Acute Myocardial Infarction Case Study

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Annually mortality from coronary heart disease claims an estimated 1.8 million lives in Europe, despite having fallen over recent decades (1). In the United Kingdom around 110,000 men and 65,000 women have an acute myocardial infarction every year, equivalent to one every three minutes (2).
In 1772 William Heberden, the original describer of ‘angina pectoris’, recounted a case of a patient who clinically improved by working in the woods for half an hour each day. However, mobility limitations were enforced on patients with acute coronary events despite some evidence of the benefits of exercise and activity, often leading to deconditioning, decline in function, prolonged length of stay and increased morbidity and mortality. Early cardiac rehabilitation
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Inactivity, dyslipidaemia, metabolic syndrome, excess body weight, elevated blood glucose, hypertension, smoking, as well as the reduction of stress, anxiety, and depression are targeted with intensive interventions, and as such are critical components of CR (17).

Acute Myocardial Infarction
Cardiac rehabilitation has long been recognised as a fundamental part of the comprehensive management of patients after a hospitalisation for myocardial infarction (MI), and the survival benefit after CR is well established. A decrease of 20-24% total mortality and a 22-25% decrease in cardiovascular mortality was shown in a meta-analyses of clinical trials of CR at 3-year follow-up (18-20). A study of patients after MI by Witt et al. showed that although women and people >70 years old were less likely to enroll in CR, overall survival benefit was better in CR patients compared with non-participants, as well as a decrease of 28% in recurrent MI (7). Study subjects demonstrated a 3-year survival of 95% compared with 64% in non-participants. The authors hypothesised that improved endothelium-dependent vasodilation of coronary arteries due to exercise training was the most important mechanism to clarify the obvious reduction in myocardial ischaemia and coronary events. However, many other mechanisms have been put forward such as advantageous effects on lipoprotein profiles, anti-hypertensive effects, and enhancement of insulin sensitivity
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