Recovery after a Heart Attack
Patients who
do not have complications following a heart attack can usually be discharged
from the hospital in six to ten days. A few patients are discharged even
sooner. Prior to discharge, patients are usually evaluated to determine the
severity and extent of their coronary disease and the degree, if any, of heart
failure. If coronary disease is significant, a surgical procedure or
angioplasty (see chapter 9) is usually planned for the near future to reduce
the risk of repeated heart attacks.
Beginning in
the hospital, a cardiac rehabilitation program of gradually increasing exercise
is begun. Generally, such programs take about two months to complete, but
patients are expected to continue exercising on their own following the
program. Patients can usually resume normal activity, such as household chores,
within three to four weeks following a heart attack, although they may not
return to work for six weeks to two months. Most physicians feel that sexual
activity can be resumed within four weeks following a heart attack.
Part of the rehabilitation
program concerns lifestyle changes to prevent worsening of the coronary
atherosclerosis. Stopping smoking, reducing cholesterol intake, and improving
control of high blood pressure or diabetes are important factors for reducing
atherosclerosis. It has been shown that persons who make significant changes in
these factors not only slow the progression of coronary artery disease, but in
some cases the disease process even reverses. Such patients will actually have
less coronary artery disease a year after their heart attack then they did
before.
Most
patients will be started on medication to help prevent future heart attacks.
Mild anti-blood-clotting drugs have been shown to lessen the risk of future
heart attacks in persons with coronary disease. Low doses of aspirin are
commonly used, but stronger anti-clotting drugs are indicated in some people.
At the same
time, medications to minimize the heart's workload are also started.
Beta-blocking drugs and calcium-channel-blocking drugs (see chapter 8) reduce
how hard the heart pumps and minimize the amount of oxygen the heart needs.
Patients who have symptoms of congestive heart failure may need to take
digitalis or another inotrope to improve the heart's pumping ability and
diuretic drugs to help remove excess fluid from the body.
For many
patients with coronary heart disease, surgical treatment will be recommended.
The decision to recommend coronary bypass surgery or angioplasty (see chapter
9) is based on the number, location, and severity of plaques in the coronary
arteries. Although both angioplasty and bypass surgery improve the condition of
the majority of patients who undergo them, the procedures do have risks
including further heart damage and even death. These risks are least when the
procedure is performed in an institution that does hundreds of the procedures a
year, and by the most experienced surgeons.
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