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Getting the Most Out of Cardiac Rehab

You’ll benefit most from your cardiac rehab program by becoming
as actively involved in it as possible. Think of yourself as the most
i m p o rtant member of your re c o v e ry team—because you are . Join
with health care professionals in designing or adjusting services to
best meet your needs. Show up for exercise, education, and support
sessions. Ask questions. Report any changes in your feelings or
symptoms.

Finally, be sure to complete the program. Even if you feel that you
already “have a handle” on how to recover, keep in mind that your
needs will continue to change throughout the recovery process.
Your cardiac rehab team can help you respond to those changing
needs, and thereby continue to help you improve your heart health.
So stick with the program!

Getting Your Life Back
As you begin to recover from a heart attack or heart procedure, you
may naturally wonder when you can return to your usual activities,
including work, sexual activity, driving, and travel. Most people can
safely return to most of their normal activities within a few weeks,
as long as they do not have chest pain or other complications.
While you should ask your doctor when you can return to each of
your usual activities, here are some general guidelines:

Work. Most people are able to return to their usual work within
several weeks. Your doctor may ask you to take tests to find out if
you can do the kind of job you did before. While most individuals
can continue their customary work with no problems, some people
choose to change jobs or reduce their hours to lighten the load on
their heart. Counselors at cardiac rehab programs may be able to
provide support and resources for those considering a job change.

Sexual activity. Most people can have sexual relations again about
3–6 weeks after a heart attack or heart procedure, as long they have
no chest pain or other complications. But since everyone recovers at
his or her own pace, your doctor may give you a stress test to deter-
mine when you can safely resume sexual activity. When you’re ready
for sex again, choose a time when you feel relaxed and rested. Wait
at least an hour after eating a full meal to allow time for digestion.
Take your time. If you have chest pain or other heart symptoms

during sexual activity, have lost interest, or are worried about having

     sex, talk with your doctor.

A special note: Couples who use medication to enhance sex should

     know that these drugs can cause irregular heartbeats. If you’ve been

     using one of these medicines or are considering taking one, ask your

     doctor whether it is safe to do so.

     Driving can usually begin within a week for most patients, if allowed by

     State law. Each State has its own regulations for driving a motor vehicle

     following a serious illness, so contact your State’s Department of Motor

     Vehicles for guidelines. People with complications or chest pain should

     not drive until their symptoms have been stable for a few weeks.

     Travel. Once your doctor tells you it’s safe for you to travel, keep

     these tips in mind:

       ¦   Keep your medications in your purse or carry-on luggage so

           they will be easily available when you need them.

       ¦   Pack light so that you can lift your luggage without strain. At

           the airport, train, or bus station, use a pull-cart to cut down on

           lifting. If possible, get help from a porter.

       ¦   Allow more time than usual to catch your flight, train, or bus.

           Who needs the extra stress?

       ¦   Walk around at least every 2 hours during trips. While sitting,

           flex your feet frequently and do other simple exercises to

           increase blood flow in your legs and prevent blood clots.

       ¦   Check with your doctor before traveling to locations at high

           altitudes (greater than 6,000 feet) or places where the temperature

           will be either very hot or very cold. When you first arrive, give

           yourself a chance to rest.

     Remember, each person’s recovery process is different. Don’t try to

     guess when you can return to normal activities. Always ask your

     doctor first.

     Coping With Your Feelings

     Anyone who has had a heart attack or has undergone heart surgery

     knows that it can be an upsetting experience. You’ve just come

     through a major health crisis, and your usual life has been disrupted.

     Afterward, it’s normal to experience a wide range of feelings.

But you may also feel worried, angry, or

     depressed. It may be reassuring to know that these reactions are

     very common, and that most difficult feelings pass within a few

     weeks. Here are some things to remember:

     Take 1 day at a time. Try not to think too much about next week

     or next month. Do what you can do today. Enjoy small pleasures:

     a walk in your neighborhood, a conversation with a loved one, a

     snuggle with a pet, or a good meal.

     Share your concerns. Talk with family members and friends about

     your feelings and concerns, and ask for support. Be sure to ask for

     the kind of support you need. (For example, if you want a sympa-

     thetic ear rather than advice, gently let your loved ones know.)

     Be sure to give family members time to say what they feel and need,

     too. Supportive relationships may actually help to lengthen life after

     a heart attack.

     Get support from “veterans.” Whether you’ve had a heart attack or

     gone through heart surgery, consider joining a support group for

     people who have shared your experience. Groups for heart patients

     can provide emotional support as well as help you develop new

     ways of handling everyday challenges. For a list of support groups

     in your local area, contact The Mended Hearts at

     www.mended.hearts.org or at 1–888–432–7899. Your local

     American Heart Association chapter may also offer support groups.

     Keep moving. Regular physical activity not only helps to reduce

     the risk of future heart problems, but also helps to relieve anxiety,

     depression, and other difficult feelings. Any regular physical activity—

     even gentle walking—can help to lift your mood.

     Seek help for depression. Up to 20 percent of heart disease patients

     battle serious depression, and many more suffer milder cases of the

     “blues.” If you find yourself feeling very sad or discouraged for

     m o re than a week or so, be sure to let your doctor know. Counseling

     and/or medication can often be very helpful. Seeking help is very

     important, not only because you deserve to enjoy life as fully as

     possible, but also because heart patients who are successfully treated

     for depression are less likely to have future serious heart problems.

Cardiac Rehabilitation

Your doctor may recommend cardiac rehabilitation (rehab) to help
you recover from a heart attack or heart surgery. This is a total
program for heart health that includes exercise training, education
on heart healthy living, and counseling to reduce stress and help you
return to an active life.

Getting involved in a cardiac rehab program is an excellent idea.
A recent study showed that people who participated in cardiac
rehab were 50 percent more likely to survive 3 years after a heart
attack than those who didn’t participate. Cardiac rehab can help to
strengthen your heart, reduce the risks of a future heart attack, and
return you as quickly as possible to your normal daily activities.
Almost everyone with heart disease can benefit from some kind of
cardiac rehabilitation. No one is too old or too young to benefit.
Women are helped by cardiac rehab as much as men are.

Getting Started
Cardiac rehab often begins in the hospital after a heart attack or
heart surgery, with very gentle physical activity and counseling on
adjusting to life at home. Once you leave the hospital, you can
continue to participate in cardiac rehab on an outpatient basis.
Outpatient programs may be located at your hospital, in a medical
center, or in a community facility such as a YMCA. Some people
continue cardiac rehabilitation at home. Regardless of the location,
your cardiac rehab team—which may include doctors, nurses,
exercise specialists, dietitians and counselors—will help you to
create a safe exercise plan, as well as provide information and
encouragement to control your risk factors.

You will need your doctor’s approval to get started in cardiac rehab.
But not all doctors bring up the topic with their heart patients, espe-
cially women. Research indicates that women are only about half as
likely as men to participate in cardiac rehab programs. This is wor-
risome, because nonparticipation increases the risk of having second
and often fatal heart attacks. So be sure to tell your doctor or nurse
that you’re interested in cardiac rehabilitation. Talk with them
about your specific needs and preferences, and ask for a referral that
is a good fit for you.

Implantable Defibrillators: New Hope for Heart Failure Patients

An implantable cardiac defibrillator (ICD) is a small, battery-
powered device that uses an electric signal to automatically
correct an abnormal heartbeat. Implanted beneath the skin of
the chest, ICDs have been used during the past decade to treat
life-threatening arrhythmias. Now, new research suggests that an
implantable defibrillator can help to extend the lives of people
with heart failure.

About 50 percent of deaths in heart failure are sudden deaths
that are probably due to an abnormally fast heartbeat in one of
the heart’s lower chambers. In a large study of patients with
moderate to severe heart failure, one-third of participants were
treated with an implantable defibrillator, while one-third took
the anti-arrhythmia drug amiodarone (sold as Cordarone or
Pacerone), and another one-third received neither treatment.
The results: ICD treatment significantly reduced deaths over the
                        next 4 years, while the medication did
                           not. The benefit from ICD therapy
                            appeared to be strongest among
                            those with moderate heart failure.

  Getting Help for a

     Heart Attack

     For many people, the first symptom of heart disease is a heart

     attack. That means everyone should know how to identify the

     symptoms of a heart attack and how to get immediate medical help.

     Ideally, treatment should start within 1 hour of the first symptoms.

     Recognizing the warning signs and getting help quickly can save

     your life.

     Know the Warning Signs

     Not all heart attacks begin with sudden, crushing pain, as is often

     shown on TV or in the movies. Many heart attacks start slowly

     with mild pain or discomfort. The most common warning signs are:

       ¦   Chest discomfort. Most heart attacks involve discomfort in the

           center of the chest that lasts for more than a few minutes.

           It may feel like uncomfortable pressure, squeezing, fullness, or

           pain. The discomfort can be mild or severe, and it may come

           and go.

       ¦   Discomfort in other areas of the upper body, including one or

           both arms, the back, neck, jaw, or stomach.

       ¦   Shortness of breath. This symptom may occur with or without

           chest discomfort.

       ¦   Other signs include nausea, light-headedness, or breaking out in

           a cold sweat.

     Get Help Quickly

     If you think that you or someone else may be having a heart attack,

     you must act quickly to prevent disability or death, and to get the

     most benefit from current treatments. Wait no more than a few

     minutes—5 at most—before calling 9–1–1.

     It is important to call 9–1–1 because emergency medical personnel

     can begin treatment even before you get to the hospital. They also

     have the equipment and training to start your heart beating again if

     it stops. Calling 9–1–1 quickly can save your life.

Even if you’re not sure you’re having a heart attack, call 9–1–1 if your

     symptoms last up to 5 minutes. If your symptoms stop completely in

     less than 5 minutes, you should still call your doctor right away.

     You must also act at once because hospitals have clot-dissolving

     medicines and other artery-opening treatments that can stop a heart

     attack if given quickly. These treatments work best when given

     within the first hour after a heart attack starts.

     When you get to the hospital, don’t be afraid to speak up for what

     you need—or bring someone who can speak up for you. Ask for

     tests that can determine if you are having a heart attack. Commonly

     given initial tests include an electrocardiogram (EKG or ECG) and a

     cardiac blood test (to check for heart damage). You have the right

     to be thoroughly examined for a possible heart attack. If you are

     having a heart attack, you have the right to immediate treatment to

     help stop the attack.

 Delay Can

                         Be Deadly

  Most people who have a heart attack wait too long to seek medical

  help—and that can be a fatal mistake. Some delay because they

  don’t understand the symptoms of a heart attack and think that

  what they’re feeling is due to something else. Others put off getting

  help because they don’t want to worry others or “cause a scene,”

  especially if their symptoms turn out to be a false alarm. Women

  are especially likely to delay. A large study of heart attack patients

  found that, on average, women waited 22 minutes longer than men

  did before going to the hospital.

  Don’t wait. When you’re facing something as serious as a possible

  heart attack, it’s much better to be safe than sorry. Waiting too long

  can cause permanent disability or death. If you have any symptoms

  of a possible heart attack that last up to 5 minutes, call 9–1–1

  right away.

Recovering Well:

Life After a Heart Attack

or Heart Procedure

Having a heart attack or a heart procedure can be a frightening and

upsetting experience. It is difficult to discover—often suddenly—

that your body isn’t working the way it should, and to be plunged

into an unfamiliar world of hospitals and high-tech procedures. But

it’s important to know that millions of people have survived a heart

attack, recovered fully, and gone on to resume active, normal lives.

Likewise, most people who undergo heart surgery recover well and

return to their usual activities. Many surgery patients eventually feel

healthier than they did before their procedure.

The time it takes to get back

to normal will depend on

many factors, including your

age and general health.

If you have had a heart

attack, the pace of recov-

ery will also depend on

the severity of the attack.

If you have undergone

surgery, recovery time will

depend partly on the type

of procedure you had.

But whatever your

situation, there

is much you

can do to

improve your health and prevent complications following a heart

     attack or major heart procedure.

     The first step: Give yourself permission to recover. You and your body

     have been through a lot, and it will take some time to feel like yourself

     again. Expect to feel quite tired at first, and to gradually regain your

     s t rength and energy. While individual needs vary, following are some

     overall tips for recovering well from a heart attack or heart surgery.

     Your First Weeks at Home

     When you first arrive home from the hospital, you’ll need to get a

     lot of rest so that your heart can begin to heal. It is very important

     to eat healthfully and to get enough sleep. Take the medications

     your doctor has prescribed for you. (See “Heart-Healing Medicines”

     on the next page.) Avoid heavy yard work, house cleaning, or other

     projects that require a lot of energy. Also refrain from physical

     activity in very hot or cold weather. Ask family and friends to help

     out with chores, childcare, and other activities that may be difficult

     to take care of during your first weeks at home.

     At the same time, it is important to get up and move around as you

     begin to recover. Your heart is a muscle that needs be exercised—

     though very gently at first. Pace yourself. Allow plenty of time for

     each thing you do during the day, from getting out of bed to taking

     a shower to preparing a simple breakfast. Rest between activities,

     and whenever you feel tired. Ask your doctor for a list of guidelines

     for activity during your first few weeks at home.

     Your doctor will want to check your progress 1 to 4 weeks after you

     leave the hospital. During your first followup visit, your doctor will

     check your weight and blood pressure, make any needed changes in

     your medicines, perform necessary tests, and check how your recov-

     ery is progressing overall. Use this opportunity to ask any questions

     you may have about safe or unsafe activities, medicines, lifestyle

     changes, or any other issues that concern you. You may want to

     write down your questions beforehand.

     For some situations and questions, it is best to call your doctor right

     away rather than wait for your next appointment. 

Controlling Your Risk Factors

     If you have heart disease, you may wonder why you have it. The
     answer is that many personal characteristics, health conditions, and
     lifestyle habits can contribute to heart disease. These are called
     risk factors.

     But risk factors do more than simply contribute to heart problems.
     They also increase the chances that existing heart disease will
     worsen. Since you already have heart disease, it is very important
     to find out about all of your risk factors and take active steps to
     control them.

     Certain risk factors, such as getting older, can’t be changed. Starting
     at age 45, a man’s risk of heart disease begins to rise, while a woman’s
     risk begins to increase at age 55. Family history of early heart
     disease is another risk factor that can’t be changed. If your father
     or brother had a heart attack before age 55, or if your mother or
     sister had one before age 65, you are more likely to develop heart
     disease yourself.

     While certain risk factors can’t be changed, it’s important to realize
     that you do have control over many others. Regardless of your age
     or family history, or how serious your heart disease is, you can take
     steps to reduce your risk of a first or repeat heart attack. You can
     also manage other problems associated with heart disease, such as
     angina, heart failure, and arrhythmias.

     It may be tempting to believe that doing just one healthy thing will
     be enough to control heart disease. For example, you may hope that
     if you walk or swim regularly, you can still eat a lot of fatty foods
     and stay safe. Not so. To reduce your risk of a heart attack and
     other complications, it is vital to make changes that address each
     risk factor you have. You can make the changes gradually, one at
     a time. But making them is very important.

  While each risk factor may contribute to worsened heart disease,
     the more risk factors you have, the higher your risk. That’s because
     risk factors tend to “gang up” and worsen each other’s effects. For
     example, if you have high blood cholesterol and diabetes, your heart
     attack risk increases enormously. The message is clear: If you have
     heart disease, you must take immediate steps to reduce your risk of
     life-threatening medical problems. It’s your heart and you have
     everything to gain from taking good care of it.

     You and Your Doctor: A Healthy Partnership
     Your doctor can be an important partner in helping you manage
     h e a rt disease. He or she may already have spoken with you about
     your heart disease risk factors, but if not, be sure to ask about how to
     control all of them to help prevent future pro b l e m s . H e re are some
     tips for establishing good, clear communication with your doctor.

     Speak up. Tell your doctor that you want to keep your heart disease
     from getting worse and would like help in achieving that goal. Ask
     questions about your chances of having a first heart attack or a
     repeat heart attack, your risk of other heart complications, and ways
     to lower those risks. If you haven’t done so already, ask for tests
     that will determine your personal risk factors.

     Be open. When your doctor asks you questions, answer them as
     honestly and fully as you can. While certain
     topics may seem quite personal, discussing
     them openly can help your doctor work
     with you more effectively to
     manage your heart condition.

     Keep it simple. If you don’t
     understand something your
     doctor says, ask for an explanation in
     plain language. Be especially sure you
     understand how to make the
     lifestyle changes your doctor
     recommends, as well as
     why and how to take
     each medication you’re
     given. If you’re wor-
     ried about under-
     standing what the

doctor says, or if you have trouble hearing, bring a friend or relative

with you to your appointment. You may want to ask that person to

write down the doctor’s instructions for you.