A heart attack occurs when a blood vessel (coronary artery) that feeds the heart becomes blocked and cuts off blood flow to the heart muscle (myocardium).

This blockage can occur from either fatty deposits (plaque), a spasm in the blood vessel or a clot.

A heart attack damages the heart muscle. The damage may be slight or extensive, depending on which blood vessel was blocked and how long the blood flow was cut off to the muscle. Observance of certain lab results and changes in your EKG over 24 to 48 hours will diagnose a heart attack.

Your doctor may recommend additional lab work and cardiac testing to determine if further treatment is needed. Your doctor also will prescribe medicines to help reduce your heart’s workload, to help the arteries heal and to improve blood flow. Most patients will have a cardiac catheterization to determine which artery is blocked and have added procedures such as angioplasty, a stent placement or possibly surgery.

During your hospital stay, your health team will monitor you closely, watching for any complications. If they occur, it is usually within a few days after a heart attack.

Common complications are:

• Heart rhythm problems
• Heart pumping problems or heart failure
• Inflammation or swelling around the heart (pericarditis)

The heart muscle heals slowly. Scar tissue forms where the heart muscle fibers were damaged and this new tissue may not contract as well as the original tissue. The healthy heart muscle near the scarred area has to work harder and, over time, tiny new blood vessels grow from the nearby arteries to carry blood to and around the damaged muscle. These little “natural bypasses” are called collateral circulation.

Before going home, you and your loved ones will receive detailed information about your medications, your cardiac risk factors, your activity progression at home. You will be instructed when to follow up with your doctor and begin the outpatient cardiac rehabilitation program (see “Lifestyle Changes for a Healthier Heart” section).

Managing Your Care at Home

The healing process has begun. Going home is a welcoming thought, but fears and concerns can accompany it. This is normal. After all, you were monitored closely for several days at the hospital and now you will be managing on your own. Your goals for the first two weeks are to follow the going home instructions, walk daily as prescribed and relax. Remember, your body is adjusting to a new health condition and to new medications that may make you feel more tired than usual.

Sit down, put your feet up and take a nap if you are tired. Listen to your body. This is the time to let others help you. Do activities that are easy and enjoyable such as playing games, watching movies, reading and just talking.

Most people do not return to work until after they have a follow-up visit with the doctor and start a cardiac rehabilitation program. Use your progressive walking program (see bottom of page) to guide you with your daily walking and refer to the “Exercising for a Healthier Heart” section in this binder for further guidelines. Remember, this lower level of activity is temporary.

It is common for you (and your partner) to feel a wide range of emotions after experiencing a heart attack. Limiting your activities, being out of your normal routine and becoming bored can affect the way you feel. At times, you may find yourself feeling tearful and depressed or you may feel overwhelmed with thankfulness and gratitude. Other common feelings are anger with yourself and those closest to you, discouragement when you don’t think you are improving as fast as you should or just being quietly scared that it will happen again. Express your feelings. Sharing with others can make the road to recovery a lot less bumpy.

Returning to sexual activity may be a concern of yours. You may not feel any desire for sexual activity at first, or you may worry it will trigger another heart attack. Actually, your risk for another heart attack during sex is low. Ask your doctor when you can return to sexual activity. In most cases, you can resume when you are able to climb two flights of stairs without chest pain, shortness of breath or an irregular heart rate. Meanwhile, showing affection with hugs, caresses and kisses is a good way to get back in touch with your partner.

Having a heart attack is a life-changing event. It is a time to become aware of what risk factors caused the problem and to make appropriate lifestyle changes (see section on “Lifestyle Changes for a Healthier Heart”).

Your doctors and a cardiac rehabilitation program will guide you on this new journey to wellness.

Progressive Walking Program

Your nurse educator will explain a walking program to you before you leave the hospital. You should begin your walking program the day after you come home from the hospital. Use the walking schedule below to chart your progress. If you are walking outdoors avoid extreme temperatures and walk on level ground, avoiding hills and grades. Please refer to the section on “Exercising for a Healthier Heart” for more guidelines.

WALKING SCHEDULE
Dates     Time
             3 to 5 minutes, ________ times a day
             6 to 10 minutes, _______ times a day
             12 to 15 minutes, ______ times a day
            18 to 20 minutes, ______ times a day
            25 minutes, once a day
            30 minutes, once a day