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Myocardial Infarction Case Study

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  • Bree Dela Rosa

Case Study #1

M.I. Soon is a construction worker and is 44 years old. He has a family history of heart diseases and is trying to stop smoking. He had his first myocardial infarction, and his physician prescribed him a medication called a beta blocker. He completes the inpatient cardiac rehabilitation a little over a week ago, and the doctor and wife are recommending that M.I. Soon to seek a fitness facility. His resting heart rate (RHR) is 78 beats per minute (bpm) with a max heart rate of 132 and blood pressure of 136/82 mmHg. M.I. Soon has never exercised before and he regularly eats fast food such as McDonald's, Burger King, etc. for lunch. He believes he has enough exercise from working, as he states, "Hey, I work hard all day, isn't that enough!". M.I. Soon regularly stops on the way home to the tavern with some friends to grab a couple of drinks.

Introduction

Myocardial Infarction (MI) is one of the common heart disorders considered to be severely fatal. In many cases, this condition requires control and prevention of atheroma as a way of preventing MI. Development of coronary occlusion is the initial presentation of atheroma, which leads to myocardial infarction. Early diagnosis has helped many patients avoid severe consequences of the condition. The initial management is to restore the perfusion in the affected myocardium. To accomplish this, various approaches must be instituted as discussed below. As such, public education is necessary for making people understand the need for early diagnosis.

Goals

Related image

Short Term (1-4 weeks)

  1. Go for a 30-minute walk in the morning before work or with his wife or after his lunch once once a day for 2 weeks.
  2. Educate him to reduce the number of cigarettes smoked per day as well as the number of cold ones.
  3. Exercise to lose a pound weekly with a combination of moderate intensity exercise and strength training.

Long Term (3months-6months)

  1. Maintain an optimal blood pressure of 120/80 mmHg.
  2. To increase the strength and intensity of the exercise as time goes, METs > 8.
  3. Burn between 1,800 - 2,000 kcals each week after the training period and eating less high saturated food, which will help lower blood pressure and improve cholesterol and blood sugar.

Recommendations for Fitting Workouts into schedule

  1. This exercise will be incorporated into the schedule during the day.
  2. The patient will do the workout in the morning before any activity.
  3. Exercise shall be done in parts whenever there is time constraint such as 10 minutes of the stationary bike or treadmill in the morning before work and 15 minutes after work.
  4. It is advisable to create time for the gym every day.

Reasons for frequency of aerobic

  1. Everyday exercise is best because the patient has a lot of free time.
  2. Due to the state of cardiovascular, aerobic exercise is more important than resistance training.

Reasons for frequency

  1. In the initial two weeks, two bouts of resistance training will help in improving muscle strength in the patient.
  2. Two sessions will help him keep normal muscle strength and to avoid soreness during aerobic exercise.
  3. Static stretches done every day during cool down exercises will help in maintaining flexibility.

Exercise Prescription and Justifications

Week 1

Monday

Warm up exercise (5 mins / 5.0 METS)

http://www.pngpix.com/wp-content/uploads/2016/07/PNGPIX-COM-Man-Running-in-Treadmill-PNG-Transparent-Image-500x620.pngMyocardial infarction patients should start their regular exercises with warm up exercises to make themselves used to exercise. This must be done on the treadmill at a gradient of 0 degrees and a low speed of 2 mph.

Reason

  • This exercise helps in increasing the body temperature and especially of the muscle in preparation for better performance in following exercises.
  • The warm up exercise also excites the sympathetic nervous system, which improves the performance during the exercise.

Treadmill exercise (30 min / 8.0 METS)

This exercise is slightly moderate 20-minute walks at a speed of 2.5 mph at a gradient of 3 degrees. Remember to slow down between the two bouts for 5 minutes.

Image result for high gradient treadmill

Reasons

  • Since it's the first treadmill exercise for him, the patient must complete the exercise to develop the habit and to keep him out of undesirable habits such as drinking.

Cooldown Exercise (8 mins / 5.0 METs)

The gradient will be set back to 0 degrees and a speed of 2 mph for 8 minutes before stepping out of the treadmill. Additionally, the patient will have to sit at a V shape and stretch in the middle from left to right.

Reasons

  • This exercise will facilitate the transition from active sympathetic nervous system to parasympathetic for recovery from the strenuous exercise for 4 minutes.

Butterfly Stretch (2 Minutes / 2.5 METs)

Sit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds.

Image result for seated v stretch

Reasons

  • This cooldown exercise will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness.

Wednesday

Warm up exercise (10 mins / 5.0 METS)

Put the treadmill at a gradient of 0 degrees and a low speed of 1.9 mph.

Image result for treadmill walking

Reasons:

  • This exercise helps in increasing the body temperature and especially of the muscle in preparation for better performance in following exercises.
  • The warm up exercise also excites the sympathetic nervous system, which improves the performance during the training.

Exercises

Leg Swings (10 Min / 3.0 METS)

Swing the leg horizontally at 90 degrees while keeping the torso straight. Do this ten times then changing to another leg for ten minutes. Simply make yourself stable and swing your legs until the end of 10 minutes as demonstrated in the image below.

Image result for walking leg swings

Reasons

  • This exercise will help stretch and warm the leg muscles in preparedness for following exercises.
  • Will warm up the muscle in preparation for further exercise.

Walking Knee Hugs (10 min / 4.0 METS)

This exercise will require stepping and lift the knee closer to the chest while keeping the back straight. Do both legs and monitor time with your phone, stopwatch, and or clock until the end of ten minutes while maintaining the balance as shown in the picture below.

https://img-s-msn-com.akamaized.net/tenant/amp/entityid/AATzQe.img?m=1&b=black&w=867&h=488&f=jpeg&q=60

Reason

  • To help the patient with balance during exercise.
  • This will also assist in warming up the muscles before the following training.

Cooldown Exercise (8 mins / 5.0 METs)

Side Lunge (4 Minutes / 3.0 METS)

Image result for side lunge stretchStand up straight with your feet shoulder width apart. Have your hands placed on your waist. Step out to one side to push your thigh until you feel a "pull" on your muscle, hold for 30 seconds each side.

Reason

  • This will help the patient warm up his muscles and gain balance on both feet increase body temperature and raise the level of intensity in exercise performance.
  • The patient will also be able to stretch his muscles moderately.

Hip flexor stretch (3 minutes / 2.5 METs)

Do the exercise with one knee on the ground and the other knee raised with foot on the ground. Make sure you slightly shift weight to the front leg while keeping torso straight and arm of down knee extended upwards as shown below. Hold each side for 30 seconds and do two sets each.

Image result for hip knee flexor stretch fat people

Reasons

  • To facilitate the active transition exercise to recovery.
  • To promote removal of lactate to decrease immediate muscle soreness.

Butterfly Stretch (2 minutes / 2.5 METs)

Sit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds.

Image result for seated v stretch

Reasons

  • This cooldown exercise will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness.

Hamstring Stretch (3 minutes / 2.5 METs)

Lying on your back in an 180-degree angle and keep your back straight. Your hips should be level with your lower back on the floor. Slowly bend your knees towards your chest, and keep your left leg extended on the floor.

Lying Hamstring Stretch Exercise

Reasons

  • Slowly bending your knees towards your chest, keep your dominant leg extended until you feel a mild discomfort from the stretch.

Friday

Warm up exercise (10 mins / 5.0 METS)

Treadmill at a gradient of 0 degrees and a low speed of 2 mph.

Image result for treadmill walking

Reasons

  • This exercise helps in increasing the body temperature and especially of the muscle in preparation for better performance in following exercises.
  • The warm up exercise also excites the sympathetic nervous system, which improves the performance during the exercise.

Exercise Treadmill Walking (40 minutes / 8.0 METS)

Walk on the treadmill for two bouts of 15 minutes at 2.5 mph at 3% grade. Between bouts remove back to 0% grade and walk at a comfortable rate at 2 mph for 5 minutes.

Image result for treadmill walking

Reasons for duration

  • I gave him two 15 minute bouts because it is her first day of the exercise program and I wanted her to be able to complete the task to increase confidence. The 5-minute rest between bouts I believe is sufficient to make sure he can complete the full duration of exercise.

Reasons for mode

  • The treadmill is very easy to adjust so that the client can set it to the particular speed and grade I have instructed to work at. I want her mode of exercise to require little thought since she may already feel uncomfortable in a gym setting because of her inexperience.
  • The treadmill is a type An exercise, so it does not require much skill to use for someone inexperienced with exercise.

Reasons for intensity (RPE)

  • The Relative Perceived Exertion (RPE) for M.I. Soon should be <10. For the exercise to be effective it should be a routine; whereby, every day he should take 30 minutes to do the exercise.
  • For the exercise to be effective it should be a routine; whereby, every day he should take 30 minutes to do the exercise. This is done to increase the level of calories lost within a week and help the individual adapt to the exercises as a lifestyle.

Cooldown (8 mins)

Treadmill (6 minutes / 5.0 METs)

Image result for treadmill walkingThe gradient will be set back to 0 degrees and a speed of 1.9 mph for 8 minutes before stepping out of the treadmill. Additionally, the patient will have to sit at a V shape and stretch in the middle from left to right.

Reasons

  1. This exercise will facilitate the transition from active sympathetic nervous system to parasympathetic for recovery from the strenuous exercise for 4 minutes.

Butterfly Stretch (2 Minutes / 2.5 METs)

Image result for seated v stretch

Reasons

  • Sit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds.
  • This cooldown exercise will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness.

WEEK 2

Monday

Warm up (10 minutes / 5.0 METS)

Stationary bike with zero resistance at comfortable speed for 5 minutes.

Image result for stationary bike

Reasons

  • To increase the temperature of muscle to perform better during exercise.
  • To activate the sympathetic nervous system to improve exercise performance.

Exercise (35min / 7.0 METS):

Image result for stationary bikeUse the stationary bike for two bouts of 15 minutes with a resistance of between 284kgm/min (50 Watts) and 406kgm/min (68 Watts). Between bouts, remove resistance and pedal at a comfortable pace for 5 minutes before beginning next bout.

Reasons for duration

  • Transitioning from the treadmill from week one to a stationary bike I am starting M.I. soon with 15 minute bouts to adjust and complete the exercise with confidence.
  • I want to give him 5 minute rests in-between to make sure there is not a lot of stress and that he receives enough intake of water so he can complete the exercise.

Reasons for mode

  • I chose the stationary bike for his form of exercise since it safe for a sedentary and obese individual with little or no experience of exercise.
  • The stationary bike is effective and useful for people who have never exercised before or who exercise a little.

Reasons for intensity (RPE)

  • The Relative Perceived Exertion (RPE) for M.I. Soon should be <10. For the exercise to be effective it should be a routine; whereby, every day he should take 30 minutes to do the exercise.
  • For the exercise to be effective it should be a routine; whereby, every day he should take 30 minutes to do the exercise. This is done to increase the level of calories lost within a week and help the individual adapt to the exercises as a lifestyle.

Cooldown (8 mins)

Stationary Bike (5 minutes)

With no resistance peddle for around 5 minutes and then get off to proceed to stretches.

Image result for stationary bike

Hamstring Stretch (3 minutes / 2.5 METs)

Lie on your back with your legs extended in an 180-degree angle and keep your back straight. Your hips should be level with your lower back on the floor. Slowly bend your knees towards your chest, and keep your left leg extended on the floor.

Lying Hamstring Stretch Exercise

Reasons

  • Stretch to the point of mild discomfort but not to the point of feeling discomfort or pain.

Wednesday

Warm Up

Warm up (10 minutes / 5.0 METS)

Stationary bike with zero resistance at a comfortable speed for 5 minutes.

Image result for stationary bike

Reasons

  • To increase the temperature of muscle to perform better during exercise.
  • To activate the sympathetic nervous system to improve exercise performance.

Exercise (35 Minutes / 8.0 METS)

Use the stationary bike for two bouts of 15 minutes with a resistance of between 284kgm/min (50 Watts) and 406kgm/min (68 Watts). Between bouts, remove resistance and pedal at a comfortable pace for 5 minutes before beginning next bout.

Image result for stationary bike

Reasons

  • Less stress on joints
  • Help reduce the mechanical stress, on back, hips, and ankles even when compared to walking.You can indulge in daily exercise with a lower risk of injury.

Cool Down (8 minutes)

Stationary Bike (6 minutes / 5.0 METs)

Remove resistance and peddle for around 6 minutes and then get off to proceed to stretches.

Image result for stationary bike

Butterfly Stretch (2 Minutes / 2.5 METs)

Image result for seated v stretchSit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds.

Reasons

  • This cooldown exercise will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness.

Day 3 Friday

Warm up exercise (5 mins / 5.0 METS)

Myocardial infarction patients should start their regular exercises with warm up exercises to make themselves used to exercise. This must be done on the treadmill at a gradient of 0 degrees and a low speed of 1.9 - 2 mph.

http://www.pngpix.com/wp-content/uploads/2016/07/PNGPIX-COM-Man-Running-in-Treadmill-PNG-Transparent-Image-500x620.png

Reason

  • This exercise helps in increasing the body temperature and especially of the muscle in preparation for better performance in following exercises.
  • The warm up exercise also excites the sympathetic nervous system, which improves the performance during the exercise.

Treadmill exercise (30 min / 7.0 METS)

This exercise is slightly strenuous as it takes 20 separate 20-minute walks at a speed of 2.5 mph at a gradient of 3 degrees. Remember to slow down between the two bouts for 5 minutes.

Image result for high gradient treadmill

Reasons

  • Since it's the first treadmill exercise for him, the patient must complete the exercise to develop the habit and to keep him out of undesirable habits such as drinking.

Cooldown (8 Minutes)

Treadmill (6 minutes / 5.0 METs)

Image result for treadmill walkingThe gradient will be set back to 0 degrees and a speed of 1.9 mph for 8 minutes before stepping out of the treadmill. Additionally, the patient must sit at a V shape and stretch in the middle from left to right.

Reasons

  • This exercise will facilitate the transition from active sympathetic nervous system to parasympathetic for recovery from the strenuous exercise for 4 minutes.

Hip flexor stretch (2minutes / 2.5 METs)

Do the exercise with one knee on the ground and the other knee raised with foot on the ground. Make sure you slightly shift weight to the front leg while keeping torso straight and arm of down knee extended upwards as shown below. Hold each side for 30 seconds and do two sets each.

Image result for hip knee flexor stretch fat people

Reasons

  • To facilitate the active transition exercise to recovery.
  • To promote removal of lactate to decrease immediate muscle soreness.

Strength and Conditioning

Week 1 (Repeat the following week)

Monday, Wednesday, Friday

Lat pull downs (5 minutes / 3.0 METs)

Ten repetitions of 25 pounds the first week, then the second week increase the weights by 5 pounds with a weight that is equivalent to a 3 or 4 rating on the RPE scale. Pull with arms starting fully extended until the bar is just below neck height in a controlled rhythm. When you begin this, take it slow. If you are feeling chest pain, stop the exercise as with all the strength exercises provided.

Related image

Lateral Band Walk (5 Minutes / 3.0 METs)

Place your feet shoulder width apart to create tension inbetween the bands. Form a 60 degree squat position, and shift your weight to the right side, steping sideways take 10-12 steps before heading back to the start postion and do the same on the left side.

Image result for lateral band walk diagram

Shoulder Press (5 Minutes / 4.0 METs)

Hold a 10 lb (this is the start) dumbbell in each hand and sit on a bench with back support, plant both feet on the ground, bend your elbows down to your ear and lift back up. Remember not to hold your breath when performing this exercise, take it slow and go at your pace.

Image result for shoulder press diagram

Leg Press (5 Minutes / 3.0 METs)

Set the leg press weight at 50 lbs. Leg and torso should be at a 90-degree angle. As you go down breathe in and out slowly push down until your legs make another 90-degree angle and push back up in start position.

Image result for leg press fat people

Reasons for exercises

  • These exercises are a combination of lower body and upper body that are doable that can be done with inexpensive equipment at home or the gym facility.
  • These are appropriate exercises for someone who is not used to strength training, regardless of job description, these are easy to follow, and they are not confusing or difficult for someone who is inexperienced
  • These exercises also target large and small muscle groups that will help with his balance.

Reasons for repetitions

  • Lifting in a rhythmic and full range in motion
  • I chose for the exercises to be ten repetitions of lighter weights for M.I. to adjust to the movement and patterns to develop technique and consistency.
  • He will gain muscular strength, lean body mass, endurance, and insulin sensitivity.
  • I highly remind and advise him each exercise session to not hold his breath while he is performing any of the strength exercises since it will increase the pressure in his chest by placing a greater workload on his heart.

Reasons for Strength or "Resistance."

  • I chose a moderate level of intensity because I want M.I. Soon to adapt to the strength and conditioning training and not make him too sore.
  • 5 minutes for each exercise will allow M.I. Soon to finish all the reps I suggested. I do not want him to feel in denial with the exercise demand, but I want him to accept the purpose of exercise and the benefits.

Cooldown (8 Minutes)

Treadmill (6 minutes / 5.0 METs)

The gradient will be set to 0 degrees and a speed of 2 mph for 6 minutes before stepping out of the treadmill.

Image result for treadmill walking

Butterfly Stretch (2 Minutes / 2.5 METs)

Image result for seated v stretchSit on the floor with legs spread out in a V position, towards the middle reach as far as you can with both arms out and hold for 30 seconds and, then towards the left and right left for 30 seconds.

Quad stretch on side (2 minutes / 2.5 METs)

Standing up grab or chair or find a pole to stand next to and lift your left leg back until you feel this "pull" in the muscle, and repeat for the right leg.

Image result for quad stretch diagram

Reasons for Cooldown:

  • This cooldown exercises will also help in eradicating the lactic acid buildup with the view of preventing muscle soreness.
  • This exercise will facilitate the transition from active sympathetic nervous system to parasympathetic for recovery from the strenuous exercise.

Education and Risk Factor Management

It is important for you to understand that the type of diet you take determines your risk of exposure to further heart complications. The point is, different food contents have different nutrients. Always remember that fast food may be affordable and presumably convenient, but it contains a lot of saturated fat, calories, and sodium. For this reason, with the Myocardial infarction, you should modify your frequency of fast food consumption. There may not be specific patterns on how to take fast food, but I recommend that you don't eat it very often. Alcohol, on the other hand, may be recommended by researchers but the exact amount has not been agreed on yet (Frederico et al., 2009). Therefore, my recommendation is that you take not more that 14 alcohol units in one week and the units should not exceed four in a single day. Also, please ensure that you have at least two days that you do not consume it. The bottom line is that moderate and habitual alcohol consumption lowers the risk of heart-related disorders. However, sometimes the short-term consequence is that it may cause sudden cardiac death.

I recommend that you refrain from smoking because it increases the chances of heart diseases infections. This is because it contributes to the fatty conditions in the coronary system. Also, be informed that the tobacco chemicals will damage your heart cells and expose you to atherosclerosis, a condition that affects the functioning of the heart and blood cells in the body (Antman, 2007). With your MI, smoking cigarettes will worsen your condition because the tobacco chemicals have the ability to weaken the resilience of the cardiovascular system and thus heighten the chances of succumbing. You should, therefore, avoid smoking at all costs to reduce the likelihood of recurring and causing more damage to the heart and other cardiovascular organs and vessels. If you find it hard to stop smoking, it would be wise to see a doctor or a practice nurse. By doing so, you will get help and advice on the how to make use of the nicotine replacement therapy.

The best medication to improve your health is the Beta-blocker due to the following reasons. First, they are drugs that will enhance your outlook. These drugs are believed to prevent vertical hemorrhage in patients who have cirrhosis and heart conditions. It is worth noting that the body has a way of responding to increased stress caused by heart attack or unstable angina. What it does is, it increases the heart rate as well as the blood pressure. Therefore, beta-blockers are good for you because they will reduce both the heart rate and its workload. You should take these drugs as soon as you your heart condition are identified. However, to increase efficiency, they can be taken together with an ACE inhibitor and sometimes a statin. The American Heart Association has recommended treatment using Beta-blockers. It has been shown to reduce morbidity and mortality as compared to other therapies. Moreover, the management of obesity would be useful in preventing the reoccurrence of myocardial infarction (Ades, Savage & Harvey, 2009). It is, therefore, important that you visit a pharmacist or a cardiologist for prescription and further directions on how to use this medication.

According the American Family Physician website, AHA (American Heart Association) standards state that they highly recommend that each patient who suffers from a heart attack must monitor your cardiac risk factor of a blood pressure lower than 140/90 mmHg. The waist circumference less than 35 inches for women's and 40 for men, a body mass index (BMI) of 18.5 and 24.9, blood cholesterol under 180 mg/dl, and blood glucose under 100 mg/dL. Our goal as we work together is to reduce your blood pressure of 136/82 down to 120/80, when performing the exercises I prescribed you, make sure to breath after each repetition and walking on a treadmill, if you do not, your blood pressure will increase. If you are experiencing high blood pressure, seek medical attention right away, and seek your primary care provider immediately.

Myocardial Infarction, Cardiac infarction, and coronary thrombosis are other terms also know a heart attack. Infarction means that there is an area of dead tissue that is caused by a significant amount of blood supply and begins to occur at the age of 45 years old for men and 55 years old for women. During a heart attack, you will feel chest discomfort, nausea, crushing chest pain, dyspnea, terror, shortness of breath, etc. During the stage of a heart attack, the heart muscle will lose blood supply to suffer from injury. The damage from the heart will result in scar tissue, and the healing process can take weeks. Regarding the loss of blood supply, all the main vital organs are still working, but since the heart is weaker than normal, it will continue to pump harder than usual in an attempt to keep up with the body's demand of oxygen throughout the body. If you are experiencing chest discomfort during any exercise activity or washing dishes, seek medical attention right away, and see a cardiologist.

Make sure you have your ways of managing weight using both diet and exercise while reducing any stressors. It is recommended to adopt a low fat, low sugar diet and including more vegetables in his meal. When you have myocardial Infarction, you have a high risk of exposure to stressors like the appraisal of harm, loss, and danger. Many health care providers will tell you that there are different stress management behaviors. According to study, most stressors have a direct relationship with your condition. Also, the stressors result from contemplations and feelings but not external events. Also, I recommend that you visit a pharmacist, a doctor or a cardiologist, to undergo the cardiac stress control. You may suffer from respiratory distress as well as diaphoresis. If you are stressed at this level, your body is like to show signs and symptoms such as unembellished orthopnea, dyspnea and oliguria. Did you know that there are four stages of stress? The first one is the environmental demand. All events taking place around you are very likely to have a particular impact on you. The second step is the assessment of the demand, and the third is the evaluation of the nervous system mobilization. Lastly, the fourth stage is the reaction to the threat.

Lastly, you will have to go through the five stages of grief, which include denial, anger, bargain, depression and acceptance. First, you will be in denial due to shock and numbness after the disorder is discovered. You will question within yourself if it is happening to you. Do not be surprised when you feel anger burning within you. This is the second stage of grief. It may be anger towards yourself or others, but either way, it should not affect you. It is a natural response to the loss of good health and you should recover from as quickly as possible. The third stage is bargaining whereby you wish life would go back to the way it used to be when you had good health. Note that you are likely to be at this stage even before your disorder has been properly established. Depression is the fourth stage and one that you should avoid if possible. I will not lie to you that you can avoid it entirely, but there are ways of controlling it. Lastly, you have to accept what has happened and do what is right for your health and the well-being of those close to you.

Conclusion

The myocardial infarction is a disease that needs physical activity and a lot of medical care. The Disease needs not only to be treated but also to be controlled. The lack of exercises and poor diet of M. I. Soon has caused the poor health. The exercise routine has both long term and short term mechanisms and should be followed consistently to get proper results. Good diet and proper exercises are good since they lead to a longer and healthy life.

References   

Antman, E. M. (2007). Cardiovascular therapeutics: A companion to Braunwald's Heart

disease. Philadelphia: Elsevier Saunders.

Frederico, M. J., Justo, S. L., Da Luz, G., Da Silva, S., Medeiros, C., Barbosa, V. A., ... & De

Souza, C. T. (2009). Exercise training provides cardioprotection via a reduction in reactive oxygen species in rats submitted to myocardial infarction induced by isoproterenol. Free radical research, 43(10), 957-964

Alcohol and Heart Health. Alcohol and Heart Health. Retrieved from

http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Alcohol-and-Heart-Health_UCM_305173_Article.jsp#.WMiClDsrKUl

Health Information and Tools - HealthCommunities.com. Heart Attack Overview - Heart

Attack - HealthCommunities.com. Retrieved from http://www.healthcommunities.com/heart-attack/overview-of-heart-attack.shtml

Home | American Academy of Family Physicians. Practice Guidelines: AHA and NHLBI

Review Diagnosis and Management of the Metabolic Syndrome - American Family Physician. Retrieved March 14, 2017, from http://www.aafp.org/afp/2006/0915/p1039.html

Health Information and Medical Information - Harvard Health. Reduce your stress to protect

your heart - Harvard Health. Retrieved March 14, 2017, from http://www.health.harvard.edu/healthbeat/reduce-your-stress-to-protect-your-heart

Ades, P. A., Savage, P. D., & Harvey-Berino, J. (2010). The treatment of obesity in cardiac rehabilitation. Journal of cardiopulmonary rehabilitation and prevention, 30(5), 289.

Barbosa, V. A., Luciano, T. F., Vitto, M. F., Cesconetto, P. A., Marques, S. O., Souza, D. R., ... & Pinho, R. A. (2012). Exercise training plays cardioprotection through the oxidative stress reduction in obese rats submitted to myocardial infarction. International journal of cardiology, 157(3), 422-424.

Billinger, S. A., Arena, R., Bernhardt, J., Eng, J. J., Franklin, B. A., Johnson, C. M., ... & Shaughnessy, M. (2014). Physical activity and exercise recommendations for stroke survivors. Stroke, 45(8), 2532-2553.

Http://www.healthline.com/health/acute-heart-failure#Overview1.Top of Form


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