Manage Symptoms, Cardiac Symptoms

Symptoms

A detailed subjective assessment of symptoms can be an invaluable tool for the CR clinician, even in the absence of more accurate scienti?c risk strati?cation data.A patient describing nocturnal or resting symptoms will be a signi?cant characteristic. Establishing a baseline pattern of cardiac related symptoms could include questions on:

• frequency

• intensity

• duration

• trigger factors, e.g. level of exertion, speci?c daily activities, stress or

emotion

• use of nitrate

• typical versus non typical patterns of symptoms

• simple description of site and type of pain

• ability to recognise and manage symptoms or absence of symptoms.

Gathering all this information gives the CR exercise leader and CR team an initial indication of physical and psychological functioning, and of whether symptoms are likely to be a limiting factor. It also enables comparison of these factors pre and post rehabilitation, by which time the patient may have learnt to manage symptoms more effectively, have gained con?dence and improved level of function.

Within the context of risk strati?cation, assessing cardiac symptoms directly links the ischaemic burden and functional capacity, if the patient can describe a level of exertion required to bring on symptoms.However, it must be remembered that the relationship between symptoms, functional ability and disease severity is complex; patients with the most severe disease do not always demonstrate the most limitation or disability. Lewin suggests that otherRisk Strati?cation and Health Screening for Exercise factors, such as health beliefs, anxiety and depression, personality, social support, social class and the patient’s own attempts to cope will in?uence the level of disability demonstrated .