Your Specialist : Heart Attack and Rehabilitation

What happens after heart attack?

A heart attack can be a real frightening experience, especially for those who had always been healthy.

Soon after a heart attack, the heart begins to heal through the formation of scar tissue and tiny new blood vessels. The scar tissue strengthens the damaged muscle. With 2 to 3 weeks of a heart attack, new arteries called collateral vessels (natural bypass vessel) near the damaged area may develop. If may take months for the natural collateral circulation to form.

Once the first few days are over, the chances of a second heart attack are not great and as time passes by, chances become lesser. To minimize the chances of recurrence medicines like aspirins and betablockers may be used.

After the first heart attack further coronary risk stratification is done mandatorily. After a heart attack few tests are undertaken to detect patients at risk of getting second heart attack. These tests are usually done a few weeks after attack. Stress test or ETT (exercise test) and echocardiography can identify patients who are at risk and require further diagnostic tests such as CAG i.e. coronary angiogram. A group of patients found to be diseases after initial assessment will require to undergo baloon angioplasty with or without stinting (PTCA with stint or without stint) or CABG (coronary artery by pass grafting) after heart attack.

How much rest is necessary after heart attack and what about exercise?

If a heart attack has not been a serious or severe one, mild form of exercise after heart attack don't do any harm rather has the advantage that the rest of the body doesn't get out of condition. If on the other hand, a heart attack patient suffer from much breathlessness or other difficulties, prolonged rest may be advised.

One may be apprehensive about exercise after heart attack. But in fact, heart is a muscle and like any other muscle in the body, needs exercise to keep it in proper working condition. Exercise, its type and intensity will be told to the patient by the doctor, attending nurse and physiotherapist. However, the exercise would be gentle initially and will increase gradually in intensity as the patient feels like getting back strength and confidence.

One should continue exercise following discharge from the hospital. Before taking daily exercise the after attack patient should warp up warmly and avoid going out on cold or windy days. He should wait atleast two hours after a heavy meal. If chest pain is experienced or if breathlessness occur during exercise - one should put off the exercise then and there and consult the doctor for advise.

Exercise is a life long activity. As told earlier, like any other muscle in the body, the heart needs exercise to keep it fit and run properly. To have a beneficial effect on the heart, one should exercise atleast three times a week for approximately 30-40 minutes.

Should one do house hold chore and everyday activity?

As soon as one feels fit and able light household chore like dusting and washing up may be undertake. Working in the garden like nursing the plants and watering etc. may be allowed. However heavy work like digging and heavy lifting should be avoided for sometime.

For everyday work physical activities should be increased gradually as weeks go by. One should not be afraid to break stairs or going out of the house. Initially one may tire easily in the early stage following heart attack. But this is quite expected and with slow and gradual exercise and other daily activities it will pass.

What about driving ?

People who make an uncomplicated recovery after heart attack will be able to resume driving in about four weeks time. However, if pain is experienced while driving or at rest, even after midication doctors consultation is advised.

Can one fly after suffering heart attack?

Most civil aircrafts are pressurised, the cabin pressure is held at a level equivalent to an altitude of 5000-6000 feet. Though this has no or little effect on normal individual, it could make a after heart attack patient, who has not yet fully recovered, breathless. However, the rule of thumb is that if the patient can walk 100 meters on the flat without symptoms two to three weeks after the attack, it is safe to fly. Much of the stress of flying for a patient is due to the problems on the ground rather than in the ground such as hurrying along he endless corridors currying heavy bags, hassle in customs and immigration and climbing steep aircraft steps are much more likely to cause symptoms than the flight itself. These difficulties can be largely overcome with the help and co-operation of the airlines and by employing porters carry bagges.

How about getting back to work?

It is usual that most people will be able to return to their previous work. This may be as early as six weeks after the heart attack. However, this depend upon the fact that the work is not physically demanding or there are only lights duties involved.

Is sex advisable?

Sex is no different from any other type of exercise. It will not put added stress on the heart. However, there is potentially higher risk of stress during extra marital affairs if you are.

What about smoking?

Smoking should be stopped once for all immediately. Tobacco smoke damages the heart and the vessels as they contain poisonous substances such as nicotine and carbon monoxide. Smoking kills the heart.

What food one should take after a heart attack?

One should always try to eat healthy food containing less fat, sugar and salt but more fibre. To reduce total fat intake we should follow the above guideline. More over saturated fat should be replaced with a healtheir alternative- that is poly unsaturated or monounsturated fat. Foods containing low saturated fat are Margarines Corn oil, Sunflower oil, Safflower oil, Olive oil, Fish, Chicken and Turkey, Cottege cheese, Skimmed semi-skimmed milk. It is better to eat learn meat, fish plenty of vegetables and fruits and also fibre rich starchy foods like whole meal bread, rice, pulses, potatoes etc.

What about Alcohol?

A small amount of alcohol i.e. one or two once a day may not be harmful. Heavy consumption, however, increases weight and blood pressure. It may cause damage to liver and even heart.

Post operative couple of months

This is the time when you may go back to the hospital for an OPD appointment with the surgeon or cardiologist. It allows your doctors to assess the progress of your recovery and to review your medications.

Normally ECG, Echo and chest X-rays and some blood test for lipids, sugar and creatinine are done at the time of your hospital visit.

Return to work

the timing of return to work depends on the kind of work involved. As a general rule, patients with light, occupations can consider returning to rowk anytime from around 9 months after the operation. Those who have heavy manual occupations may not be able to return to work for atleast 3 months after the operation to give time for the muscles, bones and joints of the chest wall to complete their healing process. The decision to return to work should be taken in consultation with the concerned surgeon and cardiologist.

Warning signs after heart surgery

Many of the aces, pains and feelings are normal part of the recovery process after heart surgery. If any of the following signs develop then it is advised that you should contact your family physician :

a) new palpitation

b) severe shortness of breath

c) Excessive sweating

d) Sudden visionary disturbance.

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