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| Division of Occupational Therapy - OT Connect Myocardial Infarction
A heart attack occurs when an area of heart muscle dies or is permanently damaged because of an inadequate supply of oxygen to that area (AllRefer Health). A heart attack occurs when blockages develop in one of the arteries supplying blood to the heart (AnneCollins.com). Common Symptoms/Course of Disease
Overview and Causes: Most heart attacks are caused by a clot that blocks one of the coronary arteries. The coronary arteries are blood vessels that bring blood and oxygen to the heart muscle. The clot usually forms in a coronary artery that has been previously narrowed from changes related to atherosclerosis. (Atherosclerosis is a condition in which fatty material is deposited along the walls of the arteries. This fatty material will eventually harden and may block the artery.) The atherosclerotic plaque inside the arterial wall sometimes cracks triggering the formation of a clot. A clot located in a coronary artery interrupts the flow of blood and oxygen to the heart muscle therefore leading to the death of the heart cells in that area (AllRefer Health). The remaining heart muscle must make up for this area of heart that is no longer functioning properly. Age of Onset: Coronary heart disease is American’s number one killer (American Heart Association). Four out of five deaths from the disease are in people over 65 (AnneCollins.com). Although your chance of a heart attack increases with age, heart attacks can happen to anyone of any age. Risk Factors: Risk factors that can be changed include:
Risk factors that cannot be changed:
Sex Biases: As mentioned above, heart disease and heart attacks affect both men and women. Women have a greater chance of dying of a heart attack, while men have a greater life long risk of having a heart attack. (AnneCollins.com). Current Medical Treatment: Confirmation of a heart attack is done through a through review of several tests performed by a physician. Tests include:
After a heart attack has been confirmed, there are several treatment pathways that can be taken. Drug / Medication Treatments:
Surgical Treatments:
Cardiac Rehabilitation: After surgery the patient may be referred to cardiac rehabilitation. The goals of cardiac rehabilitation include:
There are Three Stages of Cardiac Rehabilitation:
Occupational Therapy Involvement Occupational therapists can play a crucial part in cardiac rehabilitation. Occupational therapy, along with other disciplines, can assist patients in making the necessary lifestyle changes needed to remain healthy (Reitz, 1999). The occupational therapist’s specific role to the cardiac rehabilitation program includes:
Community based centers are a great place for occupational therapists to work. It is through a program like this that lifestyle changes can be carried over from the inpatient setting. Without community-based programs patients may relapse to their old behavior patterns (Reitz, 1999). A person diagnosed with cardiovascular disease, or who has had a heart attack, may have many questions and concerns about what activities that they can and cannot participate in (American Occupational Therapy Association). Occupational therapists are skilled in activity analysis and activity modification. It is for these reasons that occupational therapists and occupational therapy assistants are beneficial assets to the heart attack patient’s rehabilitation team. References
How OT Makes a Difference: Evidence-Based Practice Occupational therapists have a valuable role in helping the participant in cardiac rehabilitation achieve maximum potential. Patients in cardiac rehabilitation are experiencing changes not only in their physical functioning, but in their psychological and emotional functioning as well. Marital relationships, employment, self-esteem, or confidence issues can all be problem areas for patients in cardiac rehabilitation. Occupational therapists can effectively address these areas (Cronin, 1992). In an effort to help cardiac patients, Gayle A. Cronin wrote an article discussing the University of Ottawa Heart Institute Prevention and Rehabilitation Centre (HIPRC). There, the focus of occupational therapy is on (1) evaluating and establishing a functional level of activity based on cardiac status, available treadmill test results, and exercise status (2) suggesting guidelines and techniques for modifying activities of daily living and community living that are not within the energy limits of the patients (3) evaluating the home environment, and suggesting ways of adapting the home to decrease the energy expenditure (4) providing supportive counseling especially regarding anxiety, depression about loss of roles, health concerns acceptance of new limits on activity, and the major changes in life style, and (5) providing encouragement to increase self-confidence in daily life activities (Cronin, 1992). An article by the American Occupational Therapy Association further supports Gayle Cronin’s idea of the focus of occupational therapy by stating that occupational therapists can, “Evaluate a persons physical and psychological health, determine what work, home and leisure activities should be modified, adjust tasks, recommend pacing strategies and adaptive equipment, and teach coping strategies for people who have feelings of anxiety and depression,” (American Occupational Therapy Association). In an effort to do these things at HIPRC, many questionnaires and rating scales are given to the patient to determine what they want, need, and feel is most important to them. At the rehabilitation center, they found that by doing this they were better able to evaluate and focus in on each patient’s needs. Cronin states that, “The use of purposeful task engagement, activity analysis, adaptation of activity and / or equipment, and psychosocial support combine to comprise a holistic, functional approach to treatment,” (Cronin, 1992). Those with cardiovascular disease, and those that have had heart attacks, have many questions regarding the tasks and activities that make up their daily lives (American Occupational Therapy Association). Occupational therapists monitor these patients and assist them in adapting their homes, jobs, and daily activities to fit their needs during their recovery period. J is a 68-year-old retired man with hypertension and high cholesterol. He began experiencing agonizing upper back pain which persisted for one day. After fighting the pain, he was eventually taken to the emergency room. After blood tests, an EKG and an ECHO it was determined that the upper back pain he was experiencing was indicative of a heart attack. He was then scheduled for an angioplasty which found 2 blocked arteries. J then had a CABG to repair the two blocked arteries. After it was determined that he was medically stable, he was referred to the cardiac rehabilitation program in the hospital. The occupational therapist, through her evaluation determined that he experienced much fatigue with self-care activities, was having memory problems, and that he was terrified to go home. It was also discovered that Mr. J’s home was two stories and that his bedroom was on the top floor. Mr. J also lived alone and wanted to return there. The occupational therapist suggested breaking down Mr. J’s self care activities into segments through activity analysis. For, example, when Mr. J. is dressing he should: (1) sit down while putting his shirt on, (2) rest, (3) stand up to put his pants on, (4) sit back down and rest, (5) put his socks on (with adaptive equipment if needed), (6) rest and, (7) then put his shoes on. In performing activities of daily living in segments, the occupational therapist was using energy conservation and work simplification principles. Adaptive equipment was also given to Mr. J. for activities that required a lot of energy and that he tired easily in. Equipment given included: reacher, long-handled sponge, long-handled shoehorn, sock-aid, and a dressing stick. The occupational therapist also implemented a memory notebook for Mr. J. so that he would remember important dates, appointments, and scheduled tasks. He had complained that he was having difficulty remembering these things and through the notebook he would be able to monitor he days and events. Through client questioning and a home evaluation with Mr. J. and his son, the occupational therapist recommended home modifications for Mr. J. in order to safely return home. Being that his bedroom was on the top floor, she recommended that he move it downstairs, where the kitchen and bathroom were. This would let Mr. J. avoid two flights up steps and save him a lot of energy when at home. With the help of his family, this would be a relatively easy move for Mr. J. There was ample space for a bedroom down on the first floor. The occupational therapist also recommended an extended tub bench and hand held showerhead for the bathroom. Lastly, in therapy the occupational therapist and Mr. J. practiced numerous activities of daily living skills that he would need to go home. After he was deemed safe he was discharged home. (after about 8 weeks in therapy). Mr. J. is doing very well now. He reported that he is much happier now that he was before his heart problems. He reported much more energy and loves the set up of his new home. Mr. J’s son also stops in twice a week to check on him and to make sure everything is okay. Through the help of an occupational therapist Mr. J. was able to function at the highest level possible. Through task analysis, activity modification, and home modifications, the occupational therapist enabled Mr. J. to go home, and more importantly, to be safe. Do the occupational therapy that Mr. J. has received, he developed skills that enabled him to meet the challenges of daily life.
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