Intensive Cardiopulmonary Rehabilitation Program for Patients with Severe Heart Failure and Acute Stroke: A Report of Two Cases

Abstract

Cardiovascular disease is a major factor restricting successful outcomes after stroke rehabilitation. While neurological recovery after stroke has been extensively investigated, cardiovascular adaptations to physical activities poststroke have received little attention. Severe heart failure patients have been well known for limitation of ambulation, but the influence over acute poststroke patients have rarely been investigated. Exercise testing has become a mainstay for the prognostic assessment of patients with heart failure. Various studies have shown that patients with impaired exercise capacity, as measured by low peak oxygen consumption (Vo2), have an unfavorable outcome, independent of other parameters. Whether parameters from submaximal test have prognostic value have recently been studied. Exercise capacity early after stroke has been known, but what has not been documented is exercise capacity during early poststroke with severe heart failure and the effect of exercise training on those patients. We present two cases of acute poststroke with New York Heart Association (NYHA) Class III heart failure and illustrate how the cardiopulmonary rehabilitation program has helped. Such treatment for this case supports the view that intensive exercise training should be established for acute poststroke with severe heart failure patients, although their cormobility may be higher than that of stable poststroke patients.