Journal of American College of Cardiology 2007;50:13702.
2.
3.
4.
5.
6.
Wenger NK, Froelicher ES, Smith LK, Ades PA, Berra K, Blumenthal
JA, Certo CM, Dattilo AM, Davis D, DeBusk RF, Drozda JP Jr,
Fletcher BJ, Franklin BA, Gaston H, Greenland P, McBride PE,
McGregor CG, Oldridge NB, Piscatella JC, Rogers FJ. Clinical
Practice Guidelines No. 17: Cardiac Rehabilitation as Secondary
Prevention. Rockville, Md: US Department of Health and Human
Services, Public Health Service, Agency for Health Care Policy and
Research, National Heart, Lung and Blood Institute; 1995. AHCPR
Publication 96-0672.
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