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HEART ATTACK PATIENT GUIDE HEART ATTACK PATIENT GUIDE

Fostering hope, optimism, and increased quality of life for our community of heart attack survivors and their families through education.

What Is A HEART ATTACK? A heart attack (or myocardial infarction) usually occurs when blood flow to the heart muscle is cut off suddenly. When this happens, the heart muscle becomes starved of oxygen-rich blood. In just a short period of time part of the heart can be damaged or die. Two less common causes of heart attacks are an intense, prolonged spasm of a coronary artery or a tear in the artery wall, both of which can reduce blood flow to the heart muscle. That is why immediate care is crucial. If you think you are having a heart attack, dial 9-1-1 immediately. INTRODUCTION Experiencing a heart attack is scary. The “Heart Attack Patient Guide” will help you learn more about your condition, handle the changes that have happened, become a team member of your health, and learn how to successfully improve your health and reduce the risk of a future event. Your goal is to preserve your health or the health of your loved one.

Table of Contents Addressing Your Heart Attack Risk Factors �� 1 Anatomy of a Heart Attack ��2 How Is A Heart Attack Diagnosed? ��3 Classification of Heart Attacks ��3 What Are the Treatments? �� 4 Lifestyle Changes: Manage Your Health ��5 Healthy Eating ��6 Medication Teaching After Acute MI ��8 Weight Chart ��10 Glossary of Terms ��11 5 Ways to Lower Your Risk of A Second Heart Attack �� 12 Local and Web Resources �� 13 Common Heart Attack Warning Signs ��Back Cover

Addressing Your Heart Attack

RISK FACTORS

Who is at risk? Most heart attacks are due to coronary artery disease (CAD). Risk factors for CAD and heart attacks are high blood pressure, smoking, high cholesterol, obesity, sleep apnea, and diabetes. Personal risk factors that you can change are checked below: q

HIGH BLOOD PRESSURE Take control of your high blood pressure. When your blood pressure is too high, the heart muscle and blood vessel walls work harder causing damage. High blood pressure increases the risk for stroke, heart attack, heart failure, kidney damage, and more. Most of the time there are no symptoms with high blood pressure. Normal blood pressure is 120/80 or less. Your B/P has been around: __________________

SMOKING Smoking causes blood to clot more easily. Smoking increases the buildup of plaque in your blood vessel walls, causing damage all over your body. Nicotine causes blood vessels to narrow, which limits the amount of blood that flows to your organs. Nicotine and smoking increases blood pressure and your risk of heart attack.

UNHEALTHY CHOLESTEROL LEVELS Unhealthy cholesterol levels put fat deposits called plaque in your blood vessel walls. Blood vessels look like pipes. Plaque can clog the inside of your pipes and can lead to a heart attack if the clog is in the heart. You should have your cholesterol levels checked regularly. You can control your cholesterol level with medication and lifestyle changes. Your total cholesterol is: __________ Normal: less than 201

Your triglycerides are: __________ Normal: less than 151

Your LDL is: ______ Normal: less than 131

EXCESS WEIGHT To reduce your risk of heart attack or stroke, maintain a healthy weight with regular physical activity, monitoring the amount of food you eat, and watching calories. Carrying more weight around your waist and hips increases your risk even more. If your body mass index (BMI) is over 30, you are obese. If over 25, you are overweight. BMI is based on your height and weight. To lose weight you must burn more calories than you eat or drink. See lifestyle changes for ways to lose weight. Your BMI is: ___________

Your weight is: ___________lbs

SLEEP APNEA Sleep apnea means your breathing pauses from a few seconds to minutes. This can lead to gulping for air. Snoring is often a sign of sleep apnea. If left untreated, it increases the risk of high blood pressure, heart attack, and stroke. A sleep study is the first step. Treatment will depend on the severity of your sleep apnea.

DIABETES Diabetes increases the risk of heart attack by causing plaque to build up in the blood vessels at a faster rate. High blood sugar (glucose) levels cause damage to organs in the body such as heart, brain, eyes, and nerves. If you have diabetes, you should check your blood sugar, follow a diabetic/heart healthy diet, be physically active, and take your medications as recommended by your primary care provider. Your A1C is: __________ Normal: 4.5 - 5.7

Anatomy of a

If the plaque becomes unstable and ruptures, the clotting process, called thrombosis, starts inside the artery.

HEART ATTACK

A heart attack (myocardial infarction – or MI) occurs when the heart muscle does not get enough oxygen. This is caused when a blood clot or cholesterol buildup blocks the flow of blood to the heart muscle. 1 A heart attack often occurs when plaque tears open or the narrowing plaque has progressed to a significant level.

As thrombosis continues, blood supply to the heart muscle is reduced. Muscle tissue can start to die.

2 W hen plaque tears, the body tries to fix the tear by forming a blood clot around it.

3 “ The clot can block the blood flow to the heart muscle.” (CardioSmartAmerican College of Cardiology) If the clot blocks the coronary artery, all muscle tissue below the blockage can die.

Source: American Heart Association

Right coronary artery

Aortic arch

Dead cardiac muscle tissue (myocardial infarction)

Left main coronary artery

Left circumflex artery Thoracic aorta behind the heart

Marginal branch of left circumflex artery Left anterior descending artery

Posterior descending artery Marginal branch of right coronary artery

Coronary arteries supply blood and oxygen to the muscles of the heart.

Ask your doctor or nurse to show you what portion of your heart was affected by your heart attack.

How is a Heart Attack DIAGNOSED?

Your doctor usually diagnoses a heart attack based on a combination of factors: • Your signs and symptoms • S tress testing involves an injection of a medical tracer into your IV and an assessment • Your personal and family history of how well your heart muscle absorbs the • An electrocardiogram (EKG) records your heart’s tracer during rest and after exercise. Your electrical activity and shows how evenly or fast your heart is beating. It can also show if there is enough blood supply to the heart or if it is already damaged.

• E chocardiogram (ECHO) is a simple, pain-free procedure done at the bedside. The test uses high frequency sound waves (ultrasound) to make moving pictures of your heart. The doctor will assess your heart’s structure and check: 3H ow well your heart is working 3 The size of your heart 3H ow your heart moves (Do all areas squeeze and relax?) 3T he heart’s pumping strength (Ejection Fraction – The percent of blood the heart is able to pump out into the body, relative to the amount of blood available to be pumped out)

exercise EKG will also be evaluated.

• B lood tests are performed every 6-12 hours to check for certain protein levels (cardiac enzymes) that are released into the blood when heart muscle cells are under stress or are dying. Other basic blood tests will assess your cholesterol and overall health. • C oronary angiography (“heart cath”) is a procedure done in the cardiac catheterization lab. It involves threading a catheter into an artery in your wrist or groin and up to the heart. A small amount of “dye” is injected into the coronary arteries to see if they are open, partially closed, or fully closed. A heart cath is recommended when an earlier test is abnormal or if your symptoms and/or history strongly suggest coronary artery disease (CAD).

3 If the heart valves are working correctly

CLASSIFICATION of Heart Attacks There are two types of heart attacks, STEMI and NSTEMI. You may see one or the other term as the discharge diagnosis on your discharge packet.

How is a STEMI and NSTEMI Diagnosed?

Heart attacks are diagnosed through two tests. 1st we review the 12-lead EKG. This test looks at the heart muscle as it is contracting from 12 different views. 2nd is a blood test that shows elevated levels of certain cardiac enzymes released when the heart muscle is damaged or is under stress.

What is a STEMI Heart Attack?

A STEMI is a full-blown heart attack caused by the complete blockage of a heart artery. STEMI stands for ST Elevation Myocardial Infarction. “ST Elevation” refers to a particular pattern on an EKG heart tracing and “Myocardial Infarction” is the medical term for a heart attack. So, STEMI is basically a heart attack with a particular EKG heart tracing pattern.

What is an NSTEMI Heart Attack?

NSTEMI is another type of heart attack. NSTEMI stands for Non-ST Elevation Myocardial Infarction. NSTEMI is also known as a nonSTEMI. There is no ST Elevation but there is an elevation of the cardiac enzyme troponin.

STEMI vs NSTEMI – Which is Worse?

The bottom line is that they are both bad. STEMI is more of an immediate emergency because there is a known total blockage of a heart vessel (coronary artery) that needs to be opened urgently. In terms of long-term outcomes, they have equal health implications. Patients with NSTEMI often have other illnesses such as high blood pressure, high cholesterol, diabetes, and/or kidney disease. This means they have a generally higher risk over the long term.

What Are the

TREATMENTS? There are a number of treatment options including lifestyle changes, medication management, Percutaneous Coronary Intervention (PCI –> the use of a catheter with balloon or stent to open a narrowing or blockage in an artery, done during the heart catheterization), or open-heart surgery (Coronary Artery Bypass Graft “CABG”). Your treatment will depend on: Your symptoms, EKG, and lab results 3Y our age, other risk factors, overall health, and past coronary history 3 H ow much narrowing of the artery there is and where it is located in the heart 3 How many arteries are affected 3Y our distance from a cardiac catheterization lab - time is critical 3 Your preferences Medications may be recommended to treat high cholesterol, high blood pressure, and high blood sugar. Aspirin or other blood thinners may also be recommended. An antiplatelet medication is prescribed if you receive a stent. With your nurse, please review the “Medication Teaching after Acute MI: Purpose of the Medication and Side Effects” sheet on pages 8 and 9 below and handouts for any new medications you are receiving. You should know the name of each new medication, why you are taking it, and potential side effects. Please take all medications as prescribed and do not stop any new medication without first discussing it with your cardiologist. In some situations, clot-busting medications may be given when there are delays in getting to a facility with a cardiac catheterization lab and when the medication can be given within the first hours of a confirmed heart attack. Cardiac Catheterization with PCI: When a balloon and/or stent is placed in the narrowing of a vessel or a clot (blockage) to keep the artery open. Ask your nurse to view the video about stenting or for the booklet “Cardiac Catheterization.” Cardiac Rehabilitation is beneficial to all patients after a heart attack, coronary procedure, valve surgery, heart failure, or if they suffer from chest pain. The program includes a mix of supervised exercise, counseling, and education about the disease process. Our rehabilitation staff will visit you during your hospital stay, Monday – Friday. They will describe the program and can coordinate rehabilitation at a location close to home. Heart Attack Support Group: The Heart Attack Support Group offers a safe, confidential environment to meet with peers who have experienced a similar cardiac event. Additionally, a cardiac healthcare team will provide education on related topics.

Lifestyle Changes that Help You

MANAGE YOUR HEALTH Little changes can have a big impact.

BE ACTIVE If you have not been physically active, check with your healthcare provider first. Then, pick activities that you like to do that will get you moving more. Here are some simple changes that can have a big impact: • Park your car further away and walk • Garden or rake leaves • Take the stairs instead of the elevator • Swimming is an option for those with limited mobility • Walk: Start with a simple stroll for 5 minutes then walk briskly and move your arms as you go. If you cannot talk and walk, you need to slow down. Ask your healthcare provider for suggestions of what your daily walking goal/steps should be. An ideal goal is 30-45 minutes of aerobic exercise daily. LOSE WEIGHT If you are excessively overweight, you will need to work with your healthcare provider to lose weight safely. Below are some general tips: • Eat on a smaller plate. • Your goal weight will depend on you sex, age, and level of physical activity you are capable of doing. Work with your healthcare provider to determine your goal weight. • Keep your portion size reasonable. Avoid second helpings. • Don’t eat late in the evening. • Diet and exercise are the key to losing weight. MANAGE STRESS • Change your response – focus your mind on a peaceful thought, image, or word. • Practice relaxation every day. • Get a good night’s rest. • Participate in local support groups. You are not in this alone. STOP SMOKING • Track what triggers your desire to smoke. Develop a plan on how you will deal with your urge to smoke. • Using a quit-smoking product such as nicotine patch or gum increases your chance of kicking the habit for good. • Consider a stop smoking program. • Secondhand smoke is also dangerous. • Use the Smoking Cessation Resources offered on the inside of the back cover.

HEALTHY EATING

Dairy Fruits

Healthy eating may seem overwhelming with so much information out there, but it can be simplified.

Vegetables

Here are the basics: Everything you eat and drink over time affects you. The right mix can help you be healthier now and in the future. Start with small changes to make healthier choices you can enjoy.

Grains

Proteins

ChooseMyPlate.gov

Find your healthy eating style and maintain it for a lifetime. SALT/SODIUM Watch salt/sodium intake. In high doses it can be catastrophic, especially for people with high blood pressure or heart disease. • G oal intake is 2300 mg or less for all people and less than 1500mg for people with heart disease and/or high blood pressure. • Example: 1 teaspoon of salt is 2300 mg of sodium

FATS

• Make half your plate fruits & vegetables - Focus on whole fruits - Vary your veggies • Make half your grain “whole” grains • Move to low-fat and fat-free milk or yogurt • Vary your source of protein (chicken, fish, low-fat cottage cheese, beans, nuts) • Drink and eat less sodium, saturated fat, and added sugars

The Good, the Bad, and the WHOA (the really Bad) • T he Good: Good fats include monounsaturated and polyunsaturated. Both help to improve cholesterol levels when used in place of saturated and transfats. Select salmon, tuna, herring, flax seeds, walnuts, safflower oil, sunflower oil/seeds, and pumpkin seeds. • T he Bad: Saturated fats are fats that are solid (hard) at room temperature. They increase the bad cholesterol (LDL). Avoid butter, lard, cheese, fatty meats, especially red meats. • T he WHOA (really Bad): Items with labels that say, partially hydrogenated oils are transfat foods. These oils help food keep “preserved” longer on the shelf. Examples include: margarine, fried foods, doughnuts, pasta, crackers, and chips.

TRANS FAT FOODS BREAKFAST PASTRIES

BREADS

FRIED FOODS

SALTY SNACKS

PASTAS

DESSERTS

CARBOHYDRATES • Avoid simple carbohydrates, such as sugars and transfat foods listed above. • E at complex carbohydrates such as peas, beans, nuts, seeds, and whole grains. Complex carbohydrates pack in more nutrients than simple carbs, because they are higher in fiber and digest more slowly. This also makes them more filling, which means they are a good option for weight control.

SUGAR

SODA VS JUICE

Sugar is one of the “bad guys” in increasing the risk of inflammation in the body which has been shown to increase the risk of coronary artery disease (CAD). • The risk of heart disease doubles if sugar makes up 20% of your daily caloric intake. Example: If you eat 2000 calories a day, 20% = 400 calories (25 teaspoons of sugar). 1 teaspoon (tsp) = 16 calories

Coca Cola

100% Motts Apple Juice

100% Tropicana Pure Premium Orange Juice

Serving Size: 8 oz Calories: 100 Sugar: 27 grams

Serving Size: 8 oz Calories: 120 Sugar: 27.9 grams

Serving Size: 8 oz Calories: 110 Sugar: 22 grams

• Perspective: 1 Iced Mocha at Starbucks = 11 tsps of sugar, 1 can of pop = 8-9 tsps of sugar, 8 oz of orange juice = 5 ½ tsp of sugar, 8 oz of apple juice = 7 teaspoons of sugar.

IN SUMMARY Try to follow a more anti-inflammatory diet such as Mediterranean, DASH, or a vegan diet. Both the Dash and Mediterranean diets have proven health benefits. Deciding which to follow depends on your goals and preferences. • The Mediterranean Diet does not prescribe specific amounts of any food group. Instead, it offers a pyramid. Vegetables, fruits, nuts, whole grains, and vegetable oils are the base of the diet. Fish are the second tier, with at least two servings weekly suggested. Poultry and dairy in moderation. Meats and sweets should be eaten “less often.”

Look here first Balance with exercise Limit these Limit these Choose carbs w/ fiber

Avoid sugars

REMEMBER... • Go by the 80:20 rule. What we do 80% of the time is what matters. • If you are going to stick with meats, go for lean, low fat choices. Choose fish, seafood, and skinless chicken instead of red meat. • Read food labels: Remember to read the size and # of servings per container when calculating calories, sodium, fiber, etc.

Anti-arrhythmic

Date/Initials

Amiodarone (Cordarone) Digoxin Mexiletine (Mexitil)

Isosorbide (Imdur) Nitroglycerin Ranolazine (Ranexa)

Anti-anginal

Losartan (Cozaar) Olmesartan (Benicar) Valsartan (Diovan)

Date/Initials

Angiotensin Receptor Blockers (ARBs)

Enalapril (Vasotec) Lisinopril (Zestril, Prinivil) Quinapril (Altace)

Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors)

Date/Initials

MEDICATION

• Reduces abnormal heart beats. • Slows the heart rate.

• Lowers blood pressure. • Dilates blood vessels.

• Reduce chemicals that are harmful to heart muscle. • Lower blood pressure (B/P)

PURPOSE OF TAKING MEDICATION

muscle weakness)

• Diarrhea, nausea (digoxin) • Blurred vision • Slow heart rate (less than 50 bpm) • GI upset, dizziness (Mexitil)

• Low blood pressure • Flushing (Nitrates: Imdur, Nitroglycerin) • Headache • Dizziness • Constipation (Ranexa)

• Low blood pressure

• Dizziness • Raise potassium (nausea, fatigue,

• Dry cough • Low blood pressure

• Dizziness • Raise potassium (nausea, fatigue,

insert for a complete list of side effects)

SIDE EFFECTS (Please read the pharmacy

Notify your doctor if you have an increase in palpitations or difficulty breathing. Mexitil: take with food

“Nitro” take one tab every 5 mins x 3 for chest pain. Call 911 for severe pain. Do not take while driving / pull over.

HELPFUL HINTS

Do NOT wait for mail-order drugs. Your nurse and/or pharmacist should give you a handout about all new medications and discuss them with you.

before stopping them unless you’ve had a serious allergic reaction. Ensure that you pick up any new medication so it is available when next scheduled.

about stopping any, contact your physician. It is critical that you do NOT stop taking any new medications prescribed to you. Contact your physician

You should only take the medications listed in your Discharge Packet. This may mean stopping some medications you were previously taking. If unsure

3 Name of the medication 3 Purpose of taking it 3 Any side effects to watch for 3 Helpful hints that may apply to certain medications

It is very important for patients to know each of their medications:

PURPOSE OF THE MEDICATION AND SIDE EFFECTS

Medication Teaching After Acute MI:

Calcium Channel Blockers

Diltiazem (Cardizem) Amlodipine (Norvasc) Nifedipine (Procardia)

Non-steroidal antiinflammatory (NSAIDs)

Statins

Date/Initials

Atorvastatin (Lipitor) Lovastatin (Mevacor) Rosuvastatin (Crestor) Simvastatin (Zocor)

Ibuprofen (Advil) Ibuprofen (Motrin) Naprosyn sodium (Aleve)

Metoprolol (Lopressor) Sotalol (Betapace) Carvedilol (Coreg)

Beta Blockers

ASA (Aspirin) Clopidogrel (Plavix) Prasugrel (Effient) Ticagrelor (Brilinta)

Date/Initials

Anti-platelets

Warfarin (Coumadin) Dibigatran (Pradaxa) Rivaroxaban (Xarelto) Apixaban (Eliquis)

Anti-coagulants

Date/Initials

• Bleeding • Easy bruising

• Lipitor and Zocor lower cholesterol & triglycerides • Others lower cholesterol • Used to reduce/stabilize plaque in blood vessels.

• Leg or muscle cramps &/or pain

• Increases the risk of bleeding when combined with other drugs that also decrease blood clotting • Gastric upset or stomach ulcers • Hypertension

• Dizziness • Low blood pressure • Slow heart rate (less than 50 bpm) • Edema

• Lowers blood pressure by relaxing blood vessels. • Increases blood flow to the heart. • Slows the heart rate. • Can reduce pain that is caused by inflammation.

• Dizziness • Weakness • Low blood pressure • Slow heart rate (less than 50 bpm)

• Prevents damaging effects of stress on heart muscle. • Lowers blood pressure by relaxing blood vessels. • Slows the heart rate.

• Reduces the risk for blood • GI upset (ASA) clots that could result in heart • Bleeding gums attack or stroke. • Easy bruising • Rash/itching (Plavix) • Shortness of breath (Brilinta)

• Helps prevent blood clots.

• Blood tests to monitor your liver and kidneys may be ordered.

• Use with caution if taking aspirin or warfarin

• Report bruising, dark urine, or bloody stool to your physician. • Notify your physician if you have side effects.

• Warfarin: monitor PT/INR • Pradaxa: monitor creatinine, store in original container and do not crush or open capsule. • Xarelto: must take with food

POST HEART ATTACK WEIGHT CHART

Post Heart Attack

Name:

WEIGHT CHART

Date

Wt **

DATE

Heart Rate

WEIGHT

Blood

Pressure HEART RATE

Symptoms

Refer to #'s below

Desired Wt: NAME: ________________________________________________ Heart

Blood

Symptoms

DESIRED __________________________________ Date WtWEIGHT: ** Rate Refer to #'s Pressure

BLOOD PRESURE SYMPTOMS

below

DATE

WEIGHT

HEART RATE

BLOOD PRESSURE SYMPTOMS

KEY TO WARNING SYMPTOMS: ** Weigh yourself morningtight after urinating & before eating. 1. Pants, skirts, orevery belts unusually 2. Increased swelling in feet, ankles, legs, hands

KEY TO WARNING SYMPTOMS: 3. Increased shortness oftight breath 1. Pants, skirts, or belts unusually 2. Increased swellingfrom in feet, ankles, legs,short handsof breath 4. Awakens sleep feeling 3. Increased shortnessactivity of breathtolerance, increased fatigue 5. Decreased 4. Awakens from sleep feeling short of breath 6. Dry cough 5. Decreased activity tolerance, increased fatigue Dizziness or lightheadedness when going from lying to standing position 6. Dry7.cough 8. Weight gain or loss of greater pounds in 1 dayposition or 5 pounds in 1 week. 7. Dizziness or lightheadedness when goingthan from2lying to standing 8. 10 Weight gain or loss of greater than 2 pounds in 1 day or 5 pounds in 1 week.

416 Connable Connable Avenue 416 Avenue Petoskey, MI Petoskey, MI 49770 497702 231-487-4000 (231) 487-4000 mclaren.org/northern

10_2018

GLOSSARY Angina: Arrhythmia: Artery: Atherosclerosis: CAD: Coronary Artery Disease: Cardiac Markers (Enzymes):

Chest pressure or pain Abnormal heart rhythm Blood vessel that carries nutrients and oxygen from the heart to the cells in the body The buildup of plaque on the inside walls of arteries The buildup of plaque in the coronary arteries that feed the heart muscle Proteins in the blood that are released by the heart when heart muscle damage or death occurs

Cholesterol:

A waxy, fat-like substance found in all cells of the body. Your body needs some cholesterol to make hormones, vitamin D, and substances that help you digest foods. Your body makes all the cholesterol it needs.

Coronary:

Related to the arteries that deliver blood to the heart muscle

Dyspnea:

Shortness of breath

ECHO (Echocardiogram): Ejection Fraction (EF):

Hypertension:

A test that uses ultrasound waves to make moving pictures of your heart A measure of how much blood the heart is able to pump out into the body, relative to the amount of blood available to be pumped out. Normal is 55-70%. High blood pressure

MI:

Myocardial infarction (Heart attack)

PCI:

Percutaneous Coronary Intervention: a procedure to open up blocked coronary arteries using a balloon or stent

Plaque: Sodium:

Fat deposits in the walls of the arteries Salt

LOCAL RESOURCES Designed to meet outpatient needs in one dedicated state-of-the-art facility, the John and Marnie Demmer Wellness Pavilion and Dialysis Center, located at 820 Arlington Avenue in Petoskey, provides services for healing, learning, modifying, and maintaining the elements of a healthy life. The key to this concept is evidence-based design, incorporating healing-focused elements to nurture and restore balance to the body, mind, and spirit. McLaren Northern Michigan sponsored events: DIABETES/NUTRITIONAL COUNSELING CENTER IN PETOSKEY WHERE: 560 W. Mitchell, Suite 560 Petoskey 49770 CALL: 231-487-3118 MCLAREN HEART ATTACK SUPPORT GROUP WHERE: John and Marnie Demmer Wellness Pavilion (820 Arlington Avenue, Petoskey 49770) WHEN: 2nd & 4th Tuesday of each month 6:30-8:00 p.m. CALL: 800-248-6777 MCLAREN TOBACCO CESSATION CLASSES WHERE: Petoskey and Cheboygan CALL: 800-248-6777 REHABILITATION & THERAPY SERVICES WHERE: John and Marnie Demmer Wellness Pavilion (820 Arlington Avenue, Petoskey 49770) WHAT: Services include rehabilitation and therapy for many conditions including: Aquatic • Cardiac • Occupational • Physical • Speech • Stop Smoking • Stroke/Neurological CALL: 231-487-7486 [Note: Our Petoskey rehabilitation specialists can coordinate and refer your rehabilitation to a location closer to your home if desired.]

WEB RESOURCES To ensure reliable and accurate information, we recommend you use the web sites listed below. CardioSmart offers you the ability to join their site and track your improvement over time. American Heart Association

www.heart.org

CardioSmart

www.cardiosmart.org

Tobacco Cessation Quit Line

www.michigan.gov/tobacco Click on “Information for Consumers” and “To Quit Tobacco” or call 1-800-QUIT-NOW

Learn Learn more more at Heart.org/HeartAttack. at Heart.org/HeartAttack. use prohibited. use prohibited. reserved. reserved. Unauthorized All rightsUnauthorized Inc. All rightsInc. Association, Heart Association, American ÂŠ2016 American ÂŠ2016Heart