After heart attack
A heart attack can be a nasty and
frightening experience, particularly fro those who have enjoyed excellent
health previously. It is not surprising that many patients react to this situation
with fear and anxiety. When the risks of the early hours of the heart attack
are safely over, the patient has usually settled down well, but anxiety may
surface again on transfer to the general ward, when there is not the same
intense observation. However, progression to the ward is evidence that the
doctors feel that the period of danger is past and there is good reason for
optimism.
Another period of anxiety occurs on
going home. Away from medial care, the patient may worry about being left alone
or what to do if the pain comes back. But at this time the most likely
psychological problem is that of depression. Patients return to the familiar
world outside and find that they cannot, or are not allowed, to undertake their
normal activities. It is particularly distressing to housewives to find that
they are unable to do their normal household duties but perhaps even more
galling to find that their family has managed quite well without them. Patients
often become withdrawn, and are prone to outbursts of bad temper and
irritability. Others get excessively tired, feel useless, or even contemplate
suicide. These emotional reactions are “normal” after heart attack, but can be
hard for relatives to recognize as being due to depression and may be difficult
to cope with. Happily, with returning physical well – being, anxiety and
depression diminish and most patients adapt satisfactorily as they get back to
normal life. However it may take months for patients to get back to normal
life.
Some after a heart attack; the heart
begins to heal through the formation of scar tissue and tiny, new blood
vessels. Over a period of weeks, scar tissue begins to replace the damaged
heart cells. This scar tissue strengthens the damaged muscle where the heart
attack has occurred. Changes in blood flow are likely to occur. Within 2 to 3
weeks of a heart attack, new arteries called collateral vessels near the
damaged area may develop to bring additional blood to the tissues. It may take
several months for the necessary natural collateral circulation to form.
Will it happen again?
Once the first few days are over, the
chances of a second heart attack are not great and with the passage of time
they become less and less. Nevertheless, the risk does exist but it can be
greatly diminished by adopting healthy habits and taking medicines such as
aspirin and beta-blocker which greatly reduce the chance of second attack. For
those who have been smokers the most important single step is to stop smoking
completely; a healthy diet and plenty of the right forms of exercise are
important for every one.
After first heart attack further
coronary risk stratification is mandatory. After heart attack few tests can
detect who are the patients at risk of getting second heart attack. These tests
are usually done few weeks after heart attack. Stress test and echocardiography
and identify the subset of patients who at risk and require further tests like
coronary angiogram. In some hospital predischarge tress test is done for early
coronary risk assessment. A group of patients after initial assessment will
require Balloon angioplasty or by-pass surgery after heart attack.
What about rest and exercise after heart attack?
When the heart attack has not been
severe, gentle, gentle exercise started a day or two after the attack does not
do any harm, and has the advantage that the rest of the body does not get out
of condition. If, on the other hand, these have been much breathlessness or
other complications, a more prolonged period of rest may be advisable. It is
now normal practice to get patients out of bed on the second or third day after
admission; if there have been no problems. Mobilization consists of sitting out
of bed at first, followed by walks around the bed or, perhaps, to the toilet.
Within another day or two, walking around the ward is permitted and by the
fifth to seventh day some stairs may be climbed. There is, however, a
considerable variation between one individual and another in the amount of
exercise that is permitted, depending on the severity of the heart attack, the
general level of fitness and the practices of different hospital and doctors.
But the standard practice of doctors of 30-40 years ago of keeping their
patients in bed for 4-6 weeks was fortunately abandoned a long time ago.
Most patients when they go home have
been walking short distances in hospital, and may have undergone a short
exercise test on a stationary bicycle or a treadmill to see how much they can
manage comfortably. If they have gone through such a test with flying colours,
they are ready to step up their exercise programme and can progressively
increase the amount of exercise they take out of doors. Obviously, they must
use common sense, and avoid walking in cold winds or climbing up steep hills
until they have had some weeks of successfully managing less stressful
exercise. Some patients experience breathlessness on mild exercise. This may
simply be due to being out of training and will respond to a slow but steady
increase in the amount of exercise from day to day; in other cases, however, it
is due to the heart not pumping as well as it should (this is called heart
failure). A doctor’s advice is necessary in deciding which it is, in the latter
case drug treatment or even balloon angioplasty or By-pass operation may be
necessary. Angina may also be a problem at this time; this may subside
spontaneously or with treatment, but if it does not, consideration may be given
to the need for balloon angioplasty or By-pass surgery.
Exercise
It is only natural that you may feel
apprehensive about exercising after your heart attack. However, the heart is a
muscle and like any other muscle in the body, needs exercise to keep it in
tip-top condition. While you are in hospital the medical term, nurse and
physiotherapist will advise you about how much and what type of exercise is
suitable for you. Initially exercise will be gentle, but will gradually
increase in intensity as you become stronger and more confident.
The Advice about exercise given to
you may be different from that given to others. This is because everyone is
different. Follow the advice carefully. Following discharge from hospital it is
important to continue exercise at home.
Before exercise
- Wrap up warmly and avoid going out
on cold or windy days.
- Wait at least two hours after a
heavy meal.
If you experience chest pain or are
excessively breathless when you exercise, ask the doctor for advice.
Remember, exercise is essential to
maintain the strength and efficacy of the heart. It should be sufficient in
intensity to make you comfortably short of breath. To have a beneficial effect
on be heart you should exercise at least three times a week for approximately
20-40 minutes.
Exercise should be a life long
activity. Like any other muscle in the body, the heart needs exercise to keep
it fit.
Household duties
Light work in the house should be
introduced as soon as you feel fit and able, for example dusting and washing
up. Light gardening may be undertaken, but digging and heavy lifting should be
avoided in the early stages.
Everyday Activities
As well as talking recreational
exercise you may wonder about your capability to undertake other everyday
activities. Physical activity should be graduated and increased as the weeks go
by. You should be looking to extend the amount of activity you do on a daily
basis. Do not be afraid to go upstairs or out of the house. Many people become
tired easily in the early stages following a heart attack. This is to be
expected and will pass as your strength and confidence return.
Driving
Those who have made an uncomplicated
recovery following their heart attack will be able to resume driving in four
weeks. However, if you experience angina whist driving or at rest on
medication, you will to speak to your doctor.
Flying
Most civil aircraft are pressurized,
the pressure in the cabin being held at a level equivalent to an altitude of
5000-6000 feet. This has little or no effect on the normal individual, but
could make a patient who had not fully recovered from a heart attack
breathless. However, if the patient can walk 100 metres on the flat without
symptoms two to three weeks after the attack, it is safe to fly. In fact, much
of the stress of flying is due to problems on the ground rather than in the
air. Hurrying along endless corridors, climbing steep aircraft steps, carrying
heavy bags and hassle in customs and immigration are much more likely to cause
symptoms than the flight itself. These difficulties can be largely overcome if
the airline is warned of the patient’s problems in advance. Wheelchairs or
buggies can be provided porters can be employed to carry baggage and in-flight
oxygen is available if medically necessary.
Return to work
Most patients will be able to retune
to their previous occupation. This may be as early as six weeks after your
heart attack if you do not feel your work is too physically demanding or there
are only light duties involved. For others, return to work will be guided by
the nature of your employment and following discussion with your doctor.
Sex
Sex is no different from any other
type of exercise. It will not put added stress on the heart. However, there is
a potentially higher risk of stress during extra marital affairs. Therefore, it
is advisable to have sex in the usual position with the usual position with the
usual partner.
Both you and your partner may be
worried about resuming sex following heart attack. There are alternatives to
intercourse for giving and receiving pleasure. Touching and caressing may be a
useful start to increase confidence. If you are prone to angina attacks brought
on by exertion here is some helpful advice:
a. Avoid sex within two
hours of a heavy meal.
b. Keep the bedroom warm
and avoid cold sheets.
c. Avoid alcohol for at
least three hours before.
d. Choose a relaxing
atmosphere. Avoid sex if you are tense and tired.
e. Adopt a comfortable
position. Your partner may assume the more active role.
f. Take a GTN tablet/spray
beforehand and keep them at the besides as a back up.
Importance after a heart attack may
be the result of the emotional stress you are feeling. However it may also be
the result of drug treatment, including betablockers. Consult your doctor if
you are experiencing difficulties.
Quit Smoking
Tobacco smoke is packed with poisons
that can damage the heart and blood vessels. Cigarette smoke contains nicotine
and carbon monoxide. Nicotine is an addictive poison which makes the heart beat
faster and makes blood pressure soar temporarily. It also increases the risk of
blood clots. Carbon monoxide is a poisonous gas released when tobacco burns.
Inhaled by the smoker, it dramatically cuts the amount of oxygen the blood can
carry around the body and the heart. Smoking dramatically increases the risk of
developing heart disease, lung cancer and many other diseases. These diseases
are not always fatal but can seriously affect your quality of life. 40% of
heavy smokers (those smoking over 20 cigarettes a day) die before retirement
age, compared to only 15% of non-smokers. Cigarettes give off two types of
smoke- “mainstream smoke” is filtered by the cigarette and inhaled by the
smoker. The other type is side stream smoke which goes directly from the end of
the cigarette into the air. As it is not filtered it contains higher
concentrations of harmful substances than the mainstream smoke. It is therefore
potentially dangerous to non-smoker, especially when they are exposed to it for
long periods of time. Children who are exposed to their parent’s side stream
smoke are more prone than other children to serious chest illnesses such as
pneumonia, lung cancer and bronchitis. They are also more likely to smoke if
their parents do.
The risk of coronary heart disease
decreases dramatically if you give up smoking. Because nicotine is addictive
this will be difficult and withdrawal symptoms such as irritability and
restlessness can be smoking, you should not only feel much fitter but your risk
of developing heart disease will rapidly decrease during the first year. If you
continue to be a non-smoker the risks will decrease so, that in time, the risks
will be almost the same as they are for someone who has never smoked.
Not every one succeeds the first
time. It’s strong addiction, but don’t give up trying.
Healthy eating
a. Eat less fat
b. Eat more fibre
c. Eat less sugar
d. Eat less salt.
The overall aim is to reduce our
total fat intake. In addition, it is suggested that saturated fat be replaced
with a healthier alternative- that is polyunsaturated or monounsaturated fat.
Saturated fat increases the level of
cholesterol in the blood. This increases the risk of having a heart attack. It
is mainly found in food of animal origin, for example dairy products (cheese,
butter), fatty meat and coconut and palm oil.
Polyunsaturated fat appears to have a
protective effect on the heart and may reduce blood cholesterol. These are
mainly of vegetable origin, for example sunflower, safflower, Soya and corn
coil. Oily fish contain polyunsaturated fat which are particularly beneficial.
Monounsaturated fat may have a
similar effect on blood cholesterol as polyunsaturated fat. These include olive
oil, peanut oil etc.
It is wise to eat lean meat, use low
fat polyunsaturated margarine and skimmed or semi-skimmed milk. Eat more fresh
fruits and vegetables. Include more fish and poultry in your diet and fewer
cakes, pastries and biscuits. Limit whole eggs to 3 per week, because the yolk
is rich in cholesterol. You can eat as much egg white as you wish. Above all,
remember that the occasional treat will do you no harm. It is the food you eat
regularly which is important. Remember whole meal bread, pasta, rice, pulse,
fruits, potatoes and other vegetables. High fibre foods are nutritious without
containing concentrated calories, fat, sugar or salt.
Substituting polyunsaturated fats for saturated fat
Every one needs to cut down saturated
fat end cholesterol intake.
1. Only learn meat,
poultry and plenty of fish, especially the oily fish which are high in
polyunsaturated fat should be eaten.
2. Low fat cheese should
be substituted for hard and cream cheese.
3. Skimmed or semi-skimmed
milk should be used.
4. Butter should be
replaced by margarine high in polyunsaturated.
5. Sunflower or safflower
seeds oils should replace other cooking fats.
6. If overweight, both the
fat intake and the polyunsaturated fat intake should be cut down since
polyunsaturated fats are not low in calories.
7. Oils high up
polyunsaturated fat should not be heated for too long at very high temperatures
or re-used several times over, as this alters the chemical composition,
reducing the beneficial effect.
Alcohol
A small amount of alcohol, that is
one to two units a day, will do you no harm. One unit of alcohol = a half-pint
of beer; a glass of wine; or a single measure of spirits. The maximum
recommended weekly intake of alcohol for men is 21 units, and for women 14
units. This amount should be spread throughout the week not all consumed on
Saturday night. Heavy consumption of alcohol increases weight gain and blood
pressure. It may cause damage to the liver, and even to your heart. If you are
taking medication it is wise to check with your doctor that alcohol will not
affect it.
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