LIFE AFTER MI

How to look after yourself after youve had a heart attack (myocardial infarction)

www.heartattacktreatment.co.uk

Life after MI
If you are reading this booklet after suffering a heart attack, congratulations you are a survivor! The experience of having a heart attack can be frightening, and even after leaving hospital many people feel worried about the future. But there is a great deal you can do to get back to normal life, and many forms of self defence you can take to keep yourself healthy for years to come. This booklet explains what youve been through, what you can do from now on to look after yourself, and why its important to take your treatment. More and more people are surviving heart attacks thanks to improvements in medical care. You now have a second lease of life so for the sake of yourself, your family and your friends, make the most of it!

What happens during a heart attack?

A heart attack is the common name for what doctors call a myocardial infarction (or MI). This occurs when the blood supply to the heart is blocked, causing part of the heart to be damaged. The heart is a pump, made out of muscle, which sends blood around the body to supply the cells and organs with oxygen and nutrients. It is a very efficient and reliable pump, as it is designed to work non-stop for the whole of your life.

But the heart itself is also an organ which needs blood to keep it working. The blood is supplied by the coronary arteries vessels which encircle the heart. A heart attack occurs when the blood flow through the coronary arteries stops completely. This is
The heart is a pump which beats over 2.5 billion times during an average persons lifetime

usually caused by a clot (a solidified plug of blood). If the flow is blocked for a long time the heart suffers an infarction (which means an area of muscle is so starved of blood and oxygen that it dies). In severe cases the person may die too.

The classic symptoms of a heart attack are a severe pain or crushing feeling in the chest, which may spread down the arm, but not everyone experiences this. Some people feel nausea, breathlessness, exhaustion, pain in the stomach or jaw, and they may feel clammy and sweat profusely. If you have suffered a heart attack, you will know how you felt! However, some people have only mild symptoms like heartburn or wind, and some have no symptoms at all (silent MI). This is more common in the elderly and in people with diabetes. It is important to recognise the symptoms of a heart attack because the first hour after it happens is a crucial period (sometimes known as the golden hour) when treatment is most effective.
The golden hour immediately after a heart attack is the most vital time to act

A heart attack can be confirmed by an electrocardiograph or ECG a machine with leads that are attached to the chest to monitor the heart and by blood tests. People who have suffered a heart attack are usually admitted rapidly to hospital and treated with a variety of medicines including a thrombolytic or clot busting drug, which dissolves the blood clot and helps clear the blockage. In some hospitals the clot may be removed by angioplasty. This is where a very fine tube (or catheter) is put into the coronary artery (usually via the groin) and a small balloon is inflated to widen the artery, then deflated so blood can flow to the heart again. A stent (rigid tube) may be left in place afterwards to keep the artery open. Many people recover from a heart attack and are discharged from hospital with no complications, but some people need surgery (such as a coronary artery bypass operation, in which the damaged arteries are by-passed), and some develop heart failure because the heart is not able to pump as efficiently as before. Abnormal heart rhythms may occur if the electrical activity of the heart is affected, and this may result in ventricular fibrillation (fast, uncontrolled heart beats) which is usually treated with an electrical shock delivered by a machine called a defibrillator. Before leaving hospital you will be thoroughly investigated to assess your health. These tests may include an echocardiogram (which shows how well the heart muscle is pumping), an exercise test (which shows if the heart muscle is getting enough oxygen, and whether there are any electrical changes when walking or running on a treadmill), and blood tests (which measure your levels of cholesterol, blood sugar, homocysteine an indicator of heart disease and how well your kidneys are working).

Why did it happen to me?

A heart attack can happen to anyone, but your chance of suffering a heart attack is increased if you have any of the following risk factors: Smoking High blood pressure (also known as hypertension) High cholesterol Lack of exercise A stressful job or lifestyle A bad diet, high in saturated fats Overweight or obesity Drinking too much alcohol Diabetes is also a major risk factor, caused by too much sugar in the blood. People with diabetes can lower their risk of a heart attack by controlling their blood sugar, lipids (e.g. cholesterol) and blood pressure. Coronary heart disease (CHD) occurs when the blood vessels become narrower due to a build-up of fatty deposits (known as atheroma). This restricts the flow of blood to the coronary arteries, and when the heart has to work harder during exercise or stress, not enough blood gets through to supply the heart muscle. This causes a pain in the chest known as angina.
View through a blood vessel, showing the build-up of fatty deposits inside the walls

Angina usually subsides if you rest or take medication, but it can be the warning sign of an oncoming heart attack. Other names for CHD include ischaemic heart disease (IHD) and coronary artery disease (CAD). For more information, see the booklet on Living with Coronary Heart Disease. All of these risk factors can be changed by treatment or by modifying your behaviour. You are also at higher risk if you have a family history of heart disease, if you are a man, or if you belong to certain ethnic groups (such as South Asian) but these are not factors you can modify. The message is simple: to prolong your life, change your lifestyle.

Can it happen again?

After a heart attack, many people recover well and go on to live normal, active lives. However, people who have had a heart attack are at increased risk of another one, because the factors listed above may still be present, and their heart may have been weakened by the damage it has suffered. So it is especially important that you reduce your risk factors as far as possible, and are aware of the symptoms of a heart attack and phone for medical help immediately if you suspect you are having one. About ten per cent of people who have had a heart attack will have another one within a year, but the risk drops to about three per cent every year after that.

If you experience these symptoms call 999 immediately Severe chest pain similar to angina, but more intense or longer lasting Pain travelling up into the jaw, and down the left arm, or down both arms Feeling sweaty, sick or faint

What should I do to help myself recover?

Most people who have survived a heart attack are given a rehabilitation programme to follow, which may include exercise classes, group therapy, stress management, and advice on changing their lifestyle. The heart muscle begins to heal within a few days of a heart attack, and most people are discharged from hospital after 5 to 7 days. The damaged muscle turns to scar tissue within 6 to 12 weeks, during which you should gradually increase your activity levels. Exercise helps the heart to recover and improves wellbeing. Always follow the advice of your doctor or nurse regarding exercise. Dont exercise too vigorously, and tell them if you have any problems. Most people return to their normal routine after 6 to 12 weeks. Here are some of the common questions people ask: When should I return to work? This depends on how stressful and physical your job is, and how serious your heart attack was. You should be ready after about 6 weeks, or 12 weeks if your job is more demanding. Can I continue driving? Yes, when you feel confident, but try to avoid long journeys and stressful driving conditions. The DVLA prohibits driving for 1 week after a heart attack in people who are successfully treated by angioplasty, and 4 weeks in those who dont have successful angioplasty. LGV/PCV drivers are prohibited for at least 6 weeks. See www.dvla.gov.uk for detailed information. Can I resume my sex life? Yes like any form of exercise, sex is good for the heart, but take things slowly at first. If you can walk briskly up a flight of stairs without suffering problems, you should be capable of sex.

How can I protect myself in the future?

Here are the most important steps you can take to improve your health and reduce your risk of a future heart attack: Stop smoking Stopping smoking can halve your risk of having a heart attack within a year of quitting and halve your risk of getting lung cancer within 10 years. As giving up is much easier said than done, ask your doctor, nurse or pharmacist for help. They can give you advice and information on nicotine replacement therapy (gum or patches), prescription tablets, local NHS stop-smoking groups and quit lines. Lose weight if you need to Work out your Body Mass Index by dividing your weight in kilograms by your height in metres squared (BMI=kg/m2). Or use a website to calculate your BMI for you, e.g. www.bdaweightwise.com/lose/lose_bmi.html (just enter your weight and height). If your BMI is 25 or more you are overweight, and if it is over 30 you are obese. The risk of heart disease is also greater in men with a waist measurement of more than 40 inches, and in women whose waist is more than 35 inches. Losing weight is well worth while because it reduces the strain on your heart, decreases your risk of diabetes, and eating a healthier diet brings benefits in its own right (see opposite).

Eat a healthy diet Eating a healthy diet can greatly reduce your chances of heart disease. Some of the best ways to improve your diet are to: Eat food low in saturated fat by having leaner and smaller cuts of meat and lower fat dairy products Eat food with a higher amount of unsaturated fats by using spread and oils based on olive, sunflower, rapeseed and corn oil Eat food containing omega-3 fats found in oily fish such as sardines, herring, mackerel, trout and salmon and certain vegetable oils, such as linseed, flaxseed, walnut and rapeseed Eat more fruit, vegetables, nuts, seeds and pulses Base meals around wholegrain starchy carbohydrates such as wholemeal bread, cereals, rice, pasta and chapati Eat less salt as this can raise blood pressure. Avoid adding salt at the table and in cooking, and avoid eating salted peanuts and crisps

Fruit and vegetables

Lean meat

Saturated fat

Soya products (soya milk, yoghurts and meat substitutes), plant stanols and sterols (added to certain margarines, yoghurts and mini-drinks), oats, beans and nuts may actively reduce cholesterol. Try and include more of these in your diet.

Eating a healthy diet will also help to reduce cholesterol and triglycerides. For more information, see the booklet on Lipids and Cholesterol Explained. Drink alcohol in moderation People who drink a small amount of alcohol appear to have a lower risk of heart disease than those who dont drink at all. But make sure you drink no more than 21 units in a week (or 3-4 in a day) if you are a man, and no more than 14 units in a week (or 2-3 in a day) if you are a woman. Exercise regularly Regular exercise is recommended for most people who have had a heart attack, as physical activity is good for the heart, and is a major way to reduce the risk of another heart attack. But check with your doctor before beginning an exercise programme. Start off with a short walk each day, gradually increasing your distance if you feel OK. Then see if you can manage moderate exercise that gets you slightly out of breath such as brisk walking, jogging, swimming, cycling or dancing. Try taking the bus instead of the car, and take the stairs instead of the lift or escalator. You should aim for at least 30 minutes of moderate exercise on most days. Remember your medication Drug treatment is given to most patients, as medicines can reduce the risk of another heart attack by as much as 25 per cent. The treatments offered may include aspirin (to thin the blood), a beta-blocker (to slow the heart), an ACE inhibitor (to reduce blood pressure and treat heart failure), a lipid-lowering drug such as a statin (to reduce cholesterol and prevent atheroma) and an omega-3 fatty acid preparation. Some patients also receive medicines to treat abnormal heart rhythms or heart failure.
But remember that wine can be as strong as 14%, and many bars serve large glasses of wine (175ml, around 2 units) as standard. One unit of alcohol is approximately: One small glass of wine (125ml, 9% alcohol by volume) or half a pint of beer (285ml, 4% alcohol by volume).

Take control of diabetes If you have diabetes it is especially important that you eat well and take medication if necessary to control your blood sugar. Take time to relax Learn relaxation skills to help manage stress, anxiety and depression which can contribute to CHD. Listen to your heart and listen to your doctor! Your heart may not be as strong as it was before your heart attack, so watch out for any signs that it is under strain. Try to follow the advice provided by the doctor or nurse, and make sure that you take all your medication as directed by your GP. You may have to take some medicines for the rest of your life, but remember that they are designed to make your life as long and as full as possible!

Where can I find out more?

Your doctor or nurse should be the first point of contact if you have questions about your individual health. But if you want to find out more about your condition, here are some organisations which provide useful information in booklets or websites:
The British Heart Foundation (www.bhf.org.uk) Heart Helpline 0300 330 3311 H.E.A.R.T UK (www.heartuk.org.uk) 0845 450 5988 Bodytalk-Online (www.bodytalk-online.com) For support in stopping smoking: Quitline (www.quit.org.uk) 0800 002200 NHS Smoking Helpline (http://smokefree.nhs.uk/) 0800 022 4332 For support in weight loss: British Dietetic Association Weight Wise website (www.bdaweightwise.com)

Other booklets from Abbott Healthcare Products Ltd.

High Triglycerides and Type 2 Diabetes

Lipids and Cholesterol Explained

Caring after a Heart Attack

Living with Coronary Heart Disease

Healthy Eating after a Heart Attack

May 2011

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