Introduction
Heart failure is commonly referred to the state that the heart is no longer pumping enough amount of blood to meet the need of body organs, causing dysfunction of multi-organ systems. The biggest problem of patients with heart failure is the reduced cardiac output, so cardiac rehabilitation would be considered as one of the effective treatments for these patients. The case is a patient with cardiac failure who presented edema in the lower extremities even after pharmaceutical treatment with diuretic. The cardiac function of the patient was greatly improved after the cardiac rehabilitation, and the patient eventually stopped taking diuretics at the time of discharge.
Case presentation
A 81 year old male patient developed dyspnea, thus was admitted in our hospital from November 27, 2018. Echocardiography that was performed on November 28, 2018 showed ejection fraction that is equal to 26%. In December 20, 2018, the patient was additionally prescribed with Lasix 40mg#1 and Aldactone 25mg#1 for the edema on both lower extremities, but the dose of Lasix and Aldactone were subsequently increased to 80mg#1, 50mg#1 due to worsening of symptom on January 5, 2019. The patient showed improvement in edema of lower extremities after intake of increased dose of medication, but diuretics were stopped shortly after January 9, 2019 due to hyponatremia. Cardiac rehabilitation were started to control the above symptoms after diuretics were stopped. Cardiac rehabilitation was started from January 9, 2019. At the point of beginning the cardiac rehabilitation, patient was evaluated, and showed Peak VO2/HR 4.5(mL/beat), maximal PetCO2 28(mmHg), and VE/VCO2 39.6, thus the patient started training of bicycle ergometer with exercise load of 5-10Watt for 3 cycle intervals. Also, the patient's edema was evaluated using total of 7 different levels to diagnose the degree of edema on lower extremities.(Figure 1) In January 21, 2019, there was improvement in the patient's edema on lower extremities(Figure 2); hence the patient's cardiac function was re-evaluated where the result showed as Peak VO2/HR 4.6(mL/beat), maximal PetCO2 30(mmHg), and VE/VCO2 32.1.(Table 1) The patient was discharged without prescription of diuretics.
Conclusion
As a result of comparing the results of the first and last cardiac rehabilitation evaluation of the patient, patient showed the improvement in VE/VCO2 which is a marker of severity of heart failures, Peak VO2/HR which is a peak cardiac output parameter, and PetCO2 which reflects the cardiac performance. There was no recurrence of edema due to improvement in the fundamental cardiac function.
Therefore, Cardiac rehabilitation can be actively considered as one of treatment options that can effectively improve cardiac output since biggest problem of the patient with chronic heart failure is the reduced cardiac output.
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