Coronary Artery Bypass Grafting (CABG) is an open heart (surgical) procedure to graft a segment of the artery to provide blood supply to muscles of the heart. It is indicated in patients with Coronary Heart Disease (CHD), where there are multiple blockages in the coronary artery due to buildup of plaque. Coronary artery (CA) and its branches are the main oxygen-rich blood supply to the walls of the heart.
The CA occlusion exhibit shortness of breath, anxiety, angina (shooting chest pain); in a few cases heart attack can also occur. This is always a medical emergency and requires first attention. Angiography locates the occlusions, and the electrical activity is monitored with the help of Electrocardiography (ECG). In CABG a vein graft or mammary artery graft is used to re-establish the oxygen-rich blood supply. Once the procedure is finished the patient is kept under observation in coronary intensive care (CCU).
Once the patient is with medical and vital stability, then cardiac rehabilitation is required. The incisions were made in the skin, bones, and chest muscles. later, on healing, it is indicated to rehabilitate the chest along with wound care. Because of surgery, the pattern of breathing gets altered and there is less movement in chest and thorax. The patient becomes apprehensive to avoid any pain due to pressure or movement in the scar. This brings a complication because there is already insufficient breathing and the scar may lead to skin contracture, further limiting the expansion of the chest. During the recovery period, there are very limited physical activities that the patient does, this induces generalized muscle weakness. Prolonged bed rest can also lead to further weakness of respiratory muscles. This doesn't only affect but also complicates breathing; the patient will not be able to cough voluntarily to expel the chest secretions, this will lead to chest congestions.
A cardiorespiratory therapist prescribes a protocol for systemic-cardiac and respiratory fitness. An inspiratory muscle trainer, core-muscle strengthening, and incentive spirometer are very reliable modalities to improve respiratory muscle strength. This helps to achieve a normal volume of breathing. The cardiovascular and aerobic training will help the heart muscle to pump more efficiently. This training is very different from the training in the gymnasium because rehabilitation is based on a quantitative assessment of muscular strength. During physical training, breathing rate, heart rate, blood pressure, oxygen saturation, and physical fatigue is constantly monitored. The therapist mobilizes the scar to prevent the adherence of tissues beneath the scar and heal better. The mechanism of normal breathing is restored, the ribs should expand and rise during inspiration, move down during expiring air outside, and this movement of ribs is compared to the movement of bucket handle. There should be sufficient space for the heart and expansion of the lungs inside the chest cavity. The ultimate goal of this rehabilitation program is to achieve physical and mental fitness for functional independence.
Pankaj
MPT Final Year
Cardiopulmonary
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