Heart Attack - Recovery

Recovery-Heart attack




Recovering from a heart attack can take several months, and it's very important not to rush your rehabilitation.
During your recovery period, you'll receive help and support from a range of healthcare professionals, which may include:
  • nurses
  • physiotherapists
  • dietitians
  • pharmacists
  • exercise specialists
These healthcare professionals will support you physically and mentally to ensure your recovery is conducted safely and appropriately.
The recovery process usually takes place in stages, starting in hospital, where your condition can be closely monitored and your individual needs for the future can be assessed.
After being discharged, you can continue your recovery at home.
The 2 most important aims of the recovery process are:
  • to gradually restore your physical fitness so you can resume normal activities (known as cardiac rehabilitation)
  • to reduce your risk of another heart attack

Cardiac rehabilitation

Your cardiac rehabilitation programme will begin when you're in hospital.
You should also be invited back for another session taking place within 10 days of leaving hospital.
A member of the cardiac rehabilitation team will visit you in hospital and provide detailed information about:
  • your state of health and how the heart attack may have affected it
  • the type of treatment you received
  • what medications you'll need when you leave hospital
  • what specific risk factors are thought to have contributed to your heart attack
  • what lifestyle changes you can make to address those risk factors
They can also answer any questions you have about finance, welfare rights, housing and social care.

Exercise

Once you return home, it's usually recommended that you rest and only do light activities, such as walking up and down the stairs a few times a day or taking a short walk.
Gradually increase the amount of activity you do each day over several weeks. How quickly you can do this will depend on the condition of your heart and your general health.
Your care team can provide more detailed advice about a recommended plan to increase your activity levels.
Your rehabilitation programme should contain a range of different exercises, depending on your age and ability. 
Most of the exercises will be aerobic. These are designed to strengthen the heart, improve circulation and lower blood pressure.
Examples of aerobic exercises include riding an exercise bike, jogging on a treadmill and swimming.

Returning to work

Most people can return to work after having a heart attack, but how quickly will depend on your health, the state of your heart and the kind of work you do.
If your job involves light duties, such as if you work in an office, you may be able to return to work in as little as 2 weeks.
But if your job involves heavy manual work or your heart was extensively damaged, it may be several months before you can return to work.
Your care team will provide a more detailed prediction of how long it'll take for you to return to work.

Sex

According to the British Heart Foundation, you're usually able to start having sex again once you feel well enough, usually about 4 to 6 weeks after having a heart attack.
Having sex won't put you at further risk of having another heart attack.
Following a heart attack, about 1 in 3 men have erectile dysfunction, which may make having sex difficult.
This is most commonly due to anxiety and the emotional stress associated with having a heart attack.
Less commonly, erectile dysfunction is a side effect of beta blockers.
If you experience erectile dysfunction, speak to your GP. They may be able to recommend treatment.
For example, you may be prescribed medication that stimulates the flow of blood to your penis, which makes it easier to get an erection.

Driving

If you drive a car or motorcycle and you have a heart attack, you don't have to inform the Driver and Vehicle Licensing Agency (DVLA).
Many people can now return to driving 1 week after a heart attack, as long you don't have any other condition or complication that would disqualify you from driving.
But in more severe cases, you may need to stop driving for 4 weeks.
Your doctor or rehabilitation team should advise how long you must wait before driving after your heart attack.
If you drive a large goods vehicle or passenger-carrying vehicle, you must inform the DVLA if you have a heart attack.
Your licence will be temporarily suspended, for a minimum of 6 weeks, until you have adequately recovered.
Your licence will be reissued if you can pass a basic health and fitness test, and don't have any other condition that would disqualify you from driving.

Depression

Having a heart attack can be frightening and traumatic, and it's common to have feelings of anxiety afterwards.
For many people, the emotional stresses can cause them to feel depressed and tearful for the first few weeks after returning home from hospital.
If feelings of depression persist, speak to your GP as you may have a more serious form of depression.
It's important to seek advice as serious types of depression often don't get better without treatment.
Your emotional state could also have an adverse effect on your physical recovery.

Reducing your risk

Reducing your risk of having another heart attack involves making lifestyle changes and taking a long-term course of different medications.

Diet

You should aim to follow a Mediterranean-style diet. This means eating more bread, fruit, vegetables and fish, and less meat.
Replace butter and cheese with products based on vegetable and plant oil, such as olive oil.
Oily fish, like herring, sardines and salmon, can form part of a Mediterranean-style diet, but there's no need to eat this type of fish specifically to try to prevent another heart attack.
Also, omega-3 fatty acid capsules or foods fortified with omega-3 fatty acids haven't been found to help prevent another heart attack.
Never take a food supplement without first consulting your GP. Some supplements, such as beta-carotene, are potentially harmful.

Smoking

If you smoke, it's strongly recommended that you quit as soon as possible. The NHS Smokefree website can provide you with advice and support.
Your GP can also recommend and prescribe medication to help you give up.

Alcohol

If you drink alcohol, don't exceed the recommended limits:
  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over 3 days or more if you drink as much as 14 units a week
Fourteen units is equivalent to 6 pints of average strength beer or 10 small glasses of low-strength wine.
Regularly exceeding the recommended alcohol limits raises your blood pressure and cholesterol level, increasing your risk of another heart attack.
Avoid binge drinking, which is drinking lots of alcohol in a short space of time or drinking to get drunk.
Binge drinking can cause a sudden and large rise in your blood pressure, which could be potentially dangerous.
Research has found people who have had heart attacks and continue to binge drink are twice as likely to die of a serious health condition, such as another heart attack or stroke, compared with people who moderate their drinking after having a heart attack.
Contact your GP if you find it difficult to moderate your drinking. Counselling services and medications can help you reduce your alcohol intake.
Read more about treatment for alcohol misuse.

Weight management

If you're overweight or obese, it's recommended that you lose weight and then maintain a healthy weight using a combination of exercise and a calorie-controlled diet.
Read more about treating obesity.

Regular physical activity

Once you have made a sufficient physical recovery from the effects of a heart attack, it's recommended that you do regular physical activity.
Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity such as cycling or fast walking every week.
The level of activity should be strenuous enough to leave you slightly breathless.
If you find it difficult to achieve 150 minutes of activity a week, start at a level that you feel comfortable with (for example, 5 to 10 minutes of light exercise a day) and gradually increase the duration and intensity of your activity as your fitness begins to improve.

Medication

There are currently 4 types of medication widely used to reduce the risk of a heart attack:
  • angiotensin-converting enzyme (ACE) inhibitors
  • anti-platelets
  • beta blockers
  • statins

ACE inhibitors

ACE inhibitors are often used to lower blood pressure, as they block the actions of some of the hormones that help regulate blood pressure.
By stopping these hormones working, the medicine helps to reduce the amount of water in your blood and also widens your arteries, both of which will reduce your blood pressure.
ACE inhibitors have been known to reduce the supply of blood to the kidneys, which can reduce their efficiency.
This means blood and urine tests may be carried out before you start taking ACE inhibitors to make sure there are no pre-existing problems with your kidneys.
Annual blood and urine tests may be required if you continue to use ACE inhibitors.
The side effects of ACE inhibitors can include:
  • dizziness
  • tiredness or weakness
  • headaches 
  • a persistent, dry cough
Most of these should pass within a few days, although some people continue to have a dry cough.
If ACE inhibitors are taken with other forms of medication, including over-the-counter medicines, they can cause unpredictable effects.
Check with your GP or pharmacist before taking anything in combination with ACE inhibitors.
It's usually recommended that you begin taking ACE inhibitors immediately after having a heart attack and, in most cases, continue taking them indefinitely.
In some individuals who prove intolerant of ACE inhibitors, a related alternative medication (an angiotensin receptor blocker, or ARB) may be prescribed.

Anti-platelets

Anti-platelets are a type of medication that can help prevent blood clots.
They work by reducing the "stickiness" of platelets, which are tiny particles in the blood that help it to clot.
It's usually recommended that you take low-dose aspirin, which has blood-thinning properties, as well as being a painkiller.
You're more likely to be given additional anti-platelet medication, such as clopidogrel, prasugrel or ticagrelor, especially if you have had stent treatment.
These can also be used if you're allergic to aspirin.
Side effects can include:
As with ACE inhibitors, treatment with anti-platelets usually begins immediately after a heart attack.
The amount of time for which you're prescribed these medications can be anywhere between 4 weeks and 12 months, and depends on the type of heart attack you have had and the other treatment you have received.
It's usually recommended that you take aspirin indefinitely.
If you experience troublesome side effects from aspirin, you should contact your GP for advice.
Don't suddenly stop taking the aspirin, as this could increase your risk of another heart attack.
You may occasionally also be put on another blood-thinning medication, called warfarin.
This usually only happens if you have remained in an irregular heart rhythm (atrial fibrillation) or sustained severe damage to your heart.
Excessive bleeding is the most serious side effect of warfarin.
Seek immediate medical attention and have an urgent blood test if you experience any of the following side effects:
Immediate medical attention must also be sought if you:

Beta blockers

Beta blockers are a type of medication used to protect the heart from further damage after a heart attack.
They help to relax the heart's muscles so the heart beats slower and blood pressure drops, both of which will reduce the strain on your heart.
It's usually recommended that you begin treatment with beta blockers as soon as your condition stabilises, and continue taking them indefinitely.
Fairly common side effects of beta blockers include:
  • tiredness
  • cold hands and feet
  • a slow heartbeat
  • diarrhoea
  • feeling sick
Less common side effects include:
  • sleep disturbances
  • nightmares
  • inability to obtain or maintain an erection (erectile dysfunction, or impotence)
Beta blockers can also interact with other medicines, causing possible adverse side effects.
Check with your GP or pharmacist before taking other medicines, including over-the-counter medication, in combination with beta blockers.

Statins

Statins are a type of medication used to lower your blood cholesterol level.
This will help prevent further damage to your coronary arteries and should reduce the risk of another heart attack.
Statins block the effects of an enzyme in your liver called HMG-CoA reductase, which is used to make cholesterol.
Statins sometimes have mild side effects, including:
Occasionally, statins can cause muscle pain, weakness and tenderness.
Contact your GP if you experience these symptoms, as your dosage may need to be adjusted.
It's usually recommended that you take statins indefinitely.

Getting help

Everyone who experiences a heart attack will face different problems and challenges, and any guidance or advice you receive will be tailored to your needs.
There are many local and national cardiac support groups where you can meet people who have been through a similar experience.
The British Heart Foundation has a helpline that offers confidential information about your recovery and advice about how to keep your heart healthy.
The helpline can be reached on 0300 330 3311 and is open from 9am to 5pm, Monday to Friday.
Keep healthy with 150 minutes of exercise a week
In this video people describe what exercise they do, including cycling, running and swimming. They offer their tips and tricks for keeping motivated.

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