The Patient with Cardiovascular Disease and Rehabilitation: The Third Phase of Medical Care

Abstract

Rehabilitation of the patient with cardiovascular disease may be considered in the following 2 categories: (1) the disability which results from a complication of underlying systemic cardiovascular disease and where the disability is "overt," for example, hemiplegia as the result of a cerebrovascular accident; and (2) the disability that results from diminished cardiac reserve and which appears in the form of signs and symptoms of cardiac decompensation as the result of activity, either of daily living or occupational. This may be considered as "masked" disability. Using well delineated dynamic rehabilitation technics, it has been shown that the prognosis for the patient with hemiplegia, providing careful selection is effected, is not hopeless. Such patients can be rehabilitated to the point of self-sufficiency in a large percentage of cases. In addition, a certain percentage can be rehabilitated to the point of resumption of occupational activity. Patients with "masked" disability pose a more complicated problem, since many other factors other than those pertaining to the patient may condition the rehabilitation process. Basic research involving objective measures of cardiac reserve and energy expenditure, as well as observations made in Work Classification Units, may very well allow for more intelligent placement of the patient with cardiovascular disease in selective employment, providing industry accepts the patient.