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Heart attack – a guide to your recovery

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Male: Heart attacks don’t happen to people like me. Couldn’t happen to me. Could never happen to me.
Female: Well I’m back to normal. I’m a pretty good example, completely back to normal.
Male: Beyond the first few weeks, I never really felt like an invalid. And I don’t feel like an invalid, and I think that’s important.
Male: It’ll last forever if I keep going at it the right way.
Male: This could be one for me as well, so it’s go to the hospital and it turned out it was a heart attack.
Bill P: A heart attack. You can feel very alone when you have one. But in fact there are many others like you. Fifty-five people have heart attacks in Scotland every day, that’s almost 400 a week. So recovering from a heart attack has become a major event in the lives of thousands and thousands of people. Rates of coronary heart disease in Scotland are very high, among the highest in Europe. But because so many people have had heart disease here, there is a wide range of experience to learn from, and some very interesting lessons which apply throughout the country. And the first, and the most important, lesson is that a heart attack is not an end, it’s a beginning. If you come through the first 24 hours, there’s a very good likelihood of returning to normal life. With proper care and a healthier lifestyle, you can help repair the damage your heart has suffered and reduce the risk of another attack.
Male: When I had the heart attack, I was in my office and I was walking around, completely convinced that I was suffering from indigestion or anything else you want to imagine, other than a heart attack.
Male: But I suppose basically it was a feeling of heartburn or indigestion or something like that.
Female: People in the town were absolutely shattered when I’d had an MI. They just couldn’t believe it.
Male: The pains that I was suffering before I went into the hospital, I knew they werenae pains that I’d suffered before.
Bill P: A heart attack is just the end result of heart disease. The basic problem is in your arteries. The heart is a muscle. Like all muscles, it needs oxygen and nutrients from the blood to function so the heart has its own blood vessels, the coronary arteries, to supply it. But like all arteries, these can become clogged up with fatty deposits which narrow them, restricting the blood flow. When a coronary artery actually becomes blocked, an area of the heart muscle gets no more blood so, no more oxygen, and is damaged. Part of it can die. The heart may lose some of its pumping power or start to beat irregularly. As the heart begins to heal after an attack, however, scar tissue forms in the damaged area. In some cases, the scar itself is strong enough to allow the heart to pump almost as efficiently as normal. So, although the attack may feel as if it came, well, just out of the blue, it’s actually the result of a process that’s been going on for years. The clogging that restricts the blood flow through the arteries. Fortunately, that’s a process you can stop.
Male: I now know the factors that go towards causing heart attacks and I wish I had been better educated on that subject before I’d had the heart attack, and I wouldn’t have been smoking, my diet would have been better, and I would be coping with stress in a different fashion.
Male: Primary coronary care, it’s a bit like being in a cocoon. I mean, everybody’s running after you, you just have to sort of look for the way people take care of you.
Bill P: For many people the worst part of a heart attack is the surprise. You go straight from being a person to being a patient, and you wonder will I ever be myself again? What’s going to happen to my life? How will I cope? Now it’s only human nature to feel confused and worried, even feel guilty, but there is good news here as well. And the best is, having survived the attack; you’re already on the way to recovery. A coronary care unit may seem a very technical place, but you see, that’s because what has gone wrong is a technical thing, a mechanical function of the heart muscle. Here, every beat is monitored and analysed as the healing process begins. Admittedly, there’s not much for you to do here. It can be lonely and frustrating being in hospital, but this is a good time to think. To think about the things in your life that might have brought you here, and how you can change them. There are three things that affect your risk which you cannot change – it’s your age, whether you’re a man or a woman and your family history. But there are other risk factors which you can control from now on, in what you eat, whether you smoke, how active you are, and how you manage stress. If you address these factors and it’s less likely you’ll have to come back here.
Male: Possibly I’d a bad diet when I was younger, a diet heavy in fats. That’d be the most likely thing. It’s a bit difficult to identify something exactly like that, but I would say a diet heavy in fats.
Male: It’s a case of examining everything to the extent now that my children are looking at the labels, saying fat content – that’s too much and that’s ok, and it is quite informative now that you know what not to get.
Female: Changing our eating habits wasn’t difficult for me at all. I enjoy what I’m eating now much better than what I ate before. I didn’t think I would, but I certainly do.
Male: Before I had a heart attack, my eating habits would be what I would consider to be normal. I would have the Sunday breakfast with the potato scones, the sausage, the egg. Nowadays after the heart attack, my diet is a good bit different. I didn’t have a particularly bad diet before, but it’s certainly different nowadays. It’s much healthier.
Bill P: As we’ve seen, the clogging of the arteries which leads to heart attacks doesn’t just happen. It takes time and it’s very much under our own control. Our lifestyle, including what we choose to eat, can have a big influence on the state of our arteries. And the two countries in Europe which could rival Scotland for heart disease are Northern Ireland and Finland, and what we have in common with them is a diet that is high in animal fat and low in fruit and vegetables. People in less developed societies experience less heart disease, but the fact is, our bodies are tuned to expect a different diet – lots of fibre, lots of fruit, lots of vegetables. Our consumption of fats and sugars is way beyond our needs. In fact, the way some of us eat these days, it’s a bit like running a lawnmower on jet fuel! So, how do we change that? Well, there are five ways that you can reduce your risk of heart disease by a change in diet. First of all, try to get most of your calories, that’s your total energy, from starchy foods like potatoes and bread, rice and pasta.
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Male: I had to stop smoking because it would wrong for me to carry on smoking and end up under the same doctor and the same nurses, and more or less them saying are you back again?
Female: I’ve stopped smoking. I’m hoping it’s for good.
Male: Before I had the heart attack, I didn’t really know what smoking was doing to my heart and circulatory systems. I just didn’t understand, but I certainly do now.
Male: The smoking was deemed to be the reason for my heart attack. So I basically stopped smoking which was my main priority, which I have done.
Male: About twelve years before my heart attack, I stopped smoking, and I felt it’s probably – it could be one of the factors why I survived the heart attack, because I’d stopped smoking so far before it. I think it definitely helped.
Bill P: And for a lot of people, there’s never a right time to quit. But if you’ve had a heart attack, then there’s absolutely no question – the right time is now. If you’re not a smoker, that’s good. If you are one, listen to this. The link between smoking and heart disease is very clear. It increases the risk of heart attack by two to three times, and among men under 45, smoking increases the risk of death from heart attack by more than ten times. You see, smoking reduces oxygen in the bloodstream and constricts the arteries, raises the blood pressure. But that is all reversible. If you quit, 90% of your extra risk disappears after a year of not smoking. If you’ve had a heart attack, your risk of having another is reduced immediately the minute you stop smoking – it’s like having a second chance. Giving up will probably be easier after a heart attack than at any other time, after all, now you know why you’re doing it. It’s more than likely you won’t have been able to smoke in hospital, so come on, take advantage of that. Make up your mind never to smoke another cigarette. If you’ve been a smoker, staying stopped is the most important thing you can do after a heart attack. Take it one day at a time. Go to classes if you wish. Call the helplines when you get that craving. And please, don’t despair if you haven’t been able to manage it the first time. Plan, prepare and try again. As I’ve said, it is
the: most important thing to do and you can do it. And by the way, a little of this is fine – in moderation.
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Male: I got back to fitness by basically just going for a walk down to the corner to begin with, and evolved beyond that into cycling and swimming. And I think it’s important that you do have the confidence to do that, and to build up fairly quickly, as long as you aren’t over-confident.
Male: After I had the heart attack, as part of your rehabilitation you have to get out and walk and that habit has stuck. I still do that.
Male: You know, long walks and swimming for an hour this morning. Sailing – this’ll be my first sail.
Male: There was not an awful lot of difference since the heart attack because we still went dancing and walking and …
Bill P: Because the heart is a muscle, just like any muscle, it needs exercise to be strong and the stronger it is, the better it can cope with the demands that you place on it. Now, it’s very easy to believe that a damaged heart needs complete rest, but in actual fact, a carefully managed programme of progressive exercise will help it return to the job that it’s supposed to do. And being fit also helps to improve circulation and lower blood cholesterol, which reduces the problems that led to the heart attack in the first place. As the healing process begins, so can the activity. Now you can start with sitting, standing, walking in the hospital and continue with short walks at home, and then organised exercise programmes beginning three to eight weeks after leaving the hospital. Many people go on to follow their own fitness programmes, but what you need to do is to make exercise a habit if you want long term improvement. The physiotherapist at the hospital or the clinic can help you find a level of exercise which is just right for you, but you know, any sort of activity, no matter how gentle, is good. Walking, cycling, swimming. Even just talking a walk round the back garden after tea – they all help your heart and they get you back in charge of your life.
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Bill P: Activity is vital to recovery. Now the people who love you might feel like wrapping you in cotton wool. After all, they’ve had a shock themselves. But you must get out and about to get better. It’s important for people to realise that the best way to care for you is help you to get back into a full normal life again. There’s a lot of the things that we’ve talked about that you can do together. Giving up smoking, changing diet, taking more exercise, learning to relax – they can all be a team effort. Sex can start again as soon as two or three weeks after a heart attack, but all cases are different. You may just not feel like it for a while. Talk things over with your partner, have a cuddle. Physical closeness is a great help in recovery, and it’s part of that gentle return to normal life.
Female: Coping with stress I find terribly difficult.
Male: In terms of suffering from stress, I think the same amount of stress exists now as it did before the heart attack, but I deal with it in a different fashion nowadays.
Male: I’ve got a couple of tapes about stress and relaxation and I use them at least once a day, and it tries to tell you how to relax, you know, and I find it quite beneficial, that.
Bill P: Stress is a natural part of life. In fact, during prehistoric times, it was the proper response to danger or aggression. You know, when it gets dangerous for us, it’s when we don’t manage the stress properly and the habits that that leads us into like smoking, drinking too much alcohol, getting worked up while you’re driving. Learning to relax isn’t just about lying around – oh no, no, no. In fact, if anything, as you come to manage your stress, you’ll have more energy to take part in more physical activity. Managing stress is just one more simple way of learning how to control your life.
Male: To relax, I like to listen to the music, to the music centre, and read. I read, I read, l like to read.
Bill P: And there are physical techniques you can learn for reducing the feeling of stress. Deep breathing, clench and let go exercises, meditation. There are ways of thinking which reduce stress. Realising that you can’t please all the people all the time, identifying stressful situations, learning to listen to people, not taking ‘I’ve got to’ for granted, curbing aggression. And there are ways to organise life to avoid stress. Delegating, planning time, cutting out those unimportant things. Planning for rest, leisure and relaxation as part of your daily life. These techniques don’t have the medical importance of stopping smoking or changing diet or being physically active, and it’s probably not true that if you lose your temper you’ll have another heart attack, but learning how to manage stress is a good way to make a positive approach to your new life.
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Bill P: You might think that you have to transform your entire life. Everyone is telling you what you have to do just at the very time when you’re still feeling a bit shaky. The point is though, that all of it fits together. Diet, stopping smoking, being active, making time to relax, and each one of these helps you achieve the others. You don’t have to do it all at once though. Build up to it by degrees, but once you have done it, you can stop worrying so much about your heart and get back to enjoying life.
Male: I feel life’s – I feel life at the moment’s wonderful. I really feel great, I do really feel well. I feel on top of the world as a matter of fact.
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