LIFE AFTER A MYOCARDIAL INFARCTION
Overnight, you found yourself in a hospital room and were told that you had had a heart attack. Your doctor then shared a lot of information about your health and told you that you need to make important changes to your lifestyle.
Where to start?
You are not the only one feeling helpless by this unpredictable event.
A few years ago, people who had heart attacks were called“cardiacs”. The oldest of you will remember visits to a “cardiac” uncle or aunt. It was hardly possible to breathe in their house. We couldn’t make noise, whisper, move ...
This time is over. It is over thanks to undisciplined patients who did not respect the instructions to stay put and make no efforts. Over time, the medical profession found that these patients lived better and longer.
Today, we aim for a return to regular activities quickly. There are even people who will say they are in better shape after "their" heart attack than before! Cardiovascular rehabilitation centers are becoming increasingly popular, even in the more rural regions.
In addition to the importance of medication, healthy lifestyle and exercise, we will discuss everyday concerns:
● Return to daily activities
● Return to work
● Sexual health
That being said, by familiarizing yourself with your new prescribed medications, knowing the characteristics of your new heart condition and getting some good tips on how to improve your lifestyle, you will have all the tools you need to live well after a heart attack.
First, you have to understand what happened.
Remember that with any form of intense chest pain, with or without significant sweating ornausea, we must call 911.
Emergency medical technicians (EMTs) are often well able to diagnose heart attacks as soon as they arrive.
If this is the case, they quickly begin procedures on the patient. Although the patientis made aware of the different steps, sedation, nervousness and especially pain limit his understanding.
It is therefore normal not to have fully understood what is happening to him.
Let's review some basic notions of the disease.
What is a heart attack?
Myocardial infarction, commonly known as a "heart attack", is a result of the clogging of an artery in the heart.
The heart region that is irrigated by this affected artery lacks blood to nourish and adequately oxygenate the heart cells.
It is at this moment that the pain is felt by the patient. Different heart problems can occur at this point: arrhythmias, heart failure, valve dysfunction, etc.
Obviously, this urgent condition must be taken care of quickly.
Urban Hospital Center
In large urban centers, these patients are referred directly to a specialized cardiology center to perform actions to clear the affected artery.
The sooner this maneuver is performed after the symptoms appear, the less likely it is that the heart will suffer from this episode.
Regional Hospital Center
In more rural areas, patients are referred to the nearest hospital. Adjunctive therapy is administered rapidly to melt the clot in the coronary artery.
The patient may then be transferred to a specialized hospital is always possible in case this therapy does not give the expected results.
A scar on the heart
Unfortunately, in many cases following a STEMI-type infarction, a scar may be detected on the heart in the obstructed artery region. This may cause a slight decrease in cardiac performance compared to normal.
To better understand myocardial infarction, please refer to this link:
In the vast majority of cases, the noticeable consequences following a heart attack will cause very little or no symptoms in the future.
Fortunately, it is recognized that lifestyle changes with respect to diet, physical activity and stress management can significantly improve the quality of life by reducing the risk of experiencing symptoms resulting from myocardial infarction or a recurrence.
Following myocardial infarction, some medication has been prescribed to you by the attending physician during your stay at the hospital.
Although you may not want to take so many medications, they are essential to keep your heart healthy. It is therefore very important to take them according to the dosage indicated and not to stop them without the advice of a health professional who is well aware of your medical condition.
You can check the main drugs prescribed, their desired effects as well as their potential side effects from the pharmacological component.
The main classes of drugs used are:
● Antiplatelet drugs
● Angiotensin Inhibitors (ARA)
● Angiotensin enzyme inhibitors (ACEIs)
Once again; it is important to always talk to your doctor before stopping any of the above medication because of the side effects.
Several factors can lead to myocardial infarction. Obviously, we have no control over the genes we carry, but it is still possible to reduce the impact of these predispositions by modifying certain behaviors. Your overall health will even be improved.
More and more, we recognize the health conditions that are risk factors for developing myocardial infarction:
● High blood pressure
● High cholesterol
● Sedentary lifestyle
● A diet low in vegetables and whole grains and rich in processed products and saturated fats
● Lack of sleep
● And especially smoking
The common point of the elements mentioned above is inflammation.
The role of Inflammation
Inflammation is the reaction of our immune system to an alteration of our protective barriers.
It is an important phenomenon in some cases because it allows the healing of damaged tissues and the defense against foreign organisms that could invade our body.
For example, after accidently cutting a finger with a knife, our immune system secretes certain chemicals. This causes scarring while destroying bacteria that might have entered the skin
Inflammation is therefore essential for occasional healing, but is not desirable on a chronic basis. The problem is that the body sometimes does not differentiate between these types of injuries and those that are inflicted on our bodies voluntarily or involuntarily depending on our lifestyles:
● Inhalation of toxic substances in tobacco,
● Exposure to toxic molecules in the environment,
● Unhealthy diet causing diabetes or cholesterol,
● The rise of stress hormones,
● Damage to the arteries caused by high blood pressure,
Chronic inflammation in the coronary arteries
When the inflammation persists every day of our life and when it causes the secretion of the chemical substances which should be found on a very occasional basis, our arteries in our body become very fragile. These are then more likely to be invaded by cholesterol, and atheroma plaques eventually form. These plaques can crack and activate blood clotting and eventually become clogged causing clot formation.
Hence, inflammation is the phenomenon that must be controlled through the adoption of healthier lifestyle habits and more optimal control of already known health conditions, such as diabetes and high blood pressure.
Changing our way of living is something easy to say, but very difficult to implement. To get to know and understand the healthy life habits, visit the following link.
--Article including healthy lifestyle habits. To be publish later
Behavioral changes in everyday life require:
● Control blood pressure
● Weight control
● Have a healthy diet
● Diabetes control
● Regularly do physical activity
● Improve the quantity and quality of sleep
● Manage stress
● Quit smoking
Convalescence at home
“The heart is broken; you have to put a cast on the patient”
After a heart attack, a resting period of a few weeks is appropriate.
When you break a leg, you put a cast to help with the healing. But you can’t do that with a heart! In this case, the whole body must be immobilized!
The resting period is important for the healing process. The doctor responsible of you during your hospitalization will inform you of the duration of this convalescence.
The first month
Usually, the first month after your heart attack is a kind of home vacation. You must limit your activities; light home activities, outdoor walking.
During the second month, the patient resumes his regular activities, often without returning to work. Some people are more stressed when not at work. In this case, a gradual return to work is allowed, but must be done from home, if possible.
Some convalescences may be longer depending on the importance of the heart failure. This additional month really includes all the regular activities a person does when on a vacation.
Driving a car
After a STEMI-type myocardial infarction; driving is unfortunately subject to some constraints. It is generally recommended that driving be prohibited for one month following the cardiac event.
In the case of commercial driving (bus driver, truck driver, etc.), this recommendation is even extended to 3 months, starting on the day the patient is dismissed from the hospital.
For smaller NSTEMI-type heart attacks that require an observation period and a less urgent artery intervention, and when a ultrasound confirms that the consequences are minimal, driving may be allowed as soon as 48 hours after the cardiac procedures.
In the case of commercial driving, you will have to wait for up to 7 days.
Several other recommendations exist in other situations (small attack without intervention in the arteries, without problems with the valves or episodes of malignant arrhythmias, etc.), and it is rather wise to refer to your cardiologist to have the precise information on your conditition.
Doctors do not report to the SAAQ that you have just had a heart attack.
Your willingness to collaborate with medical recommendations will determine your future.
It's the law
However, if you had the misfortune to cause an accident due to a symptom or cardiac complication that occurred while driving during the time you were advised not to drive, you could be held responsible of the situation.
By driving when recommended not to, your life and the lives of others may be into play.
All patients who have had a heart attack are put on a sick leave.
For those who suffered from a STEMI-type heart attack, a 4 to 8-week leave of absence can be expected depending on the type of work performed (for example, physical and non-physical).
In the case of a NSTEMI-type infarction, depending on the presence or absence of cardiac consequences seen with the echography of the heart, 1 to 2 weeks is generally the norm.
After a prolonged sick leave, especially when your job is physical, it is often possible to return gradually to work. This allows the patient to get used to the intensity of the effort required now that his heart has an injury. The body must also relearn how to work with this pump without forgetting the possible side effects of the medication.
Remember that stress in your workplace can contribute to the progression of your heart disease in the long run. It is essential to make the changes necessary to ensure that your work environment is healthy, balanced and favorable to harmonious interpersonal relationships to allow for better stress management.
High blood pressure control (hypertension)
HTA is the leading risk factor for death worldwide and is one of the leading risk factors for cardiovascular diseases.
Controlling the blood pressure is therefore essential. However, it is not limited to taking medication.
You must make changes to your lifestyle that will have a significant and direct impact on your pressure.
For people without diabetes, home blood pressure of < 135 / 85mmHg is the target.
For diabetic people, one needs to be even more severe by aiming at a blood pressure of < 130 / 85mmHg.
When diabetes is not well controlled, the blood vessels can weaken and clog more easily. The heart is not the only organ that can be affected; the kidneys, the retina of the eyes and the nerves may also suffer.
Diabetics are 2 to 6 times more likely to have a cardiovascular disease than people without diabetes.
Cardiovascular disease is also the leading cause of death for diabetics.
The goal is to maintain a blood glucose level between 4 and 7 mmol/ L before meals and between 5 and 10 mmol / L 2 hours after meals.
The good news is that there is more and more belief that type 2 diabetes is a potentially reversible disease. Indeed, since diabetes is often a consequence of unhealthy human behaviors (mainly a diet rich in low-quality carbohydrates, processed products and saturated fats and sedentary lifestyle), it is known that changing these behaviors would make it possible to significantly improve or even eradicate this disease in some cases.
Obviously, this state of remission can last several years as long as the good life habits are maintained! As soon as they are not maintained, diabetes can quickly return.
It is possible to reduce or even put an end to the doses of diabetes medication. To do so, people must be willing to make significant changes in their lifestyle, mainly in terms of food and physical activity. For those who think that they are taking too much medicine, this is a great opportunity to end some of the doctor's prescriptions while having a healthier lifestyle!
A possible depression
People who suffered from a STEMI-like infarction, a possible depression may occur during convalescence. Energy is at its lowest. Appetite may be absent resulting in weight loss, not to mention sleep disorders.
This stress on the body can trigger some physical and emotional overflows.
After living through an event of this type, several changes must be made. Self-image can be tarnished falsely and it is understood that personal confidence falls drastically.
We must not be afraid to talk about our moods. It is often temporary, but it's important to talk to your family, friends and healthcare professionals.
Two points are important to discuss;
● Sexual activity
● Erectile dysfunction
When is it wise to resume sexual activities after an infarction?
Many people are asking this question. Unlike what many might believe, sexual activity is not a “real” effort. It generates an effort of the same intensity as walking slowly, mowing the grass or house cleaning.
This means that it is part of the normal activities of life.
Thus, this kind of activity can be resumed gradually in the first 7 days after your myocardial infarction.
Erectile dysfunction is an annoying phenomenon for men. It is even more frequent in men who had cardiac episodes.
Obesity, diabetes, sedentary lifestyle, cholesterol, hypertension, smoking, sleep apnea and cardiovascular diseases are well known risk factors that contribute to erectile dysfunction.
Side effects of the medication
Note that it is also possible that some of your new drugs prescribed because of your situation influence your sexual health.
The psychological effect
The psychological effect of a heart attack, as described earlier, may have repercussions in intimate moments. Fortunately, it is often temporary. It is important to talk to your doctor about this.
The good news is that, in some cases, sexual dysfunction improves with the adoption of healthier lifestyle habits and with the optimal treatment of several metabolic health conditions such as diabetes.
Medication against erectile dysfunction
Some drugs for erectile dysfunction to improve men’s sexual health exist: Viagra, Levitra and Cialis.
It is important to know that these medications may interact with Nitroglycerin (often prescribed as a pump when you leave the hospital) causing significant and even deadly pressure drops when both substances are taken at the same time.
Although sexual health is important, it still is not a reason not to use the drugs at your disposal to improve it unless otherwise indicated.
If you experience severe chest pain similar to the one you had during your heart attack while you are still under the influence of this medication 12 to 24 hours before and after taking it, it is rather wise to call the ambulance immediately without using nitro.
You just have to mention the time at which the medication was taken.
Integration of physical activity
The benefits of a more active lifestyle are numerous. In addition to improving your cardiovascular fitness, which has a positive impact on your quality of life, regular physical activity helps reduce blood pressure and blood sugar levels.
More than doing two things at once
In fact, regular physical activity is a catalyst for healthy lifestyles and helps with quitting smoking. It helps us become aware of our diet and shows us that the cigarette no longer has its place as it did before.
In addition, these changes lead to weight loss and they help maintain a healthy weight.
All these changes are closely tied and result in improving blood pressure and better controlling diabetes.
These effects are rapidly apparent from the beginning of a regular physical activity program.
Effects on the mental
Better physical condition contributes to better stress management. It greatly improves personal confidence, which results in a positive effect on one’s mood.
As soon as you return home
The exercise program can begin as soon as you get home. You can start doing low intensity physical activity again, such as housekeeping and slow walking.
Gradually, in the following weeks, the intensity may slowly increase.
After the first 4 to 8 weeks following your cardiac event, a higher intensity of physical activity can be achieved.
Subsequently, gradually increase the frequency, duration and intensity of your physical activities.
Your goal: 150 minutes and more of activities per week
Try to meet or exceed the Canadian guidelines for a minimum of 150 minutes of average intensity physical activity per week.
The right intensity is attained when one is able to speak, while being slightly out of breath; an intensity of 3 to 5 out of 10 on the effort perception scale (see corresponding image). These 150 minutes can be divided into slices of at least 10 minutes, several times a day. Frequency is the key! We therefore have the advantage to do it often.
It is important to always start with a warm up. Spend the first 5 to 10 minutes of your activity to warm up, gradually increasing the intensity. This will allow you to be more comfortable during your activity and it will facilitate the work to be done by your heart.
Similarly, at the end of your workout, take a few minutes to gradually reduce your intensity, catch your breath and lower your heart rate.
When doing weight training, be sure to adopt the proper breathing technique by exhaling when you force. It is important to avoid holding back or blocking your breath, which is called the Valsalva maneuver. This causes an unnecessary increase in your blood pressure.
Eliminate fear using confidence
Many people are afraid to engage in physical activity after a heart attack.
A good way to reassure yourself is to be accompanied by someone and to carry your cell phone and nitro pump on you. So, if a glitch occurs, you'll be taken care of quickly.
In addition, the best health professional to work with when you resume your physical activity is the kinesiologist. He is able to adapt a fitness program to your heart condition and can safely supervise your workout.
Specialized Centers for Cardiovascular Rehabilitation
The cardiovascular rehabilitation center has a global approach.
The interested person is well surrounded by different professionals having a common goal: improving the quality of life and survival. No pill has more impact on health than exercise and healthy eating!
In these centers, you could meet kinesiologists, nutritionists, doctors, nurses and psychologists.
It is an investment in time that can sometimes be rare, but the benefits are quickly noticeable. Remember, there is no better treatment than doing regular physical activity.
The important thing to remember is that small changes in your lifestyle can have a big impact on your health.
Even if these changes appear to you like being huge, trust yourself. Integrate your new habits one day at a time.
Nutritionists and kinesiologists can provide you with the right tools to achieve your goals. Do not hesitate to consult these health professionals who will guide you in your new way of life.
This article does not replace a medical appointment. So, if you feel the need, talk to your doctor.