Cardiac Circulatory Problems -Heart Attack
Physical therapy

The patient has with hypertension, hyperlipidemia, and tobacco use who was hospitalized with chest pain. The patient ruled in for a non-ST elevation myocardial infarction, with elevated troponin (0.18) and EKG showing inverted T waves in leads V1-V3. Patient underwent cardiac catheterization during that hospitalization which showed a 95% stenosis of the mid-LAD. This was treated with drug-eluting stent placement. Paitent also had a 60% stenosis of the mid-RCA which was treated medically (not hemodynamically significant by IFR). Discharge medications included aspirin, Effient, omeprazole, valsartan, metoprolol and rosuvastatin.

Patient was referred for phase II cardiac rehabilitation. The patient underwent cardiac rehabilitation with exercise, as well as guidance for blood pressure control, diet, and smoking cessation. The provider uses the Pritikin ICR (intensive cardiac rehab) program. The health plan has denied intensive cardiac rehab. The health plan's determination is upheld. The proposed health service of Intensive cardiac rehabilitation with exercise based on the Pritikin program is not likely to be more beneficial than a standard intensive phase II cardiac rehabilitation program, which would include exercise, diet recommendations, weight loss, and smoking cessation.
Cardiac rehabilitation in general improves outcomes in patients post-myocardial infarction, with benefits including lowering risk for recurrent myocardial infarction, improving functional status, and reducing anginal symptoms.