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A manual for heart attack survivors and those who love them by Julia Ann Purcell, RN, MN, FAAN Suzanne Cambre, RN, BSHA Barbara Johnston Fletcher, RN, MN, FAAN This book is to help you learn about your heart. It should not be used to replace any of your doctor’s advice or treatment.


“Here’s to your future good health!” Most heart attack survivors return to full activity within a matter of weeks. A heart attack is a warning that it’s time to focus on a healthier future. The key is to learn the answers to these questions:

• What happened to my heart? • What can I do to help my heart heal? • What can I do to become healthier and not have another heart attack? This book will answer these questions and help you take charge of your future. Your doctors and nurses can also answer your questions and help you make changes that will lead to a healthier heart. As you read, keep in mind that you may have a lot of emotions as you recover from your heart attack. You may even wonder if you really had a heart attack. All of this is normal.

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Contents Learn About‌ What happened to my heart?............................................................. 4-5 Diagnosis and treatment........................................................................6-8 Possible problems..................................................................................9-10 Hearts do heal..................................................................................... 11-15 Back in the swing................................................................................16-21 Take control.........................................................................................22-36 Smoking.............................................................................................. 22-23 High blood pressure................................................................................24 Heart-healthy diet.............................................................................. 25-29 Exercise.............................................................................................. 30-32 Weight management......................................................................... 33-34 The metabolic syndrome.........................................................................35 Stress........................................................................................................36

Other issues.........................................................................................37-40 Medicines............................................................................................. 41-42 Follow-up....................................................................................................43 Be heart-smart.....................................................................................44-47 Your heart is in your hands....................................................................48

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What Happened To My Heart? A heart attack is most often caused by a blood clot. It forms a dam in the stream of blood taking oxygen to your heart muscle.

Right coronary artery

Circumflex artery

Left anterior descending artery

Ask your doctor to show you the artery blockage and the part of your heart that was damaged.

4


Coronary arteries carry blood and oxygen to your heart muscle. Over time, these arteries can become narrowed by fatty deposits (plaque). This is like rust building up inside a pipe. Inflammation of the artery lining is likely a key part of this process, called coronary artery disease (CAD)*.

blood flow artery wall blood clot cracks in fatty plaque fatty plaque

When the artery lining is inflamed, splits in the plaque are likely making it easier for blood clots to form. These clots block the flow of blood and oxygen to the heart muscle. Without oxygen, part of the heart is damaged. This is a heart attack, also called a myocardial infarction (MI), a “coronary,” or acute coronary syndrome (ACS). spasm

It’s rare, but sometimes spasm of a heart artery can stop blood flow to part of the heart muscle, causing a heart attack. artery

blood flow stops

* also called coronary atherosclerosis

5


Diagnosis and treatment After hearing your symptoms, your doctor does a physical exam and uses certain tests to tell that you’ve had a heart attack: blood tests - measure enzymes that go up with heart damage EKG or ECG (electrocardiogram) can show heart damage or changes in the rhythm or heart rate MPI (myocardial perfusion imaging) - shows areas of heart muscle not getting good blood flow Sometimes an ultrasound of the heart (Echocardiogram) is done to see how well the damaged heart is squeezing. A chest x-ray is common to see if there is fluid buildup.

Early treatment The amount of heart damage you have depends on how fast you got treatment. In many cases, early treatment can lessen the amount of damage. During your hospital stay, the main goals are to prevent further damage and get you on your way to full recovery. Some tests and treatments may be needed right after your heart attack and some later in your recovery.

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Drugs Often heart damage is less if the blocked artery can be opened in the first few hours after symptoms start. A clot-buster drug (thrombolytic) may be used to try and dissolve any blood clot blocking a heart artery. Often heparin is given to reduce the chance of another blood clot. Other drugs may be given to: relax the heart arteries and relieve heart attack symptoms improve blood pressure (or heart rate) treat abnormal heart rhythms help the heart muscle squeeze better

Cardiac cath (catheterization) A cardiac cath is often done in the early stages of a heart attack. It is an x-ray study of the heart arteries. The cath pictures help your doctor decide if a balloon procedure (angioplasty and/or stents) or bypass surgery can reduce the chance of more heart damage and improve long-term survival. A small catheter (tube) is placed into an artery in your groin (or wrist) and passed along to the heart. When the tube is in place, a liquid contrast is injected. X-ray moving pictures are made of the heart arteries and chambers. Many times treatment is decided at this point.

catheter left coronary artery dye

blockage

heart damage 7


Angioplasty / Stents Angioplasty is a procedure to open narrowed heart arteries so more blood can get to the heart muscle. Angioplasty or PCI (percutaneous coronary intervention) can be done with one or more of these: balloon catheter - stretches open a narrowed artery

artery wall

stent

balloon catheter

artery wall

stent - metal coil that props open a narrowed or collapsed artery atherectomy - removes layers of fatty plaque

stent

Balloon angioplasty often works to open a blocked artery. Many times a stent is left in place to keep a dilated artery open over time. Either a bare metal stent or a drug-eluting stent (DES) is used based on which is best for the narrowed artery. DES stents are coated with a drug to help prevent future buildup at the site (restenosis). Blood clots can form in either kind of stent. Antiplatelet drugs like aspirin and/or Plavix®, Effient® or Brilinta® are standard therapy to prevent stent blood clots… for weeks, months or even years. When an artery is not suitable for a stent, other treatments are offered.

Bypass surgery Surgery is sometimes done in the early stages of a heart attack to prevent life-threatening damage. A vein from the leg or artery from the chest is used to reroute blood flow around blocked arteries.

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Possible problems Many people have no problems after a heart attack and go home in 3 to 5 days. Others may need to stay in the hospital longer to treat one of these problems: arrhythmias (dysrhythmias) - changes in the heartbeat Drugs are often used to prevent or control changes in heart rhythm. Once in a while, a shock must be given to restore a normal beat. Sometimes a pacemaker or implantable cardiac defibrillator (ICD) is needed. pericarditis - inflammation of the sac around the heart

There may be pain in the chest, neck or shoulder. It may hurt to breathe or move and can feel like another heart attack. Most of the time, anti-inflammatory drugs heal the heart sac quickly.

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Possible problems (continued) h  eart failure (also called congestive heart failure or CHF) - means the heart is having trouble pumping enough blood to the body This can lead to extra fluid in the body and in the lungs, often causing shortness of breath and swelling. Drugs are used to make it easier for the heart to fill with blood and help with pumping. Other drugs get rid of the extra fluid (diuretics), replace lost minerals (potassium), and prevent blood clots (blood thinners). Often heart failure improves after a heart attack as healing begins. You will learn to: eat less salt (sodium) weigh daily report rapid weight gain (often fluid) report any new shortness of breath

Sometimes an intra-aortic balloon pump is needed to treat heart failure. A balloon catheter is guided into the aorta (main blood vessel). This catheter is attached to a pump. Balloon deflation makes it easier for the heart to pump out the blood. Balloon inflation boosts blood flow in the heart arteries. Once heart pumping is better, the balloon catheter is removed.

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Hearts do heal A heart attack is like a quick blow to the heart. The heart can be “stunned” by the lack of blood and oxygen. When the blocked artery can be opened quickly enough, the damaged muscle gains back more of its normal function. Soon after a heart attack, small arteries (collaterals) near the damaged area begin to expand. They bring blood to the area around the blocked artery. This may help limit the amount of damage. Within a few weeks or months, damaged heart cells are replaced by scar tissue as the heart heals. Drugs often given to reduce risk of a future heart attack include: aspirin or an antiplatelet “statin” and/or other drugs to help keep cholesterol and blood fats in normal range beta blocker and/or ACE inhibitor (or ARB) Rarely a “blood thinner” (anticoagulant) is needed instead of anti-platelet drug(s). expanding arteries (collaterals)

damaged area that may recover

scar tissue

11


The emotional ride Knowing what to expect after a heart attack can help you, your family and friends deal with the changes.

You may find that your emotions go up and down like a roller coaster the first few days after a heart attack. Have people around you who care. Talk about what scares you, and ask questions about how you are doing. Holding in emotions only makes them more intense. Let family and friends help you work through them.

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Denial Early denial is very common after a heart attack. Many people have less pain than they thought they would with a heart attack, so they feel their problem is not that serious. You may even have said, “I can’t be having a heart attack.” If you feel this way, you are not alone. When heart attacks are mild, it’s common for people to deny that they even happened. This is risky. People in denial may start smoking, resume eating high-fat foods, stop doing their exercise and taking their medicines. Going back to bad habits could lead to more heart disease and another heart attack. Your choices in life have a lot to do with your heart’s health. As you begin to accept that you’ve had a heart attack, ask questions. Find out about your test results and plans for your care. When you know what’s going on, you can choose those habits that will keep you healthy.

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Depression After a heart attack some people become sad or withdrawn. Depression is common. You may not be able to do the things you used to do to cope with hard times (like smoking or eating a bag of fatty potato chips). This can make depression even worse. Give yourself time. Look for new ways to cope: Talk to a close friend, family member or

someone who has had a heart attack*.

Try to start each day with a good outlook. You can start by getting dressed each morning. Don’t stay in your pajamas all day. Try to be more active. Do some form of exercise each day. Tell your doctor if you still feel sad or depressed beyond the first week or two. If left untreated, depression can affect your recovery. A heart attack affects you AND the people who care about you. They often have the same fears as you. Keep a sense of humor, and remember that most

people return to a full and productive life after a heart attack.

* Mended Hearts Inc. (www.mendedhearts.org) is an organization of heart attack survivors who are willing to give this support. Ask if they are available in your area.

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Fear/Anxiety It’s OK to be afraid. Fear is a normal emotion after a heart attack. Fear of dying is common. But many fears are based on a lack of information or things you imagine.

Replace your fear of the unknown with facts. Ask your health care team questions about your heart attack and recovery.

You may also be anxious about making changes in your life (job, sex, finances). When you are anxious, you often: are restless can’t sleep talk a lot or don’t talk at all Sometimes, exercise or just keeping busy can ease anxiety. If you are still anxious after you go home from the hospital, ask your doctor for help.

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Back in the swing The time it takes to get back to “normal” after a heart attack depends on: the amount of heart damage your general health how active you were before the heart attack Trying to do too much too soon may put a strain on the heart. Ask

your doctor when you can go back to your normal activities.

In the hospital At first, your activities will be very light to let your heart rest. You will be able to wash, eat and use the toilet by yourself or with help from your nurse. Soon you can sit in a chair and walk around the room and in the hallways. Ask your nurse what you can do and when. Sometimes a treadmill exercise test is done before you go home. This will help your doctor advise you about activities you can do at home.

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At home Most people can return to light activity as soon as they get home from the hospital. When you first get home:

DO listen to your body follow your doctor’s advice eat right get enough sleep and rest between activities start a walking program when your doctor tells you to (avoid very hot or cold weather) Don’t lift anything over 10 lbs in the first few weeks.

Avoid things like: heavy yard work housecleaning hobbies or projects that take a lot of energy Plan to drive, return to work and travel when your doctor says it’s ok for each of these.

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Sex Most people can have sex 2 to 3 weeks after a heart attack. Having sex is often compared to the energy of climbing two flights of stairs. When you have enough energy to do this, you most likely have enough energy to start having sex again.

Hints for sex after a heart attack: Set goals that are easy to reach. Don’t rush. Be comfortable and rested. Avoid being too hot or cold. Plan sex before or 3-4 hours after a heavy meal. Avoid alcohol just before sex. People who use drugs to enhance sex and those who prefer anal sex should know that both can cause irregular heartbeats. Your doctor may tell you to avoid both until your heart is fully healed.

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If sex causes chest discomfort or shortness of breath, stop and wait for another time. Tell your doctor if this happens more than once. Also tell your doctor if you have a lot of skipped heartbeats during or after sex. Some people take nitroglycerin (NTG) before sex to avoid heart symptoms. But some find that the headache common with NTG is a turnoff to good sex. It may also cause brief loss of erection.

Do not use nitroglycerin (NTG) for symptoms of angina or heart attack if you have used an erectile dysfunction (ED) drug like Viagra®, Cialis® or Levitra®* or any over-the-counter ED product within the past 24 hours. Instead, go to the nearest ER for treatment. Taking any form of NTG (tablets, patches or sprays) within

24 hours before or after the use of an ED drug may cause a dangerous blood pressure drop. Check with your doctor if you have any questions.

* Prescription ED drugs are Viagra® (sildenafil), Cialis® (tadalafil) and Levitra® (vardenafil). The same NTG precautions also apply to drugs used for lung high blood pressure: Revatio® (sildenafil) and Adcirca® (tadalafil).

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Cardiac rehabilitation (“rehab”) After a heart attack, most people can return to full activity in a matter of weeks. Slowly add back bits of your daily routine until you can do all of your normal activity. A cardiac rehab program can help you get back to full activity. It will help you learn to exercise safely and become stronger. Many people become stronger than they were before their heart attack. It will also teach you how to reduce your risk of future heart problems. It can help you form heart-healthy habits you will keep for life.

Cardiac rehab is a great support system. You can share your feelings and problems with others who have had a heart attack. No one feels embarrassed because everyone is in the same boat. You can also bring family and friends for support. This will ease their minds about how much exercise you can safely do. Ask your doctor about getting into a cardiac rehab program. Most programs are covered by insurance.

See p. 30-32 for more details on exercise and a sample walk program.

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For family and friends Once your loved one is home, you can help most if you: let them do as much as they can on their own

Help, don’t nag. If you find yourself nagging, you may be worried about your loved one. Talk to friends or the doctor about your worries. are a good listener learn CPR* (cardiopulmonary resuscitation)  practice good health habits with your loved one (heart-healthy diet, exercise, stop smoking, etc.)

Take care of your own needs: eat right and get enough rest go for a walk with your loved one or do some other exercise each day let  others help you with meals, errands and other jobs

* Call the American Heart Association about CPR classes. You may also order the “Family and Friends™ CPR Anytime™ Personal Learning Kit (www.cpr.heart.org).

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Take Control Now that you have had a heart attack, it’s important to take steps to prevent any more problems.

Smoking The US Health and Human Services “Be Tobacco Free” website* notes that while over 2,000 youth and young adults become daily smokers each day, adult smokers have declined from 42% to 18%. If you are a smoker, cancer and future heart disease are at the top of the list of good reasons to quit. Nicotine (in all its forms) speeds up your heart rate and harms the lining of your arteries. It tightens them so less blood and oxygen get to the heart. Smokers who have CAD are at greater risk for heart attacks and sudden death.** Smokers who quit will have short and long-term benefits to their heart, lungs and blood vessels. * http://betobaccofree.hhs.gov/about-tobacco/facts-figures (2014)

Good news! After you quit smoking for: 14–90 days

y our heart attack risk begins to drop and lung function starts to improve

1–9 months

coughing and shortness of breath decrease

1 year

your risk of coronary heart disease is half that of a smoker

15 years

y our risk of coronary heart disease is back to that of a non-smoker

** 2004 Surgeon General’s Report–The Health Consequences of Smoking

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You can find help to quit smoking! Your

doctor can give you helpful hints and direct you to a good “stop-smoking” program. Nicotine replacements include gum or lozenges, nasal sprays or inhalers. Since it can be dangerous to smoke while on these products, talk to your doctor before using any of them. Many people become non-smokers by taking a prescription drug like Chantix® (varenicline) or Wellbutrin®. These drugs block the flow of brain chemicals that make you want to smoke. If you haven’t already, set a date to quit. Then go for it!

E-cigarettes are not regulated by

the FDA and are NOT permitted in checked luggage during airplane travel. Possible side effects are still not known, but these devices still deliver nicotine. Nicotine in any form is harmful to the heart.

Second-hand smoke is harmful, too. Second-hand smoke refers

to the inhalation of tobacco smoke from others who are smoking. Avoid the harm of second-hand smoke by staying away from smokefilled, public places. Try very hard to get family members and close friends who smoke to stop.

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High blood pressure (HBP or Hypertension) High blood pressure causes wear and tear to the blood vessels in your body. If it is not controlled, HBP can lead to stroke, heart failure and kidney disease. Blood pressure (BP) is recorded as two numbers (like 120 over 80). The top number (systolic pressure) is the peak pressure in the artery when the heart pumps. The bottom number (diastolic pressure) is the pressure in the artery when the heart relaxes between heartbeats. Many studies suggest an “ideal” BP for adults over 18 is when the top number is less than 120 and the bottom number is less than 80 (Ex: 120/80). The following chart describes the stages of high blood pressure (HBP):

Stages of high blood pressure Top BP number

Bottom BP number

What it means

120-139

80-89

Pre-hypertension

140-159

90-99

Stage I hypertension

160 and over

100 and over

Stage II hypertension

Seek medical help right away if top number is higher than 160 or bottom number is higher than 110. Lifestyle changes alone may keep “prehypertension” BP readings below 120/80. Medication as well as lifestyle changes are often needed when the top BP number is 140 or greater and/or the bottom number is 90 or higher. A slightly higher top BP number (150) may be allowed in the elderly. If you had HBP before your heart attack, you will likely need a drug for that by the time you return to normal activity. You may be able to keep a lower BP if you lower your salt (sodium) intake, exercise,

lose weight and limit alcohol use. 24


Heart-healthy diet Eating a heart-healthy diet means eating foods low in cholesterol, fat and sodium. You should also avoid or cut back on sugar-added beverages and foods. These are the key points: Eat more fresh fruits, vegetables and whole grains. Limit the ‘bad’ fats in your diet (saturated fat and trans fats). Eat up to 6 oz per day of poultry, fish or lean meat. Eat 3.5 oz of oily fish at least twice a week (salmon, trout or herring). Select lean meats (loin cuts, round or lowest percentage of fat in ground meat). Bake, broil, poach, grill, steam or stir fry (with low-sodium broth). Limit oil to 1-2 Tbsp per meal of a mono- or polyunsaturated oil (Ex: canola, olive, peanut, safflower, flax or sunflower). Avoid saturated fat (fat solid at room temperature) like hard margarine, butter or lard. Avoid foods with trans fats (high-fat baked goods, hard margarines and foods with partially hydrogenated vegetable oils). Choose fat-free, 1% and low-fat dairy products (milk, cheese, frozen desserts). Aim to eat less than 1500 mg sodium per day. Avoid pre-packaged/processed foods and fast foods.

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Getting started Ask your doctor or registered dietitian for help in deciding which of these daily calorie options will help you reach and maintain your ideal weight: 1,200 calories a day 1,600 calories a day 2,000 calories a day A structured meal plan like the Dietary Approaches to Stop Hypertension (DASH) diet may help you learn heart-healthy eating. All 3 calorie options in the DASH diet help you take in: less than 200 mg cholesterol a day less than 30% of your daily calories in fat (40-67 g*) less than 7% of your daily calories in saturated fat intake (9-16 g*) less than 1% of your daily calories in trans fats (0-2 g*) When possible, use mono-unsaturated and poly-unsaturated fats (found in nuts, seeds, fish and vegetable oils). Keep total fat intake to less than 30% of your daily calories. And if using the DASH diet, cut down a little more on foods high in sodium towards a goal of less than 1,500 mg of sodium/day. Make food choices that fit into your daily fat limits. Only three ounces or 84 grams of shrimp take up 57% of your daily 200 mg cholesterol allowance. But since they have no saturated or trans fat, eating three ounces of shrimp is a good protein choice once in a while. * Stay on the low end of these if you are trying to lose weight

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Lowering blood fats (lipids) Eating foods high in fat and cholesterol add to the fat and cholesterol made by your body. Blood lipids (fats) measure total cholesterol, the HDL and LDL cholesterol, and triglycerides. Fasting lipid tests are more accurate.

HDL (high density lipoprotein) is the “good cholesterol.” It helps remove “bad cholesterol” from the body. LDL (low density lipoprotein), the “bad cholesterol,” increases plaque. Non-HDL cholesterol is the total cholesterol minus the HDL portion. Blood tests can also measure triglycerides, which if high, can lead to fatty buildup.

Lipid blood tests

Goals in coronary artery disease or diabetes

Your test results on __________

Total cholesterol

Less than 200 mg/dL

mg/dL

Bad cholesterol (LDL)

Less than 100 mg/dL*

mg/dL

Good cholesterol (HDL)

40 mg/dL or more (men)

mg/dL

Non-HDL cholesterol

Less than 130 mg/dL*

mg/dL

Triglycerides

150 mg/dL or less

mg/dL

50 mg/dL or more (women)

* If you are at high risk for heart attack, your goal may be an LDL less than 70 mg/dL and a non-HDL less than 100 mg/dL.

Most people take a drug to keep blood fats normal. If you also avoid foods high in animal fat/cholesterol, lose weight and exercise, even lower blood lipids are likely. Sometimes fasting triglycerides can go down to the ideal 100 mg/dL. Learn more about healthy foods from a “healthy heart” cookbook.

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Lowering sodium Most of us eat way too much sodium. Aiming for 1500 mg sodium/day gives the least risk of stroke, kidney damage and future heart disease. The CDC Vital Signs (www.cdc.gov/features/sodium, July 2012) shows that 44% of the sodium we eat comes from these 10 foods: breads and rolls

cold cuts/ cured meats

poultry

soups

cheese

pasta dishes

pizza sandwiches meat dishes snack foods

Read nutrition labels carefully to find the lowest sodium in all your favorite foods, especially any of these 10. Although a food label may say low or reduced sodium, always go by the

sodium number on the food label for the serving size you plan to eat. Many

of these products are too high in sodium for a heart-healthy diet.

tomato sauce (& spaghetti sauce, veggie drinks/V8 juice, tomato soup), canned soups and vegetables frozen dinners, packaged deli meats and snack foods (if food label shows low sodium, check fat content as well) pre-packaged vegetables (including rice, potatoes) or those with sauces 28


The sodium content on a food label will include all forms of sodium in that product. Processed or pre-packaged foods, salad dressings and sauces often include sodium preservatives or flavor additives. Tips to help you limit your sodium to 1500 mg/day: Season foods with fresh or dried herbs, fruits and vegetables instead of table salt. Use a dash of a low-sodium seasoning if needed. Avoid high-sodium spices like MSG, teriyaki sauce or soy sauce. Make your own sauces, salad dressings, vegetable dishes and desserts. When you eat out, request no salt be added to your meal. Avoid soups, appetizers or casseroles with cheeses and meats. Ask for low-sodium food and any sauces on the side. Other resources for heart-healthy eating include: T he DASH Diet Action Plan by Marla Heller and www.dashdiet.org S  imple 7 steps of heart-healthy living by the American Heart and Stroke Associations (1-800-242-8721 or mylifecheck.heart.org)

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Exercise Regular exercise can benefit or help control your: heart’s pumping action

high blood pressure

oxygen supply (and your muscles’ use of oxygen)

body weight

blood fats

blood sugar

mental outlook Studies also show exercise has other beneficial effects to help reduce heart and blood vessel disease.

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As you begin a program, choose an exercise you like. Start out with an easy pace. Build up slowly by changing how long, how hard and how often you exercise. Stay at a level that is

comfortable for you.

Most people begin to take short walks in the first week after a heart attack. You also get benefit from small amounts of activity or energy you use in your job or with housework. Some days you may want to exercise slower or easier for a longer time. Other days you may want to exercise a bit faster or harder for less time. Listen to your body, and rest when needed. Rest plays a big part in how the heart heals. After you are back to normal activity, find a way to make exercise a part of your normal daily routine. You can try: brisk walking

gardening

housework

stair climbing

swimming

dancing

doubles tennis

jogging

bike riding

Think about the things you like to do most. When you are back to normal activity, find a way to make 30-60 minutes of exercise part of your daily routine.

Caution: Always check with your doctor before starting a new exercise program.

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A sample walk program After you leave the hospital, begin with a low level exercise program. You can walk on a flat surface or peddle a stationary bike (with light resistance) for 10 to 15 minutes at a time, 5 to 7 times each week. After the first week or two of exercise, add 5 minutes each week. Do this until you can exercise for at least 30 minutes a day, without symptoms of dizziness, chest pain, fatigue or shortness of breath. You can then add more time each day, exercise at a harder level or choose to stay at your same level.

Talk with your doctor before starting this program.

Exercise should be a part of your daily routine from now on. A good long-term program may be: walking two miles in 30 to 40 minutes, 5 to 7 times each week. Check with your doctor if you wish to increase your pace or distance (or both). Also tell your doctor if you have any: chest pain shortness of breath dizziness fatigue palpitations

32


Weight management and body mass index (BMI) chart People who are overweight increase their risk of heart disease. If your BMI score is 18.5-24.9, you are in a healthy weight range; between 25 and 29.9, you are overweight and 30 or higher, you are considered obese.

Get your BMI score* Your BMI score is: 23 24 25 26 27 28 29 30 31 Your Weight (pounds) 63” 130 135 141

146 152 158 163 169 175

64” 134 140 145 151 157 163 169 174 180 65” 138 144 150 156 162 168 174 180 186 Your Height (inches)

66” 142 148 155 161 167 173 179 186 192 67”

146 153 159 166 172 178 185 191 198

68” 151 158 164 171 177 184 190 197 203 69” 155 162 169 176 182 189 196 203 209 70” 160 167 174 181 188 195 202 209 216 71”

165 172 179 186 193 200 208 215 222

72”

169 177 184 191 199 206 213 221 228

73”

174 182 189 197 204 212 219 227 235

74”

179 186 194 202 210 218 225 233 241

• Find your height in inches (left side of the chart) • Move ACROSS that row to your weight (lbs) • Move UP through the numbers above your weight to see the red number at the top (your BMI) Example: height of 6 feet (72 inches), weight of 206 lbs = BMI of 28 Weight goal for this person would be 169-177 lbs to get a normal BMI (less than 25).

* A portion of the BMI chart, from the National Heart, Lung and Blood Institute

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Your goal is to reach a BMI score of less than 25 and stay there. You may need help from a dietitian. Diets that claim

fast weight loss in a short time can make it harder to keep the weight off. Very low-calorie diets (under 1000 calories/day) can be dangerous. Anyone on such a diet should be under a doctor’s care. The way you “wear” your weight is also a factor. Apple-shaped people (weight around the middle) are more likely to have heart disease than pear-shaped people (weight around the hips). Men should have a waist less than 40 inches and women less than 35 inches. When measuring, drop down from your “natural” waist to the top of your hip bones.

Caution: Don’t take diet pills unless your doctor has told you to take them. This includes diet pills sold “over the counter” without a prescription, as well as those sold in health food stores.

34


The metabolic syndrome The metabolic syndrome refers to people who have 3 or more of these risk factors for heart disease or stroke: “waist” measurement (top of hipbones) = more than 35 inches (women) or 40 inches (men) fasting triglycerides over 150 mg/dL low HDL cholesterol (less than 40 mg/dL for men and less than 50 mg/dL for women) blood pressure over 130 (top number)/85 mmHg (bottom number) fasting blood glucose over 100 mg/dL Anyone taking drugs for one of the above should count that item as a risk factor whether their current numbers are in the desired range or not. In many cases, people with metabolic syndrome have a hard time using their body’s insulin. Being more active and losing weight will improve all of the above risk factors. Sometimes medicine is also needed.

measure waist at the top of your hipbones

35


Stress Stress in your life can increase the risk of a heart attack. Stress causes the body to produce more adrenaline (a hormone that stimulates the heart). This leads to faster or irregular heartbeats as well as higher blood pressure and cholesterol levels. It can also increase the risk of a blood clot. Some people feel the effects of stress on their body more than others.

People who don’t have a healthy outlet for anger may have more heart problems. Education, counseling and learning ways to handle stress improve your emotional well-being. This may lower your chance of another heart attack. Many people find yoga,

meditation or exercise helpful.

Your family and friends (and pets in some cases) are very important to your well-being. People who live alone or keep themselves apart from others have a higher death rate after a heart attack. Lean on others for support and fun times, and allow them to lean on you. Regular exercise with a partner or a group of friends can reduce stress and give you support.

36


Other issues Aspirin Your doctor most likely has you on daily aspirin unless there is a reason you should not take aspirin. If not, ask your doctor if aspirin may help you prevent another heart attack. Do not take

daily aspirin without first asking your doctor.

Alcohol A small amount of beer, wine or liquor is OK for most people after a heart attack. Men can usually have 1-2 drinks per day, while women can have 1. One drink is: one 12 oz beer or 4 oz of wine or 1½ oz of 80 proof liquor (or 1 oz of 100 proof) Alcohol can help raise HDL (the good cholesterol). However, it can also raise triglycerides and add calories. Your doctor may want to use other ways to get the same benefits.

People with severe heart weakness (also called heart failure) or a past alcohol problem should not drink any alcohol. Also know that some medicines may interact with alcohol. Follow your doctor’s instructions about alcohol.

37


Antioxidants and supplements Better nutrition can improve cell function over your whole body. Eating foods rich in vitamin C and E, beta-carotene, folate and omega-3 fatty acids is likely the best way to give you more vitamins and nutrients. Omega-3 fatty acids are found in oily fish like salmon, trout and herring.

Vitamin E

Vitamin C

Beta Carotene

Folate

Sunflower seeds

Red and green sweet peppers

Pumpkin

Dried beans/ lentils

Almonds

Citrus fruits

Sweet potatoes

Spinach

Peaches

Spinach and other greens

Sweet potatoes

Strawberries

Carrots

Lettuce

Broccoli

Sweet potatoes

Cantaloupe

Corn

Lettuce

Orange juice

Spinach and other greens

Tomatoes

Broccoli

Ask your doctor before starting any new vitamin or nutrition supplement. Folic acid supplements were made to match the substance folate, found in foods.

38


Heredity These problems tend to run in families: high blood fat levels high blood pressure angina or heart attack before the age of 55 diabetes Now that you’ve had a heart attack, let other members of

your family know of their higher risk for heart disease. Teach them what they can do to lower that risk. Make healthy living a family affair.

Estrogen replacement therapy For many years, it was believed that hormone therapy after menopause (change of life) protected women from heart disease. Studies done on thousands of women suggest that this is not the case. Hormone therapy may even increase the risk of heart disease, stroke and breast cancer. There is on-going debate about hormone replacement. As in all health concerns, you need to discuss this issue with your doctor.

39


Diabetes Diabetes damages artery walls and can lead to fatty buildup. Since high blood sugar also leads to nerve damage, people with diabetes may not feel symptoms of heart disease. They are more likely to have a “silent� heart attack with symptoms like sweating for no real reason or being dizzy. If you have diabetes, be alert to any symptoms of heart disease, and take fast action. Besides helping your heart, proper diet and exercise may reduce the need for insulin or pills to keep your fasting blood sugar less than 100 mg/dL and A1C less than 7%.

Homocysteine Homocysteine is a substance found in the blood. Studies show too much homocysteine may encourage fatty deposits in blood vessels by damaging the artery lining and promoting blood clots. Persons with high homocysteine levels have more risk of heart disease, stroke and fatty narrowing in the leg/arm arteries.

C-reactive protein (CRP) High-sensitivity CRP is measured in a blood test and can show inflammation in the body. CRP cannot diagnose heart disease but research shows it may be a useful screening test for some people.

40


Medicines Drugs often used after a heart attack include:  Aspirin and/or an anti-platelet drug like Plavix®, Effient®, or Brilinta®– help prevent blood clots ACE inhibitor (or ARB) – help decrease “remodeling” of the heart muscle and improve pumping function Beta-blocker – help prevent or control abnormal heart rhythm and help the heart beat slower and use less oxygen Drug(s) to lower the ‘bad’ LDL cholesterol (& total cholesterol and high triglycerides), and increase the ‘good’ HDL cholesterol – a “statin” (most common) – a resin, fibrate, or niacin – omega-3 acids in fish oil capsules or the drug Lovaza® * See page 27 for more detail about the blood fats.

Note: Beta-blockers, ACE inhibitors and ARBs help reduce high blood pressure but do not affect normal blood pressure in most cases.

41


Write down important names and numbers:

Doctor: Nurse: Phone #: Pharmacy: Phone #: My allergies:

Keep track of medicines you need to take.

Name of medicine

42

What for

How much to take

When to take

How to take (with food, etc.)

Things to watch for


Follow-up Your doctor may want to check your progress 1 to 4 weeks after you go home from the hospital. In your first follow-up visit, your doctor will: • check your weight and blood pressure • make changes in your medicine(s), if needed • do blood work and EKG testing, if needed • check to see how you are doing to lessen your risk of heart attack in the future

My next appointment is: _____________________________

43


Be heart-smart Taking your medicines and living a heart-healthy lifestyle may prevent further heart problems. But if you do have any of these

upper body symptoms, be wise and take fast action:

t ightening, pressure, squeezing or aching feeling in the chest or arms “burning� feeling in the chest that may be confused with indigestion (heartburn) or nausea sharp, burning or cramping pain or an ache that starts in or spreads to the chest, neck, jaw, throat, shoulder, upper back, arms or wrists These symptoms may mean angina or heart attack!

44


Angina When heart symptoms are brief and go away in a few minutes with rest and/or NTG (nitroglycerin), they are called angina. Angina is a warning sign that the heart doesn’t have enough blood and oxygen to do its work. Often angina occurs during exercise or stress. It can also be caused by spasm of a normal heart artery. Tell your doctor about:  new angina symptoms in a different area of the upper body a change in your usual angina

pattern

– h  aving symptoms after not having any for a long time – s ymptoms coming on more often or during rest or sleep – more severe symptoms – symptoms lasting longer at a time – taking more NTG for relief Your doctor can give you medicines or treatment for these. This can often

prevent another heart attack.

If angina symptoms are not relieved with rest and NTG in 5 minutes, take fast action. You need medical care NOW.

45


Heart attack Heart attack symptoms are much like angina but may be more intense. They last longer and do not go away with NTG and rest. Taking fast action will limit the amount of heart damage. The discomfort of a heart attack can stay in one part of the body or move into the back, either arm or the neck and jaw. Symptoms are not always severe and can include: sweating dizziness weakness skipped heartbeats nausea/vomiting shortness of breath

Note: Women may not feel heart attacks the same way men do. They may have less intense chest pain, more nausea or more weakness. Elderly people may also have less intense symptoms. Diabetics may have few or none of the usual heart attack symptoms.

46


If you think you are having a heart attack, call 9-1-1 (or your local rescue service number*)! Minutes do matter! Emergency

Medical Technicians (EMT’s) can start life-saving care and in many cases, alert the hospital before your arrival. While you wait, chew a non-coated aspirin unless you have an allergy to aspirin. If you are alone, unlock your door, and sit or lie down. Loosen any tight clothes and take slow deep breaths. Call and ask someone to come sit with you. Don’t feel embarrassed if you are not sure whether your symptoms are indigestion, angina or a heart attack. It’s better to be safe than sorry. If angina symptoms are not relieved with rest and NTG in 5 minutes, take fast action. You need medical care NOW.

* If you are in an area without 9-1-1, do as the local emergency rescue personnel advise to get the quickest help for a heart attack. DO NOT drive yourself.

47


Your heart is in your hands Now that you’ve read this book, you know what causes a heart

attack and how to reduce your chance of having another one. You know the symptoms of CAD and how to respond to them. You are a heart attack survivor. You know firsthand how medical care has gotten you through a hard time. Now it’s up to you to take charge of your future. Remember, your heart is in your hands.

48


The heart Your doctor or nurse may use these when talking with you about your heart.

Front of heart Left Main Coronary Artery

Circumflex Branch Left Anterior Descending Branch (LAD)

Right Coronary Artery (RCA)

Posterior Descending Branch

Back of heart


Author

Reviewers

Julia Ann Purcell, RN, MN, FAAN Clinical Nurse Specialist, Cardiology 1968-1996 Emory University Hospital Atlanta, GA

Carolyn S. Brown, RN, MN, CCRN Education Coordinator Emory Healthcare Atlanta, GA

Suzanne Cambre, RN, BSHA Cardiology Nurse Northside Hospital Atlanta, GA Barbara Johnston Fletcher, RN, MN, FAAN Brooks College of Health, School of Nursing Clinical Associate Professor, University of North Florida Jacksonville, FL

Stephen D. Clements, Jr., MD Professor of Medicine, Cardiology Emory University School of Medicine Atlanta, GA Barbara Beier, MS, RD, CDE PCU Clinical Dietitian Glycemic Team Diabetes Educator PeaceHealth Southwest Medical Center Vancouver, WA Gary E. Lane, MD Assistant Professor of Medicine, Mayo Medical School Consultant, Cardiovascular Diseases Mayo Clinic Jacksonville Jacksonville, FL

Please let us know how this booklet is helping you (or your patients). Share your comments at

http://p-h.com/242

3440 Oakcliff Road, NE, Suite 110 • Atlanta, GA 30340-3006 1-800-241-4925 • www.p-h.com

Randolph P. Martin, MD, FACC Medical Director, Cardiovascular Imaging Piedmont Hospital Atlanta, GA Barbara Riegel, DNSc, RN, CS, FAAN Associate Professor San Diego State University San Diego, CA Thanks also to: Nancy Cronmiller, MMSc, RD, LD, CDE, Lori Giles, RN, Linda Shrake, RN, Valorie Sweigart, RN, Johnette Elder and Jim and Carolyn Trobaugh

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