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Heart Attack and Cardiac Disorders

(46) Heart Attack and Cardiac Disorders

 Preventing coronary heart disease

Strategies to prevent heart disease

10 Tips to Prevent Heart Disease And Stroke

How to Help Prevent Heart Disease - At Any Age

 HA44

How much will my attitude contribute to my recovery? How do I live after having had a heart attack?

After recovering from a heart attack, you have two major goals. One is the development of a special individual plan to restore your emotional as well as your physical ability to return to a normal and healthy life.

The second is control of all coronary risk factors to prevent a second heart attack. Thus, cardiac rehabilitation programs focus on three main areas: regular medical check-ups with proper medications, lifestyle adjustment with proper changes, and emotional adjustment.

It is extremely important to remember that the underlying coronary atherosclerotic process (hardening of the coronary arteries) has not disappeared or stopped even if you have been lucky enough to recover from a heart attack. In addition, it should be stressed that a second heart attack is often more serious than the first attack. Thus, recovery from a second heart attack may be even more difficult and your chances lessened.

Therefore, in recovery, you must control, minimize, or eliminate all coronary risk factors  more carefully to prevent a second heart attack.

Your doctor can help you decide whether cholesterol-lowering medications would be useful. Such medications are recommended in following situations:

• Markedly elevated total cholesterol more than 240 mg/dL and/or markedly elevated LDL (bad) cholesterol more than 160 mg/dL, particularly with low HDL (good) cholesterol less than 35 mg/dL. Cholesterol -  lowering medications may be used when low cholesterol diets and physical exercise aren’t effective.

• Moderately abnormal cholesterol levels that are present despite a low-cholesterol diet with proper exercise, especially when one or more additional risk factors are present or coronary artery disease has already been diagnosed.

There are many cholesterol-lowering medications (e.g., Lipitor, Zocor, Mevacor) available for clinical use, but proper medication for each patient will be determined by his or her physician depending upon the clinical circumstances. It is very important to remember that every individual with known coronary risk factors should be evaluated and treated regularly by his or her physician.

How do I prevent another heart attack?

Patient comment:

When you are lucky enough to recover from a heart attack, you should try very hard to prevent the second heart attack. As you already know by now, the underlying process of the hardening of arteries (atherosclerosis) that causes a heart attack never stops. Therefore, coronary risk factors must be controlled as best you can.

Your risk of another heart attack can be greatly lowered by using the common-sense approaches listed below.

• Have regular medical check-ups. Regular medical check-ups are highly recommended even for apparently healthy people (men above the age of 35 and women above 40) to make certain that any coronary risk factors  or any signs of heart diseases are discovered. Regular medical check-ups should

consist of the baseline blood tests, including blood levels of cholesterols and triglycerides, and rest ECG. When any abnormalities show up in the test results or when your doctor detects any abnormal physical findings during a medical check-up, various additional diagnostic tests (e.g., echocardiogram, stress ECG test, coronary angiogram, and cardiac catheterization) may be necessary. When any known coronary risk factor, particularly a hereditary factor, is found, regular medical check-ups are needed even for much younger people.

• Eliminate or control coronary risk factors. Millions of people have one or more coronary risk factors, but many people do not know about them or simply ignore them. The hereditary factor is beyond your control, but the remaining coronary risk factors can be controlled if you are motivated enough to understand them and to try hard to reduce their effects. Smoking is just one major coronary risk factor that can be completely eliminated if the individual is willing to work hard to eliminate it from his or her life-and the prospect of another heart attack can provide high motivation. Remember that multiple coronary risk factors have a cumulative effect (that is, they multiply the effects of each individual factor) which speeds up the atherosclerotic process ( a low-calorie process of hardening of arteries) so that it can occur very rapidly even among young people. Remember that there are often few or no symptoms in the presence of various coronary risk factors, such as high BP (hypertension), abnormal blood cholesterol levels, and diabetes - this is why heart disease is called a “silent killer.” Thus, there is no way of knowing these risk factors unless regular medical check-ups with the baseline diagnostic tests are performed.

• Eat a healthy diet. A healthy diet colow calorie of foods with a lot of vegetables, fruits, fish, and chicken (without skin). Consumption of cholesterolrich foods, such as red meats (e.g., beef, pork), butter, egg yolk, cheese, and ice cream, should be kept to a minimum. The average person should consume approximately 2,000 calories a day for good health.

• Get regular exercise. It is highly recommended to engage in a regular and proper exercise program throughout life. Recommended exercise may include brisk walking, jogging, swimming, dancing (moderate tempo), golfing and tennis (not competitive).

This does not mean you must join a gym or work out strenuously for hours on end. You do not need to become a “hard body” to have good health. Even a person who is overweight with high BP, abnormal blood cholesterol levels, and diabetes will see significant benefits from an exercise program of walking 30 minutes a day 3 to 4 times a week. Exercise is also improves emotional well being; a person who follows a simple, regular exercise program will feel happier and less stressed.

• Avoid overexertion. For people with heart problems, there are some limitations. You should avoid physical exercise on a very cold or hot day (especially with high humidity). Shoveling a snow-covered driveway on a cold day is extremely dangerous for older people, particularly those with coronary risk factors. Likewise, you should avoid any exercise for 1 to 2 hours after a heavy meal and/or alcohol consumption. Vigorous or competitive sports among older adults, particularly with known coronary risk factors or a previous history of heart attack(s), are rather dangerous and may even be fatal. Playing any sport alone is not advisable for people with coronary risk factors.

• Limit alcohol consumption. Alcohol use is not a coronary risk factor, but excessive consumption can be harmful in many ways. Alcohol may trigger various abnormal heart rhythms and may raise BP. In addition, excessive consumption of alcohol causes cardiomyopathy (heart muscle disease) and can reduce the pumping action of the heart in people with congestive heart failure (diminished pumping action of the heart). Alcohol may also produce abnormal blood levels of cholesterol and triglyceride.

• Avoid stress. Unnecessary stress should be avoided as much as possible, particularly for older adults and people with coronary risk factors and/or previous heart attack(s). People who habitually experience strong negative emotions, particularly anger, have a much higher likelihood of heart attacks than those who are realistic, optimistic, generous, and happy. It is not unusual for angry people, particularly men, to suffer a heart attack before the age of 40 even without other coronary risk factors. Therefore, practices that help to calm anger and other strong emotion can help prevent heart attacks. Techniques such as meditation, anger management instruction, yoga, tai chi, and exercise can be useful in learning to avoid negative emotions.

• Ask for cooperation and support from your spouse or partner. If you are in a marriage or long-term relationship, it is extremely important to have full cooperation and support from your partner, particularly for older adults and people with known coronary risk factors or previous heart attack(s). Eating a healthy diet often requires your spouse to change his or her eating and cooking habits as well, so it is crucial that your spouse work with you. As you try to change your lifestyle to reduce your risk of heart attack, pay attention to your relationship with your spouse or partner, and seek ways to reduce the stress of your life changes on both of you.

• Avoid denial. Many people have a tendency to deny their symptoms of a heart attack; they hope that if they ignore it, it will go away, or tell them that it is “all in my head.” As a result, they delay the emergency medical care they need, with potentially serious consequences. Remember that early recognition of symptoms and early medical care often influences the “life and death” outcome. When medical care is delayed, full recovery from a heart attack is difficult to expect, and many major complications occur-including death, which can potentially be avoided if there are no delays in care. Do not risk your life! If you experience symptoms consistent with heart attacks, seek medical attention. It is better to act and find out you were mistaken about the symptoms than to do nothing and suffer the consequences.

• Avoid self-diagnosis and self-treatment. When a patient happens to be a physician, dentist, nurse, paramedic, or someone working in the hospitals or medical research institutions, there is a tendency to make “self diagnosis” followed by providing “self-treatment.” This is rather a dangerous and   unacceptable way to handle a heart attack, because you do not have control over your physical capabilities when you’re experiencing such a serious medical problem. The temptation to provide your own medical care must be absolutely avoided so that your emergency medical care is not delayed. If you are a health care professional, you would likely advise patients not to try to treat themselves, but to seek help instead-so take your own advice and summon help if you need it.

• Learn CPR, and encourage others to do so. All lay people should learn how to perform CPR because unexpected cardiopulmonary arrest can occur at any time. The CPR technique is relatively easy to learn, and the American Heart Association and many other medical organizations provide CPR teaching courses on a regular basis. It is particularly important for family members of heart attack victims or people with multiple coronary risk factors. Obviously, you cannot perform CPR upon yourself, but if everyone in your family (including you) learns to perform CPR, you will be much safer should you have another heart attack.

• Live near a major hospital. It is advisable to live in any relatively large city not far (driving distance) from any major hospital with qualified medical staff and well-equipped medical facilities. This is especially important for older adults and people with multiple coronary risk factors and a history of a previous heart attack. By doing so, proper medical care can be provided without delay. If you already live in such a location, that’s no problem—but if you do not, you might wish to weigh the possibility of moving to a place within range of a hospital.  Whether you make such a move depends on the severity of your heart condition; you should discuss the matter with your doctor before deciding to move or stay. It might seem to be a big transition to make, particularly if your home is in a rural area, but remember that heart disease kills quickly and sometimes without much warning; deciding to move might just be a life and death decision.

• Take daily aspirin. Aspirin acts as an anticoagulant and helps prevent blockages in the bloodstream, so it can reduce chances of a heart attack in people with coronary artery disease. Daily intake of aspirin (81 mg) is recommended for most adults unless there are overriding reasons why they should not take it. Aspirin should not be taken by people with recent head trauma, peptic ulcer, recent surgery, or bleeding disorders, for example. Your doctor can tell you whether you have any conditions that might prevent you from safely taking aspirin.

Do I face lifelong medications and check-ups after recovering from a heart attack?

For most people, it takes about 2 to 3 months to return to usual (normal) life. Therefore, the first 2 to 3 months after being discharged from the hospital are very important not only for you but for all your  family members, particularly your spouse. It is essential for you to have regular medical check-ups throughout your entire life after recovering from a heart attack. During each visit, your doctor will evaluate your cardiac status, will perform any necessary tests (e.g., blood tests, electrocardiograms, and the like), and may adjust your medications as needed. If necessary, your doctor will perform additional tests, such as a stress test, an echocardiogram, or a coronary angiogram depending upon medical evaluation. In addition, your doctor may add new medications and may have to change the dosage of certain medications according to your cardiac status. Evaluation will include various functions of any medical devices (e.g., artificial pacemaker; see Question 80). Your physician should be notified immediately if any new symptom occurs or a preexisting symptom gets worse. Close communication with your physician and regular medical check-ups should be a part of your life’s routines.

Terms:

Cardiomyopathy - heart muscle disease.

Cardiac – catheterization invasive diagnostic cardiac test that measures pressures in various locations within the heart chambers and blood vessels, and any other cardiac findings.

A person who follows a simple, regular exercise program will feel happier and less stressed.

Practices that help to calm anger and other strong emotion can help prevent heart attacks. It is better to act and find out you were mistaken about the symptoms than to do nothing and suffer the consequences.

Daily intake of aspirin is recommended for most adults unless there are overriding reasons why they should not take it.

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(47) Heart Attack and Cardiac Disorders

3D Medical Animation - What is a Heart Attack?

What Is a Heart Attack?

Heart Attack: Symptoms, Diagnosis, and Treatments

heart attack45

Do heart attack survivors have to continue on medications?

Many patients who recover from a heart attack need one or more medications for a long time (and often for their entire lifetime). Many patients who recover from a heart attack need a variety of medications to control high blood pressure (BP). Doctors usually prescribe antihypertensive medications for their entire lifetime to those who have high BP, unless their physicians give special instructions to do otherwise.

When your blood cholesterol levels are markedly abnormal and low-cholesterol diets and physical exercise are not effective, you may need a variety of cholesterol-lowering medications under medical supervision (e.g., statins, niacin, and the like).

Medical experts recommend beta-blockers for every patient for 1 year or more after recovery from a heart attack. These beta-blockers reduce your heart rate and BP to lessen the demands on your heart. In a recent major study, the beta-blocker Coreg® was shown to reduce the risk of death among heart attack patients with impaired cardiac function by 23%.

Calcium-channel blockers help to relax the muscles of your blood vessels and often slow your heart rate. Blood-thinning medications (anticoagulants) make blood less sticky, so they can help to prevent blood clot formation. Doctors recommend them highly for most people who recover from a heart attack. A daily aspirin is an ideal medication for this purpose unless you demonstrate obvious reasons for avoiding them (e.g., recent surgery, peptic ulcer, and the like). For some people, their doctor may prescribe a blood thinner stronger than aspirin.

Some people with clinically significant arrhythmias (abnormal heart rhythms) need one or more medications under close medical supervision to control or to prevent arrhythmias. Thus, you may require antiarrhythmic medications even after implantation of an artificial pacemaker or ICD.

If you had a moderate to severe heart attack associated with major complications (congestive heart failure or cardiogenic shock), angiotensin-converting enzyme (ACE) inhibitors are highly beneficial in improving blood circulation of your coronary arteries and improving the pumping action of your heart.

Many patients who recover from a heart attack may need additional medications. For example, if you were diabetic, you would need insulin or other medication to control your diabetes. Also, you might require other medications depending upon coexisting diseases.

What activities should I avoid after a heart attack?

Patient comment:

Even though regular physical exercise is extremely beneficial after recovering from a heart attack, you should avoid certain activities. For example, you should avoid any competitive or vigorous sports beyond what your heart can take. Any competitive sport has a tendency to create emotional tension and anxiety that cause unnecessary stress, which is harmful to your heart. The stress may provoke angina or abnormal heart rhythms and may raise your blood pressure. Even betting money during any sport or game is not recommended for anyone who recovered from a heart attack in order to avoid unnecessary stress.

The key is: Stay relaxed! Things that make you anxious should be eliminated.

For anyone who recovers from a heart attack, it is absolutely important to stop smoking. As emphasised repeatedly, smoking is a major coronary risk factor that you can eliminate completely. There are methods available to help you quit if you are unable to do so on your own; contact the American Lung Association for information on quitting smoking. Alcohol is not directly harmful if you consume only small amounts, e.g., one to two glasses of wine with dinner, depending on your tolerance for alcohol; you should not drink a quantity that is likely to get you tipsy or drunk. However, alcohol may trigger some abnormal heart rhythms and reduce the pumping action of your heart. Thus, you are advised to take alcohol (even small amounts) under close medical supervision. You should avoid vigorous competitive or contact sports. You should avoid sudden physical exercise, such as rapid dancing, run, or be playing singles tennis, soon after meals or alcohol consumption. Any physical activity on very cold or hot days (especially with high humidity) is very dangerous, and you should avoid it. In particular, cleaning a snow-covered driveway on a cold day is extremely dangerous-it is actually almost suicidal for a person recovering from a heart attack to do this.

Driving an automobile is safe only about 3 to 4 weeks after your discharge from the hospital. Doctors recommend initially driving a short distance for half an hour or less. You should avoid rush hour traffic if possible. If you have received an ICD, you may have to wait longer until you can safely drive because of the danger of provoking serious abnormal heart rhythms during driving. If any cardiac symptoms occur during your driving, you should contact your physician for a further recommendation.

You should minimise emotional stress as much as possible after your recovery from a heart attack. Emotional stress causes a fast heart rate, raises your BP and increases your heart’s workload. You should learn how to be realistic and optimistic and to relax. Regular exercise and an optimistic attitude are very important in reducing any stress, and you should try hard to be happy. There are many options-classes, self-help books, etc.-for learning to manage your emotions if you don’t know how. If you are a chronically unhappy or angry person, consider counselling with a minister or psychological professional to address long-term emotional problems-it could be a life-or-death effort.

It is very important also for you to maintain a proper healthy diet after recovering from your heart attack, especially if you have abnormal blood cholesterol levels or are obese. You should markedly minimise your intake of high-cholesterol foods, including red meat from four-legged animals, egg yolk, butter, cheese, certain seafood (shrimp, lobster, crab, clams, oysters), ice-cream, and whole milk. You should eat more of a variety of fish (e.g., mackerel and salmon), which contain omega–3 fatty acids, and eat egg white in place of egg yolks. Fruits and vegetables and proper exercise can benefit you considerably.

By and large, if you are overweight, you should not overeat and should markedly reduce your calorie intake. Remember that the risk of coronary heart disease, including heart attack, increases significantly even if you are just 10% overweight. In addition, if you lose just 5 to 10 pounds, you can reduce your BP. If you need to lose weight, talk to your physician or ask for a referral to a nutritionist. Sometimes, weight loss can be best accomplished by educating yourself about what you can and cannot eat, and how much you should eat.

Will physical activity help to build up my body after a heart attack?

Proper exercise is beneficial for heart attack survivors. Before engaging in any exercise program, however, you should discuss your exercise plan in advance with your physician. Medical researchers highly recommend performing a stress test (exercise ECG test) to determine your exact ability to engage in any physical activity. By doing so, your doctor can scientifically measure your heart’s functional capacity (your ability to perform the physical activity).

Exercise is proven to be a major component of a cardiac rehabilitation program. Exercise is beneficial in improving the heart muscle function after a heart attack. In addition, the beneficial effects of exercise include maintaining a healthy body weight, blood pressure, and blood cholesterol levels and in controlling diabetes. Regular physical exercise usually reduces emotional stress. The American Heart Association recommends proper healthy physical exercise, such as brisk walking, bicycling, swimming, jogging, and dancing, for 30 minutes at least three to four times a week. Every individual should start any exercise program gradually and not abruptly. There is no set time schedule for when to resume a sexual relationship after you recover from a heart attack. However, it is relatively safe to resume sexual activity a few weeks after your discharge from the hospital. Resuming a sexual relationship should be gradual, and you should be certain that you are free of any cardiac symptoms (chest discomfort, shortness of breath, tired feeling, dizziness, and palpitations). You should select any sexual position that requires less physical effort, and you should feel comfortable. If any abovementioned symptom occurs during sexual activity, you should stop immediately and inform your physician. You should avoid sexual activity within 2 hours after meals or alcohol consumption. Sexual relationships with a much younger person and/or extramarital affairs are not recommended, because overexcitement may be dangerous to you. In considering sexual activity, you should consult your physician first. Some medications may cause unexpected side effects, especially when you are taking several medications together.

Returning to work is a reasonable physical activity provided that you avoid the above-mentioned risks. Most people will be able to return to work about 3 to 4 weeks after discharge from the hospital. Several factors will determine the exact time of your return to work, however: the degree of heart muscle damage, the severity of various complications, speed of recovery, and the type of work.

Initially, your return to work should be gradual and progressive, as you can tolerate it. It is a good idea for you to work only half a day at first and gradually increase your work to a full day. If your job is very physically demanding, such as work involving manual labour, you may have to change your occupation to one that demands less physical work (e.g., a desk job).

Term:

Functional capacity - ability to perform physical activity.

Every individual should start any exercise program gradually.

Initially, your return to work should be gradual.

 

 

 

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