Cardiac Rehabilitation After Your Heart Attack - Gloucestershire ...

C a r d i a c R e h a b i l i t a t i o n
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The printing of this book has been sponsored by an educational grant from Pfizer.
G l o u c e s t e r s h i r e H o s p i t a l s N H S T r u s t
GHPI0128/07/03
Contact: Cardiac Rehabilitation Unit
Review due: September 2004

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The printing of this book has been sponsored by an educational grant from Pfizer.
Online Version
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Summary
This booklet is designed to give you general guidance on recovering from your
heart attack. You should receive more specific advice during your hospital stay. If
you would like more specific advice following your return home, please contact
the rehabilitation nurse.
Acknowledgements
This booklet was first produced by the Gloucestershire Cardiac Rehabilitation
Team in 1999 and has been updated annually since. It was last updated in
September 2003. The information reflects the latest research evidence and
guidelines.
Written and produced by
Gloucestershire Cardiac Rehabilitation Team
Contributions to this booklet have been made from cardiac rehabilitation team
members past and present.
Gloucestershire Hospitals NHS Trust. September 2003.
Contents
1 Contents
2 Introduction
3 What is a heart attack?
5 What is angina?
6 What to do if you think you’re having angina
7 Cardiac rehabilitation
8 Risk factors for coronary heart disease
9 Making changes
11 Smoking
12 Hypertension
13 Cholesterol
14 Guidelines for a healthy heart
16 Weight
17 Alcohol
18 Exercise
20 Stress
22 The first few weeks at home
24 The next few weeks – getting back to ‘normal’
24 Driving after a heart attack
25 Resuming your sex life
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26 Back to work
27 Going on holiday
28 Take regular exercise
29 Thoughts and feelings
31 Medication
32 Summary
32 Acknowledgments
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Introduction
This booklet has been written by the Gloucestershire Cardiac Rehabilitation
Team. It aims to give you the information you need to help you make the best
possible recovery after your heart attack. It should answer many of the questions
that you may have. The information contained reflects the latest evidence
available to help you make informed choices about your recovery.
During your hospital stay the ward nurses and members of the cardiac
rehabilitation team will advise you further.
This booklet is designed to give you guidance for the first few weeks following
discharge from hospital. There is a lot of information, so you may want to read
it over a period of time. You can take this booklet home with you and refer to it
over the next few weeks.
If you have any questions about your rehabilitation once you are home, you can
contact the rehabilitation nurse who will be happy to discuss your concerns.
Your Cardiac Rehabilitation Nurses are:
Cheltenham General Hospital
Alison Anderson
Catherine Fern
Phone 08454 223535
Gloucestershire Royal Hospital
Julia Harrison
Chrissie Jones
Phone 08454 226893
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Medication
Following a heart attack, you will be prescribed medication to reduce your risk
of having another cardiac event. This is called secondary prevention medication.
You will get the benefits for as long as you take them, so you may be on these
for life. These medications include Aspirin, Beta Blockers, ACE Inhibitors and
Cholesterol Lowering Medication. Even when you feel better you will still benefit
from taking these medications.
Preventative medication
Aspirin
Aspirin reduces the risk of your blood clotting in the narrowed blood vessels
supplying your heart muscle. You should take your aspirin with food to reduce
the risk of it causing irritation to the lining of your stomach.
Beta Blocker
Beta blockers reduce your blood pressure and heart rate and therefore reduce
the amount of work that your heart has to do.
Cholesterol lowering drug (Statin)
Statins will lower your cholesterol level. Whilst on this medication you will need
to have a blood test every year to check your liver function. You should report
any signs of muscle fatigue, weakness or pain to your doctor as this can be a side
effect of the medication and will need to be investigated if it occurs.
ACE Inhibitor
This drug helps to reduce the workload that your heart has to cope with.
You may be prescribed a number of other medications in addition to these to
control any symptoms you may have. The most common of these is a Nitrate.
Symptom Control Medication
Nitrate
Nitrates relax your coronary arteries and allow the blood to reach the heart
muscle more easily. They also help to reduce the workload of the heart. Nitrate
tablets may be prescribed regularly to prevent angina attacks. Your GTN spray is
a nitrate. It works the same way as the tablets but gives you a smaller dose very
quickly, to relieve angina symptoms when they occur.
It is important that you understand what medications you are taking and
why you are taking them. If you are unsure, please ask your doctor, nurse or
pharmacist.
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What can I do about these feelings?
Try and get them in perspective: sudden feelings of sadness happen to most
people, they almost always fade over time. If they only happen occasionally, and
most of the time you feel OK, it is best to accept them as part of getting better.
It is a stage that most people have to go through. Remind yourself that although
the sadness is unpleasant it is not dangerous.
Feeling anxious
The next time you feel anxious or upset, note what you are thinking. Write down
the thoughts.
Look at your thoughts and try to identify whether any action can be taken
to sort them out. For example, worrying about whether your car is going
to break down could be reduced by getting the car serviced and joining a
breakdown service.
Next, try to substitute more reasonable objective thoughts, e.g. tell yourself
you are unlikely to break down as you have just had your car serviced, and
if you did, the breakdown service would get you to your destination, and
provide you with a hire car until the problem is solved.
It may help to imagine what someone else might say or think, someone
reassuring.
The aim of this exercise is not to stop having negative thoughts, but to be less
worried by them and to find ways of reducing their power by challenging them
with alternative ways of viewing the situation.
Think positively: don’t let negative thoughts stop you appreciating the positive
things in your life.
What is a heart attack?
(The medical term for a heart attack is a myocardial infarction, or MI)
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Your heart is a large, hollow muscle, which continuously pumps blood around
the body. The heart muscle needs its own blood supply to work properly. The
coronary arteries carry blood (and therefore oxygen) to your heart muscle.
Coronary artery
(Fig. 1. Heart and coronary arteries)
Over a period of time, usually many years, the coronary arteries can become
narrowed. They are usually narrowed because "fatty deposits" (atheroma) are
laid down in the lining of the coronary artery. This process is called coronary heart
disease.
Fatty deposits
(Fig. 2. Coronary arteries with 'fatty deposits')
When you have a heart attack, one of these fatty deposits breaks open and a
blood clot forms over it, blocking your coronary artery. If one of your coronary
arteries is blocked, an area of your heart muscle does not get any blood or
oxygen and is permanently damaged. This is what was happening when you
experienced your symptoms of a heart attack.
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Blood clot
(Fig. 3. Blood clot formed over ruptured 'fatty deposit')
When you came into hospital you may have been given a drug to dissolve the clot
and allow the blood supply back to your heart muscle. This type of ‘clot busting’
drug is called Streptokinase or TPA. You would have been assessed individually as
to whether these drugs were appropriate for you.
blocked coronary artery
damaged heart muscle
(Fig. 4. Blocked coronary artery and area of damaged heart muscle)
Usually a heart attack causes severe chest pain but occasionally people can have a
heart attack and experience very little pain at all. By the time you read this book
the doctors will have confirmed that you have had a heart attack.
Thoughts and feelings
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The way we think is important in determining how we feel. Feeling anxious
or miserable is often accompanied by negative thoughts. Challenging these
thoughts is an important first step in managing negative feelings.
Feeling fed up
Feeling fed up or sad is common after a heart attack. These feelings usually go as
time passes. They can range from the occasional feeling of sadness or tearfulness
to absolute despair. All these symptoms are common:
Loss of interest in things that Tearfulness
were once enjoyable Poor appetite
Sadness No energy for doing things
Early waking Loss of interest in appearance
These symptoms are unpleasant, not dangerous. However, if they interfere with,
or take over your life, they are called depression. Depression affects the way you
think, you can only see the bad side of things. Previously enjoyable things can
seem flat and dull. It is all too easy to imagine the worst when you are depressed.
For example:
"I’ll probably have another heart attack."
"I’ll never work again."
"This will last forever."
The chances are that none of these things will happen. If you are feeling
depressed, the slightest setback or difficulty may lead to thoughts of complete
disaster.
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After the first few weeks at home
Over the last 6 – 8 weeks you should have been gradually increasing your
activity. For most people now is the time to begin regular exercise. The cardiac
rehabilitation programme aims to help you with this and other aspects of your
recovery and you are encouraged to attend. If you have not been given a date to
start, please contact your cardiac rehabilitation nurse.
What sort of exercise is best?
Your exercise should be Aerobic. Good examples of aerobic exercise include:
walking, cycling, swimming and dancing.
What is enough exercise?
Research shows that you need a minimum of 20 minutes of moderate aerobic
exercise, five times a week to obtain the best benefits. We recommend daily
exercise whenever possible. The 20 minutes does not include the warm up and
cool down. Pace yourself and gradually work up to the 20 minutes. It may take
some weeks before you reach this level.
Warming up and cooling down
Warm up
This should last at least 10 minutes and should consist of gentle exercises or slow
walking, gradually increasing in intensity. The warm up will prepare you for
exercise by:
Gradually increasing your pulse and breathing rates
Enabling you to do more exercise before you feel tired
Reducing your risk of having angina. If you are prone to angina, you should
find with a proper warm up you are able to do a lot more before the angina
starts
Cool down
This should last 5-10 minutes and consist of gentle exercises or slow walking
gradually decreasing in intensity. The cool down will:
Allow your pulse and breathing rates to gradually slow down and return to
normal
Reduce the chances of you feeling stiff or aching after you exercise
If you have been exercising and stop suddenly without cooling down you may
feel dizzy and faint.
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What is Angina?
Angina is the name for the symptoms experienced when your heart muscle is not
getting enough oxygen and blood to meet its requirements. This usually occurs
when "fatty deposits" (atheroma) are laid down in the lining of the coronary
artery slowing the flow of blood to your heart muscle. Both angina and a heart
attack are symptoms of coronary heart disease but not everyone who has a heart
attack will have angina. Having angina does not mean that you will have another
heart attack.
How do I know if I have angina?
The symptoms of angina vary for each person. There are a number of factors
which might suggest that the pain or discomfort you are feeling is angina. While
it is important that you never ignore chest pain, or discomfort, it is sensible to
consider other causes such as indigestion or muscle pains.
The points below should help you to decide:
Angina can be triggered by physical exertion, emotional upset or cold
weather.
If angina is triggered by exertion it is often eased by rest.
Angina is often but not always felt across the chest.
Angina is commonly described as a discomfort, ache, tightness, heaviness,
pressure or burning sensation around the chest area. It is not always a pain.
You may have pain or discomfort in the neck or throat or down one or both
arms. This may be in addition to chest discomfort or these may be your only
symptoms of angina.
The feeling may be like indigestion and be experienced in the upper part of
the abdomen. The symptoms may be similar to the pain you experienced
when you had your heart attack, but less severe.
If the pain or discomfort is eased by GTN spray, it is most likely to be angina.
GTN spray doesn’t usually help any other kind of chest pain.
What to do if you think you are experiencing angina
You will need to see your GP if you experience any new symptoms which you
think may be angina or if your existing angina starts to become more frequent.
Keep a diary of the pain / discomfort you experience, what you were doing at the
time, how long it lasted, and what you did about it. This will help you and your
doctor decide if the symptoms you are experiencing are angina or something
else.
Angina does not damage your heart muscle in the same way that a heart attack
does. Angina symptoms mean that your heart is not getting as much blood and
oxygen as it needs. Your GTN spray will help by relaxing your coronary arteries
and letting the blood flow to the heart more easily.
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What to do if you think you’re having angina
Sit down if possible
(If you have been exercising, keep your feet moving)
Try taking a couple of deep breaths and try to relax
Use your GTN spray/tablet as directed. (Usually two sprays under your tongue)
If the symptoms haven’t eased within 5 minutes, take your GTN spray/tablet
again
If the symptoms haven’t eased after another 5 minutes, take your GTN spray/
tablet a third time
If after 15 minutes you still have chest pain/discomfort and you’ve had no relief
from your GTN spray/tablets, dial 999 and ask for an ambulance.
DON’T DELAY
If you think you’re having another heart attack dial 999,
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Going on holiday
There is no reason why you should not enjoy a holiday after a heart attack.
Remember to pace yourself. You may gain confidence to tackle longer journeys
by having a short break first.
Planning
Planning is the key to a successful holiday. Plan your journey to allow for rest
breaks and plenty of time to reach your destination. You may consider stopping
overnight to break up a long journey. Ensure you have enough medication to last
the whole holiday. It may be useful to keep a written list of what medication you
are taking – you should be able to get a printed list from your pharmacist. It may
help to write a list of all the things you need to do or pack for your holiday so
that there are no last minute hitches.
If you have a holiday booked please discuss this with the cardiac rehabilitation
nurse who can advise you further.
Flying
There is no reason why you shouldn’t fly after a heart attack. Most airlines insist
you wait at least 3 weeks. Please check with the individual airline.
Holiday insurance
It can be difficult to get reasonably priced holiday insurance following a heart
attack. It is possible but you may need to shop around extensively. Your cardiac
rehabilitation nurse can provide more information if you require this.
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Back to work
After your heart attack, many factors will determine how soon you return to
work. These include the type of job you do, the hours you work, your physical
and psychological recovery. The ‘right’ time to return to work is very individual
and you should be honest with yourself and your employers about how you are
recovering.
We recommend at least six weeks off work. Many people find they need longer
than this. It is advisable to discuss your return to work with your employer well
in advance. This will not only help you to prepare but will help your employer to
plan for your return and provide any support necessary. As with everything else
it is advisable to pace yourself where possible. One example is to return to work
for a couple of days a week at first, or to work shorter days for the first couple of
weeks. You will obviously have to negotiate this with your employer.
If your employer would like any more information or advice on supporting your
return to work, ask them to contact the cardiac rehabilitation nurse.
If your job is physically demanding, you can use your time off work to increase
your activity and exercise levels gradually, to help prepare for your return to
work. Remember that pacing is the key to a successful return to work. Even a
less physically demanding job can be tiring and stressful. Remember your stress
management and relaxation techniques. For more specific advice please speak to
your cardiac rehabilitation nurse.
Money Matters
If you would like advice about money matters while you are off work, and any
money you may be entitled to, you can contact the social services help desk on
01452 426868 for more information.
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Cardiac rehabilitation
Having a heart attack is a very stressful event for you and your family. It
has an effect on the things you do and the way you think and feel. Cardiac
rehabilitation aims to give you all the information and support you need to
make the best possible recovery. You will be seen in hospital by the cardiac
rehabilitation nurse who will discuss your initial recovery with you and your
family and help prepare you for the first few weeks at home.
What is the Cardiac Rehabilitation Programme?
The cardiac rehabilitation programme consists of 7 weekly sessions, each lasting 2
hours. Most people are ready to start about 4 - 8 weeks after their heart attack.
You will be with a group of about 10 people who have had a heart attack or
heart surgery. You are welcome to bring your partner or a friend if you wish.
Each week you will be advised by an exercise professional, psychologist and nurse
on all aspects of recovering from a heart attack. The dietitian will attend one
session.
You will be given the most up to date information and have the opportunity
to discuss your progress. You will also have the opportunity to take part in
supervised exercise sessions. We know from research, that following cardiac
rehabilitation, people are able to do more, feel less stressed and enjoy a healthier
lifestyle. It is possible for you to reduce your risk of having another heart
attack and it is possible to improve how well your heart muscle works. Cardiac
Rehabilitation aims to give you evidence based information to help you do this.
How do I join?
A member of the cardiac rehabilitation team will explain the rehabilitation
programme in more detail. You are encouraged to attend the programme which
is specifically for people like yourself.
If you agree to join the programme, you will receive your invitation,
questionnaire and more details about the programme approximately two weeks
before you are due to start.
If you have any concerns at all, please don’t hesitate to discuss them with the
cardiac rehabilitation nurse.
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Risk factors for coronary heart disease
Risk factors are things that we know will make you more likely to have a heart
attack. Risk factors are often related to your lifestyle and are therefore in your
control. You can do something about them.
Risks you can change
Risks you can’t change
smoking age
high blood pressure family history
high cholesterol levels gender
lack of exercise
prolonged stress
obesity
diabetes
excess alcohol
You may want to tick the ones that apply to you. If you have any of the risk
factors that you can’t change it is even more important to look at the ones you
can change.
By adopting a healthy lifestyle and reducing your risk factors you can greatly
reduce your chances of having another heart attack.
Having more than one risk factor doesn’t just double the risk of having another
heart attack. For example, smokers with high blood pressure and high cholesterol
levels are eight times more likely to have a heart attack than a non-smoker with
normal blood pressure and cholesterol. Reducing one risk factor can have great
benefits and with time, reducing as many risk factors as you can, will give you the
best chance of making a full recovery.
People with diabetes have an increased risk of developing coronary heart disease.
It is particularly important that your diabetes is well controlled and that you
reduce any other risk factors you have. Ask your cardiac rehabilitation nurse for
more specific advice.
Making changes in your lifestyle can be stressful. Before you make any changes
read the next section for further advice.
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Resuming your sex life
Sex is an important part of life for many people. It should continue to be so after
a heart attack. During sexual intercourse your heart rate and blood pressure rise,
as they do with any other form of exercise. The rise in blood pressure and heart
rate during sexual intercourse with your usual partner is roughly equivalent to
that experienced when climbing two flights of stairs or walking a mile at an easy
pace!
Having a heart attack is a very stressful event for you and your partner. Resuming
sexual activity may be the last thing on your mind or it may be very important for
you. It is natural to have concerns and it is important for you and your partner to
discuss your feelings and to share any worries you may have.
Approach your return to sexual activity the same as with any other exercise and
pace yourself. You may wish to regain your confidence and closeness by kissing
and cuddling, and progress from there when you feel ready. Some points you
may want to consider when resuming sexual activity:
Make sure you feel relaxed beforehand but not too tired
Familiar surroundings may help you to feel more relaxed
Make sure your bedroom is not much colder than the rest of the house
Avoid sexual activity immediately after a heavy meal or after drinking more
than a couple of units of alcohol.
Impotence
Impotence can sometimes be a problem after a heart attack. The stress of having
a heart attack may be the reason for this. It can however, be a side effect of
a type of medication called a beta blocker, which is commonly prescribed. If
impotence is a problem for you, please discuss this with your doctor or cardiac
rehabilitation nurse, who will be able to advise you.
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"Back to normal"
Driving
For drivers of private cars, the DVLA states:
After a heart attack:
Driving must cease for at least four weeks.
Driving may recommence thereafter providing there is no other disqualifying
condition.
DVLA need not be notified.
If you have angina:
Driving must cease when symptoms occur at rest or at the wheel.
Driving may recommence when satisfactory symptom control is achieved.*
DVLA need not be notified.
*If you are in any doubt about your suitability to drive please discuss this with
your GP or cardiac rehabilitation nurse.
Insurance
You should inform your insurance company that you have had a heart attack or
heart surgery before you return to driving.
When you do return to driving, remember to pace yourself. Start with a short
familiar journey, at a time when the roads are quiet.
HGV / PSV licence holders
For drivers of heavy goods vehicles and passenger service vehicles, the DVLA
state that after a heart attack, you are "Disqualified from driving for at least six
weeks."
Before you can reapply for your licence, you will be required to undergo an
exercise test and will need to meet certain requirements from this. Please ask
your cardiac rehabilitation nurse for further information.
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Making changes
Decide what you want to change: this will be different for everyone but may
include giving up smoking, reducing fat in your diet, taking more exercise, eating
more fruit and vegetables etc.
Prioritise: one thing at a time. The easiest one could give you confidence to
tackle other things. Some people may prefer to tackle things with obvious results
like losing weight. Different things work for different people.
Set goals: make sure they are achievable, e.g. I want to walk half a mile each
day.
Keep a diary: before you make any changes, get to know more about your
behaviour by writing down as much as you can. For example, about smoking:
write down how you are feeling, who you are with, where you are etc. when you
have a cigarette.
Think of ways of doing things differently: if you are feeling fed up, rather than
heading for the biscuits, go for a walk, share your feelings with your partner or
give someone a ring and have a chat.
Taking the next step
Having decided what you want to change, the next step is how to change. One
way is by focusing on one of the following:
Frequency
For example: if you go to the pub four times a week, you might reduce this to
three times a week. You may decide to have cheese twice a week instead of
three times. You may decide to go for a walk three times a week instead of once.
Intensity
For example: you might still go to the pub four times a week, but have a shandy
or halves instead of full pints. You could have half the amount of cheese, but still
have it on four occasions a week.
Time
For example: you could go to the pub four times a week and still drink pints of
bitter, but go later in the evening, so that you would spend less time there.
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What to do when you have a setback
Very few things ever go completely to plan. Set backs are bound to happen when
making changes. Try to anticipate potential set backs and plan how you’re going
to cope with them.
Making Changes
When you have decided what behaviour you want to change, keep a diary and
see if you can identify anything that relates to that behaviour that could help
you to change. Remember to start with just one area of change.
Think about some of the changes you may like to make. Write them down below.
Example 1
Example 2
I want to walk a mile each day
I want to stop smoking
Good luck with making changes to your lifestyle.
Pacing yourself is the key to a successful recovery.
Please note:
Don’t exercise if you feel unwell, e.g. have a cold or flu.
Wait at least an hour after a meal before you go for a walk.
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If extremely cold weather brings on symptoms of angina, you may have to
avoid going outside at this stage on particularly cold days.
In extremely hot weather you may tire more easily.
Always remember to pace yourself.
If you do get chest pain
Stop exercising but keep your leg muscles working by moving your feet
Take 2 or 3 deep breaths
If discomfort remains consider using GTN spray (see page 5)
Activities to avoid at the moment
Avoid heavy lifting for about three months after your heart attack. That is any
weight that is almost too heavy for you to pick up and which makes you hold
your breath, e.g. for some people this may be lifting heavy washing, or carrying
heavy shopping bags. Avoid any activity that involves a short sharp effort
that makes you grunt: e.g. shovelling snow, heavy digging, mowing the lawn,
hoovering, pushing or tugging as hard as you can against an object. For instance
pushing a car, prising open a jammed window.
Remember your ability to return to these activities increases over time as you
regain your fitness. When you do return to these activities remember to pace
yourself.
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The first few weeks at home
For the first few days at home you should take things easy, doing not much
more than you were doing in hospital. You can introduce light activities such as
washing up and preparing light meals. You may feel tired at this stage, so set
time aside each day to rest or sleep. You may use the stairs as often as you need
to.
Increasing your activity.
After the first few days, you should gradually begin to increase your
activity. Walking is an important part of your rehabilitation. Daily walking is
recommended. Everyone is different, so you will need to progress at a rate that
is right for you. Your cardiac rehabilitation or ward nurse will discuss this in more
detail with you before you go home.
Start with something easy, a few minutes walk at a pace that is comfortable for
you. Do that for 2-3 days until you feel quite confident with it. Then increase
your walking time slightly. Again stay at this level for a 2-3 days and once you
feel comfortable, increase your time again. It is important that you pace yourself.
You will have good days and bad days. Avoid the temptation to see how much
you can do on a good day. You will only succeed in making yourself extremely
tired for the next day or so. If you pace yourself and increase your activity
gradually you will be able to do more in the long term.
Continue to increase your activity over the next few weeks. If you are unsure
about how you are doing, contact your cardiac rehabilitation nurse for more
advice.
What is too much activity?
You are working too hard if:
You are too short of breath to say your telephone number including the area
code, out loud without gasping. If this happens, slow down until you can say
your telephone number without gasping.
You become excessively tired. (Either during or some time after exercise /
activity.)
You have chest pain or discomfort (angina).
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Smoking
Stopping smoking after your heart attack is the single most important thing
you can do to reduce your chances of having another one and to increase your
chances of making a good recovery. Smoking is responsible for over a third of all
deaths from coronary heart disease. Smoking after a heart attack will increase
your chances of:
Having another heart attack by 2-3 times.
Having angina, or making your existing angina
worse.
Being readmitted to hospital or needing to see
your GP.
Smoking interacts with other risk factors for heart
disease. The risk of high blood pressure and high
cholesterol levels are doubled in smokers. There is no
safe level of smoking. Cutting down does not reduce your risk of having another
heart attack.
Why is smoking harmful to your heart?
There are two main components of tobacco smoke, which are harmful to your
heart.
Nicotine: increases your heart rate and blood pressure, this makes your heart
work harder and it needs more oxygen to do this. You may have been prescribed
drugs (e.g. a beta blocker) after your heart attack, to slow down your heart rate
and lower your blood pressure. Smoking directly counteracts the benefits of this
drug. Nicotine can make your blood more likely to clot and this increases your
risk of having another heart attack.
Carbon monoxide: attaches itself to the red blood cells in your blood. Red blood
cells carry oxygen around your body. If they are bound by carbon monoxide they
cannot carry as much oxygen to your heart. This makes you more likely to suffer
from angina.
Stopping smoking completely is the most effective way to stop. We do not
suggest that you try to cut down first. If you are stopping smoking, you may find
that you do not want to make other big changes in your lifestyle until you feel
you have this under control.
If you’re a smoker, please speak to your cardiac rehabilitation nurse who can
advise you further and provide you with more information.
No matter how long you have been smoking, it is never too late to stop.
Stopping smoking has immediate benefits.
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High blood pressure (Hypertension)
A certain pressure is necessary to keep the blood flowing around the arteries of
the body. Blood pressure changes throughout the day, in response to what you
do.
Your blood pressure is recorded as two numbers. The top number (systolic) is the
blood pressure in your arteries when your heart is beating. The bottom figure
(diastolic) is the pressure in your arteries when your heart is resting between each
beat. It is measured in millimetres of mercury (mmHg). You will need to have
your blood pressure checked a few times before it can be confirmed as being
high.
What should my blood pressure be?
The most recent evidence suggests that after a heart attack it is important that
your blood pressure is lower than 140/85mmhg (lower if you are diabetic). This
will reduce your risk of having another heart attack.
What you can do to reduce your blood pressure
Learn to manage your stress
Stop smoking
Lose weight
Reduce salt intake
Take regular exercise
Keep alcohol intake within recommended limits
Take your prescribed medication
If you are prescribed medication to help lower your blood pressure, remember
that lifestyle changes are still just as important.
Try some alternative "low stress" ways of working.
Don’t take on more than you can possibly do.
Be satisfied with what you’ve achieved.
Say ‘no’ to people.
Have more relaxing things to do.
Don’t spend all your time rushing from one thing to the next.
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Be clear about what you can achieve and don’t try and cram more in.
Prioritise: write down the things you have to do, decide which are the most
important things, be realistic, and don’t punish yourself if you don’t get
everything done.
Pace yourself and take rest breaks.
Think positively and challenge worries.
Look at the things you do daily. What can you do in a more relaxed
way?
Stress management is a skill. Practice, as with any other skill, improves your
ability to use it. The most important thing is to keep working at it, so that you
learn.
Think about whether you have developed a habit of tensing up, for example
when you concentrate, or when you are driving. If so, use these situations as a
signal to relax.
Remember that preventing the stress response is most important. It is much
harder to deal with stress when it’s reached its peak.
It may be that despite all your efforts, your stress level has increased. If the level
of stress you experience is interfering with your life, it might be a good idea to
seek additional help from your family doctor.
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Effects of stress
Most people have some of these symptoms after a heart attack:
Physical. These include butterflies or tightness in the stomach; palpitations;
cold clammy hands and feet; tense, sore muscles; rapid pulse rate; dry mouth;
not being able to sit still; restlessness; problems sleeping.
Emotional. These can include flaring up at little things, irritability and bad
temper; feeling tearful or angry; not feeling in control of your emotions.
Thinking. These include problems concentrating and remembering; making
decisions; racing thoughts; lack of self confidence; feeling that you are going
mad or that your personality has changed.
How to spot stress
One of the problems about stress is that you may be the last person to notice it.
To other people you may seem like this:
always rushing
unable to make decisions or stick to them
forgetful
tense
hate sitting doing nothing
always critical of others or self
lost your sense of humour
impatient
sudden changes of mood
nag
quick to flare up
don’t really listen to others
Managing stress
Learning to manage stress, in combination with becoming physically fitter, can
reduce the risk of having another heart attack and improve your quality of life.
Stress management, in particular relaxation training, has been shown to be
effective in reducing high blood pressure.
The first steps to managing stress are:
Identify the things that cause stress, and change what can be changed.
Become better at managing stress in particular situations.
Learn relaxation skills to help reduce background levels of stress.
Learn ways to relax and to control stress.
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Cholesterol
Cholesterol is a fatty substance carried in the blood stream. It is mainly produced
by your liver. It plays an important role in the structure of cells and in making
hormones. High cholesterol levels are associated with a build-up of fatty deposits
in the coronary arteries. Reducing your cholesterol level after a heart attack
reduces your risk of a further heart attack, angina, or the need for surgery. The
amount of cholesterol you produce can be affected by what you eat, by other
lifestyle factors and by hereditary factors.
There are two main types of cholesterol:
HDL - ‘Good’ cholesterol – Acts as a scavenger, removing excess cholesterol
from the blood stream, taking it to the liver where it is removed from
circulation.
LDL - ‘Bad’ cholesterol – Responsible for the formation of fatty plaques in the
coronary arteries.
What should your cholesterol level be?
After a heart attack or heart surgery your total cholesterol level should be less
than 5mmol/l or reduced by 20-25% whichever is the lower number.
There is now evidence that even if your cholesterol is under 5mmol/l to start with
you will still benefit from reducing it further.
What you can do to improve your cholesterol level
Stop smoking
Exercise regularly
Keep alcohol intake within recommended limits
Lose weight
Continue cholesterol lowering medication if prescribed
Maintain a low fat diet
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Healthy eating
What you eat plays an important role in coronary heart disease. It can influence
your cholesterol level, your blood pressure and your weight. All these are risk
factors for coronary heart disease. Certain foods may actually help to protect
against heart disease. Research shows that by following these guidelines you can
reduce your risk of having another heart attack.
Guidelines for a healthy heart
Eat More Oily Fish
Eating at least two portions of oily fish per week (4-6oz) per week reduces your
risk of having another heart attack. Oily fish include: Sardines, Mackerel, Sprats,
Herring, Pilchards, Trout and Salmon. Fresh, frozen, smoked or tinned varieties
can be included. It does not matter whether the fish is tinned in brine, oil or
tomato sauce – it is eating the FISH that is important.
If you are unable to eat oily fish regularly, fish oil supplements can protect your
heart in the same way. An omega-3 fish oil supplement labelled as giving a total
of 500-1000mg of 'EPA and DHA' (two of the key omega-3 fatty acids) per day,
is equivalent to eating two to three portions of oily fish a week. These can be
bought from chemists, health food shops and larger supermarkets.
If you eat oily fish regularly, we do not recommend that you take the fish oil
supplements as well.
Eat More Fruit and Vegetables
Try to eat five portions of fruit / vegetables a day. These contain a large variety of
components that protect the heart.
A ‘portion’ is 80g which is roughly equivalent to a small handful e.g.
One medium apple / banana / orange
2 medium plums
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Stress
When you experience stress your body produces adrenaline. Adrenaline is a
useful chemical that makes you more alert and helps you cope with what you
have to do. However, too much adrenaline can make you feel wretched and can
increase your heart rate and blood pressure.
We all need a certain amount of stress to get us going. If we never had any
pressure to get things done we’d soon get listless and depressed. Life would be
dull and boring. It’s when things get so stressful that we feel we can’t cope any
more that life stops being enjoyable.
Most people believe that a sudden shock or being under a lot of pressure can
cause a heart attack. A row with someone, a crisis that is soon over, may make
your heart beat faster but won’t cause a heart attack.
When does stress become a problem?
Stress becomes a problem when there is a high level of these stress chemicals
in the blood, most of the time. It is the effects of prolonged periods of stress
that contribute to heart disease. Prolonged stress can also reduce your ability to
fight illness. It can lead to bad temper, worry and a number of unpleasant bodily
feelings. It is one of the causes of eating, smoking and drinking too much.
Causes of stress
Hassles. These can be frequently occurring, annoying irritations such as
getting stuck in traffic, kids leaving their things all over the house, problems
with neighbours, pressure at work. Hassles contribute to higher stress levels
than anything else.
Life events. These are usually major changes in your life, such as having a
heart attack, being made redundant, a bereavement, getting married or
divorced, a new baby, a new job. Change, whether for the better or the
worse, can cause stress.
Emergencies. Things that occur which are unpredictable and out of your
control, such as a burglary, a burst pipe or a road traffic accident.
Things that we do to ourselves. Setting impossible deadlines, never being
satisfied with what we’ve done, always rushing, not keeping fit, not having
enough enjoyable things to do, being a workaholic, being unable to say
"NO".
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Exercise
Lack of regular exercise makes it more likely that you will develop heart disease.
Your heart is a muscle and needs moderate exercise to keep it strong. Having an
active job is not the same as exercising regularly. There is a difference between
being active and being fit.
There are many benefits of exercise. Some are outlined below.
Your heart will benefit by becoming stronger and it will work more
effectively.
You are less likely to have angina if you exercise regularly and your breathing
and circulation will improve.
Regular exercise can help you to lower your blood pressure and lose weight.
Regular exercise can help improve your cholesterol, by raising the level of
H.D.L. "good cholesterol" in relation to the level of L.D.L. "bad cholesterol".
Regular exercise reduces your risk of other diseases such as osteoporosis and
stroke. It improves immunity and there is less likelihood of colds and general
illness.
Regular exercise helps you feel better about yourself by giving you increased
self-confidence and a sense of well being. It can help you to relax better and
sleep better. It will make you feel less tired.
In the long term you should be aiming to exercise for 30 minutes, 5 times a week
at a rate that is right for you. You will need to build up to this level gradually
over the next few weeks and months.
2 kiwi fruits
a slice of melon
one heaped tablespoon of dried fruit
3 heaped tablespoons of carrots / peas etc
2 spears of broccoli
one 150ml glass of fruit juice.
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Fat
The aim is to eat less saturated fats and what fat you do eat should be from
foods high in unsaturated fats especially mono unsaturated fats.
Saturated fat
Saturated fat is found in: dairy products, meat and meat products such as burgers
and sausages, pastries, cakes and biscuits, coconut and coconut oil and palm oil.
It is the saturated fat in your diet that is converted to cholesterol by your liver. It
is therefore particularly important to reduce this type of fat in your diet.
Dairy Products: Full fat dairy foods are high in saturated fats. However it is
important to eat dairy products regularly as they provide an excellent source of
calcium. Try reduced fat varieties e.g. skimmed or semi-skimmed milk and low fat
yoghurt. Low fat cheeses contain less fat than their full fat equivalent but can
still provide quite a lot of saturated fat if eaten every day.
Unsaturated fat
Monounsaturated fats are found in olive oil, rapeseed oil and peanut oil. They
are also found in avocados, almonds, hazelnuts and oily fish.
Polyunsaturated fats are found in sunflower oil, cornflour oil, grapeseed oil and
safflower oil. They are also found in nut, seed and soya oils or spreads, and all
oily fish.
What type of oil should I use?
We would recommend olive oil or rapeseed oil for regular use.
What type of spread should I use?
We recommend you use an olive oil based margarine or one which is labelled
‘high in monounsaturates’.
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Weight management
If you are overweight your heart has to work harder to carry the excess weight
and therefore it is under constantly increased strain. Being overweight is
therefore a risk factor for coronary heart disease. It is associated with high
cholesterol, high blood pressure and diabetes, so by reducing your weight even
by a modest amount, you may also help reduce these other risk factors.
Losing weight is not always easy. It is a good idea to keep a food diary for a week
to see exactly what you do eat. From this you can begin to plan the changes you
want to make. Then you need to set yourself realistic goals for losing weight.
To reduce your weight you need to eat fewer calories. Try having smaller
portions, use low fat products and fill up on fruit and low calorie snacks instead
of biscuits.
Weigh yourself once a week on the same scales and at the same time of day. You
may find losing weight easier if you join a club or if a friend also tries to lose
weight with you. Get the support of your family and friends.
Combining regular physical activity with a healthy diet is the best way to lose
weight. Be realistic about the amount of weight you wish to lose. Losing 5-
10kg (11-22lb), and keeping if off, is realistic for many people and will give you
worthwhile health benefits.
Remember it is much more important to increase your level of physical fitness
and to follow the guidelines for healthy eating than to lose weight.
Height:
My ultimate goal is:
I intend to achieve this by:
Goal 1:
Goal 2:
Goal 3:
Weight:
There are scales on the ward for your use. If you are unsure about your ideal
weight please ask your cardiac rehabilitation nurse who will be able to advise
you.
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Alcohol
There is evidence to suggest that a moderate amount of alcohol is good for
your heart. However drinking in large amounts can cause problems. If you enjoy
drinking alcohol in moderation there is no reason why you should stop. If you
do not drink alcohol or have been advised to stop drinking alcohol for other
reasons, then we don’t suggest that you start.
Guidelines for Sensible Drinking
Drinking within the following limits should not be harmful to your health.
Women:
Men:
What is one unit of alcohol?
1 small glass of wine
a maximum of 2-3 units of alcohol per day.
a maximum of 3-4 units of alcohol per day.
1⁄2 pint of ordinary strength beer, lager or cider.
1 pub measure of spirits
1 small glass of sherry
1 single measure of aperitif
This is only a guide.
Remember a home measure of alcohol is often a lot more than that of a pub
measure. So be honest when calculating your intake! If you feel it will be difficult
for you to cut down, please speak to your cardiac rehabilitation nurse or your GP
who will be able to advise you further. Alcohol in moderation shouldn’t interfere
with medications you take for your heart. If you are in any doubt, please speak
to your pharmacist.
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