I. Recovery
 The
cardiac care unit (CCU)
If you have had or are suspected of having a heart
attack, you will usually be taken from the emergency room (ER) to
the cardiac care unit (CCU). Within the first day of your CCU stay,
you may be ordered not to receive anything to eat by mouth (i.e.,
made fasting) or placed on a clear liquid diet. The reason for these
dietary restrictions is to reduce the risk of vomiting and nausea
after the heart attack. More importantly, you must be made fasting
to empty the upper gastrointestinal tract prior to the performance
of any urgent invasive cardiac procedures (i.e., cardiac
catheterization). Once it is deemed safe for you to resume eating
solid food, you will be prescribed a diet that is low in saturated
fats, cholesterol, sodium, and processed sugars (if diabetes is
present). Diets might consist of fish or lean chicken (protein),
fruits and vegetables (fiber and carbohydrates, antioxidants), and
breads and light pastas (carbohydrates). Bananas, orange juice, and
grapefruit juice might be used because they serve as plentiful
sources of potassium and magnesium and are low in
sodium.
Anxiety is
common during the first 24 to 48 hours and may be treated with
benzodiazepines (e.g., lorazepam or oxazepam), low-dose narcotics
(e.g., morphine), or haloperidol. While these medications overall
are very safe, each has its own set of side effects or adverse
reactions that could occasionally dissuade its use in particular
groups of patients. You may become temporarily confused and
disoriented to time (termed delirium, or ICU psychosis) in the CCU
because you are receiving multiple new medications, severely
sleep-deprived, or unaccustomed to your new surrounding. Patients
with multiple complex medical problems and the elderly are at
greatest risk for this condition. Fortunately, ICU psychosis is
usually tempered with medications (e.g. haloperidol),
discontinuation of problematic medications, or discharge from the
CCU to a quieter floor. You may also be given sleeping pills to
maintain as normal a day-night schedule as possible. Stool softeners
are used to prevent constipation and straining.
In the
absence of complications, patients who have had a heart attack are
not confined to bed for more than 12 hours. You can participate in
progressive daily activity depending on your vital signs (blood
pressure and heart rate), age, and physical capacity. The following
stages are used as general guidelines for activity following a heart
attack. Actual practice may vary significantly from these
guidelines, depending on your health status and
progress.
Discharge
Discharge
times vary with each patient. If you were treated with bypass
surgery and have no subsequent complications, you may be safely
discharged in fewer than five days. Discharge is more common,
however, five to six days after admission. Most complications that
prevent early discharge happen within the first day or two of
admission.
If you have
complications, discharge is deferred until your condition is stable
for several days and it is clear that you are responding
appropriately to necessary medications.
Prior to
discharge, you will be given detailed instructions about activities
in which you can engage. They should initially avoid lifting and
rest several times per day. You should be given nitroglycerin
tablets and should be instructed in their use and the use of any
other medications. A s time progresses, you should resume more
activities. Any activity, including sexual activity, that causes
chest pain should be avoided until appropriate medical follow-up and
a possible standard exercise stress test.
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II. Short-term
recovery
In at least one-third of cases, the first
sign of heart disease is a heart attack. Recovery will vary based on
the type of treatment you receive at the hospital and your overall
health, age and medical history.
Doctors will
try to open clogged coronary arteries to prevent another heart
attack for many heart attack patients. Two common surgical
techniques to re-vascularize (or open) clogged arteries are bypass
surgery and angioplasty. Bypass surgery is an invasive procedure,
often performed when patients cannot be treated with angioplasty.
Bypass recovery
After
undergoing bypass surgery, you will be taken to a surgical intensive
care unit (SICU) for postoperative recovery. The first few days of
recovery from bypass surgery are the most critical. Doctors will
watch for complications from the bypass.
For the
first 24 hours, catheters, IVs, and other monitors used for the
surgery will remain inserted and the doctors and nurses will closely
watch all vital signs. A breathing tube, if still inserted, will
prevent speaking during this period. Your hands might be restrained
to prevent the dislodgement of tubes, wires, and monitors. Physical
activity is limited. Eating will not occur for at least the
first day and usually resume after the gastrointestinal tract begins
to resume normal activity (indicated by the passing of gas and
toleration of oral fluids). A physical therapist will encourage
small movements. Walking does not usually begin until the second or
third day.
You will
have a large vertical incision line that extends the length of your
chest, and an incision from the graft site (usually on your leg).
Generally, a pressure dressing will be in place over the chest
incision for the first 24 hours after the operation. The incision
will have staples and internal or external sutures.
Postoperative care and the removal of sutures or staples is
determined by your physician and hospital protocol. On the day of
operation, exercises will be performed on the affected limb to
decrease edema (swelling), stiffness and other postoperative
complications.
Blood
pressure and temperature will continue to be monitored, and
increased activity will be encouraged. Walking is recommended to
augment normal gastrointestinal tract activity and reduce
constipation. Hospital discharge may occur sometime within one to
two weeks of surgery, depending on a patient's progress.
Angioplasty recovery
Because it
is less invasive, angioplasty patients will experience a much
quicker recovery than bypass patients. If you are treated with
angioplasty, with or without the insertion of a stent, you will be
closely monitored, and possibly discharged within 24 to 48 hours of
the procedure.
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III. Rehabilitation and long-term recovery
If you have heart disease and have experienced
a heart attack, try to view it as a wake-up call, not a death
sentence. Patients who see their illness as an opportunity to modify
lifestyle and bad habits can live with the changes for a long
time.
Some of the
most important things your doctor will discuss with you are the
following lifestyle changes: diet; exercise; medication; blood
pressure, diabetes, and cholesterol control; smoking cessation; and
stress management. These topics also will be discussed during the
series of doctor visits you will have throughout the first year
following your heart attack.
Doctor visits
You can expect to see your doctor within the
first month after leaving the hospital and again at two- to
four-month intervals for the first year following your heart attack.
The doctor will conduct a physical exam, check incisions and perform
blood tests that might include: chemistries (if on diuretics and/or
electrolyte supplements, kidney function, diabetes control), CBC
(for inflammatory responses, anemia), cholesterol levels, PT
(protimes) if on coumadin, digoxin levels if on digoxin, and liver
function tests (to evaluate if any medication liver-related side
effects).
The doctor
will also perform an electrocardiogram (ECG or EKG) to measure your
heart's electric impulses, and repeat the ECG annually or
biannually. After that, you can expect to visit your cardiologist
every four to six months for the rest of your life.
Depression
Anxiety,
depression, or a combination of both can accompany a heart attack.
Because it can sometimes be overlooked by physicians, family members
should be especially careful to watch for signs of excessive worry
and/or depression. Heart attack patients often feel that a part of
them has died and they are mourning both its loss and the loss of
their former life. People often expect their lives to be changed
immeasurably – and for the worse – after a heart attack. Not knowing
what to expect can create anxiety. This also might be your first
serious hospitalization or illness. Feelings of fragility and
vulnerability might be difficult to accept. Support groups for you
and your family members, as well as patient education programs,
are available to help manage this transition.
Even after
having resumed full strength (determined by stress tests at your
doctor's office), you and your family members often feel hesitant to
resume physical activities. Patients often wonder when it is safe to
resume sexual activity. Generally, normal activities can be
resumed over time. And doctors have encouraged resumption of sexual
activity anywhere from one day to eight weeks after returning home
from the hospital. For your emotional reassurance, speak with your
doctor regarding concerns you have about physical and sexual
activity.
After two to
four months, most heart attack patients can return to their jobs.
Some people can return to work in less time. Job-related stress,
however, must be considered when returning to work.
Lifestyle modifications
Diet. Heart attack patients must restrict their fat and
cholesterol consumption. People with high blood pressure must
restrict salt, and people with diabetes must monitor sugar intake.
Your physician can recommend a book that defines heart-healthy
dietary guidelines, or provide you with a list of items to avoid.
Some doctors refer patients to a nutritionist for dietary
counseling.
Above all,
saturated fats from meats and dairy products should be limited. More
fruits and vegetables should be added to your diet. While dietary
changes are difficult to initiate, you can adjust well to your new
diet and learn to enjoy healthier eating.
Family
members should support you in all aspects of your new habits.
Studies show that family support can help heart disease patients
achieve and maintain a healthy lifestyle, and thereby reduce future,
recurrent heart attack risk. This is especially true with
smokers.
Exercise. Exercise and increased
physical activity is important in recovering from a heart attack.
Studies show a sedentary lifestyle contributes to heart disease.
Recovery also is quicker for patients who were active before their
heart attack. Before leaving the hospital, you will be monitored to
make sure you can function with limited physical activity. When you
return to visit your doctor (anywhere from one to six weeks after
you return home), you will likely be given another stress test to
ensure your safe return to normal physical activity.
Medication. Some of the
medications your doctor prescribes might be taken only for the first
few weeks or months after your heart attack. Some of these
medications might be warfarin (for blood thinning), amiodarone (for
arrhythmias), lasix or other diuretics, potassium supplements, and
beta blockers. Others, such as cholesterol-lowering drugs, ACE
inhibitors, and aspirin, will be taken for the remainder of your
life.
Because you
will likely take several medications in combination, your doctor
might need to test various strengths and combinations before
determining the optimum drug therapy for you. If there are any
medications that cause disturbing side effects, discuss them with
your doctor immediately. Do not discontinue any medication without
first discussing it with your doctor. Some medications, such as
certain hypertension medicines, must be gradually lessened to
prevent dangerous complications.
Stop
smoking. Smoking cessation is one of the most important
steps heart attack patients can take to prolong their lives. By
stopping smoking, you greatly reduce your risk of suffering further
heart damage. Ask your doctor about ways to stop smoking, such as
programs and/or medications. Many local hospitals offer smoking
cessation classes that are helpful for people needing support when
quitting.
Smoking
cessation should begin immediately at the time of your heart attack.
Medications such as bupropion or numerous formulations of nicotine
replacement can be started in the hospital if pharmacologic
assistance to quit is necessary. Research shows smokers are more
successful at cessation when supported by their doctors, family
members, friends and co-workers. Because second-hand smoke is also
conclusively harmful, the entire family benefits when a smoker stops
smoking.
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