Thriving After a Heart Attack

If you've had a heart attack, you're probably wondering how your life is going to change.

Jerome L. Fleg, M.D., a cardiologist and geriatric medicine specialist in Baltimore, has some good news: "There is no reason why a person should not get back into a normal routine after a heart attack," he says "There are very few limitations, and even those have exceptions."

Over the long term, your quality of life is tied to how severe your heart attack was and how it was treated. Beyond that, any change will depend largely on you. If you make it happen, your life can be healthier and more active than before. Work with your doctor on a plan.

Recovery and prevention

"The most serious obstacle to having a healthy life after a heart attack is doing nothing," says Stuart J. Glassman, M.D., a fellow of the American Association of Cardiovascular and Pulmonary Rehabilitation. Dr. Glassman works with heart-attack patients in Concord, N.H.

"Heart attacks are a result of life patterns and an accumulation of problems over time. The next one could be fatal," Dr. Glassman says. That's why it's crucial to change.

The first step, Dr. Glassman says, is to work with your doctor to find the cause of your heart attack. "This could be a matter of being overweight, of smoking, of a lack of activity, diabetes, high cholesterol and abnormal lipid profile, metabolic syndrome, hypertension, or stress." A combination of factors may be to blame. Once you know what put you at risk, he says, you need to follow your doctor's recommendations for cutting that risk. "A heart attack doesn't remove the risk. So prevention is an important part of recovery," he says.

Other experts agree. "After a heart attack," says Kerry J. Stewart, Ed.D., "your risk for heart attack becomes two or three times greater than it was before." That doesn't mean, though, that the second heart attack has to happen. Dr. Stewart is a Baltimore exercise physiology expert. There are five strategies you and your doctor can use to make your life healthy:

  • Stop smoking.

  • Change your diet.

  • Become more physically active.

  • Undergo angioplasty or surgery.

  • Take your medicine.

You may need surgery to fix damage to heart muscle or angioplasty or surgery on the blood vessels that put you at risk. But surgery by itself is never enough. "Unless you make changes in the lifestyle that caused the damage in the first place, the problems will simply reappear," says Dr. Stewart.

Make healthy choices

How can you move toward a healthier lifestyle?

"Stopping smoking is the single most important thing a person can do," Dr. Stewart says. If you smoke, ask your doctor about programs that help you stop.

Exercise strengthens your heart muscle so it can pump blood more easily and strengthens other muscles so the heart doesn't have to work so hard. It can help you lose weight, lower your blood pressure, decreases stress, and decrease your cholesterol levels. A routine that focuses on aerobic exercise for 30 minutes a day at least three days a week should be your minimum goal., says Dr. Glassman. Aerobic exercise—the type that raises your heart rate—can be as easy as a brisk, 30-minute walk. Start slowly and follow your doctor or rehabilitation specialist's advice.

Dr. Fleg warns that arthritis or other problems may make some exercises tough. But that doesn't mean you shouldn't be active. Your doctor or a rehabilitation expert can help.

If walking is too painful, try a workout that doesn't stress the joints. Ride a stationary bike, for instance, or swim. "Research shows that people in a supervised program of physical activity after a first heart attack reduce their risk of dying from another heart attack by 25 percent," Dr. Stewart says. Talk with your doctor about the safest way to start.

Diet changes can help lower your cholesterol level, weight, and blood pressure. Dr. Glassman says you should avoid high-fat foods and shift to a leaner diet higher in fiber and possibly lower in salt. That means more fruits and vegetables, fewer eggs, and less butter and red meat. A dietitian can help you spot and change unhealthy eating patterns.

Don't be afraid of having sex after a heart attack. As with other activity, you may have to start slowly and gradually work into your normal habits. Some of the medications you may take after a heart attack can affect your interest in sex or the ability to have an erection or orgasm. Talk to your doctor about when you can begin to have sex or if you think medications may be causing problems.

After a heart attack, medicine is important for lowering cholesterol and controlling blood pressure. Make sure you understand when and how to take your medicine, and take it as instructed. Talk with your doctor if the medicine causes problems for you. Don't change or stop medication use on your own. Stopping suddenly can be dangerous with some medicines.

If stress is a factor in your life, it can increase your blood pressure, increase your heart rate, and make your heart disease worse. If you are under stress from work or home, get advice on stress reduction techniques or see a counselor for suggestions on how you can reduce your stress or change your response to stressful situations.

Why rehab programs matter

Cardiac rehabilitation programs aim to help people who have had a heart attack make the changes they need for a healthy lifestyle. In a rehab program, health professionals will work with you to show you how to watch your blood pressure, help you stop smoking, alter your diet, and set up an exercise routine.

"Most people who have had a heart attack get a great deal of benefit out of a cardiac rehab program," Dr. Fleg says. "Rehab helps the person who has had a heart attack take control of his or her own recovery. And taking control is what will make recovery work."

The goal of rehab, Dr. Stewart says, is to form habits that will make and keep you healthy. "There's almost no reason anyone can't start a rehab program as soon as they're released from the hospital," he says. If your doctor hasn't talked with you about a cardiac rehabilitation program, says Dr. Stewart, you should ask about it.

Recovering from a heart attack means changing your life in positive ways—not smoking, lowering cholesterol, controlling blood pressure, staying active, and forming partnerships with health professionals. Those steps don't just reduce your risk and fear of another heart attack. They also make life healthier and more fun.

The role of family

Family members can help a heart-attack patient recover and live a healthy life.

"Family members are a major part of the environment and are very important in the process of recovering," Dr. Fleg says. Husbands and wives can exercise together, for instance. "It provides support and encouragement and it can be beneficial to the partner as well."

The family can also help by joining recovering kin in a healthy diet, encouraging them to complete a rehab program or quit smoking, and reminding them to take medication.

Family members can also watch a person's mood and mental well-being, Dr. Stewart says. Depression is common after a heart attack. If it doesn't start to ease within a few weeks, it can hinder recovery and cause the person to avoid vital, positive steps. Relatives should encourage efforts to get help and call the health care provider right away.

But doctors say family members can also hamper recovery. "If a family member smokes," Dr. Glassman says, "it makes it hard for the person who has had a heart attack to stop smoking." Other lifestyle habits that contribute to a heart attack, such as lack of exercise and a high-fat diet, can be family patterns.

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