Physical rehabilitation of patients with ischemic heart disease with amputation of the lower extremities

Abstract

Combined lesions of coronary arteries (CA) and arteries of lower extremities (LE) are noted in 33.3–70.8% of patients with ischemic heart disease (IHD). Annually in the world amputations vary from 120 to 500 people per 1 million population due to the critical ischemia of the LE. Rehabilitation of patients with combined lesions of CA and arteries of the LE, including with amputation is not sufficiently studied. Evidence-based methods of physical rehabilitation (FR) are workouts with dynamic loads (55.6%), interval training (32.6%), therapeutic exercises with respiratory muscle training (6.6%). Development of the main principles of the FR for patients with atherosclerosis of the CA and arteries of LE, who underwent amputation. We examined 189 patients with IHD and 40 patients after amputation of LE due to obliterating atherosclerosis in combination with IHD: 74 women and 155 men aged 61 to 87 years. The rehabilitation complex included specially developed FE programs, as well as basic drug therapy. In the course of rehabilitation, the tolerance to physical activity, the class of motor activity (MA) was graded step by step. An analysis of the efficacy of FE in this category of patients using the scientific method was carried out. Data on mutual aggravation of the severity of patients with IHD after amputation were obtained, which determined the realistic setting of the goal and the final results of rehabilitation. It was found that the level of amputation affected the expected level of MA, the cost of walking energy, which caused lower levels of MA in patients with combined vascular lesions. Patients with LE amputation are not adapted to the general principles of FR of patients with IHD, which determines the urgency of developing specialized rehabilitation programs for them.