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Thursday, April 24, 2014
Post Catheterization Rehabilitation
My father has had two cardiac catheterizations in the last 3 years. His cardiologist continues to say that the blockages (40%) are not large enough to interrupt blood flow, so we`ll just wait and see if they get bigger. He has made no recommendations for any sort of cardiac rehabilitation to either reduce the size of the blockages (which I`m not sure is possible) or to keep them from getting any bigger. Personally, I find this approach disturing and am in the process of trying to convince my parents to change doctors.
In the mean time, should my father have to do any cardiac rehabilitation and if so, is this something that would come from his cardiologist or should he go to a cardiac rehab clinic?
Cardiac rehab is used primarily for secondary prevention due to insurance. This means that a patient must have a cardiac diagnosis, such as MI, angina or have had a procedure like a stent or bypass surgery to qualify.
If a diagnosis of angina is used, there must be documentation of a stress test that was positive for ischemia for insurance to pay for this service. If your father has had a positive stress test and has chest pain, he may qualify for cardiac rehab. Patients must be referred to rehab by their doctor.
It sounds like your father only had mild CAD (flow limiting is 80% or greater), but it is never too early to start decreasing your risk factors to prevent these blockages from progressing. Your father should follow a low fat diet, have his lipid profile checked routinely, exercise, keep his BP <130/80, and not smoke. Modifying risk factors now may prevent progression of the 40% blockages. Thanks for your interest.
Karen Kutoloski, DO
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University