No improvement of physical capacity during cardiac rehabilitation in a patient with elevated IGF-1 and normal pressure hydrocephalus
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Wojskowy Instytut Medyczny – Państwowy Instytut Badawczy, Klinika Kardiologii i Chorób Wewnętrznych, Polska
Submission date: 2023-10-17
Acceptance date: 2023-11-13
Publication date: 2024-05-13
Corresponding author
Zuzanna Janicka   

Wojskowy Instytut Medyczny – Państwowy Instytut Badawczy, Klinika Kardiologii i Chorób Wewnętrznych, Polska
LW 2024;102(1):73-77
Introduction and objectives: Multimorbidity (type 2 diabetes, hyperlipidaemia, arterial hypertension, obesity, limited exercise tolerance) is a common challenge during cardiac rehabilitation in patients with chronic coronary syndrome. Material and methods: A 54-year-old man after percutaneous coronary angioplasty followed a cardiac rehabilitation programme. He presented with generalised muscle weakness, phenotypic signs of acromegaly, as well as elevated serum creatine kinase and insulin-like growth factor 1. The qualification for rehabilitation was based on multiparametric assessment of physical exercise using ergospirometry combined with comprehensive physiotherapy examination. Kinesitherapy programme was developed on the basis of heart rate at the anaerobic threshold and then divided into 24 sessions of telemonitoring-guided cycle ergometer interval-training, which was continued for 5 weeks. Results: Worsening of muscle strength was observed after the second stage of cardiac rehabilitation, which led to extension of diagnosis. Acromegaly was excluded due to inhibition of growth hormone secretion in oral glucose tolerance test. Normal pressure hydrocephalus was detected on head magnetic resonance imaging. The patient was eventually diagnosed with Hakim syndrome. Conclusions: Patients with chronic coronary syndrome require implementation of cardiac rehabilitation as soon as possible after coronary intervention. Attention needs to be paid to every alarming abnormality during examination, therapeutic failures in particular. This allows for quick interventions, further diagnosis or treatment. Physiotherapy examination along with exercise tests is an indispensable element of planning kinesitherapy as part of cardiac rehabilitation and can contribute to indiv idualisation of therapeutic approach.
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