Living well after a heart attack

Transcription

1 Living well after a heart attack 1

2 Contents Welcome to this Heart Foundation booklet About your heart You are not alone... 4 Common causes of a heart attack... 5 Recognising a heart attack... 6 If you have this booklet then, like many other New Zealanders, heart disease has touched your life. Whether it is you or a loved one who is looking to find out more about heart attacks, you are likely to have many questions. We hope the information in this booklet will give you some of the answers, but remember you can talk to your doctor or nurse about any questions or concerns you have as well. My recovery checklist After reading through this booklet, you should be able to check off the following statements: I can recognise the signs and symptoms of a heart attack I have a heart attack action plan I have checked out the Heart Foundation s HeartHelp website I have ed hearthelp@heartfoundation.org.nz to sign up to the Heart Foundation s HeartHelp e-newsletter I have a plan for my life-long heart health I had a heart attack, now what? Finding out more about your heart... 8 Getting to grips with your medication... 9 Talk to your doctor or nurse about cardiac rehabilitation When I go home Getting behind the wheel Sex after a heart attack Returning to work Looking after yourself Angina after a heart attack Anxiety and depression Keeping your relationships strong Tackling negative thoughts Lowering my risk and staying well Will it happen again? Stop smoking Take medications Make heart healthy eating and drinking choices Move more Lose weight My personal plan for my heart health Heart attack action plan Heart Foundation of New Zealand. All rights reserved. If you would like permission to reproduce in full or in part or have any queries, please contact info@heartfoundation.org.nz

3 About your heart You are not alone Each month more than 1000 New Zealanders leave hospital after having a heart attack. A heart attack is often the result of heart disease, which is a life-long condition. After having a heart attack, you are at high risk of having another one but the good news is there are choices you can make to improve your life-long heart health. Learning to live well after a heart attack is not always easy, but it is important to remember you are not alone. Your family / whānau, health professionals and the Heart Foundation are here to support you. Common causes of a heart attack Heart disease is the most common cause of a heart attack. Heart disease often begins with plaque building up inside the arteries. If one of these plaques cracks, a blood clot will form which can block the artery. If the blood clot blocks one of the coronary arteries that feeds blood to the heart, this can cause a heart attack. Some people get angina, which is a warning sign of narrowed arteries. Others have a heart attack without having angina. Roni Lolesi had a heart attack at the age of 57. He sought urgent medical attention and, following treatment, did an intensive rehabilitation programme. Heart disease Plaque builds up in an artery It took some time for Sarah Lockett s heart attack to be diagnosed. As a woman, she had some of the less well-known symptoms of a heart attack. Sarah went on to have two stents inserted to open up the blocked arteries that caused her heart attack. Roni and his family now champion heart healthy eating to the local community. Angina Heart attack Plaque cracks and a blood clot blocks the artery It is harder for blood to get through the artery Sarah has now given up smoking and pays better attention to what she eats. Graham Lowe, a former top professional league coach, was surprised by his first heart attack. Since then, he has experienced numerous heart events and had countless stents inserted, but that hasn t stopped him from living life to the full. Graham and his wife Karen now have 11-year-old twin boys. Other causes of a heart attack include spontaneous tightening (spasm) of a coronary artery, or tearing in a coronary artery. 4 5

4 About your heart Recognising a heart attack A heart attack happens when your heart can t get enough blood. This makes it hard for your heart to pump properly, which often causes chest discomfort a common symptom of a heart attack. Heart Attack Warning Signs ARE YOU EXPERIENCING If you or someone else experience chest discomfort (with or without nausea, sweating or shortness of breath), call 111 immediately. Important: After having a heart attack, you are at high risk of having another one. Many people do not recognise their next heart attack, as it may feel different to the first one. Every heart attack is different. HEAVINESS PRESSURE In ANY of these areas: CHEST SHOULDER JAW ARM NECK YES BACK (PAIN IN MID BACK) 01 STOP TIGHTNESS Stop and rest now. Tell someone how you feel min 03 If you take angina medication and the symptoms have not been relieved within 15 minutes or if the symptoms are severe or getting worse. DISCOMFORT /PAIN You may also experience: SWEATING SHORTNESS OF BREATH NAUSEA FATIGUE DIZZINESS Call 111 and ask for an ambulance. If instructed and aspirin is available, chew one. Sarah had a heart attack while hosting friends for dinner at her Cambridge home. None of them suspected the pain was a heart attack because my pain was always across my back and not my chest, she says. Roni was working out during a morning boxing session when he suddenly experienced his heart attack. I had this feeling like a balloon blowing out in my chest, then excruciating pain that was like a knife jabbing me in the chest. This brought on cold sweats all over my body, I felt clammy and I knew I was in deep trouble, he recalls. Check out our interactive heart attack symptoms tool at firststeps.hearthelp.org.nz 6 7

5 I had a heart attack, now what? Finding out more about your heart In the early stages after a heart attack, you are likely to need to find out more about the health of your heart. Early treatment can help to reduce damage to your heart muscle. This may involve: Looking at the electrical activity of your heart (electrocardiograph, ECG) Blood tests Looking at the x-ray pictures of the arteries (angiography) and potentially opening up the arteries with a special balloon and stent (angioplasty) Making a new way for blood to flow around a blocked artery (coronary artery bypass graft surgery) Using soundwaves to look at the structure, function and size of your heart (echocardiogram) Taking medication to dissolve a blood clot (thrombolysis) When making decisions about your heart health, it is important to talk to your doctor, nurse and other health professionals to get all the information you need. You may like to ask questions such as: What do I need to know about my heart? How can I find this out? What are the risks and benefits of the tests and treatments? What other tests or treatments could I consider? What changes can I make to my lifestyle to care for my heart? What happens if I decide to do nothing? Getting to grips with your medication After having a heart attack, you are likely to be prescribed medication to help your heart recover and to lower your risk of having another heart attack. Most of these medications need to be taken for the long term to prevent another heart attack. Continuing to take your medication can help to: Control symptoms (nitrates, beta blockers) Lower your risk of blood clotting (antiplatelet agents like aspirin) Lower your blood pressure to a better level for you (beta blockers, ACE inhibitors, calcium channel blockers, thiazide diuretics) Lower your cholesterol (statins) Your doctor may recommend that you take regular medication, and you may also be taking several different types of medication. Every person is different, so it might take a while for your doctors to work out the type and dose of medication that s right for you. Feeling uncomfortable? If you have questions or concerns about your medication or unwanted side effects of the medication, please talk to your doctor, nurse or pharmacist. There may be other choices of medication available so that you can be given something that suits you better. Don t stop taking your medication without talking to your doctor or nurse. Stopping some medications suddenly can make your condition worse. To learn more about your medication, visit: firststeps.hearthelp.org.nz 8 9

6 I had a heart attack, now what? Talk to your doctor or nurse about cardiac rehabilitation Cardiac rehabilitation can involve education, exercise, emotional support and information on medications and medical treatments. Participating in cardiac rehabilitation will help you understand what has happened to you and aid your recovery. Evidence suggests that doing cardiac rehabilitation can help you get fitter, return to work and other activities sooner, and lower your chances of having chest pain and anxiety. There are usually three phases of cardiac rehabilitation: The first phase often happens in hospital The second phase starts after you leave hospital The third phase happens in your community Ask your doctor or nurse for information about cardiac rehabilitation, or contact the Heart Foundation HeartHelp online We all like to learn in different ways, so to reinforce what you are learning at your cardiac rehabilitation classes, we ve gathered some videos and stories on our HeartHelp First Steps website. When I go home The first few days and even weeks at home after having a heart attack can be difficult. You may wonder what it is safe to do, whether you should be going out and about, when you can expect to get back to work and when you can start exercising. There are no hard and fast rules to answer these questions each person will feel differently and it depends on what life was like for you before your heart attack. A good rule of thumb is to gradually build up what you do and how active you are. Start off slowly, pace yourself, see how you feel and make a plan to get back to normal. Generally, in the first few weeks after you get home you can expect to do small bouts of physical activity for a total of five to fifteen minutes a day. This may be a slow walk to the letterbox, several times a day. The exercise should feel light, and you should stop for a break if you are tired. Don t feel you are cheating by doing five three-minute walks; this is just as effective as doing it all at once. After a couple of weeks, as you get stronger, your energy levels will increase and you can return to normal daily activities. Work with your doctor or nurse to make a plan so that you slowly increase the duration and intensity of your physical activity. How much physical activity you can expect to do depends on things like your condition, and how fit you were before the heart attack. You should be able to gently increase your activity over the next six to ten weeks until you get back to normal. We ve gone out to ask other heart attack survivors and their families to share what worked for them during their journey to recovery. We ve also asked health professionals about some of the important advice you need like what to do to prevent another heart attack. Check it out at firststeps.hearthelp.org.nz Together with your doctor, talk about the types of exercise you like to do and work out an exercise plan that is right for you 10 11

7 I had a heart attack, now what? Phase two cardiac rehabilitation Phase two cardiac rehabilitation starts once you get home. This programme will help you adjust to life after hospital, learn more about what you can expect in the near future, and give you the chance to ask any questions you may have. Your cardiac rehabilitation classes are a good chance to ask about examples of the sorts of physical activity that are right for you as you progress through your recovery. Getting behind the wheel It will be at least two weeks before you can drive again after a heart attack. Different rules may apply depending on the treatment you have had, if you hold a vocational licence and if you drive passenger vehicles, trucks, forklifts, courier vans or fly aeroplanes. You may need to have an assessment by a specialist before returning to driving. It also pays to check with your insurance company to ensure that you are fully covered. For more information, visit I went along to cardiac rehab; it was a 12-week course and it was fantastic. In actual fact, I rolled it over and continued it for eight years. Graham Lowe If you haven t received an invitation to phase two cardiac rehabilitation, contact your nurse or the Heart Foundation Sex after a heart attack Many people worry that sex will put too much stress on their heart and cause damage or another heart attack. However, most people can safely return to sexual activity after they have been diagnosed with heart disease or are recovering from a heart attack. Sex is no different from any other kind of exercise; it is good for your heart. The amount of energy needed for sexual intercourse is about the same as walking up two normal flights of stairs briskly, so it will not unduly affect your heart. Find a position that is comfortable and does not place any stress on your chest or restrict your breathing, and avoid positions where your arms are supporting your body weight. If you use a GTN (glyceryl trinitrate) spray or take GTN tablets or nitrates, you should never use PDE-5 medications such as Viagra, Cialis or Levitra. Taken within 24 hours of each other, this combination of medications can cause a large drop in blood pressure resulting in dizziness, fainting or even a heart attack

8 I had a heart attack, now what? Returning to work Almost everyone can go back to work after a heart attack usually within three to four weeks after leaving hospital. How soon you can return to work depends on the nature of your job and your personal rate of recovery. Talk to your doctor about the timing that will work best for you. It is worth taking some time to think about how your heart condition will affect you in the workplace. Will you be able to do exactly the same sort of work you used to do? Will you need to work fewer hours? Will you need to learn new skills? It is normal to feel tired when you get back to work after your heart attack. One way to reduce fatigue is to include the type of activity you do at work into your home physical activity programme. You may also wish to speak with your employer or occupational health team about other options, such as a gradual return to work programme. I thought that since my heart attack, I might be a liability working in the warehouse, but they were happy with my recovery times. When I did go back, they put me on two full weeks of light duties. Keith Taulahi Looking after yourself A heart attack is often the result of heart disease. This is a life-long condition. After a heart attack, it takes time for the injured part of the heart to heal. The healing process starts soon after the attack and takes six to eight weeks. At the end of this process, your heart is left with an area of scar tissue. For many people, this scar tissue does not affect the way the heart works or how you feel. It is very important that you listen to your body. There are symptoms that you can look out for to help prevent further heart problems: Sometimes the artery leading to the heart can re-narrow and you may get symptoms of angina Sometimes extra beats in the heart can cause fluttering in your chest, dizziness or blackouts A heart attack can sometimes weaken the pumping action of the heart, which can lead to a build-up of fluid in the legs or lungs. You may feel short of breath doing minor physical activity or after lying down, feel generally tired or have swollen ankles If you have any of these symptoms, talk to your doctor at once. Early treatment can prevent these symptoms from getting worse For more information on returning to work, driving and travel, visit firststeps.hearthelp.org.nz Sarah strongly advises people to listen to their body. All I can say is you know your own body and if something is not right, stand up for yourself and push for more medical intervention. Listen to your body if something is not right, get it checked out

9 I had a heart attack, now what? Angina after a heart attack Angina is a common symptom of heart disease. It is usually caused by a narrowed (but not blocked) coronary artery, which feeds blood to the heart. After a heart attack, some people experience angina, or their angina worsens. Angina does not cause permanent damage to the heart. Sometimes people struggle to tell the difference between angina and a heart attack, as the symptoms can be the same. With angina, the symptoms will ease after a few minutes of resting or taking medication prescribed by your doctor such as GTN (glyceryl trinitrate). If you are having a heart attack, your symptoms are unlikely to ease after a few minutes of resting or taking medication. Anxiety and depression You may experience lots of different feelings, including anxiety, depression, uncertainty and fear. These feelings are common, especially when you first arrive home from hospital. One of the best ways to manage anxious, depressed feelings, and to prevent the build-up of stress, is to regain balance in your life. Each day, make sure you: Do some form of physical activity Have some rest and relaxation time Stop what you are doing and rest now Tell someone how you are feeling Take 1 puff of your GTN spray or 1 tablet under your tongue ANGINA ACTION PLAN After 5 minutes if your symptoms have not been relieved, take 1 more puff of your GTN spray or 1 more tablet under your tongue After another 5 minutes, if your symptoms have not been relieved, repeat After another 5 minutes if you still have symptoms, treat as a heart attack - dial 111 and ask for an ambulance Chew an aspirin unless advised not to If your symptoms are relieved, you can resume your activities gently. If your angina becomes more frequent, severe, lasts longer or happens when you are doing very little or resting, see your doctor in the next 24 hours. Do some form of work where you feel useful, productive and gain a sense of achievement Get plenty of sleep as this is the time when your body and mind are restored Include some enjoyable activities, especially those that make you laugh It also helps to talk with others your family, whānau or people who have gone through a similar experience. Sharing the experience helps to remind you that you are not alone. If you usually have angina, and you notice any of the following changes, talk to your doctor straight away: you get angina when you are doing very little, or resting the angina is worse and lasts longer you get angina more often Try joining a local cardiac rehabilitation or heart support group. This will offer you ongoing support from health professionals and other people living with heart disease. For a list of groups in your local community, please ask your nurse or contact the Heart Foundation 16 17

10 I had a heart attack, now what? If you are feeling really down or anxious, talk to your doctor. You may be referred to a psychologist or counsellor who can help you talk through some of your concerns. You may also benefit from taking medication for depression and / or anxiety. Graham says he s always been a confident person but the diagnosis hit him hard. Many people are just not aware of the toll that heart disease takes on a person, mentally and emotionally, he explains. Your whole life on this planet is all of a sudden at extreme risk. I think it takes a lot of courage, determination and willpower to face it. Keeping your relationships strong Family members and other loved ones may struggle to come to terms with your health scare and it is likely that they will feel scared and anxious about you having another heart attack. It is important for you to recognise that many of the feelings you and your family experience are normal reactions to your heart attack. Make sure that you and your family can talk honestly and freely about what they re feeling. No one, including children, should be excluded from the conversation. You may not be aware that children can often blame themselves when their parents become unwell, so it is important to explain to them what has happened and why it has happened. Having open and honest conversations can lower your stress and encourage the closeness and emotional support that heart attack survivors need. Julie Birch worried about her partner having another heart attack when he left hospital. When he first came home, I was really scared and I thought what do I do, how do I look after a heart patient? she explains. It s like living with a volcano, I m afraid to say anything in case he goes off! The Mental Health Foundation produces resources on depression, anxiety and stress. You can find out more on their website: For more stories, visit firststeps.hearthelp.org.nz 18 19

11 I had a heart attack, now what? Tackling negative thoughts It really helps to spot negative thoughts and tackle them because they are often quite wrong. For example, many people who have had a heart attack are worried about going out alone for the first time. So how can you tackle this negative thought? Start by challenging it slightly by asking yourself how far you can go without feeling worried. If I go out on my own I might have another heart attack! How far can I go without feeling worried? Perhaps to the end of the garden path or letter box? Try walking that distance a few times until you are sure you are not going to come to any harm. As you become more confident about going out on your own you will stop believing the negative automatic thought. Tomorrow I'll go to the end of the street! Now set your goal. Repeat the process and when you are comfortable set another target further away

12 Lowering my risk and staying well Will it happen again? After having a heart attack, you are at high risk of having another one. Many people do not recognise their next heart attack, as it may feel different to the first one. Every heart attack is different. When Julie s partner had a second heart attack, she had to convince him to let her call an ambulance. He kept saying to me, no it s not another heart attack... but then it was. A lot of people think that after you ve had one heart attack, they won t have another one. [My partner] is living proof that you can. A heart attack is a symptom of heart disease. While heart disease is a life-long condition, there are choices you can make to lower your risk of another heart attack and stay well. There are a number of factors that are known to increase your risk of heart disease. These are called risk factors. The more risk factors you have, the greater your chance of having a heart attack. Some risk factors you can t do anything about, including age, ethnicity, gender, personal or family history of heart attack or stroke. But there are other risk factors that you can change. Choices you can make to lower your risk of another heart attack Stop smoking If you smoke, stopping smoking is the best thing you can do for your heart. There is lots of support available to help you stop smoking. Talk to your doctor or nurse about what support may work best for you. Phone, online and text-to-quit Local one-on-one or group support programme Phone Quitline on or visit for more information about support to stop smoking Take medications Remember to ask questions about the medication you are taking. For you to be safe when taking your medication, you need to understand: What the medication does Why you are on the medication Patches, lozenges and / or gum What unwanted side effects you should look out for Other medications There are things you can do to help you remember when you need to take your medication. You may like to: Stop smoking Take medications Make heart healthy eating and drinking choices Move more Lose weight Set reminders on your cellphone Talk to your pharmacist about a blister pack 22 23

13 Lowering my risk and staying well Make heart healthy eating and drinking choices Move more Here are some ideas to add goodness to your food / kai: Building more exercise into your day is easy start with one of our simple steps: Add one more vege to dinner Cut the fat off meat and skin off chicken Switch to lite blue, green or yellow top milk Take the stairs not the elevator Get off the bus one stop early and walk Work out with a video that shows you how to get active Swap from white bread to wholegrain Choose baked potatoes or kumara instead of deep fried Swap from butter or ghee to oils or margarine After his heart attack, Roni knew he d need to make some drastic lifestyle changes if he was going to stick around to spend more precious time with his wife, children and grandchildren. Deliver a message to a coworker in person instead of sending an Catch up with friends during a walk instead of by phone Turn up the music and dance while doing household chores It was scary for us as a family because they realised I could have died from a heart event that has claimed other family members in the past. Embracing better eating and drinking habits, following a regular exercise plan, and taking my medication has really helped me stay alive and well. Roni is now quick to offer advice to others particularly Pacific people about taking care of their heart health. He says he s become an evangelist for the Gospel of healthy eating. In the long-term, you may like to talk to your doctor or nurse about a green prescription to help you get moving more. Aim to work up to 30 minutes a day of moderate exercise. You should be able to feel your heart pumping harder but still be able to talk comfortably. If you are too breathless to talk, then it s time to slow down. If you are able to sing or whistle, then step up the pace. Check out our Healthy Heart visual food guide and meal planner app at For more ideas about what you can do to increase your physical activity, visit firststeps.hearthelp.org.nz 24 25

14 Lowering my risk and staying well Lose weight Try these simple steps to help you reach a healthier weight You can take steps today to start managing your weight better. This is all about how you balance what you eat and the exercise you do. My personal plan for my heart health You have an important role to play in your health After reading through this section, there may be one or more things you would like to do to lower your chance of having another heart attack. Have a conversation with your health professional about any changes you are thinking about. The first step is deciding if you are ready to make this change. Reasons to stay the same What is good about staying the same? Reasons to make a change What worries me about staying the same? Keep a food diary to spot habits that trigger unhealthy eating Use a small plate rather than a big one Cut down on alcohol What worries me about making a change? What is good about making a change? Eat slowly and don t go back for seconds for 20 minutes Swap to healthier snacks For more ideas, check out the tips for heart healthy eating and moving more Based on the table, how important is it to you to make a change? For more, visit firststeps.hearthelp.org.nz Not important Very important If it is less important to you than a 7, try finding a more important change that you would like to make

15 Lowering my risk and staying well Recruiting help from friends and family / whānau A key step in making a successful change is to get the support of your friends or family. Together with your support team, think about what steps you can take to manage your risk. Your support team has two important tasks: 1. Ask questions to find out how they can support you to make your change 2. Provide emotional support as you work to make changes People on my support team: Choosing my targets Break down your goal into small, achievable steps. We ll call these your targets. Set targets that are simple and realistic. My target is: Make it detailed... Set a time... Remember to keep these achievable Example: Walk my kids to school and back. How much? How long for? How many? Example: Twice a week for 20 minutes. What days? What time? Example: Monday and Friday at 8:30am and 2:30pm An important next step is a plan. Carefully monitoring your progress against your targets each day has been shown to be a really important factor in helping people succeed in making changes. Make sure you set SMART goals. This means your goals should be: S pecific M easurable A chievable R ealistic, and have a T ime frame On a scale of 1 to 10, how confident are you that you are going to be able to do this? Not confident Very confident If you are less confident than a 7, think about starting with something easier. You want to set small, achievable targets. Discuss your plan with your support team / health professional so they know how they can support you

16 Check your progress Lowering my risk and staying well After you have completed your target, think about how much effort it took. Heart Attack Warning Signs ARE YOU EXPERIENCING HEAVINESS TIGHTNESS PRESSURE DISCOMFORT /PAIN On a scale of 1 to 10, how much effort did it take for you to achieve these targets? Too easy Trying aiming for about a 5 for effort, so if you are finding your targets too hard or too easy then change them to make them right for you. Now you might be ready for the next step to help reach your overall goal. You may like to keep the target you have already so that it becomes easier or a habit, or you may like to add a new target. Too hard In ANY of these areas: CHEST SHOULDER JAW ARM NECK BACK (PAIN IN MID BACK) You may also experience: SWEATING SHORTNESS OF BREATH NAUSEA FATIGUE DIZZINESS YES 01 STOP 15 min 03 Stop and rest now. If you take angina Call 111 and ask Tell someone how medication and the for an ambulance. you feel. symptoms have not If instructed and been relieved within aspirin is available, 15 minutes or if the chew one. 30 symptoms are severe 31 or getting worse. 02

17 Hearts fit for life, for this generation and the next The Heart Foundation is the charity that works to stop New Zealanders dying prematurely from heart disease. We are committed to helping people with heart disease live full and productive lives through better support, care, research and prevention. If you would like to assist us to help other people like yourself, please consider donating To donate: Visit: Phone: Heart Foundation, PO Box 17160, Greenlane, Auckland 1546 T F E info@heartfoundation.org.nz Revised and printed October 2015 ISBN (print) ISBN (pdf) The Heart Foundation of New Zealand is a registered charity (CC23052) under the Charities Act 2005 As a charity, we thank our generous donors for helping bring this resource to life. 32