Dana Klosner May 2, 2018
Learn to move toward life with cardiac rehabilitation, medication, a heart-healthy diet, and cognitive therapy.
It happened. You had a heart attack, but you’re not alone. According to the American Heart Association, 660,000 people will have their first heart attack this year.
Once you have a heart attack, your chances of getting another one increase. So, what can you do?
For many people, preventing another heart attack means a complete lifestyle change. You must stop smoking and drinking alcohol, if you indulged in either of those. You must become more physically active, change your diet, and keep a better check on your emotional health. A heart attack — or myocardial infarction, as it is also known — can bring on depression and anxiety, according to Dr. Nieca Goldberg, a cardiologist, AHA spokesperson, and medical director of NYU Langone Health’s Joan H. Tisch Center for Women’s Health.
But this isn’t your father’s heart attack. Heart attack recovery has evolved from what it was 50 years ago, Goldberg said.
“In the 1960s, you were in the hospital for six weeks on bedrest,” she said. “Now, we get a patient out of bed as soon as possible and get them up walking. A patient is usually only in the hospital two or three days, and if that patient feels well enough to do errands when he gets home, more power to him.”
If your heart attack was uncomplicated, you can even return to work in as soon as one to two weeks.
“It’s important to know that feeling ‘twinges’ in your heart is normal,” Goldberg said. “When you feel (chest pain anxiety), it’s important to compare it to the symptoms of when you had your attack. If you have shortness of breath and are perspiring along with the chest pain, you should reach out for help.”
In addition to medications, in most cases, your doctor will prescribe cardiac rehabilitation.
Cardiac rehab can be threefold. It includes closely monitored exercise, nutrition counseling, and, if needed, screenings for mental health issues, according to Dr. John Osborne, a cardiologist and AHA spokesperson who runs a cardiac rehab center in Dallas.
After discharge, the patient comes to a cardiac rehab center. Therapy begins with mild exercise, such as walking on a treadmill while hooked up to an EKG to monitor heart rate and blood pressure. A patient will also do some bike work on a stationary bike, he said. After that, they will start with light weights and mild resistance training.
“Being involved in cardiac rehab lowers your mortality risk by 30 percent,” Osborne said. “Probably half the benefit is the directed, guided, observed exercise. The other half is above the neck. People have been traumatized by an acute catastrophic event. The monitored exercise lets them know that they will be OK when they exercise. It’s the reassurance and knowing someone is there.”
The exercise picks up with time and turns into more vigorous activity. A lot of cardiac rehab is the talking and guiding a patient to tell them what they can and should do, Osborne said.
“The goal is that a patient should continue to exercise indefinitely,” he said. “We teach them to self-monitor their heart rate and to know what’s OK and what’s not OK physically.”
Having a built-in support group is a great emotional benefit of cardiac rehab, according to Dr. Barry Jacobs, a clinical psychologist and AHA spokesperson who works in cardiac care.
“It’s in a group setting of three or four others that cheer each other on,” Jacobs said.
About a quarter of those who have had heart attacks suffer from depression and major anxiety, Jacobs said.
“The depression may be because they are facing mortality for the first time in their life,” he said. “It increases their vulnerability. They may think their life is limited, that bad things happen, and become pessimistic.”
Therapy is the best treatment for these patients, Jacobs said. There, they may receive medication, talk therapy, and cognitive behavioral therapy.
“Patients are often fearful when they have chest pain,” he said. “We teach them to face their fear… and not jump to conclusions. We also teach people relaxation techniques, such as breathing and meditation, to bring them to a calmer state of mind.”