Following a cardiovascular condition

Risposta: Following a cardiovascular condition, the aim is not only to prevent further ‘clinical relapses’, but also to regain an active and normal life.

The first step is to enrol in a cardiovascular recovery and rehabilitation programme tailored to the patient’s age, degree of frailty, any co-morbidities, heart function, any heart rhythm abnormalities, and their previous level of physical activity. This programme must include a prescription for progressive physical exercise, education on medication and lifestyle, management of risk factors and, where necessary, psychological support.

Cardiology scientific societies, including the Italian Society of Cardiology, recommend specific targets to be achieved in these patients. For those in a clinically stable condition, the general aim is to gradually build up to 150–300 minutes per week of moderate-intensity aerobic activity, such as brisk walking or cycling, or to 75–150 minutes per week of more vigorous physical activity. For frail or sedentary patients, it is essential to increase physical activity gradually, starting cautiously. Not all individuals who have suffered a cardiovascular event can resume daily activities and exercise at the same pace. Above all, before returning to intense or competitive sports, it is advisable to discuss the level of risk with a cardiologist and assess the need for any cardiological tests, in particular an electrocardiogram, an echocardiogram and a stress test. The presence or onset of chest pain, severe shortness of breath, severe palpitations, dizziness or loss of consciousness during exercise should prompt you to stop the activity and seek specialist assessment.

The success of this post-cardiovascular event care pathway also depends on psychological wellbeing: anxiety, depression and stress are common in this context and can have a negative impact on quality of life and adherence to treatment. It is recommended that, where necessary, psychological support or stress management interventions be sought.

Family members and carers also play an important role in the patient’s recovery. A harmonious and well-informed family network helps the treatment process and should be supported, where necessary, with appropriate information and support. Resuming sexual activity is part of the return to normality for patients with cardiovascular conditions. Any difficulties or concerns should be discussed with the doctor. If specific medications to support sexual activity are being considered, it is important to consult a specialist to rule out any possible contraindications and to assess potential interactions with concurrent cardiac treatments. Where anxiety or fear persist, psychological support and the involvement of one’s partner can help facilitate a return to a more harmonious relationship.

Recovery must go hand in hand with the prevention of further cardiovascular events. The objectives must be specific and measurable: complete cessation of smoking, adherence to prescribed cardiac treatments, and a healthy diet. In this regard, the recommended diet is the Mediterranean diet, favouring the consumption of polyunsaturated fatty acids, eating at least 200 gr of fruit or vegetables a day and eating fish at least twice a week. It is also essential to limit alcohol intake (no more than two glasses a day for men and one glass a day for women) and salt intake (no more than 5 grams a day). If present, it is important to manage diabetes through appropriate lifestyle choices and suitable treatments, maintaining glycated haemoglobin levels below 7 per cent. It is important to achieve and maintain a healthy body weight, with a body mass index (BMI) between 20 and 25 kg/m², and a waist circumference of less than 94 cm for men and 80 cm for women. The blood pressure target is a systolic pressure below 130 mmHg and a diastolic pressure below 80 mmHg. LDL cholesterol, commonly known as ‘bad cholesterol’, should generally be below 55 mg/dL.