RECOVERING FROM A HEART ATTACK - Information Leaflet
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RECOVERING FROM A HEART ATTACK Information Leaflet Your Health. Our Priority. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
Page 2 of 20 A little about your heart ............................................................................................... 3 Risk Factors ................................................................................................................ 4 Psychological effects that may occur following your heart attack ................................ 5 Physical Activity Following Your Heart Attack ............................................................. 6 Home Exercises .......................................................................................................... 9 Daily Indoor Exercise programme ............................................................................. 11 Maintaining your fitness following a Heart Attack ...................................................... 12 Relaxation ................................................................................................................. 14 Practical advice following your heart attack .............................................................. 15 Guidance about what to do if you experience chest pain/discomfort ........................ 16 What is Cardiac Rehabilitation? ................................................................................ 18 What happens in a Cardiac Rehabilitation Programme? .......................................... 18 www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
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A little about your heart
Your heart is not worn out
If you live with someone, allow them to read this booklet too
Why did I have a heart attack?
Your heart is a muscle (about the size of your own
clenched fist) which pumps blood to all other parts of
your body. The heart has its own blood supply called the
coronary arteries (about the size of a biro refill). Most
heart attacks happen because part of one of these
arteries gets blocked. However some people have type 2
heart attacks
Why did the artery get blocked?
Your artery was blocked by fatty deposits
(cholesterol) which is called “atheroma”, or
hardening of the arteries. A build-up of
cholesterol deposits occurs over a number of
years. This build up is called Coronary Artery
Disease. The cholesterol deposit can suddenly
tear and expose a raw area.
As the blood flows through the artery a clot
formation occurs. If the artery is already very
narrow then it can block the artery. If the
blockage becomes complete, the blood can no
longer reach the heart muscle. At this stage you
may have experienced persistent pain lasting
longer than 15 minutes. If the clot does not
dissolve quickly then the heart becomes
damaged.
This is called a myocardial infarction or sometimes coronary thrombosis.
www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill HospitalPage 4 of 20
What causes coronary artery disease?
The things that cause it are called Risk Factors. The more risk factors you have, the more
likely you are to have a heart attack. Most risk factors can be reduced or got rid of, therefore
reducing the risk of having another heart attack.
It is not properly understood how exactly the fatty deposits build up. In countries where people
are reducing their risk factors, the number of heart attacks has slowly reduced.
Nearly half of the middle-aged people in this country have some coronary heart disease.
Risk Factors
How ready are you to look
at reducing this risk factor
Tick your on scale of
Risk Factors
risk factors 1 – 10?
(1 = not ready
10 = 100% ready)
Family history of heart disease
N/A
(heredity)
Age N/A
Being male N/A
Smoking
High blood pressure
High Cholesterol
Being overweight
Coping with stress the wrong way
Lack of physical exercise
Diabetes
To read more about risk factors and how to lesson your risks then refer to the British
Heart Foundation Information Series.
These booklets can be obtained through the cardiac rehabilitation department.
Type 2 Heart Attack
These heart attacks are not caused due to a blockage in the coronary artery but either due to a
sudden increase in oxygen demand to the heart muscle or a sudden decrease in the supply of
oxygen to the heart muscle.
For example:
Sudden loss of blood – anaemia
Fast irregular heart rhythm – arrhythmia
Infection – sepsis
Coronary artery spasm
www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill HospitalPage 5 of 20 Physical effects that may occur following your heart attack Following discharge from hospital after a heart attack can be an anxious time. The following advice will help you to understand how you may feel: 1. You may get tired Don’t be surprised how easily you tire. This will gradually improve as your heart gets stronger. If your heart gets tired, you may feel breathless or experience some tightness in your chest or throat. This is because you heart is asking for more oxygen (food). If you experience either of these symptoms stop what you are doing, sit down, if possible take slow deep breaths, relax and your heart will soon recover. If however, should you become increasingly breathless consult you’re GP, especially if this is associated with any ankle swelling or sudden weight gain of 2-3 lbs overnight. 2. Being aware of your heart You may experience an uncomfortable awareness of your heart, for example an occasional missed beat or thump especially when you are resting and nothing else is going on around you. This is quite harmless and is nothing to worry about, but if you feel your heart racing for a period of time, the contact you’re GP, as this may need treatment. Psychological effects that may occur following your heart attack Your heart attack may have happened suddenly and without warning. This may make you feel not in control and part of your rehabilitation process is to allow you to overcome these feelings. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
Page 6 of 20 The early weeks You may find the early weeks following your heart attack, that your concentration is poor and favourite pastimes, e.g. television, reading etc. do not have their usual appeal. This is often quite normal and will improve and return to normal as you recover. Some people find that they are more irritable after a heart attack. Many people feel depressed and angry (“why me?”). Restrictions regarding mobility, not being allowed to drive or smoke can also increase both anger and frustration. Remember, it is expected that you will get back to normal or near normal and restrictions are only temporary with the exception of not smoking which must cease for good. Your Family The impact of your heart attack may also cause your family to experience similar emotions. They too may be worried about you and because of this may become very over protective, initially trying to protect you from too much stress and activity. This can often lead to frustration and conflict. It is therefore important to talk about how you are feeling with your partner, be honest with yourself and try to be open about your fears and worries with each other. Physical Activity Following Your Heart Attack You may have had an echocardiogram whilst you were in hospital. This will inform the doctor whether there has been any impairment to your heart muscle. If there is no impairment you may be able to return to normal activities within two weeks. If there is impairment, for the first six weeks while the heart is healing and allowing scar tissue to form, it is important to ask yourself the following questions. Does it involve undue pushing, pulling, or a sudden burst of activity, or does it weigh heavier than 10lbs? If the answer is yes don’t do it yet, allow your heart muscle to heal properly without undue strain on it. It is important to exercise following a heart attack but at the right level, in order to maintain heart fitness. Walking is an ideal exercise for your rehabilitation; it is relaxing, non-strenuous exercise and is free, easy and safe. The following scale will give an idea on how the activity feels in the muscle you are about to use and in your breathing and heart response. This guide should allow you to do an activity safely. BUT Stop exercising if you experience any of the following: Pain or tightness in the chest Palpitations Sickness or nausea Dizziness / faintness www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
Page 7 of 20 Excessive shortness of breath /speechless Excessive sweating for you Activity Scale This is a scale for rating perceived exertion. Perceived exertion is the overall effort or distress of your body during exercise. The number 6 represents no perceived exertion in your breathing, heart rate response or in your muscles and 20 represents the greatest amount of exertion that you have ever experienced. For the first 4 weeks work, only up to a rating of 11- 12 From 4 weeks you can work up to a rating of 13 It is not recommended to ever work past a rating of 15. BORG SCALE FOR RATING OF PERCEIVED EXERTION 6 No exertion at all 7 Extremely light 8 9 Very light 10 11 Light 12 13 Somewhat hard 14 15 Hard (Heavy) 16 17 Very hard 18 Extremely hard 19 Extremely hard 20 Maximal exertion After Activity After your activity or exercise, if you have worked at a light level then you should feel back to normal within 2-5 minutes. If you have worked at a somewhat hard level then your recovery may take a little longer 5 -10 minutes A longer recovery of more than 10 minutes means that you have pitched your activity at a hard level for you now. If you feel tired or exhausted when you get up in the morning look at the activities you did yesterday. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
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If there is impairment of your heart muscle
Remember in the first 6 weeks of your recovery you should not do anything which requires:
Lifting above 10lbs Pulling Pushing
A sudden burst of energy, for example, running up stairs or for a bus.
Try to avoid constipation
Permitted Activities:
Light house work.
Dusting, washing dishes, making tea.
Light hand washing.
Ironing if the ironing board is set up.
Shopping (someone else must carry the heavy load).
Bath / shower, stair climbing.
Light gardening.
Weeding, planting out, trimming, using a trowel.
Socialising with close friends (try for short periods only at first).
Sexual relationships with your partner
Activities to be avoided for 4 weeks, then start gradually:
Heavier house work.
Vacuuming, sweeping, washing windows, changing bed linen.
Light painting, try using a light hover mower.
Activities to be avoided for at least 6 weeks:
Lifting items, moving furniture, decorating.
Washing the car, washing the windows.
Heavy gardening.
Mowing, digging, watering with a can.
Walking
Walking is an ideal exercise for your rehabilitation. To build up your stamina, follow
these five simple stages.
Remain at each stage until you can complete it comfortably (at least 2 days or until you rate it
very light – 9).
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Move onto the next stage only when you feel ready. It is important to remember that everyone
will recover at different speeds and not one person will be at the same level of activity following
a heart attack.
Go at your own pace
Stage 1: (2-4 times daily)
Take a short walk for approximately 5 minutes
Rating – 11
Stage 2: (1-2 times daily)
Gradually increase your walk to 10 minutes
Rating light – 11
Stage 3: (Once a day)
Gradually increase your walk to 20 minutes
Rating light – 11
Stage 4: (Once a day)
Gradually start to increase walking time to 45 minutes
Rating light – 11
Stage 5: (Once a day)
Keeping distance you have already attained try to do it in less time,
while still feeling comfortable
Rating light – 11 (for the first 15 minutes) then
Rating 12 – 13 moderate / somewhat hard
Home Exercises
Whenever you feel ready you may start your home exercises. It is important to work through
the warm up exercises first. For some of you this section may be just enough to start with.
Keep your activity level light – rating 11.
Walk on the spot for 2 minutes
Stand with feet shoulder width apart, relax knees slightly and breathe normally.
Lift shoulders as in a shrug 6 times.
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Lift and circle shoulders backwards 6 times.
Rotate neck slowly from side to side 6 times.
Walk on the spot for 2 minutes
Bend sideways 6 times to the left and then 6 times to the right.
Turn your body around to look behind in one direction 6 times to the left
and then 6 times to the right.
Hips should be facing forward throughout this exercise.
Stand feet together. Point alternate right and left foot forward 6 times with
toe to floor. Repeat action but with heel to the floor 6 times.
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Walk on the spot for 2 minutes
Daily Indoor Exercise programme
Try to work towards rating 11 -12
These exercises should feel light to moderate but not uncomfortable or too strenuous. Work at
your own pace and build up gradually over the weeks.
Do each exercise for approximately 30 seconds. Stay at the level until the exercise is very light
– 9. Then increase exercise time to 1 minute. Continue to increase by half a minute.
Step ups
Stand 12 inches away from stair (about 8 inches high) Step up, leading
with one leg for half of the time then change legs.
March on the spot.
Sit to stand
Use a dining room chair. Sit with hands on knee and then stand with
arms out stretched for balance.
Walk round for a minute.
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Wall press
Stand arm distance from the wall, arms shoulder width apart. Move head
towards the wall and then gently push away five times. Continue this
amount of repetitions until you rate it very light – 9 then increase by 5
more until reaching 30 then remain at that number.
Bicep Curl
Elbows kept close to waist, alternatively lift arm towards shoulder then the
other over 5 times using no weights. Increase as in wall press exercise.
Walk round slowly for one to five minutes to cool time.
Maintaining your fitness following a Heart Attack
The following important points should be borne in mind regarding physical exertion:
Realistic expectations
The exact nature of your chosen exercise is not important and, within reason, can be a matter of
preference. Much more important is the graduation of the exercise and the regularity with which
it is performed. After 2-4 weeks your exercise programme should be moderate enough to
enable you to breathe more deeply and should be performed 5 times per week.
In the first six weeks of your recovery, if you have any impairment of your heart muscle, you
should not do anything which requires lifting above 10lbs, pulling, pushing or sudden burst of
energy. It is advisable to reserve a regular daily time to exercise, such as first thing in the
morning or sometime after returning from work. Exertion should not take place within 1-2 hours
of a meal, and any walking is probably inadvisable within one hour.
When you undertake any new exercise, remember first to increase its duration gradually and,
only then, the speed.
Aches and pains in the muscles and joints are usually the result of excess exertion. It is best to
reduce your intensity of exercise until these settle. It is a good idea to follow a specific regular
exercise route or distance. You will then notice any possible deterioration in your condition
quite quickly.
www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill HospitalPage 13 of 20 During holidays, it is unwise to discontinue your training habits completely. During busy holidays you should resist the temptation of being overactive. Heavy exertion Do remember in the long term that heavy exertion is dangerous if it does not involve movement. This is called isometric exercise. Examples are: Carrying a heavy load Pushing a car Prising open a jammed window Heavy spadework Prising loose stones that are heavy This sort of exercise is comparatively dangerous for people who have had a heart attack, and, on the whole, should be left to others. Weather If you suffer from angina then you should be aware to avoid extremes of temperature which may aggravate your symptoms. Walking against the wind is like climbing a hill; it puts added strain on your heart. If you suffer from angina when walking against a cold wind turn your back to the wind or breathe in warm air from your scarf. A very hot and humid temperature can be as bad as this also increases the workload of the heart, this includes bathing. If a particular activity or change of temperature aggravates symptoms of angina, a glycerine trinitrate (GTN) tablet or use of a spray may be used as a preventative measure, prior to activity or going out on a cold and windy day. Illness You should never exert yourself if you are at all unwell. Even colds and minor ailments should be improving again before you gradually return to your accustomed level of exertion. It is important to remember fitness rapidly deteriorates on stopping activities and must be gradually regained after any sedentary period such as an illness or heart attack. Unaccustomed activity, whether prolonged or sudden and short-lived may be dangerous. Sports You are advised to avoid a high level of competitive sports until six months after your heart attack. Before participating in sport, it is essential you achieve a level of fitness. If you like competitive sport, such as tennis, badminton, squash or netball/basketball, it is a good idea to reduce the workload on the heart by avoiding highly competitive opponents and situations by playing doubles rather than singles. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
Page 14 of 20 Activities such as golfing, gardening, walking, hiking, cycling and swimming are certainly good for you, if you like them, and are excellent for maintaining your level of fitness. If you hike a lot, take frequent rest periods and carry loads on your back not in your arms; this also applies to the fishing enthusiast. Activities requiring muscular contractions against a heavy resistance such as water-skiing and weight lifting are best avoided – these are isometric activities (see previous page). Whatever your sport you are cautioned against extremes of environmental temperature (see previous page). Finally, remember that after exercise there should be a feeling of well being and satisfaction – our bodies were designed for exercise to keep fit and healthy. Maintenance of reasonable fitness is the long-term aim, not the achievement of an athletic standard. Relaxation Exercise to help you recognise tension The first few months of recovery following your heart attack can be very stressful. Psychologists do not necessarily feel stress causes heart disease but it is felt that if the overall balance is not quite right then health can be compromised. Relaxation can be a way of recognizing tension that is being built up within you. Try to practice this activity once a day. At other times, “watch” yourself for signs of tension. When you feel you are becoming tense, you now know how to overcome it. Sit comfortably in a chair or lie on the bed or floor. Whilst practicing think carefully about what your body feels like, don’t let your mind wander. Push your heels away from you, toes up towards your face. Notice the tension in your feet and legs. Let go. Notice the difference. Press in your abdomen and tighten your buttocks. Notice what this feels like. Let go. Notice the difference. Now tighten them just a little. Notice particularly what it feels like as it’s more like the tension produced by worry and anxiety. Let go. Take a deep breath. Hold. Notice the tension around your back and chest. Breathe out and notice the felling of relaxation in your back and chest. Make a fist with each hand. Notice what your hands and arms feel like. Uncurl your hands, letting them rest, separated and relaxed on your lap. Notice the difference. Clench your teeth. Notice the tension in your jaw and face. Relax your jaw, separating teeth slightly, lips soft and slightly parted, cheeks heavy. Notice the difference. Frown. Notice what it feels like. Smooth your brow. Feel the difference. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
Page 15 of 20 Notice the all over relaxation and occupy your mind for a few minutes with one of the mind- quietening exercises. Quick release of tension/emergency relaxation method Whenever you feel anxious, panicky or uptight: Say “stop” to yourself. Let your breath go (don’t breathe in first). Take in a slow, gentle breath: hold it for a second. Let it go, with a leisurely sigh of relief. Drop your shoulders, at the same time and relax your hands. Breathe in deeply again and as you breathe out make sure teeth are not clenched together. Take two small quiet breathes. If you have to speak, speak more slowly and in a lower tone of voice. Based on Jane Maddes’ Stress and Relaxation, Dunitz, 3rd Edition, 1981. Practical advice following your heart attack Driving Depending on the treatment and type of heart attack you have had will depend on whether you may recommence driving after a week or a month. Your doctor or cardiac rehabilitation nurse will be able to inform you of this. You should consult your GP before resuming driving if you have had a complicated recovery. It is necessary to notify your insurance company other wise your insurance will be invalid. The DVLA need not be informed unless you experience angina whilst driving. If you hold an LGV or PSV license then notify the DVLA straightaway. You will need to have further investigations on your heart for them to be happy for you to continue to use your license. This will all take time. So try not to delay letting them know. If you have any problems with filling in the forms then contact the cardiac rehabilitation team who will guide you through them. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
Page 16 of 20 Returning to work Most people will be able to return to their previous employment. Returning back to work should be considered on an individual basis. Discuss your work and any worries or concerns with the cardiac rehabilitation team, your consultant or GP who will offer you the appropriate guidance. Financial Worries You may have particular concerns about managing financial matters. Needing time off work may lead to financial difficulties for some of you. If you feel this may become a problem then you can contact your local Welfare Rights Officer either whilst in hospital or when you go home. Your local Citizen Advice Bureau will have all the appropriate telephone numbers. Holidays Most people can fly within 10 days but it is advised to discuss your case with your consultant/GP. Although there are usually no concerns about flying following a heart attack you may find most insurance companies will not offer medical cover without incurring excess charge. If you have already pre-booked a holiday within the three month period do inform your holiday insurance. Your GP or hospital consultant will be able to sign your claim form. Medication Before you leave hospital you will be given at least a weeks supply of medication. Ensure that a member of staff has explained them to you and when to take them. It is important never to stop taking medication without informing your doctor first. You will need to obtain further tablets when you go home from your GP. Follow up appointments Your consultant follow up appointment will come via the post. Guidance about what to do if you experience chest pain/discomfort In the early days of convalescence it is not unusual to experience aches and pains in the chest area. A lot of these may not be anything to do with the heart. But if you start to experience a symptom that is always similar in nature whilst doing an activity even if it is classed as mild symptoms but settles with rest within 5 minutes then do discuss this with your GP whom can offer advice. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
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Always stop if it occurs with activity, and wait for it to go before recommencing. If the symptom
is angina it will normally settle within five minutes of rest or the use of the GTN spray.
If you experience chest discomfort or pain
Stop
Sit down
Use your GTN
If the symptom continues after 5 minutes.
Repeat GTN
If the symptom continues after a further 5 minutes.
Repeat GTN
After 15 minutes if your symptom has been continuous.
Don’t delay
Telephone 999
Do not get someone to drive you in.
www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill HospitalPage 18 of 20 What is Cardiac Rehabilitation? The Cardiac Rehabilitation Programme is for patients who are recovering from either heart problems or heart surgery. The programme takes place in the hospital or at home, from as early as 10 days after discharge. It can be beneficial in several ways, whether you are mildly or severely affected by your heart disease. If you have severe disease that may affect your activities the programme can help to restore your confidence, maximise your recovery and improve the quality of your life. The programme also helps you to understand and gives you an opportunity to discuss prevention of heart disease; this includes lifestyle issues, medication and stress. Therefore one of the best things you can do to help your recovery and stay healthy is to join the cardiac rehabilitation programme run by an enthusiastic team of healthcare professionals. What happens in a Cardiac Rehabilitation Programme? Initially, you will be contacted at home post discharge to discuss your recovery and any concerns you may have at the present time. At this point you will be invited to attend for an induction/assessment, or offered a home based programme. At induction/home visit we will discuss your progress and concerns about returning to your normal routine (resuming household chores, hobbies, DIY projects, physical activity and if appropriate return to work). If you have an induction you will meet one of the cardiac rehabilitation staff who will then perform a treadmill walk test (if appropriate) to assess your overall physical fitness. They will then work out a programme of exercises for you, tailored to your individual needs, aimed at helping you return to your normal routine. Your heart rate, blood pressure and any changes in symptoms will be monitored. You will be taught how to self monitor your progress and fitness levels. This will be useful, even after the programme has been completed, when trying new physical activities. You will gradually move on to different levels of exercise that will build up your overall fitness level. You can learn skills to help manage and reduce stress. If you feel you may need more psychological support we have access to a cardiac stress management course. This can help you take control of your life and help with low mood, depression, excessive worry or sleep problems. Please ask your cardiac rehabilitation nurse for more information. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
Page 19 of 20 We offer sessions on lifestyle changes and current therapy, giving you the opportunity to ask questions and talk about any worries you may still have, and help you to understand how these can reduce the risks of further problems. We offer advice and help on smoking cessation. NHS Quit Smoking Line. Tel: 0800 1690169 Stockport Smoking Cessation. Tel: 0161 426 5085 You will have a dietary assessment. Support will be offered to help you create a healthy eating plan to reduce the intake of foods which are high in saturated fat and cholesterol and also guidelines on weight control. If required you may want to be referred to a dietician. You will meet our community based exercise facilitator who will help and encourage you to continue exercising when discharged, by ensuring the appropriate exercise to meet your needs. You will meet people who have had similar concerns with their health. By the end of the programme patients tell us they feel better and fitter than they have done in a long time. Finally on discharge we refer you back to your Practice Nurse who will continue to monitor you at least yearly. www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
Page 20 of 20 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MED18 Publication date October 2015 Review date October 2017 Department Cardiac Rehabilitation Location Stepping Hill Hospital www.stockport.nhs.uk Cardiac Rehabilitation | Stepping Hill Hospital
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