Circulatory response to a 50-m walk in the coronary care unit in acute coronary syndrome.
BACKGROUND
Lack of a standardized and monitored technique to start rehabilitation of patients with acute coronary syndrome (ACS) in the coronary care unit.


OBJECTIVE
To describe the technique of and circulatory response to a 50-m walk (W50m).


METHODS
Experimental cross-sectional study of 65 patients with ACS; of these, 36 (54%) with acute myocardial infarction (AMI), Killip I, 29 (45.2%) with unstable angina (UA), 61.5% males with age of 62.8 +/- 12.7 years. Walk was started 45+/-23 h after hospitalization. Parameters measured: systolic blood pressure (SBP mmHg), diastolic blood pressure (DBP mmHg), heart rate (HR bpm), double product (SBP mmHg X HR bpm), peripheral oxygen saturation (SpO2%), walking time, and exercise tolerance by Borg scale (BS). Measurements were taken while supine, sitting, in orthostasis (phase 1 [gravitational stress]), end of the walk, and after a 5-minute rest (phase 2 [exercise stress]).


RESULTS
Increased HR in response to the sitting gravitational stress (Delta=4.18) and with orthostasis (Delta=2.69) (p<0.001) was observed. At the end of walk, there was an elevation in SBP (Delta=4.84), (p<0.001), HR (Delta=4.68), (p<0.001) and DP (Delta=344.97), (p=0.004), and a reduction in SpO2 (Delta=-1.42), (p<0.001), with return to baseline values after 5 minutes. Walking time was 2'36''+/-1'17'', and exercise tolerance by BS was good. SBP response >or= 142 mmHg when sitting was associated with a significant increase (p=0.031) of 11 mmHg at exercise in 13 patients with overweight/obesity and 85% with hypertension. Adverse effects occurred in 19 (29.2%) patients and dizziness in 23.1%, which impaired the walk in three of them.


CONCLUSIONS
In this sample, patients did not present severe collateral effects to W50m. 24 hours after a coronary event.
Hospital Aliança, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Fundação de Amparo à Pesquisa do Estado da Bahia (Fapesb), Salvador, BA, Brasil. cristianedias7@yahoo.com.br
Cristiane Maria Carvalho Costa
CM
Dias
Ana Célia Carneiro de Almeida
AC
Maiato
Kátia Maria Moreno
KM
Baqueiro
Alessandra Maia Furtado
AM
Fiqueredo
Fernanda Warken
FW
Rosa
Janaina Oliveira
JO
Pitanga
Ludmila Ivo Catão
LI
de Souza
Armênio Costa
AC
Guimarães
D054058:Acute Coronary Syndrome / Q000534:rehabilitation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000503:physiopathology; D001775:Blood Circulation / Q000502:physiology*; D003325:Coronary Care Units; D003430:Cross-Sectional Studies; D005080:Exercise Test / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology; D016138:Walking