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Return to Work After Myocardial Infarction: A Path to Rehabilitation

A myocardial infarction or acute coronary syndrome is a major medical emergency. It not only marks a pause in one’s professional life but also the beginning of a delicate recovery journey.

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After the emergency, stabilization in a hospital setting constitutes the first step. During this period, interventions such as surgery or angioplasty may be necessary. Once the patient’s condition is stabilized, early physiotherapy is implemented to avoid complications associated with immobility.

The second step is rehabilitation, which is essential to regain physical capabilities and reduce risk factors. It includes a complete cardiovascular evaluation and planning for the return to activity. This phase also involves education on indispensable lifestyle changes to minimize the risk of recurrence, such as smoking cessation, healthy eating, and reducing sedentary behavior.

The final step aims to consolidate the gains of rehabilitation. Maintaining regular physical activity and adopting a new lifestyle are crucial. Activities such as walking, swimming, or cycling, recommended by the physician, help stabilize weight and maintain good physical condition.

The Role of the Occupational Physician

A pre-return visit is organized to assess work capacity and consider the necessary adjustments. Based on the rehabilitation data, the occupational physician may propose workplace modifications or professional reorientations.

A left ventricular ejection fraction (LVEF) greater than 50% generally indicates sufficient residual work capacity. The results of the exercise test provide a good evaluation of the maximum work capacity. The issue is not the risk of recurrence of the infarction but subsequent heart failure.

The psychosocial state of the worker is also taken into account, as mental health influences convalescence and the ability to return to work. Untreated depression can increase the risk of recurrence. Therefore, psychological support is a fundamental aspect of rehabilitation.

The social environment of the company significantly impacts the return to work. If the worker feels good about their position, there will be a beneficial effect on their health.

Practical Technical Solutions

Positions that expose workers to carbon monoxide, a risk of hemorrhage (e.g., manual labor leading to wounds), or significant stress are discouraged. Only very intense electromagnetic fields can pose a problem.

Part-time therapeutic work, which can be used immediately or later, is very useful to facilitate the implementation of functional rehabilitation. The supervised trial helps to confirm that the position is well suited to the work capacity.

Prevention and occupational health services can participate in health promotion actions, by encouraging sports activities. A minimum of 150 minutes of physical and sports activities per week, divided into 3 sessions, can reduce the risk of sedentariness. Group practice, with guidance trained in adapted physical activity, fosters motivation and safety.

Cardiofrequency testing can be carried out, especially for positions requiring physical effort, to determine if the employee is capable of performing these tasks, in correlation with their maximum capacity assessed by the exercise test.

In Conclusion:

Returning to work after a myocardial infarction is a complex process that requires cooperation between patients, health professionals, and employers. Each party must work together to ensure a successful transition of the patient back to their professional life, with the ultimate goal of preserving health and preventing any recurrence.

Philippe Casanova

Specialist in occupational medicine and forensic medicine.