The heart, like every other muscle, needs oxygen. When the blood flow that supplies that oxygen is severely reduced or blocked completely, a heart attack occurs — this is technically known as a myocardial infarction (MI).

This happens to someone about every 42 seconds in the United States.

Given the seriousness of a heart attack, it’s expected that survivors experience psychological effects. Depression is common, and fear and anxiety of another heart attack may also come into play. At the same time, some may experience a new lease on life, having dodged a bullet.

IN-HOSPITAL RECOVERY

Recovery is usually determined by how severe the heart attack is. In the simplest cases only one coronary vessel is blocked, and it is treated quickly so there’s minimal damage to the heart muscle.

If the heart function is normal, those patients can be discharged from the hospital quickly, usually within four to six days.

When there is more damage, either because the patient doesn’t get to the hospital quickly enough or because there are more arteries involved, it’s more complicated. In these cases the patient will normally stay in the hospital longer as we’re assessing heart function and identifying the right medication to help heal the heart.

The most severe level occurs when the patient has multiple blockages and needs bypass surgery. In that case their hospitalisation and recovery are going to be much more complicated.

AFTER DISCHARGE

Once the emergency is over and the survivor is discharged, treatment will almost always involve medication and lifestyle changes to slow the progression of atherosclerosis and reduce the risk of developing blood clots. In most cases cardiac rehabilitation is also prescribed.

Stop smoking cigarettes. I always counsel patients that the use of any kind of tobacco has to stop. That’s mandatory.

However, that is easier said than done because of the addictive properties of nicotine. You may need professional help from a counsellor to help with your smoking cessation.

Choosing a heart-healthy diet is equally important. The American Heart Association recommends a diet that limits saturated and trans-fats, sodium, added sugars, and red meat. A healthy eating plan should include fruits and vegetables, whole grains, low-fat dairy products, skinless poultry, legumes (dried beans and peas), non-tropical vegetable oils, and unsalted nuts and seeds.

It is important for MI survivors to complete in-patient and out-patient cardiac rehab. Cardiac rehab has been shown to lower mortality in patients who have a heart attack. I like to get patients started right away. If they’re in pretty good health, I really encourage them to start as soon as possible.

Patients who have bypass surgery will have to wait a little longer. But usually I like to have them start within the first couple of weeks after surgery.

After rehab, being physically active most days of the week is essential. If you need to lower your cholesterol or blood pressure, aim for 50 minutes of moderate-to-vigorous physical activity three times per week or 30 minutes five times per week.

Medication is an important part of post-MI treatment. Generally, anybody that comes in with a heart attack due to atherosclerosis should get some kind of cholesterol-lowering medication. MI survivors should also take a baby aspirin every day, and if they’ve had a stent, they need an additional anticoagulant or antiplatelet medication to prevent clots from forming within the stent.

Because most survivors have high blood pressure, they will usually be on at least one medication to control it. But even without hypertension, after an MI, medication that lower blood pressure, such as ACEI and beta blockers, may be recommended due to the damage to the heart. There are a lot of different parts to recovery, but when you add them all up it translates to large reductions in both complications and mortalities.

AVOIDING ANOTHER MI AND HOSPITALISATION

Nobody wants a second MI or another hospital stay, but about 18 per cent of survivors are readmitted. Survivors can certainly improve their chances of recovery and avoid readmissions by taking the recommended actions of their medical team seriously and sticking to them.

An important step is to make, and keep, a follow-up appointment with the cardiologist. I usually like to see them within two weeks after being discharged to make sure they’re tolerating all their medication. Often patients are going from no medication to having a regimen of six or more. Psychologically that’s a blow as well, because it makes people think they’re really sick. But that may be what it takes in order to minimise the risk of recurring problems.

Patients should come to their follow-up appointments armed with questions; talk with their doctor about any symptoms they are having so the doctor can either reassure them it’s nothing serious, or so the doctor can be aware of the situation and monitor it.

Are there any side effects from medications? Anticoagulants and antiplatelet drugs can cause bleeding, and blood in the stool can be a symptom. Is there increased shortness of breath and swelling in the ankles? Those are some of the things that your doctor needs to be aware of.

After such a traumatic incident, often including having chest pain, MI survivors may become acutely concerned with any pain in their chest. Most chest pain does not indicate an MI, but the question is how to know if that chest pain is another heart attack or heartburn or something else.

Another heart attack will feel similar to the first one. If it feels very different — if it’s a sharp pain, if it’s focal, if it’s transient, lasting only seconds, that’s not the heart. Heart pain would be heaviness, tightness, pressure, burning, an ache that’s more diffused, and that typically lasts minutes or longer and gets worse with exertion and better with rest.

Dr Claudine Lewis is an adult cardiologist and medical director at Heart Smart Centre in Montego Bay. She is also a cardiologist at the Cornwall Regional Hospital and an associate lecturer with the University of The West Indies. Questions may be sent to questions@heartsmartcentre.com and for additional information call 684-9989 or visit the website www.heartsmartcentre.com.