Returning to fitness after a heart attack - A patient's guide
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A patient’s guide
Returning to
fitness after a
heart attack
A patient’s guide
1A patient’s guide
Returning to fitness after a
heart attack Please remember that in an
The first few days and weeks emergency you should ring
following your discharge from 999.
Papworth Hospital can be
confusing and worrying for you Don’t forget to drop your
and your family. This leaflet will discharge letter into your GP
help you to understand what surgery straight away so that
has happened to your heart. they are informed of your
It gives you an idea of what to recent illness.
expect over the next few weeks
and also helps you to think If you feel unwell, follow the
about your recovery and how advice on page 6 under the
to get the best from life after section ‘What happens if you
your heart attack (myocardial get more chest pain after going
infarction) and the stent home?’
procedure.
If you still feel unwell, call an
You may still have some ambulance. If you need to visit
questions and concerns after your GP or go to your local
you have read this leaflet. hospital, please remember to
Papworth Hospital has an take with you the complete
advice line, which you may discharge pack that you were
telephone between 9.00am and given when you left Papworth
4.30pm Monday to Friday. Hospital.
If we are unable to answer You should make an
personally, leave your details appointment to see your GP
on an answer machine and we in the first week following
will contact you as soon as we your discharge from Papworth
can. The advice line number is Hospital, in order check your
01480 364468. progress and review your
medicines.
For advice at other times,
please ring NHS Direct on 111.
1A patient’s guide
Cardiac rehabilitation The rehabilitation staff will
Whilst you were in hospital help you to continue with your
you will have received some recovery. They will help you
information about cardiac to identify any relevant risk
rehabilitation. Your details factors for heart disease, to
will have been passed on to a enable you to adopt a healthy
specialist cardiac rehabilitation lifestyle and to get the most
team who will contact you in out of your procedure. You can
the next few days after you follow a programme that is
have gone home. suitable for your own level of
ability.
Some people choose to go to
a local cardiac rehabilitation If you have any additional
programme and others prefer queries please telephone
to return to Papworth Hospital. the Rehabilitation Team for
On the inside back page you information and advice (see
will find the contact details page16).
for the cardiac rehabilitation
teams. You will be given some What is coronary artery
information about the choices disease?
that are available to you. The heart is a muscular organ
which pumps blood around the
Research studies have shown body. In order to do this work
that people who attend effectively it needs a good
cardiac rehabilitation after a supply of blood and oxygen
heart attack are able to do itself. The heart receives its
more, feel more confident and blood supply through blood
lead a healthier lifestyle than vessels called coronary arteries.
those who do not attend. It is
possible to improve how well Over time (usually many years)
your heart works and to reduce the coronary arteries can
your risk of having another become narrowed by deposits
cardiac event. called plaques. The plaques
contain fat and cholesterol.
They occur within the wall of
the artery.
2A patient’s guide
• Excess alcohol
• Prolonged stress
Risk factors you can’t change:
• Age
• Family history
• Gender
• Your ethnic origin
• Diabetes (but you can
improve it!)
Risk factors for coronary artery
disease What is angina?
Risk factors are things that Angina is a term used to
we know make it more likely describe pain or heaviness in
that you will develop coronary the chest, arm, shoulders or
artery disease. Some risk factors jaw. Sometimes the pain can
are related to your lifestyle, occur elsewhere. It occurs if the
so you can work towards heart muscle is not receiving
changing them. Others are not enough oxygen because there
possible to change, but your is a narrowing in one of the
chances of having another arteries taking blood and
cardiac event can be reduced oxygen to the heart muscle. If
greatly by following a healthier the artery relaxes and widens
lifestyle. again, the blood will get
through the narrowed artery
The cardiac rehabilitation staff and the pain is relieved.
will help you to recognise your
own risk factors and to make Many people are given a
sensible plans to change them. Glyceryl Trinitrate (GTN) spray
to use if they get angina,
Risk factors you can change: which acts quickly to relax and
• Smoking widen the artery. Angina pain
• Obesity is usually relieved by rest and
• High cholesterol level GTN within a few minutes.
• High blood pressure It does not cause permanent
• Lack of exercise damage to your heart.
3A patient’s guide
Signs of angina pain How to use your GTN spray
Heaviness or pressure around GTN is a drug that acts very
the chest. This may happen quickly to widen the coronary
after increased activity. arteries, and to relieve the
effects of angina.
• Heavy, aching pain in the
back, shoulders, arms or jaw. Follow the guidelines below:
• Feeling unusually breathless • Always sit down and try to
after walking a short distance rest and relax.
• Waking up at night feeling • Spray the GTN once, under
very short of breath. your tongue.
• Thumping or palpitations • Rest for five minutes.
in the chest, especially if it • If the pain has not gone,
makes you feel dizzy or light- repeat the GTN spray under
headed. your tongue.
If you have any of these • Rest for five minutes.
feelings, you should rest. • If the pain has not gone,
repeat the GTN spray under
If you have pain follow the
your tongue.
guidelines opposite for using
GTN. If at anytime you think you
are having a heart attack or if
you still have chest pain after
15 minutes, call 999 for an
ambulance.
If your pain is relieved
completely by the GTN spray,
you should rest for 10 minutes
before you carry on.
You should make an
appointment to see your GP
if you have not had angina
before or if your angina feels
worse or is more frequent.
4A patient’s guide
Fatty deposits
Blood clot
Artery blockage
Damaged heart muscle
What is a heart attack? The pain caused by a heart
A heart attack occurs if you attack is not relieved by
develop a blood clot in one of rest and Glyceryl Trinitrate
the coronary arteries (blood (GTN). The sooner you receive
vessels) that take blood and treatment to re-open the
oxygen to the heart muscle. blocked artery, the sooner
The blood clot usually occurs the blood flow is restored to
in an area within a coronary the affected part of the heart
artery that is already narrowed muscle. If this is done very
by fatty deposits. This means quickly, less heart muscle will
that the blood vessel is be damaged, which increases
completely blocked. Part of the your chance of a full recovery.
heart muscle is starved of blood
and oxygen, which often causes With good care, information
severe chest pain, like the pain and planning, you may even
that led to you coming into lead a healthier life than you
hospital. had before.
Some people feel very sick and
sweaty, and often appear very
ill.
5A patient’s guide
This removes the blood clot
that may have been causing
your heart attack and re-
establishes blood flow to the
affected area of heart muscle.
This should relieve your pain
immediately.
What happens to the stent
after it is fitted?
The stent sits tightly against the
wall of your artery. After a few
weeks or months, your artery
wall will grow to cover the
metal mesh, so your artery will
be held open permanently.
However, until this happens it
Coronary artery stent
is very important that you do
your best to look after your
What is a coronary stent? stent, and your artery. You will
A stent is a small metal tube be given some tablets (aspirin
made of open meshwork. It is and clopidogrel) to prevent
placed through the narrowed further blood clots from
or blocked part of your forming within the stent and
coronary artery that is causing elsewhere in your arteries. You
your severe angina or heart should take these tablets as
attack. directed by your doctor.
The stent is inserted into the What happens if you have
artery via a balloon. When the chest pain after going home?
balloon is inflated, the stent It is common for people to
widens to fit perfectly within experience further pain in
your artery and the fatty their chest in the first few days
deposits are squashed back and weeks following a stent
against the wall of the artery. procedure.
6A patient’s guide
This is because your artery has Medication
suffered some trauma and Most people take several
bruising, first from the blood tablets following a heart
clot, and then from the stent attack. You may have been
being fitted. You can have given some of these medicines
episodes of pain or discomfort before.
as the stent settles into place.
Some of the medicines are
This pain is usually quite only recommended for a short
different from that of angina. period of time. Others are
It is felt quite locally in the recommended for life because
chest, and is often described they will help you to remain
as sharp or stabbing. This type as fit as possible in the long-
of pain may be relieved by term, and to avoid any further
paracetamol. problems with your heart.
It is also very common to be Remember to order your repeat
more aware of your heart beat, prescriptions in good time
especially at night, and you and do not stop taking any
may feel more tired than usual. medicines without discussing it
These feelings are usually a with your doctor first.
normal part of getting over a
heart attack, and should reduce Some people occasionally
over a couple of weeks. experience side-effects from
certain medicines but there
Some people may experience are almost always alternatives
further angina. This is because available so let your doctor
you may have other narrowings know if you are having
within other coronary arteries problems. He or she can work
that were not treated at the with you to find a medicine
time of the emergency care. that suits you better.
Very occasionally there may
be further problems with the You should make an
stented artery, and this will appointment to see your GP
require rapid treatment. within one week of leaving
Papworth Hospital, as it is
7A patient’s guide
important for you to have your stent. Taking clopidogrel and
medicines reviewed and to aspirin will reduce the risk of a
make sure that you are taking further heart attack.
the most appropriate doses.
Warfarin
►Aspirin You may already be taking
This is called an anti-platelet warfarin in which case your
drug. It helps to prevent consultant will probably
platelets in your blood from want you to take aspirin and
sticking together and forming clopidogrel in addition to this.
small clots. It is very important You will be advised about any
to prevent clots forming extra monitoring needed for
around the new stent. your warfarin levels.
Aspirin is taken once daily, Statin (eg simvastatin)
after some food to help protect This medicine will help to
your stomach. Tell your GP if reduce your cholesterol
you get indigestion after taking together with a healthy low fat
aspirin. Another medicine may diet. This is very important to
be prescribed to counteract help control further build up
this. You will need to take of fatty areas (plaques) which
aspirin lifelong. restrict blood flow in your
coronary arteries.
Clopidogrel
This is another anti-platelet It is very important for you to
drug and works together with know what your cholesterol
aspirin to give the best possible level is - ask your GP for the
cover. This may be prescribed numbers. This will help you to
for either one month or 12 monitor your own progress.
months, depending on the type As cholesterol is produced
of stent used. overnight in your body this
medicine will work best when
It is very important that you taken at night. You must avoid
continue taking this drug as eating grapefruit or drinking
prescribed to prevent small grapefruit juice as this can alter
clots forming around your the level of statin which may be
8A patient’s guide
dangerous. If you experience Some people develop an
any new muscle aches or irritating cough. If you do,
tenderness, please consult your then do not stop taking this
GP. You will need to take this medicine but consult your
medicine lifelong. GP who will prescribe an
alternative.
Beta Blockers (eg atenolol or
bisoprolol) ►GTN (Glyceryl Trinitrate)
This medicine will slow your Use of GTN has been described
heart rate, keeping it in a on page 4. Always keep your
regular rhythm and at a safe GTN with you in your pocket
level which will protect your or bag. You can buy GTN spray
heart. This will also help your or tablets over the counter at
heart to pump blood around a pharmacy in an emergency.
your body more efficiently. Always read the instructions
Your blood pressure will also and expiry dates.
be reduced. These effects will
reduce your risk of having a Additional medicines
further heart attack. You may be prescribed other
drugs in addition to these.
►ACE Inhibitors (angiotensin- For further information ask
converting enzyme inhibitor eg your pharmacist or GP. Please
ramipril) read the patient information
This medicine is used to leaflets inside your medicines
reduce the workload for your packet for a complete list of
heart by reducing your blood side effects and information.
pressure. It is easier then for Additional information can
your heart muscle to pump be found in the British Heart
blood around your body. It Foundation booklet 17.
will also protect your heart. ‘Medicines for the Heart’.
The dose of this medicine will
be increased gradually by It is safe to take any
your GP. This will give you the supplementary alternative
best possible benefit from the medicines?
medicine long-term so do not If you are considering taking
be concerned. any supplementary alternative
9A patient’s guide
medicines then consult your You should rest the arm/leg for
pharmacist before doing so as a couple of days after you go
they may interact with your home and you should elevate
medicines prescribed by the GP. the leg when you are sitting.
Follow the advice below about
It is a good idea to keep a copy resuming activity gradually.
of your prescription with you
at all times. You may have a shower at
home, or a tepid bath, but for
Going home the first week do not sit in a
You will be discharged home hot bath.
after a few days. This can be
worrying for some people but You may get some mild pain
remember that you will not from the wrist/groin area.
be allowed home until your This should be relieved by
doctors have assessed that Paracetamol. It is unusual
you are in a safe and stable to experience severe pain. If
condition. your arm/leg becomes very
painful, hot to the touch or you
You will need to care for your develop a swelling that feels
wrist/groin wound, as well as to like an egg in the wrist/groin,
think about your recovery from you should contact your GP or
the heart attack. go to your local hospital.
Care of your wound Remember to take all your
It is normal to have bruising discharge information from
around the wrist/groin in the Papworth Hospital with you.
area where the tubes were
inserted in order to carry out Getting back to normal activity
your stent procedure. This is The following guidelines are
because a lot of drugs were suitable for most people who
used to thin the blood during are making a straightforward
the procedure. The bruising recovery. They are not hard and
may look quite extensive but fast rules. Do not push yourself
will fade over the next couple faster than the guidelines.
of weeks. Listen to your body and do not
10A patient’s guide
worry if you feel you are not 88 No heavy work such as
progressing fast enough. vacuuming, making beds,
hanging out washing or
Things you should not do for lifting.
four weeks:
88 No driving, and limit
• Drive the car (this is a DVLA
journeys as a passenger to
directive). Your doctor will
one or two local trips.
advise you if you may drive
sooner.
Week 2
• Travel long distances - even 33 Walk for 10 minutes on
as a passenger. the flat such as short trips
• Ride your bike. to local shops or walks
• Heavy lifting or other heavy outdoors.
physical activity. 33 Light housework such as
• Vacuuming. making beds, washing up
• Any DIY. and preparing simple meals.
• Any sporting activity other 33 Gradually increase your
than walking. daily activities as you feel
• Mow the lawn or cut hedges. able, but still incorporate a
rest during the daytime.
What you can do:
Week 1 Weeks 3-4
33 Increase your walking to 20
33 Potter around the house, sit
minutes a day.
or stroll in the garden if the
weather is warm. 33 Light housework, such
as tidying and dusting,
33 If you go outside, do not
hanging out washing, but
walk up any hills.
rest after 20 minutes.
33 You may make light snacks,
33 Some light gardening, such
coffee and tea etc.
as easy weeding or planting
33 You may peel vegetables out. Bend from your knees
sitting at a table. rather than from the waist.
33 Make time for a nap after 33 Short social outings.
lunch and rest when your
body tells you to.
11A patient’s guide
Weeks 5-6 Travelling and transport
33 Visit your GP to ask about It is wise to stay fairly close to
resuming driving. Inform home for the first couple of
your insurance company weeks. If possible try to avoid
that you have had a heart going out and about on your
attack. own. Use familiar routes when
33 Increase your daily walking going out. You can increase
to 30 minutes if you feel your journeys as your recovery
able. continues.
33 General housework, If you have a mobile phone
including ironing and take it with you!
vacuuming, but rest after
30-40 minutes. Travelling by car
33 Moderate garden work, It is a DVLA rule that you may
such as lawn mowing, not drive for four weeks after a
weeding and light hoeing, heart attack. Very occasionally,
but rest after 30 minutes. some people are allowed to
drive sooner than this. Do not
33 Normal social activities. do so unless your doctor has
88 Still no heavy lifting. told you that you may.
Remember to take you GTN • You must check with your
with you at all times. GP before starting to drive
again.
Make sure you are warmly • You must inform your
dressed and avoid cold winds. insurance company that you
Avoid going out in very hot or have had a heart attack, but
very cold weather. you do not need to inform
the DVLA.
• Begin with short, familiar
journeys.
• If you ever develop chest
pains when you are driving,
you should stop. Follow
the guidelines for use of
12A patient’s guide
GTN. Contact your GP or • Always carry your medicines
Consultant when you arrive in your hand luggage.
back home and discuss • Drink plenty of water during
further driving. the flight, and avoid alcohol
If you hold a PSV or LGV licence until you arrive at your
you must not drive for three destination.
months. You must inform the
DVLA that you have had a Planning holidays
heart attack and they will ask Inform the travel agent when
you to take a special cardiac you book a holiday that you
exercise test before they re- have had a heart attack. You
issue your licence. will need effective travel
insurance. The British Heart
Travelling by aeroplane Foundation gives good advice
Following a heart attack you about travel and car insurance
may travel short distances by companies via their website or
air (ie less than three hours) by telephone.
from about 10 days after your
discharge from hospital. The most stressful part of a
holiday is often travelling so
Ask your doctor or Cardiac make sure you allow plenty
Rehabilitation specialist for of time. Do not lift heavy
advice about when you may suitcases.
fly, but you should take short
journeys by air (i.e. less than Always make sure you have a
three hours) initially. Airline good supply of your medicines,
companies vary, so check with and keep them in your hand
the airline and insurance luggage. Take a separate list
conditions before you book. of your medication names and
You will need to wait longer doses with you.
for long-distance fights.
• Inform the airline when you
book your tickets.
• Make sure you have effective
travel insurance.
13A patient’s guide
Sex your future lifestyle. This is best
Many people are anxious about done by attending your Cardiac
resuming sexual activity. If you Rehabilitation programme.
are worried, try to increase
your confidence by being close Talk to your employer as
and intimate with your partner. many are sympathetic and will
arrange for you to return part-
Generally if you can time at first. This can help you
comfortably climb two flights to avoid becoming too tired
of stairs, you can resume and having to travel in the
sex. Do not force yourself to rush hour. If you have been
‘perform’ and make sure your doing heavy manual work,
room is warm and comfortable. see whether you can return to
Try to relax and let your lighter duties at first.
partner take a more active role
at first. If you are self-employed, seek
advice from the local Citizen’s
You should not use Viagra, or Advice Bureau.
any similar tablet such as Cialis
or Levitra, if you are also using Why should you attend
GTN spray or any other form of a cardiac rehabilitation
nitrate tablets. programme?
The cardiac rehabilitation
Returning to work programme will help you and
Most people return to their your family to:
usual job after a heart attack,
and this can help you feel • Gain more understanding
you are getting back to about your heart condition.
normal. Your doctor will give • Gain support from specially
you guidance about when trained staff.
to return, but most people • Meet other people with
normally take at least six weeks similar problems and
off work. concerns to yourself.
You can use this time to recover • Learn to make choices about
and to put plans in place for improving your lifestyle.
14A patient’s guide
• Improve your health and
fitness.
• Above all, boost your
confidence and allow you to
feel that you can get on with
the rest of your life!
The nurses at Papworth
Hospital will refer you to the
Rehabilitation staff at your
local hospital. You will find
their telephone number on the
next page.
They will contact you to book
an appointment to discuss your
progress in more detail.
15A patient’s guide
Useful contacts
Papworth Hospital Advice Line
01480 364468
British Heart Foundation Heart Information Line
08450 708070
www.bhf.org.uk
The British Cardiac Patients Association
01949 837070
www.bcpa.co.uk
NHS Smoking Helpline
0800 169 0 169
www.givingupsmoking.co.uk
NHS Direct
111
www.nhsdirect.nhs.uk
DVLA
0870 240 0009
www.dvla.gov.uk
Cardiac Rehabilitation Contact details within your area
Addenbrooke’s Hospital............................................ 01223 216985
Bedford Hospital........................................................ 01234 792618
Doddington Community Hospital............................. 01354 644232
Princess Alexandra Hospital...................................... 01279 827548
James Paget Hospital................................................. 01493 452547
Norfolk and Norwich University Hospital................. 01603 286513
Papworth Hospital..................................................... 01480 364429
Peterborough District Hospital .. ............................... 01733 874804
QEII Hospital King’s Lynn........................................... 01553 613867
Suffolk Rehabilitation Services.................................. 01473 275211
West Suffolk Hospital................................................ 01284 713611
Ipswich Hospital......................................................... 01473 702073
16A patient’s guide Papworth Hospital NHS Foundation Trust Papworth Everard, Cambridge, CB23 3RE Tel: 01480 830541 Fax: 01480 831315 www.papworthhospital.nhs.uk A member of Cambridge University Health Partners Papworth Hospital is a smokefree site Follow us on Keep in touch with Papworth Hospital and receive a quarterly newsletter. Join our membership free of charge at www.papworthmembership.com Tel: 01480 364240 Author ID: Cardiac Rehabilitation Nurse Large print copies and Department: Cardiac Rehabilitation Reprinted: June 2014 alternative language Review due: June 2017 versions of this leaflet Version: 4 Leaflet number: PI 103 can be made available © Papworth Hospital NHS Foundation Trust on request.
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