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This eBook has been developed by Idorsia Pharmaceuticals Ltd as a resource
to improve understanding of a heart attack, known medically as an Acute Myocardial Infarction (AMI). It provides a useful summary of current information about the causes, symptoms and management of a heart attack.
It highlights the impact a heart attack can have on the individual and on those around them. It also outlines the strategies heart attack survivors can use to help to reduce the risk of a further heart attack.
The book is intended for the use of a general audience.
About this eBook
“When I had my first heart attack, I felt really down and not sure how to go forward. I was fit and couldn’t understand why it happened.”
— Patient
Introduction
A heart attack is life-threatening and should be treated as a medical emergency. Anyone who thinks they – or another person – are having a heart attack should call the emergency medical services immediately and ask for an ambulance. Any delay can dramatically reduce the chance of survival and increase the risk of permanent heart damage.
Understanding a heart attack
Diagnosis and management of heart attack
Burden of
heart attack
Practical
guidance on life after heart attack
Introduction
Disclaimer
This resource has been developed by Idorsia Pharmaceuticals Ltd in order to provide an environment to deliver a better understanding of heart attack and to pool information regarding the disease, the diagnosis procedure, available treatments and the impact it can have on somebody who suffers heart attack. The resource is for use by a general audience.
The information in this resource is not intended as a substitute for advice/treatment by a physician, whose instructions should always be followed. Neither does the information provided constitute an alternative to advice from a doctor or a pharmacist and should not be used on its own to produce
a diagnosis or to commence or cease a particular treatment.
The links provided are for informational purposes only; they do not constitute an endorsement or an approval from Idorsia of the services or opinions of the corporation, organization or individual. Idorsia bears no responsibility for the accuracy, legality or content of the external sites or subsequent links.
Disclaimer
You are requested to contact the respective external site for answers to questions regarding its content.
The information provided is valid on the publication date but may be subject to further modifications. Even though Idorsia aims to provide accurate and up to date information at all times, please acknowledge that the present resource is made available “as is”.
Idorsia does not give any warranty or representation, whether expressly stated or implied, or any kind related to the comprehensiveness, usefulness, reliability or timelines of the content of this resource. Idorsia cannot be held liable for any direct or indirect damage or a material or non-material nature that might be caused by the use or non-use of the information presented.
Introduction
Understanding BED
Diagnosis and treatment of BED
The burden of BED
Practical Guidance on Managing BED
About this eBook
About this eBook
This eBook has been developed by Idorsia Pharmaceuticals Ltd as a resource to improve understanding of a heart attack, known medically as an Acute Myocardial Infarction (AMI). It provides a useful summary of current information about the causes, symptoms and management of a heart attack. It highlights the impact a heart attack can have on the individual and on those around them. It also outlines the strategies heart attack survivors can use to help to reduce the risk of a further heart attack.
This book is intended for the use of a general audience.
In fact, one of the key reasons for patients failing to receive prompt treatment is patient delay in seeking medical help. Timely treatment for a heart attack can be very effective and survival rates are improving. However, more than 15% of people who suffer a heart attack die before they arrive in hospital. When a heart attack strikes, every minute counts!
“I was sent home from work - despite reassuring them I was just feeling
a little unwell. As I was traveling home,
my temperature rose and the chest pain and numbness in my arm worsened so
I diverted to my local hospital where
they confirmed I’d had a heart attack.”
— Patient
Understanding
a heart attack
Most often a heart attack (myocardial infarction) happens when one of the coronary arteries that normally delivers oxygen-rich blood from the heart, through the coronary arteries, to the heart muscle (also called myocardium) becomes partially or fully blocked, usually as a result of a blood clot.
This reduces or cuts off the blood flow to that part of the
heart muscle and it begins to die due to a shortage of oxygen.
How common is heart attack and who is at risk?
What causes
a heart attack?
Medical
terminology
How does the heart work?
Myocardial Infarction (MI) or Acute Myocardial Infarction (AMI) is the most commonly used
medical term for a heart attack.
ST segment elevation myocardial infarction (STEMI) is the most serious type of heart attack, where there
is a complete interruption to the blood supply and extensive damage to the heart muscle.
non-ST segment elevation myocardial infarction (NSTEMI) is usually when the blood flow to the heart muscle is only partially blocked and a smaller section
of the heart muscle is affected.
Unstable angina (chest pain caused by reduced blood flow to the heart muscle) is the least serious type of ACS. Although the blood supply to the heart muscle
is still seriously restricted, there is no permanent damage and the heart muscle is preserved.
Medical terminology
A heart attack requires immediate emergency treatment as
any delay can result in permanent damage to the heart muscle, or even death of the patient. The concept of ‘time is muscle’, outlined more than 50 years ago, refers to the fact that the first hour following a heart attack is vital to prevent further damage to the heart muscle.
How does the heart work?
A heart attack usually occurs in patients with coronary heart disease (CHD), where coronary arteries are narrowed due to the build-up of fat, cholesterol
and other substances (known as plaque or atheroma).
This process of build-up is called atherosclerosis.
The development of atherosclerosis can progress
over decades and often has no symptoms - this explains why many people have no warning signs before a heart attack.
If a plaque ruptures, it triggers the formation
of a blood clot in the same site, this is called
coronary thrombosis.
This can lead to a partial, or in extreme cases
a full obstruction of the coronary artery, called
coronary occlusion.
Both coronary thrombosis and coronary occlusion obstruct the blood flow in the coronary arteries and starves the heart muscle of oxygen (a process known as myocardial ischemia).
What causes a heart attack?
Globally, more people die annually from cardiovascular disease than from any other cause and around 80%
of these deaths are due to heart attack and stroke.
Women often underestimate the risk of heart attack but in fact, heart attack claims the lives of 3.3 million women worldwide every year.
How common is heart attack and who is at risk?
Introduction
A heart attack is life-threatening and should be treated as a medical emergency. Anyone who
thinks they – or another person – are having a heart attack should call the emergency medical services immediately and ask for an ambulance. Any delay can dramatically reduce the chance of survival and increase the risk of permanent heart damage.
“When I had my first heart attack,
I felt really down and not sure how
to go forward. I was fit and couldn’t understand why it happened.”
— Patient
Introduction
In fact, one of the key reasons for patients failing
to receive prompt treatment is patient delay in seeking medical help. Timely treatment for a heart attack can be very effective and survival rates are improving. However, more than 15% of people
who suffer a heart attack die before they arrive
in hospital. When a heart attack strikes, every minute counts!
“I was sent home from work - despite reassuring them I was just feeling
a little unwell. As I was traveling
home, my temperature rose and the chest pain and numbness in my arm worsened so I diverted to my local hospital where they confirmed I’d
had a heart attack.”
— Patient
Understanding a heart attack
Understanding a heart attack
Most often a heart attack (myocardial infarction) happens when one of the coronary arteries that normally delivers oxygen-rich blood from the heart, through the coronary arteries, to the heart muscle (also called myocardium) becomes partially or fully blocked, usually as a result of a blood clot. This reduces or cuts off the blood flow to that part
of the heart muscle and it begins to die due to
a shortage of oxygen.
How common is heart attack and who is at risk?
Medical terminology
How does the heart work?
A heart attack requires immediate emergency treatment as any delay can result in permanent damage to the heart muscle, or even death of the patient. The concept of ‘time is muscle’, outlined more than 50 years ago, refers to the fact that the first hour following a heart attack is vital to prevent further damage to the heart muscle.
How does the heart work?
The heart is a muscle that pumps blood around the body via a network of blood vessels called the circulatory system. The heart beats around 100,000 times a day, delivering oxygen and other vital nutrients to all parts of the body and carrying away unwanted waste products.
CLOSE
Like every other living tissue, the heart needs a constant supply of blood containing oxygen in order to function.
The heart muscle has its own supply of blood – the coronary arteries, which
spread across the outside of the heart.
Medical terminology
Acute coronary syndrome (ACS) is
a general term which includes:
Myocardial Infarction (MI) or Acute Myocardial Infarction (AMI) is the most commonly used medical term for
a heart attack.
Other terms are also used for specific types of heart attack:
ST segment elevation myocardial infarction (STEMI) is the most serious type of heart attack, where there is a complete interruption to the blood supply and extensive damage to the heart muscle.
CLOSE
non-ST segment elevation myocardial infarction (NSTEMI) is usually when the blood flow to the heart muscle is only partially blocked and a smaller section
of the heart muscle is affected.
Unstable angina (chest pain caused by reduced blood flow to the heart muscle)
is the least serious type of ACS. Although the blood supply to the heart muscle
is still seriously restricted, there is no permanent damage and the heart muscle
is preserved.
What causes a heart attack?
A heart attack occurs when there is
a sudden interruption of the blood supply to some part of the heart muscle.
A heart attack usually occurs in patients with coronary heart disease (CHD), where coronary arteries are narrowed due to
the build-up of fat, cholesterol and
other substances (known as plaque or atheroma). This process of build-up is called atherosclerosis. The development of atherosclerosis can progress over decades and often has no symptoms -
this explains why many people have no
warning signs before a heart attack.
If a plaque ruptures, it triggers the formation of a blood clot in the same site, this is called coronary thrombosis.
This can lead to a partial, or in extreme cases a full obstruction of the coronary artery, called coronary occlusion.
CLOSE
“When I had my second heart attack,
I knew straight away I was in trouble
again. This time the ambulance was
called immediately. I’d learnt my lesson to act quickly – it’s better
to be sure.”
— Patient
Diagnosis and management of heart attack
When somebody has a heart attack, time is of the essence to prevent permanent damage to the heart muscle (the ‘Time is Muscle’ principle). This means
it is vital to gain an accurate diagnosis as soon
as possible.
Diagnosis and treatment
of heart attack
The emergency services attending a patient will ask a number of questions regarding type and duration of symptoms, previous medical history and potential immediate risk factors in order to build up a medical profile. They may also perform some initial tests and provide pain relief, if this is needed. If a heart attack is suspected or confirmed, the patient will be transferred to hospital.
Devices to manage complications
of recurrent
heart attack
Medication to treat symptoms or reduce the risk of recurrence
Procedures used to treat heart attack
Healthcare professionals involved in the management of heart attack
Procedures used to treat heart attack
CLOSE
Medication to treat symptoms or reduce the risk of recurrence
Some medicines will be given in hospital as soon as possible after a heart attack and in many cases a combination of drugs will be prescribed. Many patients will need to continue taking some or all of this medication for the rest of their lives and it is important
to continue taking the drugs when feeling healthy and well. Key options are:
CLOSE
Pain relief: patients experiencing pain
will be offered pain relief, which may be delivered intravenously (in liquid form into a vein), a spray used under the tongue or in tablet form out of hospital.
Antiplatelet and anticoagulants (blood-thinning) agents: to reduce the risk of further blood clots forming and recurrent heart attacks, particularly if one or several stents have been but in place.
Clot-busting medication: delivered via injection to destroy the tough protein that makes up blood clots and limits the extent of the heart attack.
Devices to manage complications of recurrent heart attack
Most common devices are:
CLOSE
Implantable Cardioverter Defibrillator (ICD): a battery-powered device placed under the skin that keeps track of heart rhythm. If an abnormal heart rhythm preceding cardiac arrest is detected the device will deliver an electric shock through thin wires to the heart to
restore a normal heartbeat.
Pacemaker: a small battery-operated device that helps the heart beat in
a regular rhythm.
Healthcare professionals involved in the management of heart attack
The main physician for patients who suffer
a heart attack will be a cardiologist (heart specialist) but a range of other healthcare professionals may be involved in the care
of heart attack patients, including:
CLOSE
Emergency physicians
What is cardiac rehabilitation?
The term ‘cardiac rehabilitation’ refers to support and information designed to support heart attack survivors in their recovery and allow them to return to maximum health as quickly as possible. Part of rehabilitation is also education on reducing the risk of having another heart attack. In some countries, when heart attack patients leave hospital, they are referred to a formal cardiac rehabilitation service.
It offers advice and information on a range of health education topics such as keeping active, healthy eating, stopping smoking and maintain
a healthy weight. The aim is to address any “modifiable” risk factors that may have contributed to a patient’s heart attack and may lead to a second heart attack. This also allows a phased return to exercise, starting gradually and building up over the weeks and months.
In other countries no formal rehabilitation programs are available. However, all heart attack survivors should focus on maintaining a healthy lifestyle and minimising modifiable risk factors
such as high blood pressure and obesity. Patient support groups can be a useful source of information on these topics.
“When I was informed it was a heart attack, I was emotionally scared and confused. I immediately felt life would never be the same. It suddenly felt like I wasn’t young anymore and that I was nearer to reaching death, through life expectancy alone.”
— Patient
Burden of heart attack
The impact of insomnia is often underestimated.
In reality, it can be a distressing condition that can reduce quality of life. It may affect many aspects
of daily life, from studying and employment to social activities and relationships.
Insomnia can have a significant economic impact and increases the risk of accident and injury on the road or in the workplace.
Burden of
heart attack
Becoming informed
Managing the inpact on sexual relationships
Being open with family and friends
Making positive life changes
Practical guidance on life after heart attack
Patients who have suffered a heart attack will usually need to take medication indefinitely to reduce the risk of a further attack, but there is
also a great deal they can do themselves to minimize any risk factors associated with
their condition.
“Some mornings you get up and wonder how on earth you are going to get through the day. Somehow you do, but it can be a massive struggle.”
— Patient
Practical guidance on life
after heart attack
Making positive life changes
Lifestyle changes can be an important factor in reducing the risk of a recurrence. Often specific tailored advice on these measures
is provided as part of cardiac rehabilitation support. Key areas to focus on are:
CLOSE
Being open with family and friends
Suffering a heart attack is a frightening experience and It can be difficult to cope with the fear of a recurrence. This is particularly true in the early stages of
the recovery period when patients leave the ‘secure’ environment of a hospital.
CLOSE
It is natural to feel vulnerable and anxious initially and it is best to share these feelings
with family and friends rather than shutting them out. Loved ones are usually only too
happy to offer support.
If feelings of anxiety or depression persist,
it is worth talking to a doctor or other healthcare professional about ways of managing these feelings. In some cases, medication will be prescribed.
People who have had a heart attack sometimes find it difficult to be honest
about negative feelings and are reluctant
to worry family and friends. It can
sometimes be easier to talk to a counsellor
or independent third party.
Managing the impact on sexual relationships
People who have had a heart attack may be concerned about resuming sexual relationships as they fear putting a strain on their heart, but in most cases, this will not present a problem. The healthcare team can advise on this.
CLOSE
Some patients experience loss of sex drive or experience sexual dysfunction, either due to the stress associated with a heart attack or as a result of medicines such as beta blockers. These problems are often temporary but on-going issues should be discussed with a healthcare professional.
Changes in self-esteem or loss of confidence can also impact on personal relationships. Being open and honest will reassure partners and help to maintain
a sense of intimacy.
Becoming informed
CLOSE
Many heart attack survivors find it
helpful to arm themselves with as much information as possible. This can help them to feel more in control.
It is important to keep on top of treatments and to be clear about
dosage, instructions about when
to take medicines and side effects. Medication should be continued
even when patients are feeling well.
Patients who have suffered a heart
attack may not be able to return to work immediately or at all, if the job requires strenuous activity. The length of time needed off work will depend on the amount of damage caused by the heart attack. The healthcare team will advise
on the best way forward.
Inability to work or reduced working
hours will have a financial impact on
a heart attack survivor and their family
and can also damage self-esteem and confidence levels. The person who has suffered a heart attack may feel they are
a burden on loved ones.
Work and employment
Heart attack survivors are not usually allowed to drive immediately after an attack and in some countries, must declare it to their local vehicle licensing agency. The cardiac team will provide guidance on when it is safe to resume driving. This will depend on the treatment undergone and the stability of the condition.
Driving
A heart attack is a frightening and life-changing experience that can have
a severe emotional impact.
The emotional impact of heart attack
Heart attack survivors often need practical assistance when they return home from hospital, as well as on-going emotional support.
Friends and family
Work and
employment
Driving
The emotional impact
of heart attack
Friends
and family
Disclaimer
This resource has been developed by Idorsia Pharmaceuticals Ltd in order to provide an environment to deliver a better understanding
of heart attack and to pool information regarding the disease, the diagnosis procedure, available treatments and the impact it can have on somebody who suffers heart attack. The resource is for use by a general audience.
The information in this resource is not intended as
a substitute for advice/treatment by a physician, whose instructions should always be followed. Neither does the information provided constitute an alternative to advice from a doctor or
a pharmacist and should not be used on its own
to produce a diagnosis or to commence or cease
a particular treatment.
The links provided are for informational purposes only; they do not constitute an endorsement or an approval from Idorsia of the services or opinions of the corporation, organization or individual. Idorsia bears no responsibility for the accuracy, legality, or context of the external sites or subsequent links.
You are requested to contact the respective external site for answers to questions regarding
its content.
The information provided is valid on the publication date but may be subject to further modifications. Even though Idorsia aims to provide accurate and
up to date information at all times, please acknowledge that the present resource is
made available “as is”.
Idorsia does not give any warranty or representation, whether expressly stated
or implied, or any kind related to the comprehensiveness, usefulness, reliability or timelines of the content of this resource. Idorsia cannot be held liable for any direct or indirect damage or a material or non-material nature that might be caused by the use or non-use of the information presented.
Disclaimer
A heart attack is usually caused by coronary heart disease (CHD). The risk of developing CHD is increased by a number of factors, some of which are modifiable (can be changed) and some of which are non-modifiable (can’t be changed).
Smoking
Risk factors for a heart attack
Family history
There may be a family history of cardiovascular diseases if:
There are different types of heart attack and a number of different medical terms are used.
Introduction
Understanding a heart attack
Diagnosis and treatment
of heart attack
Burden of
heart attack
Practical guidance on life after
heart attack
Risk factors for
a heart attack
Family
history
Symptoms of
a heart attack
It is important to be aware of all the possible symptoms
of a heart attack and to know what to do in the case of
a suspected heart attack. Prompt treatment reduces the
risk of complications, disability and death.
The heart is a muscle that pumps blood around
the body via a network of blood vessels called the circulatory system. The heart beats around 100,000 times a day, delivering oxygen and other vital nutrients to all parts of the body and carrying away unwanted waste products.
Like every other living tissue, the heart needs
a constant supply of blood containing oxygen
in order to function.
The heart muscle has its own supply of blood – the coronary arteries, which spread across the outside
of the heart.
100,000
beats a day
Blood flows into the heart and
is pumped to the lungs
Blood - oxygenated by the lungs - flows back to the heart to be pumped around the body
Coronary arteries: delivering
a constant supply of blood
to the heart muscle
Circulatory system:
delivering oxygen,
vital nutrients and
carrying away
unwanted waste
Acute coronary syndrome (ACS) is a general term which includes:
Other terms are also used for specific types
of heart attack:
A heart attack occurs when there is a sudden interruption of the blood supply to some part
of the heart muscle.
Plaque
Plaque
Thrombus
Plaque
Thrombus
Atherosclerosis
Partial coronary occlusion
Full coronary occlusion
Every year, about 735,000 people living in the US have a heart attack. Of these, 525,000 are a first
heart attack and 210,000 happen in people who
have already had a heart attack.
Heart attack causes more than a third of deaths
in developed nations annually.
Heart attack can affect people of all ethnicities, genders and ages.
The risk of heart attack increases with age: In the US the average age at the first heart attack is 66 for
men and 72 for women.
Heart attack
can occur in:
All ages
All ethnicities
All genders
of deaths in developed nations can be attributed to heart attack
1/3
of deaths caused by cardiovascular disease are due to heart attack and stroke
80%
people living
in the US have
a heart attack
each year
735,000
Recurring heart attack
1st heart attack
66
72
Average age at the first heart
attack– risk increases with age
3.3 m
woman die of heart attack worldwide ever year
Women tend to underestimate the risk of heart attacks
Diabetes
Modifiable risk factors, which can be addressed or controlled through lifestyle changes and medication:
High blood pressure
High cholesterol
Being overweight or obese
Excessive alcohol consumption
Inactivity
Non-modifiable risks are:
Age: the risk of having a heart attack increases with age. The majority of people who die of CHD are 65
or older.
Gender: men have a greater risk of heart attack than women in younger years, women’s hormones may offer some protection in the pre-menopause, but the risk post menopause is comparable to that of men.
Your father or brother was under the age of 55 when they were diagnosed with cardiovascular disease, or
Your mother or sister was under the age of 65 when they were diagnosed with cardiovascular disease
People with a family history should have regular heart checks and are encouraged to adopt positive lifestyle choices to reduce their risk of having
a heart attack.
Most people think of chest pain as a key symptom of a heart attack. In fact, the warning symptoms of a heart attack can vary. It is possible to have a heart attack without experiencing chest pain.
Heart attack symptoms can be sudden and intense and cause sudden death. However, in other instances heart attacks are not always painful, but can start with mild symptoms that develop gradually and symptoms are sometimes mistaken
for less serious issues such as indigestion.
Symptoms can vary from men to women. Women may not suffer the ‘classic’ chest pain and be more likely to experience some of the less common symptoms such as breathlessness, nausea/vomiting and back or jaw pain. Many women still regard heart attack as a ‘male’ disease and do not recognise the symptoms, which can lead to delays in seeking medical help. This can have a major impact on survival.
People who have had a previous heart attack may experience different or less/more severe symptoms if they have a second heart attack. For this reason, it is important for heart attack survivors and their loved ones to be aware of the range of possible symptoms of heart attack.
Key facts
Heart attacks are not always painful and do not always cause chest pain
Symptoms can vary and can come on suddenly or slowly
Men and women may experience different symptoms
Symptoms of a second heart attack may be different from those of a first attack
Emergency medical help should be called at the first sign
of a suspected heart attack
Recognizing
symptoms
Pain or discomfort in the chest: this can include heaviness, pressure, burning, tightness or a feeling of having a band around the chest or a weight on the chest.
These symptoms can travel to the left arm or both arms, to the upper back, to the neck or jaw or gums.
These chest symptoms can also be associated with shortness of breath, feeling the need to take in more air, feeling lightheaded, breaking out in a cold sweat, or feeling sick.
Unexpected or unexplained nausea, vomiting
or indigestion.
Recognizing symptoms
Chest pain
Chest discomfort
Chest pressure
Chest tightness
Heaviness in the chest
A feeling like a band around
the chest or weight on the chest
Common heart attack symptoms
Any of the chest symptoms can travel to
The left arm
or both arms
Between the shoulders
The neck or jaw or gums
These chest symptoms can also be associated with
Feeling the need
to take in more air, shortness of breath
Feeling lightheaded
Breaking out
in cold sweat
Unexpected or unexplained indigestion, nausea or vomiting
“When I had my second heart attack,
I knew straight away I was in trouble
again. This time the ambulance was
called immediately. I’d learnt my lesson
to act quickly – it’s better to be sure.”
— Patient
Diagnosis and management
of heart attack
When somebody has a heart attack, time is of the essence
to prevent permanent damage to the heart muscle (the ‘Time
is Muscle’ principle). This means it is vital to gain an accurate diagnosis as soon as possible.
The emergency services attending a patient will ask a number of questions regarding type and duration of symptoms, previous medical history and potential immediate risk factors
in order to build up a medical profile. They may also perform some initial tests and provide pain relief, if this is needed.
If a heart attack is suspected or confirmed, the patient will
be transferred to hospital.
Recognizing
symptoms
What tests are used to diagnose a heart attack?
Blood tests: are carried out to detect signs of whether a patient has suffered a heart attack, such as a protein called troponin which leaks into the bloodstream from the damaged heart.
Echocardiogram: A test that uses high frequency sound waves (ultrasound) to create pictures of the structure of the heart and
its pumping action.
Electrocardiogram (ECG): This is a test that measures the electrical activity of the heartbeat. It can be carried out at a patient’s home
or wherever they are situated, or it will be performed as soon as
a patient reaches hospital. In some cases, this will be sufficient to diagnose a heart attack. If the results are inconclusive, additional
tests will be carried out.
Following a clinical examination of the patient, a variety of tests
may be used to confirm a heart attack diagnosis and to determine
the severity of the damage to the heart.
Angiogram (or coronary angiography): to see the precise location and extent of the blockages in the coronary arteries. This will help to determine the best treatment strategy. Following a local anesthetic,
a catheter (a thin, flexible tube) is passed into an artery (usually from the wrist) and directed into the heart. A dye is flushed through to show up any narrowed areas or blockages in the artery and a series
of X-ray images is taken.
What treatments are available
for heart attack and to reduce
the risk of recurrence?
It is vital to start treatment as soon as possible after a heart attack to resume blood flow to the damaged part of the heart muscle and to prevent further damage. The specific treatment will depend on the type of heart attack and how quickly blood flow was returned to the blocked artery. Most patients will
be given a combination of drugs following an attack to break down blood clots and reduce the risk of further clots forming. Today, it is common that invasive treatment such as stents or angioplasty (see Procedures used to treat heart attack) is used to improve the blood supply to the heart muscle as fast as possible.
Procedures used to treat heart attack
Medication to
treat symptoms
or reduce the risk
of recurrence
Devices to manage complications
of recurrent
heart attack
Healthcare professionals involved in the management of heart attack
Procedures used to treat heart attack
Common procedures include:
Primary percutaneous coronary intervention (PCI), is a procedure to mechanically widen narrowed parts of the coronary artery that caused the heart attack. It is complex and requires specialist staff and equipment, which is not available in all hospitals.
In most cases, a stent (a small stainless-steel mesh) is placed inside the artery and is left in position to keep the artery open.
Bypass surgery: For patients with lesions which cannot be managed by PCI and stent, a cardiac surgery, known as coronary artery bypass graft (CABG) surgery, is needed.
In this procedure, one or more blood vessels are grafted between the aorta (the main blood vessel leaving the heart) and the coronary artery. The aim is to re-route blood around the clogged artery to improve the supply of blood and oxygen to the heart. This is a complex procedure which can only be managed in experienced cardiac surgery department and therefore may not be available in all hospitals.
Medication to treat symptoms or reduce the risk of recurrence
Some medicines will be given in hospital as soon
as possible after a heart attack and in many cases
a combination of drugs will be prescribed. Many patients will need to continue taking some or all
of this medication for the rest of their lives and
it is important to continue taking the drugs when feeling healthy and well. Key options are:
ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) to relax and widen the blood vessels. This lowers blood pressure and improves blood flow to the heart and prevent risk of recurrent heart attack.
Pain relief: patients experiencing pain will be offered pain relief, which may be delivered intravenously (in liquid form into a vein), a spray used under the tongue or in tablet form out of hospital.
Antiplatelet and anticoagulants (blood-thinning) agents: to reduce the risk of further blood clots forming and recurrent heart attacks, particularly
if one or several stents have been but in place.
Clot-busting medication: delivered via injection to destroy the tough protein that makes up blood
clots and limits the extent of the heart attack.
Beta-blockers: to slow the heart beat and reduce strain on
the heart. This in turn prevents recurrent heart attacks.
Statins: to reduce the level of cholesterol, reduce the risk of fatty build-up in the arteries and reduce the risk of recurrent heart attacks.
Healtscare professionals involved in
the management of heart attack
The main physician for patients who suffer a heart attack
will be a cardiologist (heart specialist) but a range of other
healthcare professionals may be involved in the care
of heart attack patients, including:
Emergency physicians
Devices to manage complications of recurrent heart attacks
Most common devices are:
Implantable Cardioverter Defibrillator (ICD): a battery-powered device placed under the skin that keeps track of heart rhythm. If an abnormal heart rhythm preceding cardiac arrest is detected the device will deliver an electric shock through thin wires to the heart to restore a normal heartbeat.
Pacemaker: a small battery-operated device that helps the heart beat in a regular rhythm.
General practitioners
Nurses and nurse specialists
Thoracic surgeons
Rehabilitation specialists
Dietitians
Psychologists
What is cardiac rehabilitation?
The term ‘cardiac rehabilitation’ refers to support and information designed to support heart attack survivors in
their recovery and allow them to return to maximum health
as quickly as possible. Part of rehabilitation is also education
on reducing the risk of having another heart attack. In some countries, when heart attack patients leave hospital, they are referred to a formal cardiac rehabilitation service. It offers advice and information on a range of health education topics such as keeping active, healthy eating, stopping smoking and maintain a healthy weight. The aim is to address any “modifiable” risk factors that may have contributed to
a patient’s heart attack and may lead to a second heart
attack. This also allows a phased return to exercise, starting gradually and building up over the weeks and months.
In other countries no formal rehabilitation programs are available. However, all heart attack survivors should
focus on maintaining a healthy lifestyle and minimising modifiable risk factors such as high blood pressure and obesity. Patient support groups can be a useful source
of information on these topics.
“When I had my second heart attack,
I knew straight away I was in trouble
again. This time the ambulance was
called immediately. I’d learnt my lesson
to act quickly – it’s better to be sure.”
— Patient
“When I was informed it was a heart attack, I was emotionally scared and confused.
I immediately felt life would never be the same. It suddenly felt like I wasn’t young anymore and that I was nearer to reaching death, through life expectancy alone.”
— Patient
Burden of heart attack
The experience of having survived a heart attack can have
a profound impact on many aspects of everyday life from studying, employment or exercising to personal and sexual relationships and social activities. Many heart attack survivors struggle to come to terms with what has happened to them and find it difficult to face the future with confidence.
Work and employment
CBT
Driving
The emotional impact of heart attack
Friends and family
Patients who have suffered a heart attack may not be able to return
to work immediately or at all, if
the job requires strenuous activity.
The length of time needed off work will depend on the amount
of damage caused by the heart attack. The healthcare team will advise on the best way forward.
Inability to work or reduced working hours will have a financial impact on a heart attack survivor and their family and can also damage self-esteem and confidence levels. The person
who has suffered a heart attack may feel they are a burden on loved ones.
Work and employment
A heart attack is a frightening and
life-changing experience that can have
a severe emotional impact.
One in eight heart attack survivors suffer post-traumatic stress disorder (PTSD) and survivors
with PTSD have double the risk of having another cardiac event or of dying within one to three years, compared with survivors without PTSD.
The emotional impact of
heart attack
Heart attack survivors often need practical assistance when they return
home from hospital, as well as on-going emotional support.
Caring for someone who has had a heart attack can be physically and emotionally draining. In the UK two in five family members live in constant fear of their loved one having another heart attack.
Everyone is different: some patients want to be treated as normal rather than being ‘fussed over’ while others may welcome additional care and support.
Friends and family
Heart attack survivors are not usually allowed to drive immediately after an attack and
in some countries, must declare it to their local vehicle licensing agency. The cardiac
team will provide guidance on when it is safe to resume driving. This will depend on
the treatment undergone and the stability of the condition.
Driving
Fear of a second attack is common and this can lead to anxiety and uncertainty about the future. Often a period of re-adjustment is needed before patients can begin to return to normal.
In the US, major depression occurs in about 20%
of patients after they have a heart attack, and 65% experience at least 1 symptom of depression.
Fatigue is common following a heart attack
and this can make it difficult to enjoy social
or leisure activities.
In some cases, surviving a heart attack can have
a more positive impact, by prompting the patient to re-appraise the way they live and to adopt
a healthier lifestyle. Some people regard
a heart attack as a ‘wake-up call’.
“I was instructed to stay off work and to not exert myself for 7 weeks, but I felt totally useless. As soon as I was allowed,
I started adding activity back into my day – the whole time I couldn’t wait to return
to my usual routine of work and regular cycle rides.”
— Patient
Practical guidance on life
after heart attack
Patients who have suffered a heart attack will usually
need to take medication indefinitely to reduce the risk
of a further attack, but there is also a great deal they
can do themselves to minimize any risk factors associated
with their condition.
Making positive lifestyle changes
Becoming informed
Managing the impact on sexual relationships
Being open with family and friends
Making positive lifestyle changes
Lifestyle changes can be an important factor
in reducing the risk of a recurrence. Often specific tailored advice on these measures is provided as part of cardiac rehabilitation support. Key areas
to focus on are:
Following a healthy, balanced diet: the emphasis should
be on foods that are low in saturated fat and sodium (salt) and high in fiber, with at least five portions of fruit and vegetables a day
Keeping cholesterol and blood pressure under control: these are important risk factors and should be checked regularly and medication taken if prescribed
Keeping blood glucose levels under control: patients with diabetes should monitor their blood sugar levels regularly
Smoking: this is a key factor in heart health so giving
up smoking is one of the most important changes
a heart attack patient can make. It is also important
to avoid ‘second-hand’ smoke by avoiding
smoky atmospheres
Keeping physically active: like any muscle the heart needs physical activity to keep it in good condition. Patients will often be given a program of phased return to exercise, starting slowly and gradually building up the level of activity. Adults should aim to do at least 150 minutes of moderate-intensity aerobic activity (such as cycling or fast walking) every week
Maintaining a healthy weight and body shape: obesity and being overweight are key modifiable
risk factors
Taking medication as prescribed, even when feeling fit
and healthy
Keeping alcohol intake to within guidelines
Managing the impact on sexual relationships
People who have had a heart attack may be concerned about resuming sexual relationships as they fear putting a strain on
their heart, but in most cases, this will not present a problem.
The healthcare team can advise on this.
Some patients experience loss of sex drive or experience sexual dysfunction, either due to the stress associated with
a heart attack or as a result of medicines such as beta blockers. These problems are often temporary but on-going issues should be discussed with a healthcare professional.
Changes in self-esteem or loss of confidence can also impact on personal relationships. Being open and honest will reassure partners and help to maintain a sense of intimacy.
Being open with family and friends
People who have had a heart attack sometimes find it difficult to be honest about negative feelings and are reluctant to worry family and friends. It can sometimes be easier to talk
to a counsellor or independent third party.
It can be daunting to make major lifestyle changes such
as giving up smoking, but a great deal of advice and support
is available. It is also helpful to break goals into smaller segments and to tackle one element at a time.
Suffering a heart attack is a frightening experience and It
can be difficult to cope with the fear of a recurrence. This
is particularly true in the early stages of the recovery period
when patients leave the ‘secure’ environment of a hospital.
It is natural to feel vulnerable and anxious initially and
it is best to share these feelings with family and friends rather than shutting them out. Loved ones are usually only too happy to offer support.
If feelings of anxiety or depression persist, it is worth talking to a doctor or other healthcare professional about ways of managing these feelings. In some cases, medication will be prescribed.
Becoming informed
It is vital to be aware of the symptoms of a heart attack.
No two heart attacks are the same and a patient who experienced specific symptoms during a first heart attack
may experience different ones if they have a recurrence.
This is important not only for the heart attack survivor, but also for family and friends.
Patient support organizations are a good source of information and support on a variety of topics from treatments to benefits and social services.
Some people find it helpful to attend support group meetings or to join online forums to communicate with other people who share similar experiences.
Many heart attack survivors find it helpful to arm
themselves with as much information as possible.
This can help them to feel more in control.
It is important to keep on top of treatments and to be clear about dosage, instructions about when to take medicines and side effects. Medication should be continued even when patients are feeling well.
It is important to learn about the lifestyle changes
that can make a difference to the risk of a recurrence.
The cardiac rehabilitation team and patient support groups can be very helpful in this respect.
Getting support
There are many patient associations that are dedicated to helping patients and their families to live well after heart attack, through providing detailed information, practical advice, and valuable support.
In Europe, the European Heart Network (EHN) has many member associations across European countries: www.ehnheart.org.
The American Heart Association (AHA) has offices across the US,
as well as International activities and events: www.heart.org.
Introduction
Understanding
a heart attack
Diagnosis and treatment
of heart attack
Burden of
heart attack
Practical guidance on life after
heart attack
Introduction
Understanding
a heart attack
Diagnosis and treatment
of heart attack
Burden of
heart attack
Practical guidance on life after
heart attack
Introduction
Understanding
a heart attack
Diagnosis and treatment
of heart attack
Burden of
heart attack
Practical guidance on life after
heart attack
What to do if you think you (or somebody else) are having a heart attack
If the person experiencing a heart attack is unconscious, try to measure their pulse on their wrist or neck. If you don't feel any heartbeat, begin with cardiopulmonary resuscitation (CPR) and / or follow the device instructions if an automated external defibrillator (AED) is available.
Open tight-clothing, sit in a comfortable position (do not lie down) and try to rest calm while waiting for the emergency services to arrive. This helps to avoid any unnecessary strain on the heart.
The first priority is to immediately call the emergency medical
services and explain all the symptoms that are being experienced.
Highlight that you suspect a heart attack.
What happens to the heart
after a heart attack?
After a heart attack, the heart develops scar tissue as part of the healing process. Areas of scar tissue do not perform as effectively as healthy muscle tissue. The size and location of the scar tissue will affect how efficiently the heart pumps and the damage may result in the heart being weakened.
The healing process usually takes about 8 weeks. The recovery period will be significantly longer for patients with complex conditions or who have undergone major surgery.
Potential complications
Potential complications
Even if treatment is delivered promptly, complications can occur in the aftermath of heart attack and these may require extensive treatment. Complications can occur immediately after an attack or may develop in the longer term and include:
Recurrent heart attack: Having one heart attack increases the risk of having a second attack
Arrhythmias: abnormal heart rhythms or electrical ‘short-circuits’ that result in abnormal heartbeats (slow, fast or irregular heartbeat)
Heart failure: the heart muscle is unable to pump enough blood through the heart to meet the body’s need for blood and oxygen. It can result in an enlarged heart and shortness of breath. A common symptom of heart failure is edema, an accumulation of fluid that causes swelling in the legs and ankles, or in the lungs (pulmonary edema)
Cardiogenic shock: this is similar to heart failure but more serious. It occurs when the heart muscle is so severely damaged that it can no longer pump enough blood to maintain the body’s function
What is the outlook for people with heart attack?
The outlook for a person who has had a heart attack depends on how quickly they are able to access appropriate treatment and the degree of damage to the heart muscle. Without treatment, heart attacks can be fatal but with prompt, effective treatment, the majority of patients survive and,
in many cases, go on to enjoy a good quality of life.
Having one heart attack increases the risk of having a second attack: according to the American Heart Association around 20% of patients aged 45 or above who have suffered a heart attack will have another heart attack within five years of their first. This is why it is so important for heart attack survivors to be aware of all the possible symptoms of heart attack and to act immediately if a heart attack is suspected.
ITreatment has improved dramatically. If we take Australia for example, in 2000, 10.6% of those admitted to hospital with
an AMI died within 30 days. By 2012, this mortality rate had dropped to 4.5%. However, the majority of heart attack survivors will need to take medication for the rest of their
lives as high blood pressure or cholesterol and adapting lifestyle through a healthy diet and exercise.
There are different types of heart attack and
a number of different medical terms are used.
What causes
a heart attack?
Risk factors for
a heart attack
Family history
Symptoms of a heart attack
It is important to be aware of all the possible symptoms of a heart attack and to know what to
do in the case of a suspected heart attack. Prompt treatment reduces the risk of complications, disability and death.
Most people think of chest pain as a key symptom of a heart attack. In fact, the warning symptoms of a heart attack can vary. It is possible to have a heart attack without experiencing chest pain.
Heart attack symptoms can be sudden and intense and cause sudden death. However, in other instances heart attacks are not always painful,
but can start with mild symptoms that develop gradually and symptoms are sometimes mistaken
for less serious issues such as indigestion.
Symptoms can vary from men to women. Women may not suffer the ‘classic’ chest pain and be more likely to experience some of the less common symptoms such as breathlessness, nausea/vomiting and back or jaw pain. Many women still regard
heart attack as a ‘male’ disease and do not recognise the symptoms, which can lead to
delays in seeking medical help. This can have
a major impact on survival.
People who have had a previous heart attack may experience different or less/more severe symptoms if they have a second heart attack. For this reason,
it is important for heart attack survivors and their loved ones to be aware of the range of possible symptoms of heart attack.
Key facts
Heart attacks are not always painful and
do not always cause chest pain
Symptoms can vary and can come on suddenly or slowly
Men and women may experience different symptoms
Symptoms of a second heart attack may be different from those of a first attack
Emergency medical help should be called at the first sign of a suspected heart attack
Recognizing
symptoms
If the person experiencing a heart attack is unconscious, try to measure their pulse on their wrist or neck. If you don't feel any heartbeat,
begin with cardiopulmonary resuscitation (CPR) and / or follow the device instructions if an automated external defibrillator (AED)
is available.
Open tight-clothing, sit in a comfortable position (do not lie down) and try to rest calm while waiting for the emergency services to arrive. This helps to avoid any unnecessary strain on the heart.
The first priority is to immediately call the emergency medical services and explain all the symptoms that are being experienced.
Highlight that you suspect a heart attack.
What to do if you think you
(or somebody else) are having
a heart attack
Both coronary thrombosis and coronary occlusion obstruct the blood flow in the coronary arteries and starves the heart muscle of oxygen (a process known as myocardial ischemia).
How common is heart attack and who is at risk?
Globally, more people die annually from cardiovascular disease than from any other cause and around 80% of these deaths are due to heart attack and stroke.
Every year, about 735,000 people living in the US have a heart attack. Of these, 525,000 are a first heart attack and 210,000 happen in people who have already had a heart attack.
Heart attack causes more than a third of deaths in developed nations annually.
Heart attack can affect people of all ethnicities, genders and ages.
CLOSE
The risk of heart attack increases with age: In the US the average age at the first heart attack is 66 for men and 72 for women.
Women often underestimate the risk of heart attack but in fact, heart attack claims the lives of 3.3 million women worldwide every year.
Risk factors for a heart attack
A heart attack is usually caused by coronary heart disease (CHD). The risk of developing CHD is increased by a number of factors, some of which are modifiable (can be changed) and some of which are non-modifiable (can’t be changed).
Modifiable risk factors, which can be addressed or controlled through lifestyle changes and medication:
Diabetes
CLOSE
High blood pressure
High cholesterol
Being overweight or obese
Smoking
Excessive alcohol consumption
Inactivity
Non-modifiable risks are:
Age: the risk of having a heart attack increases with age. The majority of
people who die of CHD are 65 or older.
Gender: men have a greater risk of heart attack than women in younger years, women’s hormones may offer some protection in the pre-menopause, but the risk post menopause is comparable to that of men.
Pontential complications
Even if treatment is delivered promptly, complications can occur in the aftermath of heart attack and these may require extensive treatment. Complications can occur immediately after an attack or may develop in the longer term and include:
Recurrent heart attack: Having one
heart attack increases the risk of having
a second attack
CLOSE
Recognizing symptoms
Pain or discomfort in the chest: this can include heaviness, pressure, burning, tightness or a feeling of having a band around the chest or a weight on the chest.
These symptoms can travel to the left arm or both arms, to the upper back, to the neck or jaw or gums.
These chest symptoms can also be associated with shortness of breath, feeling the need to take in more air, feeling lightheaded, breaking out in a cold sweat, or feeling sick.
Unexpected or unexplained nausea, vomiting or indigestion.
CLOSE
Common heart attack symptoms
Any of the chest symptoms can travel to
These chest symptoms can also be
associated with
What happens to the heart
after a heart attack?
After a heart attack, the heart develops scar tissue as part of the healing process. Areas of scar tissue do not perform as effectively as healthy muscle tissue. The size and location of the scar tissue will affect how efficiently the heart pumps and the damage may result in the heart being weakened.
The healing process usually takes about 8 weeks. The recovery period will be significantly longer for patients with complex conditions or who have undergone major surgery.
Potential complications
Family history
There may be a family history of cardiovascular diseases if:
People with a family history should have regular heart checks and are encouraged to adopt positive lifestyle choices to reduce their risk of having a heart attack.
Your father or brother was under the age of 55 when they were diagnosed with cardiovascular disease, or
Your mother or sister was under the age
of 65 when they were diagnosed with cardiovascular disease
CLOSE
Heart failure: the heart muscle is unable to pump enough blood through the heart to meet the body’s need for blood and oxygen. It can result in an enlarged heart and shortness of breath. A common symptom of heart failure is edema, an accumulation of fluid that causes swelling in the legs and ankles, or in the lungs (pulmonary edema)
Arrhythmias: abnormal heart rhythms or electrical ‘short-circuits’ that result in abnormal heartbeats (slow, fast or irregular heartbeat)
Cardiogenic shock: this is similar to heart failure but more serious. It occurs when the heart muscle is so severely damaged that it can no longer pump enough blood to maintain the body’s function
What is the outlook for people
with heart attack?
The outlook for a person who has had a heart attack depends on how quickly they are able to access appropriate treatment and the degree of damage to the heart muscle. Without treatment, heart attacks can be fatal but with prompt, effective treatment, the majority of patients survive and, in many cases, go on to enjoy a good quality of life.
Treatment has improved dramatically. If we take Australia for example, in 2000, 10.6% of those admitted to hospital with an AMI died within 30 days. By 2012, this mortality rate had dropped
to 4.5%. However, the majority of heart attack survivors will need to take medication for the
rest of their lives as high blood pressure or cholesterol and adapting lifestyle through
a healthy diet and exercise.
Having one heart attack increases the risk of having a second attack: according to the American Heart Association around 20% of patients aged 45 or above who have suffered a heart attack will have another heart attack within five years of their
first. This is why it is so important for heart attack survivors to be aware of all the possible symptoms of heart attack and to act immediately if a heart attack is suspected.
Angiogram (or coronary angiography): to see the precise location and extent of the blockages in the coronary arteries. This will help to determine the best treatment strategy. Following a local anesthetic, a catheter (a thin, flexible tube) is passed into an artery (usually from the wrist) and directed into the heart.
A dye is flushed through to show up any narrowed areas or blockages in the artery
and a series of X-ray images is taken.
Blood tests: are carried out to detect signs of whether a patient has suffered a heart attack, such as a protein called troponin which leaks into the bloodstream from
the damaged heart.
Echocardiogram: A test that uses high frequency sound waves (ultrasound) to create pictures of the structure of the
heart and its pumping action.
Electrocardiogram (ECG): This is a test that measures the electrical activity of the
heartbeat. It can be carried out at a patient’s home or wherever they are situated, or it will
be performed as soon as a patient reaches hospital. In some cases, this will be sufficient
to diagnose a heart attack. If the results are inconclusive, additional tests will be carried out.
Following a clinical examination of the patient, a variety of tests may be used to confirm a heart attack diagnosis and to determine the severity of the damage
to the heart.
What tests are used to diagnose a heart attack?
What treatments are available
for heart attack and to reduce
the risk of recurrence?
It is vital to start treatment as soon as possible after
a heart attack to resume blood flow to the damaged part of the heart muscle and to prevent further damage. The specific treatment will depend on the type of heart attack and how quickly blood flow was returned to the blocked artery. Most patients will
be given a combination of drugs following an attack to break down blood clots and reduce the risk of further clots forming. Today, it is common that invasive treatment such as stents or angioplasty
(see Procedures used to treat heart attack) is used
to improve the blood supply to the heart muscle
as fast as possible.
Common procedures include:
Primary percutaneous coronary intervention (PCI), is a procedure to mechanically widen narrowed parts of
the coronary artery that caused the heart attack. It is complex and requires specialist staff and equipment, which is not available in all hospitals.
In most cases, a stent (a small stainless-steel mesh) is placed inside the artery and is left in position to keep the artery open.
Bypass surgery: For patients with lesions which cannot be managed by PCI and stent, a cardiac surgery, known as coronary artery bypass graft (CABG) surgery, is needed. In this procedure, one or more blood vessels are grafted between the aorta (the main blood vessel leaving the heart) and the coronary artery. The aim is to re-route blood around the clogged artery to improve the supply of blood and oxygen to the heart. This is a complex procedure which can only be managed in experienced cardiac surgery department and therefore may not be available in all hospitals.
ACE (angiotensin-converting enzyme) inhibitors or ARBs (angiotensin receptor blockers) to relax and widen the blood vessels. This lowers blood pressure and improves blood flow to the heart and prevent risk of recurrent heart attack.
Beta-blockers: to slow the heart beat and reduce strain on the heart. This in turn prevents recurrent heart attacks.
Statins: to reduce the level of cholesterol, reduce the risk of fatty build-up in the arteries and reduce the risk of recurrent heart attacks.
General practitioners
Nurses and nurse specialists
Thoracic surgeons
Rehabilitation specialists
Dietitians
Psychologists
Fear of a second attack is common and this can lead to anxiety and uncertainty about
the future. Often a period of re-adjustment
is needed before patients can begin to
return to normal.
In the US, major depression occurs in about 20% of patients after they have a heart attack, and 65% experience at least
1 symptom of depression.
One in eight heart attack survivors suffer post-traumatic stress disorder (PTSD) and survivors with PTSD have double the risk of having another cardiac event or of dying within one to three years, compared with survivors without PTSD.
Fatigue is common following a heart attack and this can make it difficult to enjoy social or leisure activities.
In some cases, surviving a heart attack can have a more positive impact, by prompting the patient to re-appraise the way they live and to adopt a healthier lifestyle. Some people regard a heart attack as
a ‘wake-up call’.
Caring for someone who has had a heart attack can be physically and emotionally draining. In the UK two in five family members live in constant fear of their
loved one having another heart attack.
Everyone is different: some patients want to be treated as normal rather than being ‘fussed over’ while others may welcome additional care and support.
Smoking: this is a key factor in heart health so giving up smoking is one of the most important changes a heart attack patient can make. It is also important to avoid ‘second-hand’ smoke by avoiding
smoky atmospheres
Keeping physically active: like any muscle the heart needs physical activity to keep it in good condition. Patients will often be given a program of phased return to exercise, starting slowly and gradually building up the level of activity. Adults should aim to do at least 150 minutes of moderate-intensity aerobic activity (such
as cycling or fast walking) every week
Maintaining a healthy weight and body shape: obesity and being overweight are
key modifiable risk factors
Following a healthy, balanced diet: the emphasis should be on foods that are low in saturated fat and sodium (salt) and high in fiber, with at least five portions of fruit and vegetables a day
Keeping cholesterol and blood pressure under control: these are important risk factors and should be checked regularly
and medication taken if prescribed
Keeping blood glucose levels under control: patients with diabetes should monitor their blood sugar levels regularly
Taking medication as prescribed, even when feeling fit and healthy
Keeping alcohol intake to within guidelines
It can be daunting to make major lifestyle changes such as giving up smoking, but
a great deal of advice and support is
available. It is also helpful to break goals
into smaller segments and to tackle one element at a time.
It is important to learn about the lifestyle changes that can make a difference to
the risk of a recurrence. The cardiac rehabilitation team and patient support groups can be very helpful in this respect.
It is vital to be aware of the symptoms of a heart attack. No two heart attacks are the same and a patient who experienced specific symptoms during a first heart attack may experience different ones if they have a recurrence. This is important not only for the heart attack survivor,
but also for family and friends.
Patient support organizations are a good source of information and support on
a variety of topics from treatments to benefits and social services.
Some people find it helpful to attend support group meetings or to join online forums to communicate with other people who share similar experiences.
Getting support
There are many patient associations that are dedicated to helping patients and their families
to live well after heart attack, through providing detailed information, practical advice, and
valuable support.
In Europe, the European Heart Network (EHN) has many member associations across European countries: www.ehnheart.org.
The American Heart Association (AHA) has offices across the US, as well as International activities and events: www.heart.org.
Joining a patient association
Joining a patient association
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