Heart attack - Recovery 

Recovering from a heart attack 

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Media last reviewed: 17/01/2012

Next review due: 17/01/2014

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Recovering from a heart attack can take several months and it is very important not to rush your rehabilitation.

During your recovery period, you will receive help and support from a range of healthcare professionals, which may include:

  • nurses
  • physiotherapists
  • dietitians
  • pharmacists
  • exercise specialists

These healthcare professionals will support you physically and mentally to ensure your recovery is conducted safely and appropriately.

The recovery process will usually take place in stages starting in hospital, where your condition can be closely monitored and your individual needs for the future can be assessed. After discharge, you can continue your recovery at home.

There are two important aims of the recovery process:

  • to gradually restore your physical fitness so you can resume normal activities (known as cardiac rehabilitation)
  • to reduce your risk of another heart attack

Cardiac rehabilitation

Your cardiac rehabilitation programme will begin when you are in hospital.

A member of the cardiac rehabilitation team will visit you in hospital and provide detailed information about:

  • your state of health and how the heart attack may have affected it
  • the type of treatment you received
  • what medications you will need when you leave hospital
  • what specific risk factors are thought to have contributed to your heart attack
  • what lifestyle changes you can make to address those risk factors

Once you return home it is usually recommended you rest and do only light activities, such as walking up and down the stairs a few times a day or taking a short walk.

Gradually increase the amount of activity you do each day over several weeks. How quickly you can do this will depend on the condition of your heart and your general health. Your care team can provide more detailed advice about a recommended plan to increase your levels of activity.

You may also be invited to a cardiac rehabilitation programme at your local hospital four to eight weeks after leaving hospital. The programme consists of one to two hour exercise sessions, once or twice a week.

The type of exercise can vary depending on the programme, but should mainly be aerobic.

Aerobic exercises are designed to strengthen the heart, improve circulation and lower blood pressure. Examples of aerobic exercises include riding an exercise bike, jogging on a treadmill, and swimming.

Returning to work

Most people can return to work after having a heart attack, but how quickly will depend on your health, the state of your heart and the kind of work you do. If your job involves light duties, for example if you work in an office, you may be able to return to work in as little as two weeks.

However, if your job involves heavy manual work and /or your heart was extensively damaged, it may be several months before you can return to work.

Your care team will provide a more detailed prediction of how long it will take for you to return to work.

Sex

According to the British Heart Foundation, you should be able to safely have sex once you are fit enough to walk briskly up two flights of stairs without getting chest pains or becoming out of breath.

This is usually about four weeks after having a heart attack. Having sex will not put you at further risk of having another heart attack.

Following a heart attack, about one in three men have erectile dysfunction which may make having sex difficult.

This is most commonly due to anxiety and the emotional stress associated with having a heart attack.

Less commonly, erectile function is caused by a side effect of beta-blockers.

If you experience erectile dysfunction, speak to your GP. They may be able to recommend treatment.

For example, you may be prescribed medication that stimulates the flow of blood to your penis which makes it easier to get an erection – read more about treating erectile dysfunction.

Driving

If you drive a car or motorcycle and you have a heart attack, you do not have to inform the Driver and Vehicle Licensing Agency (DVLA).

However, the DVLA strongly recommends you stop driving for at least four weeks after a heart attack. After this, you will be able to drive provided you do not have any other condition or complication that would disqualify you from driving.

If you drive a large goods vehicle or passenger carrying vehicle, you must inform the DVLA if you have a heart attack.

Your license will be temporarily suspended, for a minimum of six weeks, until you have adequately recovered.

Your license will be reissued if you can pass a basic health and fitness test and do not have any other condition that would disqualify you from driving.

Depression

Having a heart attack can be frightening and traumatic, and afterwards it is common to have feelings of anxiety. For many people, the emotional stresses can cause them to feel depressed and tearful for the first few weeks after returning home from hospital.

If feelings of depression persist, speak to your GP because you may have a more serious form of depression.

It is important you seek advice because serious types of depression often do not get better without treatment.

Your emotional state could also have an adverse effect on your physical recovery.

Reducing the risk

Reducing your risk of having another heart attack involves making lifestyle changes and taking a long-term course of different medications.

Lifestyle changes

Diet

It is recommended you eat two to four portions of oily fish a week. Oily fish contains a type of fatty acid known as omega-3. Omega-3 can help to lower your cholesterol levels.

Good sources of omega-3 include:

  • herring
  • sardines
  • mackerel
  • salmon
  • trout
  • tuna

If you are unable, or unwilling, to eat oily fish your GP may recommend that you take an omega-3 food supplement.

Never take a food supplement without first consulting your GP. Some supplements, such as beta-carotene, could be potentially harmful.

It is also recommended you eat a Mediterranean-style diet. This means eating more bread, fruit, vegetables and fish and less meat. Replace butter and cheese with products based on vegetable and plant oil, such as olive oil.

For more dietary information and advice, see changing your diet after a heart attack.

Smoking

If you smoke, it is strongly recommended you quit as soon as possible. The NHS Smokefree website can provide you with support and advice.

Your GP will also be able to recommend and prescribe medication that can help you give up. See treatment for quitting smoking for more information.

Alcohol

If you drink alcohol, do not exceed the recommended daily limits (no more than three to four units a day for men, and two to three units a day for women). A unit of alcohol is roughly half a pint of normal strength lager, a small glass of wine, or a single measure (25ml) of spirits.

Regularly exceeding the recommended alcohol limits will raise your blood pressure and cholesterol level, increasing your risk of another heart attack.

Avoid binge drinking (drinking more than three alcoholic drinks in one to two hours). Binge drinking can cause a sudden and large rise in your blood pressure, which could be potentially dangerous.

Research has found that people who have had heart attacks and continue to binge drink are twice as likely to die of a serious health condition, such as another heart attack or stroke, compared with people who moderate their drinking after having a heart attack.

Contact your GP if you find it difficult to moderate your drinking. Counselling services and medications can help you reduce your alcohol intake. See treatment for alcohol misuse for more information.

Weight management

If you are overweight or obese, it is recommended you lose weight and then maintain a healthy weight using a combination of exercise and a calorie-controlled diet.

Read more about treating obesity.

Regular physical activity

Once you have made a sufficient physical recovery from the effects of the heart attack (see cardiac rehabilitation, below, for more information about how long this usually takes), it is recommended you do regular physical activity.

Adults should do at least 150 minutes (two and-a-half hours) of moderate-intensity aerobic activity (such as cycling or fast walking) every week.

The level of activity should be strenuous enough to leave you slightly breathless.

If you find it difficult to achieve 150 minutes of activity a week, start at a level that you feel comfortable with (for example, 5-10 minutes of light exercise a day) and gradually increase the duration and intensity of your activity as your fitness begins to improve.

Medication

There are currently four types of medication widely used to reduce the risks of heart attacks.

These are:

  • angiotensin-converting enzyme (ACE) inhibitors
  • anti-platelets
  • beta-blockers
  • statins

ACE inhibitors

ACE inhibitors are often used to lower blood pressure. They block the actions of some of the hormones that help regulate blood pressure. By stopping these hormones from working, the medicine helps reduce the amount of water in your blood and also widens your arteries, both of which will reduce your blood pressure.

ACE inhibitors have been known to reduce the supply of blood to the kidneys, which can reduce their efficiency. Therefore, blood and urine tests may be carried out before you start taking ACE inhibitors to make sure that there are no pre-existing problems with your kidneys.

Annual blood and urine tests may be required if you continue to use ACE inhibitors.

The side effects of ACE inhibitors can include:

  • dizziness
  • tiredness or weakness
  • headaches 
  • a persistent, dry cough

Most of these should pass within a few days, although some people continue to have a dry cough.

If ACE inhibitors are taken with other forms of medication, including over-the-counter medicines, they can cause unpredictable effects.

Therefore, check with your GP or pharmacist before taking anything in combination with ACE inhibitors.

It is usually recommended that you begin taking ACE inhibitors immediately after having a heart attack and, in most cases, continue taking them indefinitely. In some individuals who prove intolerant of ACE inhibitors, a related alternative medication, an angiotensin receptor blocker (ARB), may be prescribed.

Anti-platelets

Anti-platelets are a type of medication that can help prevent blood clots. They work by reducing the 'stickiness' of platelets. Platelets are tiny particles in the blood that help it to clot.

It is usually recommended you take low-dose aspirin, which has blood-thinning properties as well as being a painkiller.

You may also be given an additional anti-platelet medication such as clopidogrel, prasugrel or ticagrelor. These can also be used if you are allergic to aspirin.

Side effects can include:

As with ACE inhibitors, treatment with anti-platelets usually begins immediately after a heart attack. The amount of time for which you are prescribed these medications can be anywhere between 4 weeks and 12 months, and depends on the type of heart attack you have had and the other treatment you have received.

It is usually recommended you take aspirin indefinitely. If you experience troublesome side effects due to aspirin you should contact your GP for advice. But do not suddenly stop taking the aspirin as this could increase your risk of another heart attack.

You may occasionally also be put on another blood thinning medication, warfarin. This is usually only if you have remained in an irregular heart rhythm (atrial fibrillation) or have sustained severe damage to your heart.

Excessive bleeding is the most serious side effect of warfarin. Seek immediate medical attention and have an urgent blood test if you experience any of the following side effects:

  • passing blood in your urine or faeces (stools or ‘poo’)
  • passing black faeces
  • severe bruising
  • prolonged nosebleeds (that last longer than 10 minutes)
  • blood in your vomit
  • coughing up blood
  • unusual headaches
  • in women, heavy or increased bleeding during your period or any other bleeding from the vagina

Immediate medical attention must also be sought if you:

Beta-blockers

Beta-blockers are a type of medication used to protect the heart from further damage after a heart attack. They help relax the heart’s muscles so the heart beats slower and the blood pressure drops, both of which will help reduce the strain on your heart.

It is usually recommended that you begin treatment with beta-blockers as soon as your condition stabilises and continue taking them indefinitely.

Fairly common side effects of beta-blockers include:

  • tiredness
  • cold hands and feet
  • slow heartbeat
  • diarrhoea
  • feeling sick

Less common side effects include:

  • sleep disturbances
  • nightmares
  • inability to obtain or maintain an erection (erectile dysfunction or ‘impotence’)

Beta-blockers can also interact with other medicines, causing possible adverse side effects.

Therefore, check with your GP or pharmacist before taking other medicines, including over-the-counter medication, in combination with beta-blockers.

Statins

Statins are a type of medication used to lower your blood cholesterol level. This will help prevent further damage to your coronary arteries and should reduce the risk of another heart attack.

Statins block the effects of an enzyme in your liver called HMG-CoA reductase, which is used to make cholesterol.

Statins sometimes have mild side effects, including:

Occasionally, statins can cause muscle pain, weakness and tenderness. Contact your GP if you experience these symptoms as your dosage may need to be adjusted.

It is usually recommended that you take statins indefinitely.


Getting help

Everyone who experiences a heart attack will face different problems and challenges, and any guidance or advice you receive will be tailored to your needs.

There are many local and national cardiac support groups where you can meet people who have been through a similar experience.

The British Heart Foundation has a helpline that offers confidential information about your recovery and advice about how to keep your heart healthy.

Call the helpline on 0300 330 3311 from 9am to 6pm, Monday to Friday.


Page last reviewed: 13/03/2012

Next review due: 13/03/2014

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