Recovery after a Heart Attack
Patients who do not have complications following a heart
attack can usually be discharged from the hospital in six to ten days. A few
patients are discharged even sooner. Prior to discharge, patients are usually
evaluated to determine the severity and extent of their coronary disease and
the degree, if any, of heart failure. If coronary disease is significant, a
surgical procedure or angioplasty (see chapter 9) is usually planned for the
near future to reduce the risk of repeated heart attacks.
Beginning in the hospital, a cardiac
rehabilitation program of gradually increasing exercise is begun. Generally,
such programs take about two months to complete, but patients are expected to
continue exercising on their own following the program. Patients can usually
resume normal activity, such as household chores, within three to four weeks
following a heart attack, although they may not return to work for six weeks to
two months. Most physicians feel that sexual activity can be resumed within
four weeks following a heart attack.
Part of the rehabilitation program
concerns lifestyle changes to prevent worsening of the coronary
atherosclerosis. Stopping smoking, reducing cholesterol intake, and improving
control of high blood pressure or diabetes are important factors for reducing
atherosclerosis. It has been shown that persons who make significant changes in
these factors not only slow the progression of coronary artery disease, but in
some cases the disease process even reverses. Such patients will actually have
less coronary artery disease a year after their heart attack then they did
before.
Most patients will be started on
medication to help prevent future heart attacks. Mild anti-blood-clotting drugs
have been shown to lessen the risk of future heart attacks in persons with
coronary disease. Low doses of aspirin are commonly used, but stronger
anti-clotting drugs are indicated in some people.
At the same time, medications to
minimize the heart's workload are also started. Beta-blocking drugs and
calcium-channel-blocking drugs (see chapter 8) reduce how hard the heart pumps
and minimize the amount of oxygen the heart needs. Patients who have symptoms
of congestive heart failure may need to take digitalis or another inotrope to
improve the heart's pumping ability and diuretic drugs to help remove excess
fluid from the body.
For many patients with coronary heart disease,
surgical treatment will be recommended. The decision to recommend coronary
bypass surgery or angioplasty (see chapter 9) is based on the number, location,
and severity of plaques in the coronary arteries. Although both angioplasty and
bypass surgery improve the condition of the majority of patients who undergo
them, the procedures do have risks including further heart damage and even
death. These risks are least when the procedure is performed in an institution
that does hundreds of the procedures a year, and by the most experienced
surgeons.
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