Heart attack overview
What is a heart attack?
A heart attack, also called a myocardial infarction, refers to damage to the heart caused when the blood supply to part of the heart muscle is blocked. A heart attack happens because the blood supply has been cut off following a blockage in a branch of one of the coronary arteries (blood vessels that supply the heart muscle).
This is usually the result of 2 processes: the development over many years of fatty plaques in the walls of the arteries, and the formation of a clot on one of the plaques. Treatment given early during a heart attack can help to dissolve the clot, reducing damage to the heart muscle.
What causes the build-up in the arteries?
The process that leads to the narrowing and blockage of the coronary arteries (atherosclerosis) starts as early as adolescence and builds up slowly over the years. No single cause of coronary artery disease has been identified. There are, however, several things that are known to increase the risk of a heart attack.
These are called risk factors. The more risk factors you have, the greater your chance of having a heart attack. However, science has not revealed all the factors leading to coronary artery disease, so some people have a heart attack without having currently recognised risk factors.
Risk factors that you may be able to change include:
- raised blood cholesterol;
- cigarette smoking;
- raised blood pressure (hypertension);
- lack of physical activity;
- obesity;
- excess alcohol consumption;
- diabetes;
- depression; and
- social isolation, or lack of social support.
Risk factors that cannot be changed include:
- age;
- gender;
- previous history of heart disease; and
- family history of heart disease.
I've already had a heart attack: what can I do now?
After a heart attack, you can try to prevent further build-up of fatty plaques in the arteries by reducing your risk factors. This should reduce your chance of further heart problems and improve your quality of life.
How much muscle has been damaged?
This varies from person to person but often the amount of muscle injured is not great and the heart continues to pump well.
Tests, including blood tests, an electrocardiogram (ECG), myocardial perfusion (sestamibi) scan, and an echocardiogram (ECHO), give some idea of the amount of damage.
The big thing to remember is that most people make a good recovery. The heart is a tough muscle and heals very well, although healing can take some time. The injured heart muscle starts to heal soon after the attack and takes 6 to 8 weeks.
The final result is an area of strong scar tissue, and although it won't contract like the normal areas of heart tissue, for many people this does not affect the function of the heart or how they feel. Psychological healing is also important and this may take longer. There is usually a lot of fear and anxiety associated with having had a heart attack.
Getting back to your normal life
What should you do when you first get home from hospital? Just potter around quietly for the first few days. Recognise when you're tired and rest. Initially you may wish to limit visitors and telephone calls. Be up and dressed each day, and keep increasing your daily activities gradually. Climb stairs at a pace you find comfortable.
How much physical activity should I do?
Regular physical activity is a vital part of your return to normal life. As well as being an important part of your recovery from a heart attack, regular moderate physical activity helps control your weight, improves blood cholesterol and blood pressure levels, and reduces the chances of another heart attack.
People return to their usual activities at different rates. You may have been given instructions before leaving hospital, especially if you have had an exercise test. If not, you should talk to your doctor.
Walking is recommended for most people after a heart attack. However, not all people enjoy walking every day. If you don't, try to find some activities you enjoy and will stick to. Aim to accumulate 30 minutes of physical activity on most days.
Incorporating a variety of physical and recreational activities into your life helps increase confidence and maintain an exercise habit. If you are planning on doing vigorous exercise such as jogging, you should discuss it with your doctor first.
Walk for your heart
From the time you leave hospital, do some easy walking around the house and garden or out in the street. Go for a walk each day. Start by walking on flat ground at a pace you find comfortable, for 10 to 15 minutes a day, building up to 30 minutes if you feel able. You should be able to talk as you walk. Start off and finish your walk at a slower pace to warm up and cool down.
Each individual is different and you must progress at your own rate. As well as increasing the time, you can progress by increasing the distance and speed and by incorporating some slopes and hills into your walk.
Wait for an hour or so after a heavy meal before walking. Wear suitable clothes in cold, wet or windy weather or on hot days. Remember to take your medication with you and use as directed. If you get angina, shortness of breath or dizziness, stop, rest and use your angina medication. Do not exercise while experiencing angina. When the angina passes, you can continue your walk.
However, if chest discomfort is prolonged and not relieved by rest and medication within 15 minutes, do not continue, call an ambulance. Dial 000 immediately.
What about sport?
Sport provides exercise and relaxation and is generally sociable, so it can do you good. When returning to sport after a heart attack, it's important to build up gradually. For example, golfers may wish to start with just 3 to 4 holes and bowlers may wish to start with fours and non-competitive games.
Physical activities that require sudden bursts of energy, such as squash, heavy weight-lifting and diving, are not recommended after a heart attack. However, if you are really keen on these activities, discuss it with a cardiologist or specialist physician first.
What do I do if I get angina?
Angina is a common symptom of heart disease. It is most often described as an unpleasant feeling or discomfort, like a tightness or weight on the chest. It can affect people in different ways. It is usually felt across the centre of the chest. It may also be felt in either or both shoulders, the neck or jaw, down one or both arms and in the hands.
Some people experience it only in one of these areas and not in the chest at all. The pain usually only lasts a few minutes if you rest and/or take medication. If it does not stop, call an ambulance. Dial 000 immediately. If the frequency of your angina attacks is increasing, or you start to get angina at rest when previously you only had angina on exertion, see your doctor urgently.
If you get chest pain or discomfort on exertion, use your medication before starting the activity as directed by your doctor. You may find it prevents chest pain or discomfort and allows you to do more. However, you should tell your doctor about your symptoms to ensure you get the best advice for your situation and condition.
What about housework?
If possible, you should let someone else run the house for the first week or so. Return to running the home gradually. Begin with activities such as preparing the meals, doing the dishes and light dusting. Let others help you for a while with more strenuous jobs such as vacuuming or chopping wood. When lifting, organise heavy loads into smaller ones or get help.
Resuming sexual activity
Most people can resume their usual sexual activity within a few weeks after a heart attack, but sexual activity is not generally advised in the first two weeks. As a guide, if you are able to climb 2 flights of stairs comfortably, your heart should be able to meet the demands needed for sex.
Less desire for sex is common after a heart attack. This may be related to tiredness, depression or anxiety. Also some heart drugs may reduce sexual drive or function. Your doctor or nurse can advise you about this. It is also important to discuss concerns with your partner, because you may both be feeling unsure. Here are some helpful points for resuming sexual activity.
- It is preferable that sexual activity does not occur straight after a heavy meal.
- Familiar surroundings and a comfortable room temperature reduce anxiety.
- Use what was the most comfortable and easiest position in the past.
- Angina may occur during sexual activity just as it may with other activities.
- Report to your doctor any excessive tiredness and/or chest discomfort during activity.
Is it normal to feel emotional or irritable?
The fears you first felt in hospital can last for some time until you get your confidence and strength back. It is quite normal to have periods when you may feel tired, irritable, tearful or depressed. You may also have trouble sleeping.
The first one or 2 weeks at home may be quite stressful, not only for you but also for your spouse/partner and family. This is common after a heart attack and will usually pass in time. It will help if you talk about it with your family and friends. Also bear in mind that they, too, are adjusting to your illness.
Speak to your doctor or cardiac rehabilitation nurse if you're worried that you're not coping: there's always someone who understands and can help.
How often should I see my doctor?
See your family doctor within a week of discharge from hospital. He or she will then guide you about how often you should be seen and when you are fit for work.
Will I need medication?
You will need certain tablets or other forms of treatment. Your doctor may advise you to carry your angina medication, such as Nitrolingual spray or Anginine tablets, or other medication with you at all times.
Most people who have had a heart attack or have angina will remain on regular tablets to reduce the risk of developing a further heart attack. Do not stop taking your medication without discussing it with your doctor.
When should I consider getting back to work?
Most people can go back to work after a heart attack, often within 4 to 6 weeks after leaving hospital. However, the nature of your work and individual rate of recovery and capabilities will need to be assessed. Discuss this with your doctor.
Most employers will co-operate with your plans to return to work as long as they are kept informed of your progress. Whether you go back part-time or full-time at first will depend on the job and your employer.
Some fatigue may be expected after a long period away. This can be mental as well as physical. Try to include the type of activity you do at work into your home exercise programme, particularly if your work involves arm activity.
When can I drive again?
Austroads is the Association of Australian and New Zealand road transport and traffic authorities, and promotes best practice for use of the road system. In their publication, Assessing Fitness to Drive they make recommendations for driving with cardiovascular conditions.
For drivers of cars, light rigid vehicles and motorcycles, Austroads recommends that people who have had a heart attack with no complications should not drive for at least 2 weeks afterwards. However, if there are complications, it may take longer and you may need an assessment from a specialist before you drive again. Discuss this with your doctor. When you first resume driving, take short journeys in light traffic and stick to routes you know.
If you have angina, Austroads recommend that you may drive if it's well controlled (that is, you usually don't get angina with mild exertion).
In November 2002, the Cardiac Society of Australia and New Zealand (CSANZ) issued new guidelines for driving restrictions, including a recommendation that people who have had a heart attack (myocardial infarction) be considered fit to drive 2 weeks following their heart attack if there is usually no angina on mild exertion and there are no complications or other conditions that would make a person unfit to drive.
Is it safe for me to travel by air?
Discuss air travel plans with your doctor first. Most airlines permit travel 7 days after a heart attack, although it may be more appropriate to wait until you're fully recovered, say 4-6 weeks after.
People who have had an ICD (implantable cardioverter defibrillator) implanted require a certificate of fitness to travel. Contact the airline if you're in any doubt.
As well as informing airlines about a recent heart attack and any special requirements, passengers should also ensure that they take all required medication in their hand luggage for easy access.
What are the guidelines for healthy eating?
Everyone who has had a heart attack should aim to follow these healthy eating guidelines.
- Make vegetables a major part of at least one meal each day and eat fruit frequently.
- Choose wholegrain breads instead of white varieties more often.
- Eat more cereals (rice, pasta and other grains) and legumes (dried peas and beans). Try flavouring these with small amounts of lean meat, rather than basing the whole meal around meat.
- Use only small amounts of very lean meats and poultry without skin.
- Choose low-fat dairy products (milk, yoghurt and cheese).
- Eat fish (fresh or tinned, but not fried) at least twice a week.
- Make high fat and/or high sugar bakery products, fast foods, desserts, soft drinks and confectionery occasional treats rather than everyday food.
- Use small amounts of margarine and vegetable oils (preferably olive and canola) instead of butter.
- Grill, boil, steam, bake or microwave rather than fry.
- Reduce your salt intake.
- Look for the Heart Foundation Tick for healthy food choices.
- Rediscover the joy of cooking wholesome meals at home, and teach your kids!
If you are overweight or have high blood cholesterol, other dietary changes may be advised by your doctor or dietitian. Reducing fat intake and maintaining regular physical activity are top priorities for reducing body fat. Fat around the waist is a particular risk for heart disease.
Should I drink alcohol?
Men and women should drink no more than 2 standard drinks a day. In moderation, alcohol should not cause further harm to the heart. One or 2 alcohol-free days a week is a sensible precaution.
Should I smoke?
No! Cigarette smoking is one of the main contributors to heart disease and so quitting is one of the most important steps you can take to prevent another heart attack. It's never too late to stop. One year after quitting, you will have reduced your risk of another heart attack by 50 per cent. If your spouse or partner is a smoker, it would be helpful if he or she also stopped.
Does high blood pressure matter?
If it is not controlled, high blood pressure (hypertension) can overload the heart and accelerate the artery-blocking process, which may lead to another heart attack or other health problems, such as stroke.
High blood pressure usually does not give any warning signs: you can't feel it. The only way to find out if your blood pressure is controlled is by having it checked regularly by your doctor.
To keep your blood pressure down:
- keep a healthy weight;
- be physically active;
- follow healthy eating guidelines (see above);
- limit alcohol to 2 drinks or less a day; and
- take medication as prescribed.
Cardiac rehabilitation
After a heart attack, people usually review their lifestyle. Lifestyle changes such as enjoying healthy eating, taking up regular physical activity, and stopping smoking not only improve quality of life, but also reduce the chances of further heart problems.
Cardiac rehabilitation services provide support and advice to help people with heart problems to return to an active life and to help prevent heart attacks or other heart problems in the future.
Cardiac rehabilitation starts in hospital, and then, after discharge from hospital, people generally attend an outpatient programme for 4 to 12 weeks: the programmes are run by qualified health professionals. Ask about the cardiac rehabilitation services provided by your hospital. Cardiac clubs and support groups in the community can also offer ongoing opportunities for support and companionship, exercise and education. Your local National Heart Foundation office or branch can tell you about community groups nearest you.
Suggestions for family members
- Ensure you and your partner understand the recovery process.
- Attend a rehabilitation programme together, if possible.
- Discuss your feelings and problems with each other.
- Encourage independence.
- Be aware of being overprotective.
Learn CPR
It is very important that everyone learns how to perform cardiopulmonary resuscitation (CPR). Someone's life may depend on it. This is all the more important if your partner, family member or friend has had a heart attack.
CPR involves breathing air into a person's lungs and doing chest compressions to keep oxygen circulating in their body until emergency medical help arrives.
Make sure that you, and all family members including children, know who to call in an emergency and know how to call 000.
Last Reviewed: 05 June 2009
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