Heart attack recovery

Heart Disease

Lifestyle changes

Changing your lifestyle can greatly reduce your risk of a further heart attack:

  • Give up smoking – this halves your risk.
  • Eat a healthy diet.
  • Take regular exercise.
  • Keep your weight under control.
  • Have your blood pressure checked regularly.
  • Learn to deal with anger and stress, which can trigger an attack.
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Heart attack recovery

Heart Disease

Drug treatments

After a heart attack, drug treatments can reduce the risk of having another by as much as 25 per cent, depending on your particular condition.

Drugs that may be prescribed include:

  • Aspirin and other drugs – these reduce the formation of blood clots.
  • Lipid-lowering drugs – these reduce cholesterol and other harmful fats in the blood, making the coronary arteries less likely to fur up. In the UK, most people are treated with these after a heart attack.
  • Beta blockers – these drugs are particularly useful in high-risk patients, such as those with high blood pressure or diabetes, but many patients have contraindications to their use.
  • ACE inhibitors and angiotensin receptor blockers (ARBs) – these types of drug are particularly useful when the heart is failing to work as efficiently as it should (heart failure) and for controlling blood pressure.
  • Drugs to treat abnormal rhythms of the heart.

Heart attack recovery

Heart Disease

Back to normal

In uncomplicated cases, you should be back to your normal routine after six to 12 weeks.

  • Work – exactly when you return depends on your job and how serious the heart attack was. Take it in stages and rest when you feel tired. Some very physical jobs may be beyond your ability at first.
  • Driving – avoid long journeys and stressful driving situations, such as in a city or in the rush hour.
  • Sex – many people worry that sexual activity may be too strenuous after a heart attack, but research shows these fears are generally unfounded. Like all exercise, take it slowly at first.

Heart attack recovery

Heart Disease

Rehabilitation after a heart attack

The first 48 hours after a heart attack are critical. After this, recovery begins. Within a few days, the tissues of the heart begin to heal and, if there are no complications, you may be discharged from hospital after five to seven days.

As the weeks pass, the damaged muscle is replaced by scar tissue. This process takes six to 12 weeks, during which time you should be increasing your activity levels gradually.

Many people are terrified of exercising after a heart attack for fear that it will trigger another attack, but exercise helps to speed recovery.

A gradual increase in exercise helps the heart to get back in shape and adapt to any scars left behind. It also improves general wellbeing and encourages good quality and regular sleep. It helps test out the heart, so the patient and doctor become aware of any residual problems, such as angina or breathlessness.

Always follow expert advice regarding this gradual increase in exercise. Never overdo things. Excessively vigorous exercise, especially if it includes isometric exercise, can increase the risk of another heart attack.

Heart attack recovery

Heart Disease

Risks after a heart attack

Many people live in fear of another heart attack – and with good reason. About 10 per cent of those who have a heart attack will have another one within a year of leaving hospital. This risk drops to about three per cent every year after that.

Proper rehabilitation, which includes making changes to your lifestyle, can reduce these risks and increase your life expectancy. If you’re not offered a formal rehabilitation programme, ask your doctor if there’s one in your local area.

Heart attack

Heart Disease

Causes of a heart attack

The UK has one of the worst heart attack rates in the world. It’s estimated that someone has a heart attack every two minutes in the UK. More than 1.4 million people have angina and each year about 275,000 people have a heart attack. Of these, more than 120,000 are fatal.

Common causes include:

  • Atherosclerosis, where fatty plaques build up on the inner lining of the coronary arteries (often compared to the furring up you see inside a kettle)
  • Smoking
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Family history of heart disease

Men are also more likely to have a heart attack than women.

There are many steps you can take to change your lifestyle and reduce your risk, including quitting smoking, eating healthily and keeping your weight under control, and getting regular exercise.

Heart attack

Heart Disease

Heart attack symptoms

Unfortunately, for many people the first indication that something’s wrong is a heart attack. This happens when the blood supply to a part of the heart muscle is completely interrupted or stops, usually when a blood clot forms in a diseased coronary artery that’s already become narrowed by atherosclerosis.

The symptoms of a heart attack include:

  • Chest pain, usually a central crushing pain that may travel into the left arm or up into the neck or jaw, and persists for more than a few minutes. Unlike angina, the pain doesn’t subside when you rest. Sometimes it can be mild and be mistaken for indigestion. Some people have a heart attack without experiencing pain
  • Stomach or abdominal pain
  • Shortness of breath or difficulty breathing
  • Nausea or vomiting
  • Sweating
  • Unexplained anxiety
  • Weakness or fatigue
  • Cold sweat or paleness
  • Feeling light-headed or dizzy
  • Palpitations or an abnormal heart rate

Heart attacks must be recognised and treated as quickly as possible because once a coronary artery is blocked, the heart muscle will die within four to six hours.

If you suspect you or someone else is having a heart attack, seek medical help immediately by calling 999. Modern treatments can restore the blood supply to the heart muscle. The sooner treatment is given, the less permanent damage there will be.

Heart attack

Heart Disease

What is a heart attack?

The heart beats on average 70 times a minute to push blood around the body. Like any busy muscle, the heart tissues need a good supply of blood from their blood vessels, which are called the coronary arteries. When this process is interrupted or doesn’t work properly, serious illness and even death can result.

A heart attack occurs when blood flow to part of the heart is blocked, often by a blood clot, causing damage to the affected muscle. The clot, often caused by rupturing or tearing of plaque in an artery, is sometimes called a coronary thrombosis or a coronary occlusion.

If blood supply is cut off for a long time, the muscle cells are irreversibly damaged and die, leading to disability or death depending on the extent of the damage.

Diseases that narrow the coronary arteries can reduce the supply of blood and cause a shortage of oxygen and essential nutrients in the heart muscle. This triggers chest pain known as angina, especially when the heart is made to work extra hard, for example during exercise. If someone has angina, the more severe the narrowing of the arteries, the less they can do before they experience pain.

A heart attack can occur if the shortage of oxygen to an area of heart muscle is severe and prolonged. Heart attacks (also known as a myocardial infarction or MI) can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.

Most of the deaths from heart attack are sudden, occurring within one hour of onset of symptoms and before reaching hospital, and are often due to dangerous heart rhythms. Most people who survive the first month will still be alive five years later, but many are left with long-term heart problems.

Organs – Heart

Heart Disease

Cardiac muscle

Your heart is an incredibly powerful organ. It works constantly without ever pausing to rest. It is made of cardiac muscle, which only exists in the heart. Unlike other types of muscle, cardiac muscle never gets tired.

Four chambers

Your heart is divided into four hollow chambers. The upper two chambers are called atria. They are joined to two lower chambers called ventricles. These are the pumps of your heart.

One-way valves between the chambers keep blood flowing through your heart in the right direction. As blood flows through a valve from one chamber into another the valve closes, preventing blood flowing backwards. As the valves snap shut, they make a thumping, ‘heart beat’ noise.

Double pump

Blood carries oxygen and many other substances around your body. Oxygen from your blood reacts with sugar in your cells to make energy. The waste product of this process, carbon dioxide, is carried away from your cells in your blood.

Your heart is a single organ, but it acts as a double pump. The first pump carries oxygen-poor blood to your lungs, where it unloads carbon dioxide and picks up oxygen. It then delivers oxygen-rich blood back to your heart. The second pump delivers oxygen-rich blood to every part of your body. Blood needing more oxygen is sent back to the heart to begin the cycle again. In one day your heart transports all your blood around your body about 1000 times.

Your right ventricle pumps blood to your lungs and your left ventricle pumps blood all around your body. The muscular walls of the left ventricle are thicker than those of the right ventricle, making it a much more powerful pump. For this reason, it is easiest to feel your heart beating on the left side of your chest.

Pacemaker

Unlike skeletal muscle cells that need to be stimulated by nerve impulses to contract, cardiac muscle cells can contract all by themselves. However, if left to their own devices, cardiac muscle cells in different areas of your heart would beat at different rates. Muscle cells in your ventricles would beat more slowly than those in your atria. Without some kind of unifying function, your heart would be an inefficient, uncoordinated pump. So, your heart has a tiny group of cells known as the sinoatrial node that is responsible for coordinating heart beat rate across your heart. It starts each heartbeat and sets the heartbeat pace for the whole heart.

Damage to the sinoatrial node can result in a slower heart rate. When this is a problem, an operation is often performed to install an artificial pacemaker, which takes over the role of the sinoatrial node.

Heart rate

Without nervous system control, your heart would beat around 100 times per minute. However, when you are relaxed, your parasympathetic nervous system sets a resting heart beat rate of about 70 beats per minute, (resting heart rate is usually between 72-80 beats per minute in women and 64-72 beats per minute in men).

When you exercise or feel anxious your heart beats more quickly, increasing the flow of oxygenated blood to your muscles. This is triggered by your sympathetic nervous system. Your heart rate also increases in response to hormones like adrenalin.

On average, your maximum heart rate is 220 beats per minute minus your age. So a 40 year old would have a maximum heart rate of 180 beats per minute.

Oxygen supply to your heart

Although your heart is continually filled with blood, this blood doesn’t provide your heart with oxygen. The blood supply that provides oxygen and nutrients to your heart is provided by blood vessels that wrap around the outside of your heart.

Angina

Heart Disease

Treatment of angina

Treatment of angina includes:

  • Lifestyle advice to manage risk factors, such as weight loss, exercise, quitting smoking and a healthy diet.
  • Medical treatment, including a drug called glyceryl trinitrate or GTN which can be taken repeatedly as a tablet put under the tongue or as a spray, and medical advice on what to do if pain persists (ie. if there is a risk of a heart attack).
  • Assessment and treatment for coronary artery disease, including a variety of drug treatments to help open the arteries or treatments such as aspirin and a statin type drug which help to reduce the risk of a heart attack. More invasive treatments to open up the coronary arteries may be recommended especially when there is severe blockage. These are known as coronary revascularisation. The main two types are either coronary artery bypass grafting, or percutaneous transluminal angioplasty.

Angina

Heart Disease

Tests for angina

Many problems can be confused with angina, especially indigestion or gastro-oesophageal reflux. It’s important tests are done to establish the diagnosis, to ensure the affected person gets the right treatment.

An electrocardiogram (ECG) is essential and may show typical changes but can be normal in angina. Blood tests can be done to check for causes such as anaemia and look for chemical enzymes (called Troponins) released from the heart if a heart attack has occurred. Other checks for cholesterol levels, blood fats, diabetes and thyroid disease may be done. In most areas of the UK these tests will be done at the local Rapid Access Chest Pain Clinic.

More complex tests such as an ECG during exercise, echocardiogram or other sophisticated x-ray tests may be recommended. However, NICE has recently produced guidelines which direct which tests should be done based on a statistical calculation of how likely to patient is to have angina. For example, invasive coronary angiography (where a tube is inserted into the coronary arteries and dye injected to produce x-rays pictures of the coronary arteries) is usually offered when there is a greater than 61 per cent chance of coronary artery disease.

Angina

Heart Disease

Causes of angina

Angina is common – about eight per cent of men and three per cent of women aged between 55 and 64 have experienced it, and it becomes more common with age.

It’s most commonly caused by narrowing of the arteries that carry oxygen to the heart muscle by a process called atherosclerosis (sometimes known as hardening of the arteries). This is a common condition where fatty deposits or plaques build up in the coronary arteries. Symptoms don’t usually develop until there is at least a 50 per cent blockage of the artery.

Most people in the developed world will have some atherosclerosis by the time they reach mid-life (and often much earlier), but some conditions can make it worse including:

High cholesterol – especially if there’s an inherited tendency to high cholesterol or a strong family history of heart disease
Cigarette smoking
Diabetes mellitus
High blood pressure
Other conditions can also interfere with the blood supply to the heart muscle and lead to angina. These include:

Abnormal heart rhythms – for example when the heart beats so fast it isn’t pumping blood efficiently around the body
Heart valve disease
Inherited structural abnormalities of the coronary arteries
Severe anaemia – where the blood count is so low that it cannot carry much oxygen to the tissues
Other important risk factors for angina include obesity and raised levels of chemical in the blood called homocysteine, or other chemicals involved with clotting.

In another condition, called Prinzmetal’s angina or coronary artery spasm, the coronary arteries aren’t permanently blocked but intermittently narrowed by spasm. This often develops in the early hours of the morning and may last up to 30 minutes. Those affected may also complain of palpitations and abnormal heart rhythms, or have similar conditions linked to spasm of the arteries such as migraine or Raynaud’s phenomenon.

Events which put extra strain on the heart can make angina worse, such as:

Fever
Infection and serious illness
Emotional stress
Overactive thyroid gland
Sudden extreme exertion
However, angina can come on at rest, even when a person is lying in bed.

Angina

Heart Disease

Symptoms of angina

Symptoms of angina include:

  • Pain in the chest, which may begin as a vague discomfort or ache usually in the centre of the chest. The type of pain varies and may be described as tightness, burning, crushing, pressure or heaviness. Some people get a choking sensation.
  • The pain may radiate or move, typically to the neck, shoulder, jaw or down into the left arm.
  • The pain usually lasts just a few minutes and quickly responds to treatment (usually glyceryl trinitrate (GTN) as tablets or spray under the tongue).
  • The person may also feel short of breath, anxious or nauseous.

Angina

Heart Disease

What is it angina?

Angina pain develops when the muscles of the heart are not getting enough oxygen. This is usually caused by narrowing or blockages of the coronary arteries that deliver oxygen-rich blood to the heart muscle, known as coronary artery disease. Angina is a sign of heart disease.

If the blockage of a coronary artery progresses and becomes complete, the blood supply to part of the muscles of the heart is lost, causing a heart attack. Angina is a warning sign that the heart is at risk of an attack and should be taken very seriously. One patient in 10 will go on to have a heart attack within a year of diagnosis of angina.

Angina may be an occasional problem or may rapidly increase in severity and duration until a heart attack occurs.

Lung transplant ‘gave me 20 more years with my husband’

Heart Disease
Kirstie Mills was 21 when a lung transplant became her only hope of survival.

Kirstie Mills was 21 when a lung transplant became her only hope of survival.

During the previous two years her health had deteriorated rapidly. The cystic fibrosis which had made her ill all her life had finally taken hold.

She regularly used a wheelchair, she was on oxygen to help her breathe and was spending longer and longer in hospital.

By that time, Kirstie had met and fallen in love with Stuart.

She had introduced him to her daily dose of medicines, chest infections and hospital visits, all part of the incurable condition’s cruel regime.

But soon that regime changed for the worse.

“I had a stair lift fitted and what was once my fitness room, became a dedicated treatment room, full of medicines and devices to help me breathe. I knew we were running out of time”

"I didn't expect to be so near the edge of life"

"I didn't expect to be so near the edge of life"

Faced with the prospect of little time left together, they planned their wedding in Cyprus only to relocate it to Somerset when Kirstie became too sick to travel.

“We got married three weeks before my transplant. There were numerous medical staff there as well. Stuart had a Do Not Resuscitate card in his pocket because if I had collapsed I did not want to be ventilated, because that would have ruled out a transplant.

“It was the best day of my life but we thought it was going to be my last too.”

Agony of waiting

Two weeks later she was airlifted to Harefield Hospital in London to wait for a transplant – a last-resort operation which can extend life expectancy but can be very risky too.

Kirstie was hooked up to an ECMO machine which imitates the job done by the lungs

Kirstie was hooked up to an ECMO machine which imitates the job done by the lungs

Kirstie says waiting for the transplant was the worst time imaginable for her family and new husband.

“At one point I tried to beg them to switch off the machines that were keeping me alive but, because I had a tracheotomy in, no one understood me.

“I was in agony, I felt like I was constantly drowning or suffocating. The number of tubes attached to me was incredible so I couldn’t move, couldn’t do anything. I felt desperate.

“I didn’t think my transplant would come and, if it did, it would surely be too late because I was so weak.”

Kirstie wrote an emotional letter to Stuart in case she did not survive.

With her life ebbing away, Kirstie was finally given a new pair of lungs in July 2011.

“It was just in the nick of time,” she says. “I had hours left.”

But the aftermath of the operation was far from easy. Kirstie still felt very ill when she came round and was still being ventilated.

“I’d had a major operation and it was like starting from scratch again. I thought it was a sick joke. I still felt like I was dying.”

Return to fitness

Kirstie’s new lungs needed time to function fully and properly and that meant constant pain and a steady diet of painkillers for several weeks.

Before the transplant: Kirstie with Stuart and comedian Russell Howard on a good day

Before the transplant: Kirstie with Stuart and comedian Russell Howard on a good day

Intensive rehabilitation got her back on her feet, breathing on her own and with Stuart by her side she knew she would recover.

Her lung function is now at 100%, which Kirstie’s doctors are very pleased by.

She maintains that it is down to all the exercise she is doing – six fitness classes a week and three to four hours in the gym – which is key to making the lungs work well.

She is returning to fitness pole dancing and is soon getting back into teaching.

Now she is looking forward to really celebrating Christmas with her family, for the first time in years, and to taking part in a 180-mile charity bike ride.

Yet she is keenly aware that the transplant does not mean she is cured.

“I still won’t have the same life expectancy as you, but the transplant will give me maybe 20 more years. I just have to keep managing and controlling the condition as best I can.”

In the meantime, Kirstie and Stuart are enjoying the freedom of having her health – and her life – back.

Cardiac Rehabilitation: Mending the Heart

Heart Disease

Cardiac rehabilitation. Learning to live again, one step at a time.

If you have been sidelined by a heart attack, heart surgery, or another heart or blood vessel problem, you may worry whether you’ll ever get back on your feet. The road to recovery can be challenging, but a cardiac rehabilitation program can help. Cardiac rehab can help:

Recovery (for example after a heart attack or heart surgery)
Reduce your chances of future heart problems
Restore your confidence and quality of life
Cardiac rehab isn’t just about exercise. That’s usually an important part, but, there’s much more to it. Being in cardiac rehab also means you will take part in supervised medical programs that address all aspects of recovery. Programs typically include counseling and support for needed exercise, nutrition, and lifestyle changes. You may also be evaluated for depression and stress – which often follow a serious health event like a heart attack. Research shows that people who actively take part in cardiac rehab programs live longer and have a better quality of life than those who don’t.

Cardiac rehabilitation is helpful for people who have these conditions or procedures:

  • Heart failure
  • Chest pain
  • Heart attack
  • Atrial fibrillation or other heart rhythm problems
  • Peripheral arterial disease (problems with circulation in your legs)
  • Bypass surgery, angioplasty, or heart valve surgery
  • Placing a pacemaker or other cardiac device
  • Heart transplant

Cardiac rehab programs are typically designed in several phases. This stepped approach safely and gradually gets you back on your feet and helps you learn how to make healthy life choices. Rehab often starts while you are still in the hospital. Members of your health care team may begin the step-by-step process of getting you moving again. While in the hospital, that may mean just getting out of bed, getting dressed, or taking a shower.

As you get better, your rehab goals progress with you. You may receive cardiac rehab services in your home or an outpatient facility. In any setting, you’ll be closely monitored and coached by trained health professionals. As you recover, you will gradually be able to do more on your own and with less supervision.

Adapting to life with a heart condition can be overwhelming. It takes time for your body to heal and you’ll be faced with many changes and new things to learn. To help you with this, cardiac rehab is usually paced over several weeks to months. As you’re ready, you’ll work with dietitians and counselors to learn how to make heart-healthy food choices and explore ways to make important lifestyle changes. These may include quitting smoking and reducing your blood pressure and cholesterol levels. Your cardiac rehab team may also help you learn how to take your medications and manage stress.

Finally, a key part of cardiac rehabilitation is learning about your heart condition and understanding your limitations. Your cardiac rehab team will help you recognize symptoms that require immediate action and what changes to report to your doctor. With time and support, you’ll soon regain the strength and self-reliance to live an active and healthful life.

Cardiac Rehabilitation

Heart Disease

WHAT ARE THE BENEFITS AND RISKS OF CARDIAC REHAB?

Benefits

Cardiac rehab has many benefits. It can:

  • Reduce your overall chance of dying, the chance of future heart problems, and the chance of dying from a heart attack
  • Decrease pain and the need for medicines to treat heart or chest pain
  • Lessen the chance that you will have to go back to the hospital or emergency room for a heart problem
  • Improve your overall health by decreasing the risk factors for heart problems
  • Improve the quality of your life and make it easier to work, participate in social activities, and exercise

People who attend cardiac rehab on a regular basis also reduce stress, become more independent, and prevent disability.

People who receive help for their emotional health and also start an exercise program can improve their overall health. They can lower their blood pressure and heart rate. They also can lower their LDL (“bad”) cholesterol and raise their HDL (“good”) cholesterol. These people are less likely to die or have another heart attack.

Treatment for emotional health also can help some people quit smoking.

Risks

The lifestyle changes that you make during cardiac rehab have few risks.

At first, physical activity is safer in the rehab setting than at home. Members of the rehab team are trained and have experience teaching people with heart problems how to exercise.

Your rehab team will watch you to make sure you’re safe. They will check your blood pressure several times during your exercise training. They also may use an EKG (electrocardiogram) to see how your heart reacts and adapts to exercise. After some training, most people learn to exercise safely at home.

Very rarely, physical activity during rehab causes serious problems. These problems may include injuries to your muscles and/or bones, or heart rhythm problems that can lead to death or recurrent heart attack.

Your rehab team will tell you about signs and symptoms of possible problems to watch for while exercising at home. If you notice these signs and symptoms, you should stop the activity and contact your doctor.

Cardiac Rehabilitation

Heart Disease

WHAT TO EXPECT DURING CARDIAC REHABILITATION

Cardiac rehab continues on a regular basis for 2 to 3 months. During this time, you learn how to:

  • Increase your physical activity and exercise safely
  • Follow a heart healthy eating plan
  • Reduce risk factors for future heart problems
  • Improve your emotional health

The rehab team works with you to create a plan that meets your needs. Each part of cardiac rehab helps lower your risk for future heart problems.

Overall, you usually work with the team for 6 to 12 months. The length of time depends on your situation. The lifestyle changes you make during rehab will become more routine. They will help you maintain a reduced risk for heart disease.

Support from your family can help make cardiac rehab easier. For example, family members can help you plan healthy meals and do physical activities. The healthy lifestyle changes you learn during cardiac rehab can benefit your entire family.

INCREASE PHYSICAL ACTIVITY AND EXERCISE SAFELY

Your cardiac rehab team will assess your physical activity level to learn how active you are at home, at work, and during recreation. If your job includes heavy labor, the team may recreate your workplace conditions to help you practice in a safe setting.

You will work with the team to find ways to safely add physical activity to your daily routine. For example, you may decide to park farther from building entrances, walk up two or more flights of stairs, or walk for 15 minutes during your lunch break.

Your rehab team also will work with you to create an easy-to-follow exercise plan. It will include time for a warmup, flexibility exercises, and cooling down. It also may include aerobic exercise and resistance training.

You will get a written plan that lists each exercise and explains how often and for how long you should do it.

You’re more likely to make exercise a habit if you enjoy the activity. Work with the rehab team to find forms of physical activity that you enjoy and that are safe for you. If you prefer to exercise with other people, join a group or ask a friend to join you.

You may only be able to tolerate very light conditioning exercises. The rehab team will help decide what level of exercise is safe for you.

Aerobic Exercise

Typically, your rehab team will ask you to do aerobic exercise 3 to 5 days per week for 30 to 60 minutes. The exercise specialist on your team will make sure that your exercise plan is safe and right for you.

Examples of aerobic exercise are walking (outside or on a treadmill), cycling, rowing, or stair climbing.

Resistance Training

Typically, your rehab team will ask you to do resistance training 2 or 3 days per week. Your exercise plan will show how many times to repeat each exercise.

Resistance training may include lifting weights (hand weights, free weights, or weight machines), using a wall pulley, or using elastic bands to stretch and condition your muscles.

Exercise at the Rehab Center and at Home

At the start of cardiac rehab, you will exercise at the rehab center. Members of your rehab team will carefully watch you to make sure you’re exercising safely.

A team member will check your blood pressure several times during exercise training at the rehab center. You also may need an EKG (electrocardiogram) to check your heart’s activity during exercise. This test shows how fast your heart is beating and whether its rhythm is steady or irregular.

Your exercise program will change as your health improves. After awhile, you will add at-home exercises to your plan.

FOLLOW A HEART HEALTHY EATING PLAN

Your rehab team will help you create and follow a heart healthy eating plan. This plan will help you reach your rehab goals, which may include managing your weight, blood pressure, diabetes, kidney disease, heart failure, and/or other health problems that your diet can affect.

You will learn how to plan meals that meet your calorie needs and are low in saturated andtrans fat, cholesterol, and sodium.

A dietitian or nutritionist may advise you on how to follow a heart healthy eating plan.

REDUCE RISK FACTORS FOR FUTURE HEART PROBLEMS

Your cardiac rehab team will work with you to control your risk factors for heart problems. Risk factors include high blood pressure, high blood cholesterol, overweight or obesity, diabetes, and smoking.

High Blood Pressure

High blood pressure raises your risk for future heart problems. The rehab team will work with you to reach the blood pressure goal your doctor sets. This goal will depend on factors such as your age and whether you have heart failure, diabetes, or kidney disease.

Exercising, losing weight, limiting how much salt and alcohol you consume, and quitting smoking can help you lower your blood pressure.

You may need medicine to lower your blood pressure if lifestyle changes aren’t enough.

High Blood Cholesterol

Too much cholesterol in the blood can cause heart disease. Your rehab team will work with you to lower high blood cholesterol.

Following a heart healthy eating plan, losing weight, exercising, quitting smoking, and limiting how much alcohol you drink can help lower cholesterol. Physical activity also can increase HDL cholesterol, which is “good” cholesterol.

You may need medicine to lower your cholesterol if lifestyle changes aren’t enough.

Overweight and Obesity

If you’re overweight or obese, your rehab team will help you set short- and long-term weight-loss goals. You can reach these goals by following the eating and exercise plans that the team creates for you.

Diabetes

If you have diabetes, your rehab team will work with you to control your blood sugar level. Following a heart healthy eating plan, losing weight, and exercising can lower your blood sugar level.

The doctor may suggest that you test your blood sugar before and after exercising to watch for numbers that are too high or too low. Your doctors will tell you what numbers to look for.

You may need medicine to lower your blood sugar level if lifestyle changes aren’t enough.

Smoking

Smoking is a risk factor for heart disease. If you smoke, quitting will help you avoid future heart problems. Quitting can help lower your blood pressure and keep your cholesterol levels healthy. You also should avoid secondhand smoke.

It may help to set a “quit date.” Some people find it helpful to enroll in smoking cessation programs or to seek counseling. Other people find acupuncture or hypnosis helpful.

Your doctor also can prescribe medicines to help you to quit smoking.

IMPROVE EMOTIONAL HEALTH

Psychological factors increase the risk of getting heart disease or making it worse. Depression, anxiety, and anger are common among people who have heart disease or have had a heart attack or heart surgery.

Get treatment if you feel sad, anxious, angry, or isolated. These bad feelings can affect your physical recovery. Depression is linked to complications such as irregular heartbeats, chest pain, a longer recovery time, the need to return to the hospital, and even an increased risk of death.

The cardiac rehab team needs to know whether you use alcohol or other substances. Alcohol can raise your blood pressure and harm your liver, brain, and heart. Seeking help is important. Group or individual counseling helps lower your risk for future heart attacks and death. It also may motivate you to exercise and help you relax and learn how to reduce stress.

People with heart disease who receive mental health treatment often show improvements in blood pressure, cholesterol, and other measures of physical health.

The rehab team may include a mental health specialist or be able to refer you to one. Without help from a professional, these problems may not go away.

Some communities have support groups for people who have had a heart attack or heart surgery. They also may have walking groups or exercise classes. Help with basic needs and transportation also may be available.

Counseling for Sexual Dysfunction

People with heart problems sometimes have sexual problems. The most common is less interest or no interest in sex. Impotence or premature or delayed ejaculation may occur in men.

Depression, medicines, fear of causing a heart attack, or diabetes can contribute to sexual problems.

Sexual activity is often safe for low-risk patients. The maximum heart rate during usual sexual activity is similar to other daily activities, such as walking up one or two flights of stairs.

Talk to your doctor if you’re having sexual problems and to find out whether sexual activity is safe for you.

Cardiac Rehabilitation

Heart Disease

WHAT TO EXPECT WHEN STARTING CARDIAC REHABILITATION

Your doctor may refer you to cardiac rehab during an office visit or while you’re in the hospital recovering from a heart attack or heart surgery. If your doctor doesn’t mention it, ask him or her if cardiac rehab might benefit you.

Rehab activities vary depending on your condition. If you’re recovering from major heart surgery, rehab will start with a member of the team helping you to sit up in a chair or take a few steps. You will work on range-of-motion exercises. These include moving your fingers, hands, arms, legs, and feet. Over time you will increase your activity level.

Once you leave the hospital, rehab will continue in a rehab center. The rehab center may be part of the hospital or in another place. Try to find a center close to home that offers services at a convenient time. If no centers are near your home, or if it’s too hard to get to them, ask your doctor about home-based rehab.

You will need to go to rehab regularly to learn how to reduce risk factors and to begin an exercise program.

HEALTH ASSESSMENT

Before you start your cardiac rehab program, your rehab team will assess your health. This includes taking your medical history, doing a physical exam, and performing tests.

Medical History

A doctor or nurse will ask you about previous heart problems, heart surgery, and any heart-related symptoms you have. He or she also will ask whether you’ve had medical procedures or other health problems (such as diabetes or kidney disease).

The doctor or nurse will want to know:

  • Whether your family has a history of heart disease.
  • What medicines you’re taking, including over-the-counter and herbal medicines. Describe how much, how often, and when you take each medicine.
  • Whether you smoke and how much.
  • How you check your blood sugar level, and how often you do it (if you have diabetes).
  • Whether you’ve ever had hypoglycemia. This condition can occur in people who take medicines to control their blood sugar level.

Your rehab team will ask questions to help them assess your quality of life and well-being.

Physical Exam

A doctor or nurse will do a physical exam to check your overall health, including your heart rate, blood pressure, reflexes, and breathing.

Tests

Your doctor may order tests to check your heart.

A resting EKG (electrocardiogram) is a simple test that detects and records the electrical activity of your heart. It shows how fast your heart is beating. It also shows the heart’s rhythm (steady or irregular) and the strength and timing of electrical signals as they pass through each part of your heart.

You also may need tests to measure your cholesterol and blood sugar levels. If you have diabetes, staff also will do an HbA1C test to check your blood sugar control. This test shows how well your diabetes has been managed over time.

Cardiac Rehabilitation

Heart Disease

WHAT ARE THE GOALS OF CARDIAC REHABILITATION?

The overall goals of cardiac rehab are to help you:

  • Recover after a heart attack or heart surgery.
  • Address risk factors that lead to coronary artery disease and other heart problems. These risk factors include high blood pressure, high blood cholesterol, overweight or obesity, diabetes, smoking, lack of physical activity, and depression and other emotional health concerns.
  • Adopt healthy lifestyle changes.
  • Improve your health and quality of life.

The rehab team will work with you to reach these goals. You will do this through increased daily physical activity, following a heart healthy eating plan, quitting smoking, and improving your emotional health.

INCREASED DAILY PHYSICAL ACTIVITY

Physical activity lowers your risk for heart problems, such as a heart attack. It helps reduce LDL (“bad”) cholesterol and increase HDL (“good”) cholesterol. It also helps control your blood pressure and blood sugar level.

Physical activity will help you improve muscle strength, flexibility, and endurance. It can help you lose weight, which can lower your risk for heart disease. Physical activity also helps you cope better with stress, and it may boost your sense of well-being.

Exercise training as part of cardiac rehab may not be safe for all patients. For example, people who have very high blood pressure or severe heart disease may not be ready for exercise training. These patients can still benefit from other parts of the cardiac rehab program.

FOLLOWING A HEART HEALTHY EATING PLAN

Improving your diet will help you control your cholesterol, blood pressure, and blood sugar. It also may help you lose weight if you’re overweight or obese, which is an important step for lowering heart disease risk.

The dietitian on your cardiac rehab team will help you create a personal eating plan.

QUITTING SMOKING

Quitting smoking will help you control cholesterol and blood pressure and lower your risk for heart problems. It also will make it easier for you to take part in physical activities.

IMPROVING YOUR EMOTIONAL HEALTH

Learning how to manage stress, relax, cope with problems, and build a social support network can improve your emotional as well as your physical health.

Some communities have support groups for people who have had a heart attack or heart surgery. They also may have walking groups or exercise classes.

Physical activity helps some people cope with stress. Other people reduce stress by listening to music or learning to focus on something calm or peaceful. Some people learn yoga, tai chi, or how to meditate.

There are many different types of “relaxation techniques” (ways to relax). By learning to relax and cope with stress, you can reduce your anxiety and lower your blood pressure, heart rate, and cholesterol.

This is true even if you don’t reduce other risk factors. Improving your emotional health can decrease your risk of death and future heart problems. It also can increase the chance that you will quit smoking and adopt other healthy behaviors.

Your rehab program also may offer individual or small group counseling to help you.