After a heart attack

If you’re recovering from a heart attack, you and your family undoubtedly have lots of questions. The information below from the American Heart Association will help answer a lot of them. The more informed you are, the better prepared you’ll be to make smart choices that will aid your recovery and reduce unnecessary anxiety. Understandable and reliable information also can help you take concrete steps to reduce the risk of future heart problems.

Need some help with all the medical terms? Click here to see the heart glossary. It defines some words you may have heard, but don’t know.

If you have questions that aren’t covered here, write them down, and then ask your doctor. He or she is your best source of information.

There’s no doubt about it…

If you’ve had a heart attack, you’ve had a very frightening experience. Your life was threatened, and that’s scary for anyone. Now, even though your doctor says you’re going to be all right, you’re probably still anxious.

After what you’ve just been through, feeling apprehensive is normal. But remember that your heart is healing every day. With each passing day, you’ll get stronger and more mobile. The worst is behind you.

Remember, you’re not alone. Every year tens of thousands of Americans survive heart attacks. The vast majority of people go back to work again and continue to enjoy life. You have every reason to be confident that you’ll recover.

I wasn’t doing anything unusual. Why did I have a heart attack?

A heart attack can occur anytime; at work or on vacation, while you’re resting or in the middle of a strenuous workout. Heart attacks occur very suddenly, but the stage is set for them over many years. Heart attacks result from arteriosclerosis in the arteries that carry blood (and thus oxygen) to the heart muscle.

Arteriosclerosis develops slowly and is a complex process. Many scientists believe it begins because the inner, protective lining of the artery is injured. When this happens, fats, cholesterol and other substances in the blood may gradually be deposited. As these fatty deposits in the artery wall build up over time, the insides of the arteries narrow, making it harder for blood to flow. If a blood clot forms in a narrowed artery, it can block the entire channel and shut off blood flow to the heart muscle. This causes a heart attack. The medical term for this is coronary occlusion. The injury to the heart muscle that results from a decreased blood supply is called a myocardial infraction.

What’s sudden cardiac death?

A damaged heart may develop an abnormal electrical activity. This can keep it from beating normally. If this happens, sudden cardiac death may occur.

The most common heart rhythm in sudden cardiac death is ventricular fibrillation. In it, the heart suddenly stops working as it should and sends a person into cardiac arrest. Most cardiac arrests occur when the heart starts beating chaotically. If ventricular fibrillation isn’t treated right away, sudden cardiac death will occur.

A key aspect of sudden cardiac death is that death occurs unexpectedly and within minutes after the heart stops. Cardiac arrest usually can be reversed if it’s treated within a few minutes with a defibrillator. A defibrillator shocks the heart and restores a normal heart rhythm. Time is even more critical for sudden cardiac death than for a heart attack. Heart attack patients are watched around the clock in the hospital so that any life-threatening complication is treated at once.

Why didn’t I have any warning?

Atherosclerosis often develops over many years without any symptoms. The reason there may be no warning signs is that if a coronary artery becomes narrowed, other nearby vessels that also deliver blood to the heart often expand to help compensate. Put another way, a detour forms to reroute blood to the heart. This is called collateral circulation.

Collateral circulation helps protect some people from heart attacks, by helping the heart get the blood it needs. In other cases, it develops after a heart attack and helps the heart muscle recover.

How was my heart injured, and how will the damage impact the way it works?

When a heart attack occurs, a small part of the heart dies because its supply of oxygen-carrying blood is cut off. But the heart is a remarkably tough organ. Even though part of it may have died, the rest keeps working.

Your situation is much like that of an athlete with a torn leg muscle. Until the muscle heals, his or her effectiveness is reduced. Likewise, because your heart has been damaged, it’s weak and can’t pump as much blood as usual.

During the first few days after a heart attack, rest is essential. But even after that initial period of rest, you should limit your activities until your heart has had time to heal. When your heart is healthy again, you can return to your normal lifestyle.

As the damaged part of your heart heals, a scar forms. This takes time: it’s still forming even after you begin to feel good again. It typically takes between a month and six weeks for your heart to repair itself. The length of time depends on the extent of your injury and your own rate of healing. That’s why doctors recommend different amounts of activity for each heart attack patient.

What feelings are normal after a heart attack?

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

Fear may be the most common emotion, and the most understandable. If you’re like most people, you’ve probably had thoughts like: Am I going to die? Am I living on borrowed time? Will my chest pain (or shortness of breath) come back? These are troubling thoughts, but as time passes your worries will diminish.

Physical symptoms may set your fear in motion, too. For instance, before your heart attack, you probably never gave small, fleeting pains a second thought. But now the tiniest twinge in your chest may cause concern. That’s normal. The passing of time will ease these fears, too.

Anger is another common emotion. You’ve probably thought, “Why did this have to happen to me? And why did it have to happen now, at the worst possible time?”

Bitterness or resentment is 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’s normal to resent a heart attack. Your misfortune isn’t their fault. Being angry is one stage in your recovery, so accept it and do your best not to take it out on your loved ones.

Finally, you may have the blues and think you’re hopelessly damaged or crippled. You may even think life is over. This too is normal.

One of your biggest fears may be that you won’t be the same person you were before your heart attack. You may be afraid you won’t be able to work as hard, be as vigorous, or be a helpful spouse or parent. You may even think that it’s too late to do all the things you’ve dreamed of doing. To some extent everyone who has had a heart attack feels this way. But try not to anticipate the worst. Give yourself a chance to recover before jumping to conclusions.

Finally, you may be worried about whether you’ll be able to perform sexually. Perhaps you think that others will think you’re a weak, incomplete person. Again, understand that your fears are normal for someone in your situation, but they’re not necessarily true.

Expect drastic mood swings, and your thoughts will reflect your changing moods. Don’t take them too seriously. Concentrate on resting. And if things do start to bother you, tell someone you trust how you feel. Don’t just pretend that nothing is wrong. Time will cure most of your unpleasant feelings, but until then you don’t have to suffer. You’re not abnormal for feeling the way you do.

What do family members feel?

It’s very likely that your heart attack had a big emotional impact on your family. Your family members were probably very scared when you were in the coronary care unit. Now they may feel resentful, thinking that your heart attack came at a bad time. This is normal. They’re really not blaming you, even though it may sometimes seem like it.

It’s also common for family members to feel guilty. They may feel that they’re somehow responsible for doing something that gave you a heart attack. Teenage children, in particular, may feel this way. Talk to them about their feelings and reassure them that even though heart attacks happen suddenly, the conditions that cause them take years to develop.

If there are fears and resentments in your family, it’s better to discuss them openly. Don’t let bad feelings smolder—they’re destructive. If you think counseling would help your family deal with your heat attack more quickly, ask your doctor or nurse for a referral.

How long will I be depressed?

Be patient. After a heart attack it’s almost impossible not to be scared, irritable or depressed. It usually takes two to six months before these feelings fade away completely.

Because this is a trying time, you and your family and friends need understanding and sympathy. If you’re constantly irritable, depressed or drinking heavily, tell your doctor, then follow his or her advice.

How do I recognize an abnormal depression?

Several warning signs indicate that a serious depression had developed. These include:

1. Sleep problems. You have trouble sleeping; or you want to sleep all the time.
2. Appetite problems. Food doesn’t taste good anymore and/or you’ve lost your appetite.
3. You tire very easily and have no energy.
4. Emotional stress. You’re tense, irritable or agitated, or you feel listless and apathetic.
5. Loss of alertness. You have trouble concentrating.
6. You lose interest in hobbies that once excited you.
7. Low self-esteem. You feel worthless or inadequate.
8. You have repeated thoughts of death or suicide.
9. You don’t tend to your appearance or clean up after yourself.

If you have any of these symptoms, tell your doctor. He or she can decide whether your symptoms are normal, or whether you’re slipping into a more serious depression. If your doctor thinks you may be depressed, he or she may prescribe medication to help you feel better.

Why do I feel weak now that I’m home? Is it heart damage?

If you rested a lot in the hospital and stayed in bed, you’ll feel weak when you get home. The main reason for this is not damage to your heart from your heart attack. You feel weak because inactive muscles lose their strength very quickly. Without activity muscles lose 15 percent of their strength in just one week.

Muscles regain strength only through exercise. That’s why your doctor has given you a program of gradually increasing activities you can do at home. But even with regular exercise, it normally takes two to six weeks to get muscles back into shape.

Another point to remember is that the more athletic you were before your attack, the longer it will take to regain your former level of conditioning.

What are my chances for leading a normal life again?

Most people who’ve had a heart attack can resume their former activities in a few weeks or months. When your heart has healed, the scar usually isn’t big enough to interfere with your heart’s ability to pump blood. That means you won’t need to curtail your activities very much, if at all. You may need to make some lifestyle changes, though.

The vast majority of heart attack victims survive their first heart attack. Most fully recover and enjoy many more years of productive activity.

When can I go back to work?

Between 80-90 percent of heart attack victims return to work in two to three months. Usually they can return to their former jobs, although it depends on three things: how badly their heart was damaged, what treatment they received and how demanding their job is. Some people switch jobs to do something that’s less taxing on their heart.

Cardiac rehabilitation units are available in many communities. Your doctor may send you to one to find out how much and what kind of work you can do. Most communities have some type of rehabilitation program for vocational guidance, training and placement of heart patients who can’t return to their former occupations. For more information about these programs, contact your local American Heart Association.

When I go back to work, will I still need to rest whenever I’m not working? A reasonable amount of rest is necessary, of course. But recreation, exercise and social life are as good for you as they are for everyone else. Many times doctors recommend that people who’ve had heart attacks get even more exercise than they got before.

Getting a good night’s rest is important for everyone, but it’s even more important for people who’ve recently had a heart attack. Sometimes a nap or short rest period during the day is helpful, too. It’s important for heart patients to rest before they get too tired. Your doctor can tell you what he or she thinks will best fit your needs. Most heart attack patients find they have ample energy for both work and leisure activities.

What kind of exercise can I do?

Most people who recover from a heart attack can take walks, play golf, fish, swim and enjoy a wide range of activities with no trouble at all. In fact, exercise is recommended for most heart patients. Still, don’t exercise until you first talk to your doctor to find out how much physical exertion is right for you.

By giving you special tests on a treadmill, exercise bicycle or steps, your doctor can determine how much exercise and what level of intensity is best for you. You may be tested in a cardiac rehabilitation unit or in your doctor’s office.

Am I likely to have chest pain?

Not everyone has chest pain (angina pectoris) after a heart attack. In fact, many people don’t. But it’s possible that you will. Angina is a light pain or pressure in the chest that occurs when part of your heart muscle doesn’t get enough blood (hence oxygen) for the work it has to do. That’s why angina usually occurs during or right after physical exertion, intense emotion or a heavy meal. If you do have anginal attacks, tell your doctor. He or she can prescribe medication to ease or prevent pain.

Besides medication, another treatment for angina is exercise. After you’ve been on an exercise program for awhile, you may find that you can exert yourself for longer than before. Angina attacks, if they occur at all, will take much longer to occur. This is because your heart will get more oxygen and blood than it could before because of collateral circulation.

If your angina gets more painful over time or starts to occur after very little exertion, see your doctor right away.

I’ve lost some weight, which my doctor says is good. Do I have to stay on a reduced-calorie diet?

To maintain a heart-healthy weight, you may have to eat less than before. It’s important for people with heart disease to keep at or even a little below normal. It’s also important to eat a well-balanced diet that contains healthy amounts of protein, vitamins and minerals, and enough energy food to fuel your activities.

Your diet also should be consistent with the American Heart Association Diet, which is low in total fat, saturated fat, cholesterol and sodium. It’s described below.

If you’ve been a big eater in the past, now is a good time to change your habits to keep your weight down. Heavy meals make big demands on your heart, and that’s something you don’t need. It will be better to have several fairly light meals a day instead of three heavy ones. If this isn’t practical, eat three moderate-sized meals instead of three big ones.

What’s a fat-controlled diet, and why is it recommended?

A fat-controlled diet is an eating plan to help you cut down on calories from fat, particularly from meat, high-fat dairy products and saturated fats. It will also lower your intake of dietary cholesterol from egg yolks, organ meats and other animal products.

The goal of a fat-controlled diet is to reduce the cholesterol and other fatty substances in your blood, and thus lower your risk of a heart attack.

Polyunsaturated and monounsaturated fats and margarines made with no more than two grams of fat per tablespoon are used as partial substitutes for saturated fats such as butter, lard and hardened margarines, which are prominent in the average American diet. The reason: unsaturated fats tend to reduce the level of blood cholesterol.

The basic elements of the American Heart Association dietary guidelines are:

• Total fat intake should be less than 30 percent of calories.
• Saturated fatty acid intake should be less than 10 percent of calories. Saturated fatty acids are found primarily in animal fats, but also in palm, palm kernel and coconut oil.
• Polyunsaturated fatty acid intake should be no more than 10 percent of calories. Corn, soybean and sunflower oils are examples of polyunsaturated fatty acids.
• Monounsaturated fatty acids make up the rest of total fat intake, about 10-15 percent of calories. Canola and olive oil are examples of monounsaturated oils.
• Cholesterol intake should be no more than 300 milligrams per day. Cholesterol is found in foods from animals, including beef, pork, mutton, poultry, fish, dairy products and eggs.
• Sodium intake should be no more than 3,000 milligrams (3 grams) per day. To cut down on salt, substitute herbs and spices. Read food labels to find compounds that contain salt.

If you’re overweight, losing weight may help you reduce your blood cholesterol level, lower your blood pressure and improve your glucose tolerance. Getting a blood test from time to time will show how effective changing your diet (and losing weight) has been. In some cases, you may have to modify your diet even more to reach the goal your doctor has set for you.

Your doctor also may prescribe medicine to lower your blood cholesterol.

What about carbohydrates?

You’ll probably be reducing the amount of fat in your diet to less than 30 percent of total calories. Right now, if you’re like most Americans, your diet contains about 37 percent fat. To make up for the decrease in calories from fat, you’ll need to eat slightly more carbohydrates. Ideally, your carbohydrates should come from vegetables, fruits and cereals.

Can I still have an alcoholic drink or two?

Your doctor may tell you that it’s OK to drink moderate amounts of alcohol. But if you’re trying to lose weight, remember that alcoholic beverages are high in calories.

Is there anything else I should watch out for? Scientists are studying other dietary factors such as fiber, coffee, trace minerals, water hardness and vitamins to see if they play a role in the development of heart disease. But right now scientists don’t know enough to make any firm recommendations.

Should I stop smoking?

YES! Smoking is unhealthy for everyone! And it’s an even bigger risk for people who have coronary disease. In fact, if you resume smoking after a heart attack, your chances of having a second one are doubled.

Smoking increases the strain on your heart because it causes blood vessels to constrict, and some of them are already narrowed and damaged. Smoking also causes your heart to beat faster. Finally, smoking increases the level of carbon monoxide in your blood, and thus deprives your heart of the oxygen it needs.

What about my blood pressure?

High blood pressure is a risk factor for heart attack and stroke. That’s why your doctor will want your blood pressure checked regularly.

If your blood pressure is high, your doctor will provide steps to lower it. Usually some combination of diet, exercise and medication is recommended to control blood pressure.

Many people with high blood pressure are also overweight. If that’s true for you, a diet may be prescribed to help you cut down on calories and lose weight. If you’re given a diet, follow it closely, including any advice about drinking less alcohol.

Sometimes reducing the amount of sodium you eat can help lower blood pressure. If your doctor thinks this might help you, he or she will suggest a sodium (salt) restricted diet. You’ll have to avoid salty foods, cut down on how much salt you use in cooking and at the table and carefully read package labels regularly to learn how much sodium is in prepared foods.

Exercise also can help you lose weight and lower your blood pressure. Check with your doctor before you start an exercise program, though.

For some people, losing weight, reducing sodium and making other lifestyle changes doesn’t lower blood pressure enough. For them, medication is necessary. If your doctor prescribes medications for you, take them as directed. If you don’t feel well after taking the medication, tell your doctor exactly how you feel. He or she can adjust your medication so you won’t have unpleasant side effects.

It’s very important to keep your blood pressure under control, so be sure to follow your doctor’s advice.

Is sexual activity permitted?

Most people can resume sexual activity after they recover from a heart attack. If this question worries you or your sexual partner, talk to your doctor. If you get anginal chest pain when you exert yourself during sex, your doctor may prescribe nitroglycerin to take before having sexual relations.

Will I have to take medicines to keep my blood from clotting?

It’s possible. Depending on the circumstances surrounding your heart attack, your doctor may decide to prescribe anticoagulant drugs. For some patients, such drugs are beneficial; in others, they’re not needed or even potentially harmful. Only your doctor should decide if anticoagulants are right for you.

Can coronary artery surgery be helpful?

After a heart attack, your heart heals naturally. In some cases surgery can be helpful, particularly when certain complications result from the heart attack. Whether or not you need surgery is a question that only your doctor can answer.

Since I’ve had one heart attack, should I expect to have another one?

Not necessarily. Of course no one can say for sure whether you’ll have another heart attack. But if you follow your doctor’s recommendations regarding weight, diet, work, medicine, exercise and rest, you’ll have a better chance of living comfortably and avoiding future attacks.

Research into coronary disease is uncovering new insights into heart attacks every day. The outlook for coronary patients is better today than it was just a few years ago. And it will continue to improve. There’s a lot to be hopeful about.