Heart attack or a Cardiac procedure like PTCA (angioplasty or stenting) or CABG (Bypass surgery) with or without heart attack is a serious and major event in any body’s life.
Though it is possible for the majority to go back to their routine life within 2 weeks after heart attack or PTCA and within 4 weeks after CABG, it is important that they take some precautions and adopt a healthy life style to lead a healthy and happy life and for secondary prevention of cardiac events.
Things to do after Heart attack / PTCA / CABG:
1. Drug compliance:
Adherence to medication as prescribed by the doctor is very important after a cardiac event. These medicines have various important functions like preventing blood clotting and occlusion of stents, decreasing the cholesterol levels for further prevention of events and problems elsewhere in the vascular territory, for optimising heart function and relief of symptoms. Please consult your doctor if you stop or want to stop any medication for whatever reason.
2. Physical activity:
- In general, after a cardiac event or procedure, it is important to start exercise as soon as possible.
- Patients should not exercise if they are generally unwell, symptomatic, or clinically unstable.
- Allow at least 2 hours between your last large meal and beginning to exercise.
- If you use a GTN spray or Asthma inhaler, have it with you before you start the exercise.
- In general, isotonic exercises like walking, jogging, cycling, and swimming are suitable exercises. (Swimming is usually not recommended in the first 6 to 8 weeks). Competitive games and exercise to music are not recommended as their intensity is dictated at least in part by factors, not under the control of the individual.
- It is important to warm up before and to cool down after the exercise. It is important to start slowly about 5 to 10 minutes per day, achieving about 60 to 75% of THR (220 – age) and gradually increase to 30 minutes per day in 4 to 6 weeks’ time, achieving up to 70 to 85% of THR.
- It is important to exercise up to only as much as is comfortable. Stop the exercise and consult your doctor if you experience the symptoms that came on during your heart attack or chest pain or heaviness, extreme breathlessness, palpitations, giddiness, or excessive sweating symptoms.
- Initially start exercising at least 3 days a week and by 6 weeks to 3 months, do it daily (at least 5 days in a week).
- Muscle-strengthening exercises also can be done but has to be built up very gradually and cautiously. In the first 2 weeks after a heart attack, it is advisable not to lift weights more than 5 kgs. Then, on the advice of your doctor, it can be gradually escalated.
3. Diet:
- Diet should provide adequate vitamins, minerals, antioxidants and dietary fibre and should contain fruits, vegetables, whole grains, nuts, legumes, beans, vegetable-based oils, low fat dairy products, fish, eggs, skinless poultry and lean meat.
- Avoid harmful fats (trans fats and saturated fats), high calorie diets, high carbohydrate diet, soft drinks and excessive salt.
- Processed foods contain a lot of salt, unhealthy fats (trans fats and saturated fats) and sugars and should be avoided.
4. Habits and addictions:
Cessation of smoking and all forms of tobacco usage is very important to prevent further cardiac events. If possible, cessation or at least moderation of alcohol intake is very important to preserve health.
5. Weight reduction:
If obese, it is important to lose weight. The goal BMI is ≤ 25. But, losing even 5 to 10% of the body weight also certainly reduces the risk of heart attack and stroke.
6. Reducing the stress:
Excessive stress / anxiety / anger is linked with increased risk of heart problems. It is important to learn stress management / relaxation techniques / yoga / meditation to help lower the stress levels.
7. Adequate rest:
Adequate rest is very important and can be achieved by inculcating healthy sleep habits and decreasing the anxiety and stress.
Healthy sleep habits include having consistent sleep timings daily and allotting 7 to 8 hours for sleep, avoiding electronic gadgets before sleep, keeping the bedroom quiet and relaxing and at a comfortable temperature and without bright lights, avoiding large meals before sleep, avoiding caffeine in the evening and later, avoid consuming alcohol late evening and reduce fluid intake before bedtime and reduce daytime naps.
8. Other medical conditions:
It is equally important to take care of other medical problems like Diabetes, Hypertension, Hypothyroidism, Hyperlipidemia etc.
Some of the goals are:
- FBS < 130 MG%, PLBS < 180 MG%, Hb A1c < 7%.
- B.P < 130/80 mm Hg
- LDL < 70 MG%, TG < 150 mg%.
9. Driving after a cardiac event:
- After a coronary angiogram or angioplasty (without heart attack), one can resume driving after 2 days.
- After a heart attack or after PTCA for heart attack, sometimes there may be events in the immediate days after a heart attack and sometimes there can be drug-induced problems that can influence driving skills, therefore, it is important to wait for at least 2 weeks and confirming with your doctor before resuming driving.
- Patients with heart failure symptoms should stop driving for at least 1 month.
- Post CABG, with or without a heart attack, it is important to wait for 4 weeks post-procedure before resuming driving. When compared to heart attack and post-heart attack PTCA patients, additional 2 weeks are needed to allow for sternal wound healing.
- For those driving commercial vehicles, the waiting times may be much longer (up to 1-month post-heart attack / PTCA and up to 3 months for post CABG) and it is important to check with the concerned authorities.
- If you or your family feels anxious about you driving, there are small things you can do like not driving alone, driving in known routes, avoid driving in rush hours, etc.
10. Travelling:
- Travelling as a passenger after a heart attack / PTCA / CABG after discharge by car, bus or train is not a problem. After a heart attack without complications, most will be able to travel by air in 2 to 3 weeks’ time. Those with complications should discuss with doctors regarding air travel.
- Sometimes, one may feel more tired or car sick than usual can be helped by taking regular breaks.
- Better to have a reserved seat while travelling by public transport by bus or train.
- For patients post CABG and within 4 weeks, a pillow or rolled towel may be placed between chest and seat belt to reduce pressure on the sternal wound.
11. Sexual activity recommendations:
If a person can do 5 to 6 METS of physical activity comfortably, sexual activity can be undertaken safely. Most patients who recovered from a heart attack without complications can perform sexual activity when they feel comfortable to do so usually after 1 to 2 weeks.
12. Regular follow ups:
Regular follow ups as advised by your doctor is very important for assessment, dose adjustment and for optimising treatment benefit.
13. Do not ignore or hide symptoms:
Complications in this group of patients can be life threatening. Any symptom that may occur at any uncomfortable time or location, especially any form of chest pain or breathlessness should not be ignored and should be immediately brought to the notice of your doctor and rule out any significant problem.
