If you are a heart attack survivor, you are likely facing a number of emotions and fears, as well as physical after-effects from the heart attack and from the treatment that saved your life. The road to recovery may be long, but there are many medical professionals and support groups available to help you. And, for those patients who take their medication as prescribed and take measures such as enrolling in a cardiac rehabilitation program, the prognosis is typically good. Heart attack recovery is a group effort involving you and your care team.
Many patients have concerns about how to move forward with their lives after a heart attack. Follow the links below or scroll down to read about what comes next for heart attack survivors when they leave the hospital.
Your recovery will also involve long-term lifestyle changes and emotional adjustments. Please visit Lifestyle Changes After a Heart Attack for information about how you can make beneficial changes to your diet and appropriately increase your level of physical activity. SecondsCount also features information on depression – which is very common in heart attack survivors – and sexual activity and cardiovascular disease. This information can help you learn how to get the support you need to address any emotional concerns that may be interfering with your quality of life.
At Home After Angioplasty and Stenting
Angioplasty is a catheter-based procedure to reopen blocked arteries and stop a heart attack in progress. For the procedure, a catheter – a thin plastic tube – is inserted through a puncture site in the skin near the groin or in the wrist, and a tiny wire is guided to the site of the blockage. A small balloon is opened and closed to push the blockage aside. A stent, which acts as a tiny metal scaffold, is inserted where the blockage has been cleared to permanently prop the artery open and prevent it from collapsing, allowing blood to flow to the heart muscle.
Because angioplasty is a minimally invasive procedure, recovery from the procedure itself is typically brief. Discharge from the hospital is usually 12 to 24 hours after the catheter is removed. Many patients are able to return to work within a few days to a week after a procedure. At that point, a patient’s focus will be on taking medication and adopting lifestyle changes that can help prevent future heart attacks. Angioplasty fixes life-threatening blockages, and blockages that cause symptoms, but it does not stop the disease process of atherosclerosis, or “hardening of the arteries,” that can cause future blockages. Angioplasty and stents can be thought of as simply putting a bandage on the problem of atherosclerosis. But medications and healthy lifestyle are needed if one truly wants to treat this more systemic problem, for atherosclerosis is a diffuse process that affects arteries throughout the body.
Read After Your Angioplasty & Stenting Procedure for detailed information on wound care, including what is normal and what you should contact your doctor about, and resuming normal activities.
At Home After Cardiac Bypass Graft Surgery
You may have received bypass surgery for heart attack treatment. In cardiac bypass graft surgery (CABG), arteries or veins are taken from other parts of the body, such as the chest and the legs, and sewn onto the diseased arteries in the heart, beyond the blockage. The new arteries and veins serve to detour blood flow around the blockage, keeping blood flowing to the heart muscle. After bypass surgery, you may stay in the hospital for three to five days, and then continue recovery at home for four to six weeks.
At home, be sure to follow your physician’s instructions for resuming activities, and also take your medications exactly as prescribed. Once your surgical incision has healed and your home recovery is complete, your focus will be on taking medication and adopting lifestyle changes that can help prevent future heart attacks. Bypass surgery reroutes blood to the heart muscle around specific blockages, but it does not stop the disease process of atherosclerosis, or “hardening of the arteries,” that can cause future blockages.
While angioplasty and stenting or cardiac bypass graft surgery can restore blood flow to the heart muscle, your heart may have temporary or permanent damage after the heart attack. A heart attack starves the heart muscle of oxygen, causing the heart muscle cells to be damaged and begin to die. The amount of heart muscle damage depends on the severity and duration of the heart attack. Common complications from a heart attack are heart failure, abnormal heart rhythms and valve problems.
- Heart failure. In heart failure, the heart is not able to pump enough blood out to the body to meet your body’s need for oxygen and nutrients. This is not the same thing as cardiac arrest, which is when your heart stops pumping because of an electrical problem. Heart failure after a heart attack may be temporary or permanent, depending on how damaged the heart muscle is. Lifestyle changes, including exercise and medications can help reverse heart failure.
- Abnormal heart rhythms. An abnormal heart rhythm, or arrhythmia, results when the heart’s natural electrical system is damaged. Normally, a series of electrical impulses that travel through the heart cause the heart’s chambers to contract in a particular sequence. This is your heartbeat. The damage caused to heart tissue by a heart attack can cause problems with this electrical system.
- Valve problems. Scar tissue from a heart attack can cause heart valve problems. If a heart valve does not open and close properly to allow blood to travel through the heart, the heart is not able to pump blood efficiently to meet the body’s needs.
In addition to complications caused directly by the heart attack, as with any procedure, treatment can also cause complications. Bypass surgery, angioplasty and stenting, and medications can have complications such as those listed below, though serious complications are uncommon.
- Bypass surgery: heart attack, stroke, blood clots, death, chest wound infection, fever and chest pain, loss of memory or mental clarity, bleeding, kidney failure and reactions to anesthesia.
- Angioplasty and stenting: heart attack, stroke, blood clots, death, infection of the catheter insertion site, blood vessel damage, reaction to the contrast dye used during the procedure for imaging, bleeding.
- Medications. Side effects vary from medication to medication. Read the patient information accompanying your medication and speak with your physician about possible side effects.
Your heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.
Medications you are likely to be prescribed after a heart attack fall into the following classes:
- Antiplatelet agents – to prevent blood clots and keep the stent open. Examples include aspirin, clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilinta). It is critical that these medicines not be stopped without checking with your cardiologist, for stopping them prematurely can result in another heart attack from the stent closing off abruptly.
- Statins – to lower cholesterol levels. Examples include atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor) and pravastatin (Pravachol).
- Beta blockers – to treat high blood pressure and decrease the incidence of abnormal heart rhythms. They can also help the heart remodel and improve heart function. They decrease the amount of work the heart has to do. Beta blockers after a heart attack have increased survival rates. Examples include metoprolol (Lopressor, Toprol XL), carvedilol (Coreg), nebivolol (Bystolic), atenolol (Tenormin) and bisoprolol (Zebeta).
- ACE-inhibitors/Angiotensin receptor blockers (ARBs) – to lower blood pressure. They can also help the heart remodel and improve heart function. ACE-inhibitors after large heart attacks have increased survival. Examples of ACE-inhibitors include lisinopril (Prinivil, Zestril), ramipril (Altace), captopril (Capoten), quinapril (Accupril) and enalapril (Vasotec). Examples of ARBs include losartan (Cozaar), valsartan (Diovan), irbesartan (Avapro), olmesartan (Benicar) and azilsartan (Edarbi).
- Calcium channel blockers – to reduce blood pressure and control the amount of calcium that enters the heart and arteries, allowing blood vessels to relax and reducing the workload of the heart. An example is verapamil (Isoptin SR, Calan SR).
- Nitrates – to expand the arteries leading to the heart and relieve chest pain. Examples include sublingual nitroglycerin, isosorbide (Imdur), isosorbide dinitrate (Isordil) and the nitroglycerin patch.
- Antianginal agents – to relieve chest pain. Besides nitrates (see above), ranolazine (Ranexa) may also be given to help decrease chest pain.
- Anticoagulants – to reduce the blood’s ability to clot. If there is evidence of a blood clot in the heart after a heart attack, then warfarin (Coumadin) may be used to eventually dissolve the clot. If there is evidence for a certain type of abnormal heart rhythm, then depending on one’s risk for stroke, warfarin (Coumadin), dabigatran (Pradaxa) or rivaroxaban (Xarelto) may be prescribed to thin the blood and decrease the risk for stroke
- Medications to protect the stomach – Because a heart attack is a stressful event, and subsequent medication regimens to keep the stent clear often include aspirin and other antiplatelet agents that can be tough on the stomach and increase the chance for bleeding from the stomach, your cardiologist may (or may not) recommend medications to protect the stomach. Examples include H2 blockers such as cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac), or proton pump inhibitors such as pantoprazole (Protonix).
Important note: After you suffer a heart attack, it is likely your doctor will precribe taking an aspirin every day for the rest of your life. If you receive a bare metal stent, you may also be prescribed Plavix, Effient or Brilinta for a minimum of a month after the procedure. If you receive drug-eluting (coated) stents, your doctor will likely prescribe Plavix, Effient or Brilinta for at least a year after stent implantation. Taking these medications exactly as prescribed is critically important to prevent a blood clot from potentially forming in the stent.
Additionally, men should not take erectile dysfunction (ED) medications without talking with their cardiologist first. These medications can have dangerous, or even deadly, interactions with a range of common cardiovascular medications, especially medications that contain nitroglycerin.
Cardiac rehabilitation, or “cardiac rehab,” is a monitored, structured exercise and prevention program that is available at many hospitals for patients who have heart disease. It is appropriate (when recommended by the treating physician) not only for heart attack survivors but also for patients who have not had a heart attack but who have undergone angioplasty and stenting or cardiac bypass graft surgery to restore blood flow to the heart. It also helps patients who have had heart valve surgery, heart transplantation or some types of heart failure.
Research has shown that patients who enroll in, and complete, cardiac rehab after a heart attack are more likely to be alive five years after that heart event. It can also help improve the quality of your life. Cardiac rehab programs are staffed by trained professionals who can monitor your physical health and exercise plan and are experienced in assisting patients with lifestyle changes involving diet and nutrition, stress reduction, medications or quitting smoking . They may also be able to screen patients for depression – which can worsen heart disease – and help patients seek appropriate help. Additionally, patients who enroll in cardiac rehab often report that they enjoy the camaraderie of swapping stories with other patients with heart disease while getting in better shape at the same time.
Cardiac rehab programs are effective for men and women of all ages who have heart disease. Medical professionals individualize cardiac rehabilitation according the medical history and ability of the patient. For more information about cardiac rehab and to find a program near you, visit the website of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).
Medicare and private insurance rules for cardiac rehab change over time. If, for example, you are a Medicare recipient, cardiac rehab coverage has expanded in some cases. Your heart health is too important for you to assume that cardiac rehab is not covered without verifying coverage levels with your insurer. Also, be sure to check to see what copayments or coinsurance you may be responsible for.