Life after a Heart Attack

After a heart attack, you and your family members will definitely have a lot of questions. It is the aim of this brochure to help you answer those questions. The more you know about your condition, the better you will feel as it lessens worries and anxieties. There might be questions that will not be covered in this brochure and it is advised that you visit your doctor since your physician is the best source of information.

Why did I experience a heart attack?

A heart attack happens when the arteries of the heart (the coronary arteries) get diseased (atherosclerosis) or become blocked (coronary artery disease). It usually occurs suddenly but the stage was set for this attack many years ago. A heart attack starts from the fatty build-up in the coronary arteries which carries blood and nutrients to heart muscle, termed as atherosclerosis.

Atherosclerosis is a complex process and develops through time. Cholesterol, fats, and other substances in the blood slowly build up in the arterial walls forming a plaque. The diameter of the artery inside becomes small and narrow and impedes blood flow. This causes a heart attack. The blood flow to the heart muscle is shut off causing damage or death of the muscle supplied by the segment of the artery that was blocked. This is known as a myocardial infarction.

Why did I not feel any warning signs that I am having a heart attack?

Plaque build-up or atherosclerosis often does not present with any symptoms. The absence of any warning signs in an artery that has narrowed may be explained by a process called collateral circulation. This phenomenon happens when the nearby arteries of a blocked vessel expand to help compensate for the blockage. A detour is created to re-route blood to the areas in the heart that are in need of oxygen and nutrient supply. It helps protect the patient by helping the heart get the blood it requires. Collateral circulation in some cases develops after a heart attack and helps the muscle to recover.

Is heart damage the reason why I feel weak now that I am home?

It is not the damage caused by the heart attack that is causing you to feel weak. Weakness happens because your skeletal muscles have been inactive while you were confined and have lost approximately 15% of their strength. You will be advised to undergo cardiac rehabilitation and an exercise program to help you regain your strength. The program usually takes two to six weeks to get your muscles back into shape.

What are my chances of leading a normal life again?

Most heart attack survivors can go back to their previous activities in a few weeks. The scar that has formed is usually not large enough to interfere with the heart’s ability to pump. It follows then that you do not have to reduce your activities too much, if at all. A change in lifestyle is encouraged, though.

The majority of patients who suffered heart attack survive their first attack. Most patients fully recover and enjoy many more years of fruitful life.

Do I still need to rest after a heart attack?

It is important for you to rest after a heart attack, but it is just as important for you to participate in recreation and social events and to start making physical activity a part of your daily life. In many cases doctors will recommend that survivors get more physical activity than they had before their heart attack.

A good night's rest is especially important for heart attack patients.  If you feel tired during the day, take a nap or a short rest. Heart patients should rest before they get too tired. Your doctor will tell you what is best for your specific situation, but most heart attack patients find they have plenty of energy for both work and leisure activities.

When can I go back to work?

Most heart attack patients go back to work within two weeks to three months depending on the severity of the heart attack. Your doctor will determine when you can go back to work and if your current job is still suitable for a person who has had a heart attack.

Cardiac rehabilitation units are available in many hospitals. Your cardiologist may recommend that you enroll in cardiac rehabilitation program to know how much and what kind of work you can do. For more information about these programs, talk to your doctor.

What feelings are normal after a heart attack?

After suffering a heart attack you will probably have a wide range of emotions. Three of the most common are fear, anger and depression.

Fear may be the most common emotion. If you are like most people, you have probably had thoughts like: “Am I going to die? Am I living on borrowed time? Will my chest pain come back?” These are troubling thoughts, but as time goes on, your worries will go away.

Anger is another common emotion. Though like “Why did this have to happen to me?” and “Why did it have to happen now, at the worst possible time?” may have crossed your mind.

Along with anger, bitterness and resentment are also common after a heart attack. You may lose your patience; your friends and family may irritate you. But before you snap at them, remember that it is normal to resent a heart attack. Try to understand that your family and friends are just as worried as you are. Your misfortune is not their fault. Being angry is one stage in your recovery, so accept it. There is no reason to take it out on your loved ones.

Although depression is normal after a heart attack, if it interferes with sleeping, eating, self-esteem, or if you have thoughts of suicide, you should talk to your doctor and those close to you about your feelings. Never be afraid to ask for help. Recovery is much faster with a trusted support team of healthcare professionals, family and friends.

How do family members feel?

Your heart attack has probably had a big emotional impact on your family. They may feel frightened, angry, resentful or even guilty. Your teenaged children are especially sensitive and may think that something they did caused you to have the heart attack. It is better for everyone to get their feelings out in the open. Do not bottle up your feelings that can be destructive. If you think counseling would help your family deal with your heart attack more quickly, ask your doctor to refer you to someone for help.

What lifestyle changes are important?

Making changes in your lifestyle is one of the most important things you can do to prevent another heart attack, heart disease and stroke. The ABCs of prevention are:

• Avoid Tobacco, Vaping and E-Cigarettes — If you smoke after a heart attack, your chances of having a second one are doubled.
• Become More Active — Regular physical activity will ease stress and depression, help control your weight and help lower blood pressure and cholesterol levels.
• Choose Good Nutrition — Good nutrition will help control your weight, lower blood pressure and cholesterol levels and help your body heal faster.

Even if you are taking prescription medication, it is still extremely important to lead a heart-healthy lifestyle.

What kind of physical activity and exercise can I do?

Most heart attack survivors can take walks, play golf, fish, swim, and enjoy similar activities without problems. Actually, physical activity is healthy and is recommended for most heart attack survivors. However, do not engage in any exercise until you first consult with your doctor to find out how much physical activity and exercise you can engage in.

Your doctor can determine the right amount of physical activity for you by giving you special tests on a treadmill, exercise bicycle, or steps. You may be tested in a Cardiac Rehabilitation Unit as part of a program or in your doctor’s office.

What about sex after a heart attack?

Most people can continue their same pattern of sexual activity after they recover from a heart attack. Talk to your doctor. You may be prescribed nitroglycerin if you experience chest pain (angina) during or after sexual activity.

Cardiac Rehabilitation

One of the best gifts you can give yourself is to enroll in a cardiac rehabilitation program. Everything you require to get and stay healthy is in one place, and medical staff is on hand at all times. Rehabilitation can do a lot to speed up recovery and reduce chances of future problems.

During your rehabilitation program, you will be asked to exercise using a treadmill, bike, walk or jog around a track. You will be monitored by a nurse or another health care professional for a change in symptoms. You will be guided to start slowly, following a safe exercise program that helps you to develop strength over time. Progressively, you will be able to move into a more intensive program that allows you to work out longer and harder.

Who can benefit from Cardiac Rehabilitation?

Cardiac rehabilitation programs benefit patients who have or are recovering from heart or vascular diseases or procedures, such as:

• Cardiovascular disease, angina or heart attack (myocardial infarction)
• Heart surgery: coronary artery bypass graft (CABG), valve repair or replacement, aortic aneurysm repair or replacement, heart transplant, other types of surgery
• Interventional procedures, such as angioplasty with stents
• Device implants, such as pacemakers or internal defibrillators (ICDs)

What are the goals of cardiac rehabilitation?

The goals of cardiac rehabilitation are to:

• Improve your overall heart health
• Enhance your return to a healthy lifestyle
• Increase your understanding about your heart or blood vessel disease and treatment
• Direct you in making the right lifestyle changes to decrease your risk of future cardiovascular problems
• Increase your ability to perform your job and your daily or recreational activities
• Provide you and your family with the support and motivation you need to make important lifestyle changes

Who comprises the Cardiac Rehabilitation clinical team?

The Cardiac Rehab Team, which is dedicated to your success, includes the following:

• Cardiologist
• Physiatrist
• Registered physical therapist
• Registered nurses
• Registered dietitians

These healthcare professionals provide and monitor individualized lifestyle adjustments including lipid management, nutrition, exercise, smoking cessation and weight loss.

The Medical City Cardiovascular Institute (TMC CVI) offers a comprehensive and specialized Cardiac Rehabilitation Program. We offer a customized program of exercise and education. The goals are to help you regain your strength, to prevent your condition from getting worse, and to reduce your risk of future heart problems. These can add up to a better QUALITY OF LIFE.

Most people survive their first heart attack and return to their normal lives to enjoy many more years of productive activity.But having a heart attack means you need to make some changes in your life. Your doctor will advise you of the medications and lifestyle changes according to how badly your heart was damaged and what degree of heart disease you have. It is up to you to follow your doctor's recommendations so that you will be able to make a full recovery.

Note: This information is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment.

For inquiries you may contact:

CARDIOVASCULAR  INSTITUTE

TEL. no. (+632) 988-1000/ (+632) 988-7000 ext. 6314

CENTER FOR PATIENT PARTNERSHIP

Tel. No. (+632) 988-1000 / (+632) 988-7000 ext. 6444

References:

The Medical City Cardiovascular Institute

Whooley MA, de Jonge P, Vittinghoff E, et al: Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 300:2379, 2008.

Ades PA: Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med 345:892, 2001.