| 제목 |
Cardiac Rehabilitation Concept for the Patient with Spinal Cord Infarction due to Aortic Dissection |
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Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Department of Rehabilitation Medicine1, Yonsei University College of Medicine, Severance Hospital, Department and Research Institute of Rehabilitation Medicine2, National Health Insurance Service Ilsan Hospital, Department of Physical Medicine and Rehabilitation3 |
| 저자 |
Doyoung Kim M.D.1*, Juntaek Hong M.D.2, Jun Min Cha M.D.3, Jinyoung Park M.D.1†, Junghyun Park M.D. , Ph.D1† |
Introduction
Individuals survived from aortic dissection often have questions about regarding lifestyle, return to normal physical activity, and even exercise. The optimal dose of exercise in patients after aortic dissection still remains unclear. The goal of exercise is a reduction in resting blood pressure and improved cardiovascular health, while possibly minimizing the risk of aortic dissection. In this report, we present a case of paraplegia patient with spinal cord infarction due to aortic dissection and its 2-month follow-up after rehabilitation program.
Case report
A 69-year-old woman visited our hospital with lower extremities weakness. Three months ago, she felt severe back pain and lower extremities weakness developed. After the admission to the local hospital clinic, she was diagnosed with aortic dissection and intramural hematoma by computed tomography (CT) (Figure 1). The magnetic resonance imaging (MRI) on T2WI showed increased signal intensity in the spinal cord (T11 to L1 level), such as spinal cord infarction (Figure 2). She was transferred to our hospital for comprehensive rehabilitation and appropriate exercise intensity settings. The initial manual muscle test showed trace to fair grade in lower extremities (Table 1). She could sit to stand and stand alone. But she could not gait independently, so need wheelchair for ambulation. Goal of physical activity in post-aortic dissection is decreasing the risk of future aortic complications by aerobic exercise. To set the exercise intensity of aerobic exercise, VO2 max monitoring is needed. However, this patient was unable to walk and could not measure VO2 max in the conventional manner. Therefore, exercise intensity was set indirectly by checking METs and blood pressure. A MET is defined as oxygen uptake in ml/kg/min with one MET equal to the oxygen cost of sitting quietly, equivalent to 3.5 ml/kg/min. In another study, aerobic activity at an intensity of 3 to 5 metabolic equivalents (METs) may lower resting blood pressure by a greater amount and reduce the chance of aortic complication. Our target parameters as rehabilitation program are Borg scale 10-11, target blood pressure below 146~160 mmHg according to METs intensity, maximal heart rate below 83~105 per minute by Karoven formular. After 2-month rehabilitation program, manual muscle test showed improved grade in lower extremities in compared with initial status (Table 1). Functional level also improved, this patient could gait with mono-cane and showed increase endurance of gait to 30 min. No serious complications occurred during rehabilitation.
Discussion
Our report shows that beneficial impact and safety of physical activity on post-aortic dissection patients. Alteration of aerobic capacities in paraplegic patient also needed considering functional capacity and habitual physical activity. Further studies are necessary to investigate the intensity of rehabilitation program and the target parameter during exercise.
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Table 1. 2-month follow up of manual muscle test (MMT) on lower extremities
Figure 1. Initial aorta CT shows type A intramural hematoma (white arrow) and bilateral pleural effusion.
Initial spine MRI shows increased T2 signal intensity in spinal cord, T11 to L1 level.
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