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.