Prevention and physical activity
Prevention in CHD and complex challenge given the heterogeneity of the group of patients with CHD. It is conditionally possible to allocate prevention of congenital heart defects, prevention of adverse progression of CHD and prevention of complications of congenital heart disease.
Prevention of CHD is very complex and in most cases boils down to genetic counselling and advocacy work among the patients of the increased risk of the disease. In addition, careful observation and study of women who had contact with the rubella virus or with comorbidities that could lead to
the development of congenital heart defects.
Prevention of unfavourable development of CHD is largely confined to the timely establishment of the defect and determine the need for and timing of surgical correction of the defect.
It should also be noted that, except for critical cases threatening the life of the child, special treatment (including cardiac surgery) must be held immediately upon the detection of the defect, and not in the very early stages, and in the most optimal terms that depend on the natural development of the relevant defect and the potential of the cardiac surgery Department.
Prevention of complications of congenital heart disease is determined primarily by these complications.
Threatening complication the UPU is, for example, bacterial endocarditis, which may complicate any type of blemish, and can appear as early as preschool age. However, an increased risk of IE does not have all the UPU, but only special situations: Nekorregirovannyh (non-operated) UPU with cyanosis, or if there is residual or unresolved defects, palliative shunts or conduits. The UPU after full removal of the blemish without the development of residual defect with prosthetic material identified during surgical correction or with percutaneous technique in the first 6 months after the procedure. While maintaining residual defect at the site of implantation of prosthetic material or device during surgical correction or with percutaneous technique. In these patients, it is vital for the prevention of IE antibiotics especially when planning dental surgery and the benefits. In these cases, the question is discussed individually with Your doctor.
In certain types of faults (especially occurring in childhood with cyanosis, cyanosis of the skin) may develop polycythemia (blood clots), which can cause frequent headaches, as well as thrombosis and inflammation of peripheral vessels and embolism of cerebral vessels.
Frequent complications with the lungs, ranging from frequent respiratory diseases and to very serious complications from pulmonary vessels and lungs.
Treatment and prevention of these complications is decided only in consultation with your doctor.
How do I engage in physical activity?
Patients operated with defects, in cases where the operation was carried out woermann and without complications as well as patients with very severe disease physical activity is shown, does not prohibit participation in sports and active rest. The restriction is essentially only one thing: it is strictly forbidden to participate in sports, because of the inability to control and dosed physical load. At the very same serious flaws as a rule, severe General condition of the patient, by itself, does not allow to increase physical activity.
With the regulation of physical activity is associated and the choice of a profession.
You must take this case into account other potentially adverse factors, such as the bad effect of high temperature at certain heart defects. On that consideration, when choosing a career in these patients must take into account the opinion of a cardiologist.
And how to be in the presence of clinical manifestations of the disease, the presence of complications, especially heart failure symptoms?
Today it is obvious that strict and absolute limitation of physical activity not indicated in patients with CHD, regardless of the stage of the disease. But physical activity should be considered as a therapeutic measure as physical rehabilitation. The only requirement can be considered stable patient with CHD when there is no need in an emergency taking diuretics and intravenous medications.
Physical rehabilitation is contraindicated in: non-operated CHD with severe narrowing of the valve hole (pulmonary stenosis, aortic stenosis, cyanotic congenital heart disease, rhythm disturbances, high grades, angina pectoris in patients with impaired ventricular work, when signs of high pulmonary hypertension.
The main mode of the loads is the original definition of tolerance using test 6-min walk. This test You have to spend under the supervision of Your physician. For patients who were less than 150 m, i.e. being in FC III–IV, as well as having a distinct lack of body weight, cachexia, common physical exercise is not shown (at least initially). In these cases, the first phase (the period of stabilization of the condition), the patient performs exercises to train the muscles of inhalation and exhalation. For training use respiratory equipment with the creation of additional resistance on the inhale and the exhale (like breathing simulator Frolov).
Regular exercise in the form of breathing exercises with difficulty breath lead to a systemic effect on the body. Increases exercise tolerance, improves the quality of life, slowing the progression of cachexia.
Upon stabilization of the patient need to make an attempt to test 6-min walk. Further tactics depends on the results obtained. If the distance less than 200 m, it is recommended for patients to continue breathing exercises. If the distance travelled is more than 200 m, it is advisable to recommend to physical exercise in the form of a walk. Deterioration (increased dyspnea, tachycardia, the progression of fatigue, reduction of total body mass) is the basis for the previous step or return to breathing exercises. Complete rejection of unwanted physical activity and should be regarded as an extreme measure. For patients who underwent a 6 min. at least 350 m shown dynamic loads (primarily in the form of a walk.
The method of performing physical activity in the form of a walk
I stage. Occurrence.
Stage duration is 6-10 weeks. Exercise frequency to 5 times a week. The movement speed is 25 min / 1 km The distance is 1 km.
With a stable clinical picture of a transition to the second stage.
The duration is 12 weeks. Exercise frequency to 5 times a week. Speed – 20 min / 1 km – 2 km In stable clinical condition – the transition to permanent forms of employment.
For patients who underwent more than 500 meters in 6 minutes, shows a dynamic physical activity (such as walking with a progressive increase of the load to a speed of 6 km / h and a duration of approximately 40 minutes per day). Titration of the load – up to 6-8 months.
Due to the inability to assess in each specific case, the maximum oxygen demand load calculation is given in specific numbers – distance, load, duration.
Given that the positive effect of physical training disappears within 3 weeks after the introduction of restriction of physical activity introduction physical activity in long-term (life) program management of the patient is the necessary standard.