Pulmonary Issues Related to Cardiac Rehabilitation

Abstract

Chronic cardiac diseases and chronic pulmonary diseases coexist in many patients. In a review of the National Hospital Discharge Survey (1979-2001), 16% of chronic obstructive pulmonary disease (COPD) patients had coexistent hypertension, 15% had coexistent ischemic heart disease, and 10% had coexistent congestive heart failure (1). In the outpatient setting, the majority of the patients entering a pulmonary rehabilitation program were identified as having important cardiovascular issues such as hypertension (34%) and arrhythmias or coronary artery disease (27%) (2). The fact that these two categories of disease have so much overlap is important when considering these patients for rehabilitation programs. Indeed, although the principles of rehabilitation are similar for both types of patients, there are important differences in focus, assessment, monitoring, and rehabilitation methods that need to be understood. The remainder of this chapter will draw from the pulmonary rehabilitation evidence base to illustrate the mechanisms by which pulmonary disease can impact cardiac patients and to provide approaches to cardiac patients with pulmonary disease in terms of pulmonary assessment, rehabilitation strategies, and expected outcomes.