Heart Conditions

Patient Education from Capital Cardiology Associates

After a Heart Attack

This page discusses information you need to know after you have had a heart attack or myocardial infarction, including: warning symptoms, exercise, diet, medications, emotions, lifestyle changes, risk factors and community resources. If you or a family member has any additional questions or concerns, please feel free to discuss them with your doctor or nurse at any time.

After a Heart Attack

What are the warning symptoms?

After a heart attack, it is possible to have further heart problems despite expert medical treatment. Common warning signs that your heart is in trouble are:

• Pain different from angina, such as heavy pressure or squeezing in the center of the chest. This is often described as “an elephant sitting on my chest.” This pain may travel to the arm, jaw, neck, arms or back and be accompanied by sweating, nausea, vomiting, dizziness and heart palpitations, and a feeling that something is very wrong

• Shortness of breath or suffocation

• Swelling of legs, ankles, hands or face

• Sudden weight gain

• Unusual fatigue with activities that were previously easy for you

Anytime these symptoms occur, sit down immediately and rest. Use your nitroglycerin as prescribed. If the symptoms persist, call your doctor. If you cannot contact your doctor, call 911. If you are in the hospital and any of these warning symptoms occur, report them immediately to your nurse.

Exercise

As your heart continues to heal, you will slowly be able to be more active. Your doctor will monitor your activity level and decide how quickly you should advance. Exercises to strengthen your heart, such as walking, jogging, swimming, cycling and dancing, are recommended because:

• A heart strengthened by exercise can do more work using less oxygen.
• Exercise reduces blood pressure, stress, tension and cholesterol levels.
• Exercise makes you feel better mentally and encourages circulation.

General guidelines for a balanced activity program are:

• Consider a structured walking program, since walking is an excellent form of exercise.
• Increase your amount of exercise slowly, or as instructed.
• Exercise on a regular basis (5-6 times weekly) in activities you enjoy, such as swimming, walking, bicycling, etc.
• Avoid exercising to the point of exhaustion or in extremes of hot or cold weather.
• Exercise before eating or wait 1 1/2 – 2 hours after eating.
• Avoid strenuous activity such as push-ups, heavy weightlifting and heavy shoveling.
• Learn proper warm-up and cool-down exercises.

Diet

You will receive information on developing and maintaining a satisfying healthy diet that controls weight and cholesterol.

Lowering fats

Cholesterol is derived from foods with cholesterol or saturated fats. Foods high in cholesterol include: egg yolk, organ meats (liver, kidney, brains), whole dairy products, fatty meats and many lunch meats. Saturated fats include: coconut oil, palm oil, hydrogenated (hardened) oil, chocolate and solid animal fats from whole milk, butter, lard, ice cream and meat.

Triglycerides are formed from carbohydrate foods, including many sweets and desserts. If diet does not control your blood cholesterol, your doctor may order a cholesterol-lowering medication.

Sodium

Sodium (salt) can cause water retention in tissues of the body, which can increase your blood pressure. It is recommended that sodium be limited in your diet. There are several ways to flavor foods without adding excessive salt. The dietitian can help you with suggestions. Many processed foods, such as canned soup, contain excessive amounts of sodium. These amounts should appear on the containers’ labels.

Medications

Before discharge, you’ll receive extensive information concerning your specific medications. Please follow these general guidelines:

• Never take any medication, even aspirin, without first talking with your doctor.
• Carry a list of your medications in your wallet.
• Take this list to doctor appointments and to the hospital.
• Never discontinue, reduce or take a former medication without first speaking to your doctor.

Emotions

Having a heart attack can be a frightening experience. Many people also express disbelief when they are told they have heart disease or have had a heart attack. Some may become depressed and wonder if they will recover. These reactions are not uncommon or unreasonable. All of these emotions are a normal reaction to a life-threatening event. They may be experienced by not only you, but by your friends and family as well. None of these feelings is a sign of weakness. Sharing your feelings with those closest to you can reduce stress and strengthen relationships. If you are not comfortable sharing feelings with friends and family, please discuss them with your doctor, nurse or chaplain.

Lifestyle changes

Changes in health sometimes require changes in the way we live, our relationships with others, our social roles and our jobs. While change often requires effort, some people find that broad lifestyle changes may actually be less stressful than minor adjustments.

Relationships: The anxiety experienced during the diagnosis, treatment and daily living with an illness can affect relationships with family and friends. Anxiety over the future is common. Those closest to you can be overprotective or cope by denying the illness. Your role, whether it is breadwinner, housekeeper or family financial manager, may change or be temporarily put on hold. Routines of daily living can be disrupted and this can be a source of stress for all. However, illness can actually help you, your family and friends grow closer together. There are constructive ways to cope with these changes:

• Communicate: Encouraging open discussions of health concerns from both your perspective and others will ease stress and fears. Particularly with children, fear of the unknown can be very threatening. Encourage children to draw you pictures of what they feel is happening and to share that with you. Your doctor, nurse, or other health care giver will be happy to assist if you need help answering the many questions from loved ones.

• Share information: Information about your illness should be shared with those around you; for example, they should be aware of your diet, medication, prognosis, and activity level so they can understand and be supportive of the changes that need to be made.

• Seek support: If you or a loved one needs support or counseling, please share this with your doctor or nurse. Concerns about adjusting to your illness, returning to work, disability and changes in roles and routines may need the help of an expert. Our Clinical Social Work department can help in arranging home-health care or rehabilitation services, referrals for financial assistance and counseling to cope with adjustments in lifestyle. Call

• Sexual concerns: Sexual activity is not over just because you have had a heart attack. It is advisable to avoid anything that adds tension or stress to sexual activity. Avoid positions you find tiring or that causes angina. Wait for a few hours after a heavy meal and be rested before sexual activity. Let your doctor know if you are having angina pain or any unusual symptoms during or after intercourse.

• Home and work: At home and work you must learn to pace yourself, reduce stress factors and allow for periods of rest. If you examine your daily work habits, there are usually ways to simplify what you do: Avoid unnecessary trips on stairs. Organize your week to avoid doing all your hardest work on the same and entertainment. Use proper body mechanics to avoid straining, and work at an even pace. In the summer, work in the early morning or evening hours and in the shade. In the winter, dress warmly with several layers of light clothing and do not shovel snow or use a snow blower without your doctor’s permission.

• Health habits: It is never too late to start a healthy lifestyle. Good health habits help you feel better both mentally and physically for a sense of better well being.

Heart healthy suggestions

• Watch your weight and avoid fad or crash diets.
• Exercise regularly within your prescribed program.
• Don’t smoke and avoid second-hand smoke. (If you need help with quitting smoking, Capital Cardiology Associates has smoking cessation classes. Please ask for information or 518-292-6000.)
• Set aside time each day to relax.
• Learn how to manage stress.
• Knowing how to contact your doctor in case of warning symptoms and do not hesitate to call 911.

Risk factors

Risk factors are characteristics that increase the risk of developing coronary artery disease (CAD). Risk factors fall into two categories: those we cannot change and those we can. The risk of CAD can be reduced by modifying the risk factors we are able to change.

Risk factors that can be changed
• Smoking: Smoking strains your heart by increasing your blood pressure and making it beat faster. The ability of the red blood cells to carry oxygen also decreases and the artery walls become more sensitive to cholesterol. Tobacco of any kind – cigarettes, pipes, cigars or other tobacco products, causes cancer and lung disease. Please discuss the use of nicotine substitutes (gums, patches) at length with your doctor.
• Cholesterol: Cholesterol is the major component of the plaque found in arteries. Cholesterol can be reduced through diet and prescription medication.
High blood pressure: The work of the heart is greatly increased and the heart muscle can become thickened and enlarged when long-standing high blood pressure is present. Blood pressure can be lowered by diet, exercise, stress management and prescription medication.
• Diabetes: Studies have shown that atherosclerosis progresses more rapidly in people with diabetes. Diabetes can be controlled by diet and prescription medication.
• Obesity: Every pound of extra weight means your heart has to do extra work. Extra weight increases your blood pressure, cholesterol level and the risk of diabetes. You can reduce your risk of having another heart attack by losing extra weight and by keeping the weight off. Please discuss diet with your doctor.
• Stress: When you are under stress, your blood pressure goes up, your muscles get tense, your breathing becomes rapid and your heart beats faster. Exercise and stress management can reduce stress.
• Lack of exercise: Studies have shown that individuals who are less active are at greater risk for heart disease. Regular exercise (3-5 times a week) decreases your risk of heart disease and helps control weight, blood pressure, diabetes and high cholesterol levels.

Risk factors that we cannot change
• Heredity: CAD is more likely to develop in people whose parents, brothers or sisters have had the
disease at an early age.
• Sex: Men have a higher incidence of CAD than women, but after menopause a woman’s risk increases greatly.
• Race: African Americans are more at risk for high blood pressure, which greatly contributes to stroke and heart disease.
• Age: Risk of CAD increases with age.

Community resources

Home-health care agencies are organizations that provide skilled nursing care, home health aides, and physical, occupational and speech therapy, according to your doctor’s orders.

Questions?

We hope this page answers some of your questions and helps you better understand coronary artery disease, the recovery process and important lifestyle changes you can make for a healthy life. If you or your family has any questions or concerns, please discuss them with your doctor or nurse.

Angina

Angina (angina pectoris) is recurring discomfort, typically in the center of the chest, behind the breastbone. It usually lasts only a few minutes. It may take the form of feeling of heaviness, burning, tightness, oppressive pain, pressure or squeezing. It may sometimes spread to the arms, neck or jaws, or it may cause numbness in the shoulders, arms or wrists.

The symptoms in women may be less intense, last longer or appear in other areas of the body, such as the back, shoulders or neck. Shortness of breath and nausea may also occur in women.

Angina is caused by insufficient blood supply (and oxygen) to the heart muscle, especially during periods of exercise or emotional stress. In these periods, your heart rate and blood pressure increase and your heart muscle needs more oxygen.

Is angina the same as heart attack?
No. Although both conditions involve blood flow to the heart muscle, there is an important difference.

In angina, the blood flow is reduced. Permanent damage to the heart seldom occurs. In fact, the body can often increase blood flow to the heart muscle by expanding other arteries nearby and opening up tiny new branches to carry more blood to the affected area. This process is called collateral circulation and, if it becomes well developed, it can help reduce or reverse the symptoms of angina.

In a heart attack, blood flow is cut off suddenly by blocking of a coronary artery that supplies blood to the heart muscle. The heart muscle is often permanently damaged.

What causes angina?
Atherosclerosis (the narrowing of coronary arteries by deposits of fatty substances such as cholesterol) is the cause of angina and heart attacks. Atherosclerosis normally starts early in life and everyone has it to some degree by middle age.

Diagnosing angina
If you think you have angina, your doctor can usually make the diagnosis from your description of symptoms. Your physical examination and a resting electrocardiogram may be perfectly normal. In such cases, you doctor may recommend an electrocardiogram during an exercise test to determine if your heart muscle is getting enough oxygen. If the diagnosis of angina is still inconclusive, other tests may be recommended by your doctor.

Thallium stress test: In this procedure, a radioisotope (thallium) is injected into a vein and the blood flow to you heart is measured while you exercise.

Coronary arteriogram: This is an x-ray motion picture of the coronary arteries. Blood flow is made visible by a special that is injected into the arteries and is visible on the x-ray equipment. Narrowed or blocked arteries are easily identified, and the location and severity of blockage can be determined.

Medical treatment of angina
Nitroglycerin is effective in relieving or preventing chest discomfort caused by angina. Tiny tablets that dissolve under the tongue or a mouth spray are typically used.

Nitroglycerin tablets are inexpensive and they react quickly. They are safe and not habit forming, and they can be used as frequently as needed to relieve or prevent symptoms. Your doctor will recommend dosage and use for your specific condition.

Long-acting forms of nitroglycerin may also be prescribed, or your doctor may prescribe beta blocking drugs to slow your heart rate and lower your blood pressure. Other options include calcium blocking and beta blocking drugs to reduce blood pressure and heart rate.

Interventional procedures
If your angina can’t be controlled by medication, your doctor may suggest one of the following procedures:

• Percutaneous transluminal coronary angioplasty (PTCA)
• Stent insertion
• Coronary Artery Bypass Grafting

Heart Murmurs

Murmurs are sounds made by blood circulating through the chambers and valves of the heart or through the blood vessels near the heart. Your doctor can hear these murmurs by listening to your heart through a stethoscope.

When should I worry about a heart murmur?
Heart murmurs are common and may be heard in 20 to 30 percent of normal adults. Most murmurs are benign and are not associated with any structural abnormalities of the heart. These murmurs are sometimes referred to as innocent murmurs, functional murmurs, or physiologic murmurs.

Many murmurs are very soft. Your doctor may not always hear your murmur. Murmurs may also disappear and then reappear.

Should I have further testing?
When your doctor first hears your murmur, or possible change in your murmur, he may want to order an echocardiogram or ultrasound of your heart to rule out any problems with your heart valves.

Do I need to take antibiotics before surgical procedures and dental work, including routine dental cleaning?
Some surgical procedures, including dental cleaning, allow bacteria to temporarily travel in your bloodstream. If this bacteria lands on an abnormal valve, it is possible, though rare, that this may cause an infection called endocarditis. Taking a small dose of antibiotics before such procedures may prevent this potential infection.

Not everyone with a murmur needs to take antibiotics before surgical procedures. In most cases, you do not need to take antibiotics if your echocardiogram is normal. Be sure to ask your doctor if you need antibiotics.

Syncope

Syncope, or fainting, is a sudden and brief loss of consciousness from which recovery is spontaneous. Syncope is common and disabling, but its causes are difficult to diagnose. An important issue is distinguishing syncope from several other symptoms. Dizziness, presyncope, and vertigo do not result in a loss of consciousness. Vertigo is associated with a sense of motion.

Distinguishing syncope from seizure can sometimes be difficult. However, a loss of consciousness that is precipitated by pain, exercise, urination, defecation, or stressful events is usually associated with syncope and not seizure. Also, disorientation after the event, slowness in returning to consciousness, and unconsciousness lasting more than five minutes suggest a seizure.

Syncope often leads to hospital admission, multiple consultations, and the performance of many diagnostic tests.

What causes syncope?
The most common cause of syncope is a vasovagal attack – also termed neurocardiogenic syncope. Examples of vasovagal syncope include emotional fainting and situational syncope (caused by cough, urination, or defecation). Vasovagal syncope may also be associated with symptoms such as sweating, nausea, and a clammy sensation.

The mechanism that causes vasovagal syncope is not well understood, syncope may be caused by blood pressure falling excessively when a patient stands (orthostatic hypotension). This can be caused by dehydration and by certain medications, but is also common in older patients. Episodes of syncope in athletes who don’t have heart disease are usually vasovagal.

When should I worry about syncope?
The presence of heart disease – coronary artery disease, congestive heart failure, valvular heart disease or congenital heart disease – has emerged as the most important factor for predicting the risk of an adverse event. Although syncope may represent a simple fainting spell, syncopal episodes should be reported to your physician for evaluation and possible treatment.

Patients with heart disease and/or abnormal electrocardiogram have an increased risk of adverse events. Most arrhythmias are found in these patients. Since syncope caused by arrhythmias can be more dangerous, a more extensive evaluation may be required.

How is syncope diagnosed?
Syncope is diagnosed through:
• A careful history and physical examination
• An electrocardiogram
• 24-hour Holter monitoring

Additional diagnostic tests include:
• Echocardiogram
• Tilt-table testing
• Event recorder
• Electrophysiological testing
• Carotid artery ultrasound

Additional Reading

Read our brochure on Coronary Disease

Read our brochure on Heart Failure

Read our brochure on Heart Attack

Read our brochure on High Blood Pressure