Heart attack recovery

Risks after a heart attack

Many people live in fear of another heart attack - and with good reason. About 10 per cent of those who have a heart attack will have another one within a year of leaving hospital. This risk drops to about three per cent every year after that.

Proper rehabilitation, which includes making changes to your lifestyle, can reduce these risks and increase your life expectancy. If you're not offered a formal rehabilitation programme, ask your doctor if there's one in your local area.

Rehabilitation after a heart attack

The first 48 hours after a heart attack are critical. After this, recovery begins. Within a few days, the tissues of the heart begin to heal and, if there are no complications, you may be discharged from hospital after five to seven days.

As the weeks pass, the damaged muscle is replaced by scar tissue. This process takes six to 12 weeks, during which time you should be increasing your activity levels gradually.

Many people are terrified of exercising after a heart attack for fear that it will trigger another attack, but exercise helps to speed recovery.

A gradual increase in exercise helps the heart to get back in shape and adapt to any scars left behind. It also improves general wellbeing and encourages good quality and regular sleep. It helps test out the heart, so the patient and doctor become aware of any residual problems, such as angina or breathlessness.

Always follow expert advice regarding this gradual increase in exercise. Never overdo things. Excessively vigorous exercise, especially if it includes isometric exercise, can increase the risk of another heart attack.

Back to normal

In uncomplicated cases, you should be back to your normal routine after six to 12 weeks.

• Work - exactly when you return depends on your job and how serious the heart attack was. Take it in stages and rest when you feel tired. Some very physical jobs may be beyond your ability at first.
• Driving - avoid long journeys and stressful driving situations, such as in a city or in the rush hour.
• Sex - many people worry that sexual activity may be too strenuous after a heart attack, but research shows these fears are generally unfounded. Like all exercise, take it slowly at first.

Drug treatments

After a heart attack, drug treatments can reduce the risk of having another by as much as 25 per cent, depending on your particular condition.

Drugs that may be prescribed include:

• Aspirin and other drugs - these reduce the formation of blood clots.
• Lipid-lowering drugs - these reduce cholesterol and other harmful fats in the blood, making the coronary arteries less likely to fur up. In the UK, most people are treated with these after a heart attack.
• Beta blockers - these drugs are particularly useful in high-risk patients, such as those with high blood pressure or diabetes, but many patients have contraindications to their use.
• ACE inhibitors and angiotensin receptor blockers (ARBs) - these types of drug are particularly useful when the heart is failing to work as efficiently as it should (heart failure) and for controlling blood pressure.
• Drugs to treat abnormal rhythms of the heart.

Lifestyle changes

Changing your lifestyle can greatly reduce your risk of a further heart attack:

• Give up smoking - this halves your risk.
• Eat a healthy diet.
• Take regular exercise.
• Keep your weight under control.
• Have your blood pressure checked regularly.
• Learn to deal with anger and stress, which can trigger an attack.

Psychological issues

Depression affects one in four people after a heart attack. It's critical to address any depression - it won't just go away on its own and it can make it harder for you to make any necessary lifestyle changes or follow your doctor's advice on particular treatments. Without specific help, those who become depressed don't recover as well as they might.

If you take part in a cardiac rehabilitation programme, it will be able to offer treatments ranging from medication to group therapy and stress management (stress and anger may contribute to a heart attack by producing changes in your body that increase your risk of blood clots).