Effectiveness of a Modified Cardiac Rehabilitation Program with Integrated Psychological Support in a 45-Year-Old Female Patient with Ischemic Heart Disease Post-PTCA: A Case Report

Background: Ischemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide and is often associated with reduced functional capacity, psychological distress, and impaired quality of life following coronary intervention. Cardiac rehabilitation (CR) plays a central role in secondary prevention and functional recovery after percutaneous transluminal coronary angioplasty (PTCA). Case Presentation: This case report describes the rehabilitation of a 45-year-old female patient with non-ST-segment elevation myocardial infarction (NSTEMI) and diabetes mellitus who underwent PTCA to the mid left anterior descending artery. At baseline, she presented with exertional angina, poor exercise tolerance, anxiety related to physical exertion, and reduced quality of life. Initial evaluation included echocardiography, coronary angiography, stress testing, and psychological and quality-of-life assessment using the 12-Item Short Form Health Survey (SF-12), Kessler Psychological Distress Scale (K10), and Patient Health Questionnaire-9 (PHQ-9). Baseline stress testing revealed impaired exercise tolerance (3.4 METs) and was terminated due to chest pain and anxiety. Intervention and Outcomes: The patient underwent a supervised, modified, and progressive cardiac rehabilitation program involving interval and continuous aerobic training, functional strengthening exercises, physiological monitoring, and psychological support through therapeutic communication and reassurance. Exercise intensity was adjusted based on heart rate, rating of perceived exertion (RPE), and symptom response. Initial sessions were complicated by exertional angina and emotional stress, requiring medical reassessment and reassurance. After rehabilitation and medical optimization, the patient showed marked improvement in exercise tolerance, symptom control, psychological status, and quality of life. SF-12 scores improved from baseline PCS-12: 21.92 and MCS-12: 29.08 to post-rehabilitation PCS-12: 56.81 and MCS-12: 57.88. K10 scores decreased from 34/50 to 12/50, and PHQ-9 scores improved from 19 to 2. She demonstrated enhanced confidence and functional performance without recurrence of significant cardiac symptoms. Conclusion: This case highlights the value of individualized and multidisciplinary cardiac rehabilitation following PTCA in patients with ischemic heart disease. The integration of structured CR, medical management, and psychological support contributes to improvements in physical function, symptom management, and psychological well-being, particularly in female patients with significant emotional distress and cardiovascular risk factors.