الفهرس 
PSYCHOLOGICAL CONSEQUENCE OF MYOCARDIAL INFARCTIONOnly 14 pages are availabe for public view
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Abstract
T
he epidemic of the current is CAD and it is estimated to be the single most important disease in the world in the terms of mortality, morbidity, disability, and economy even the 2020. Therefore cardiac preventive programs greatly needed.
Cardiac rehabilitation in post-MI patients would have beneficial effects on cardiac function without adversely affecting LV remodeling or causing serious cardiac complications..
The benefits of comprehensive cardiac rehabilitation (CR) and supervised exercise training for patients with coronary artery disease (CAD). It is class1 recommendations in ESC guidelines.
Apart from improving physical capacity, the effects of CR include the modification of the symphato-vagal balance and improving mental competence.
The present study aimed to assess the effectiveness of cardiac rehabilitation on depression, anxiety and physical capacity in patients after myocardial infarction.
This is a prospective study that was conducted on 60 STEMI and NSTEMI patients, the study population was categorized into two groups:
• group 1: included 30 STEMI and NSTEMI patients who underwent cardiac rehabilitation
• group 2: included 30 STEMI and NSTEMI patients who did not undergo cardiac rehabilitation..
Inclusion Criteria:
• Sinus rhythm.
• Patient with compensated heart failure.
• Valvular heart disease
• Clinical stability for at least two weeks prior to entry to the study plus optimal and stable medical treatment.
Exclusion Criteria:
• Unstable angina.
• Patient who cannot exercise
• Patient refusal
• Patients with pre-existing major psychological disorders
• Uncontrolled hypertension.
• Impaired renal or hepatic function.
• Decompensate heart failure
All the included patients were subjected to:
• Complete History taking including:
- Age & gender.
- Presence of risk factors for CAD, including; systemic hypertension, diabetes Mellitus, dyslipidemia, smoking and family history of CAD.
• ECG: Standard ECG was done on admission.
• Echocardiography: Transthorathic echocardiography was done for assessment the heart including Left ventricular end-systolic volume (ESV), end-diastolic volume (EDV) and LV ejection fraction.
• Baseline and follow up psychological evaluation.
After initial investigation, patients underwentan 8-week training programme (CRP) consisting of 24 interval trainings three times a week, was started on average 2;4weaks after MI.
Psychological evaluation:
Before and after the training program each patient was filled out the state–trait anxiety inventory (STAI).
Depressive disorders was be diagnosed in patients whose BDI outcome is 10 points or more.
Hospital Anxiety and Depression Scale (HADS) was used to determine the levels of anxiety and depression that a person is experiencing.
By analyzing and processing the data obtained from the history and examination, the study declared that:
• Comparison between the 2 groups regarding echocardiographic measurement on baseline revealed no significant difference as regard LVEDV, LVESV and EF (P-value= 0.1795, 0.586 & 0.235).
• Comparison between the 2 groups regarding psychological measurements on baseline revealed no significant difference between the 2 groups regarding; STAI, BDI and HADS (P-value= 0.081, 0.5068 &0.6767).
• Comparison between the 2 groups regarding echocardiographic changes on follow up, there was significant difference between 2 groups regarding LVEDV, LVESV and EF (P-value=0.0001, 0.0082 & 0.0261). with significantly changes EF and significantly lower with STAI in group 1 as compared to group2
Comparison between the 2 groups regarding psychiatric changes on follow up revealed that there was significantly lower difference as regard STAI, BDI and HADS scores in group 1 compared to group 2 (P-value= 0.0001, 0.0001 & 0.0001) respectively