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Good news for people who have had a heart attack: the worst is over!

Most people survive the “first heart attack” and go on to live a full and productive life. They do however, make some much needed healthy changes in their lifestyle.

A heart attack occurs when the arteries (blood channels) that supply blood to the heart muscle, get blocked .Blood clots form over pre-existing areas of fat-laden plaque damage causing complete occlusion of the blood channel. The heart muscle suddenly becomes deficient in oxygen and pain called “angina” occurs. If the flow of blood stays choked for long enough (usually more than 30 minutes or so) some of the heart muscle dies and this is called a “heart attack”. Damage to the heart can vary from “slight” with little impact on heart function to “extensive” with significant impairment. Typical symptoms include chest tightness, burning or pressure, left arm numbness, nausea and sweating.

Following a heart attack, people have to come to terms with the emotional impact of what has happened to them. The family members are devastated and the well-wishers overwhelmed. A strange perception of chill running down the spine with sweat pouring all over the forehead is something most of us have experienced after losing a loved one to heart disease .A doctor’s role at this stage is a lot more than the usually depicted “untouchable celestial species” like attitude.


I feel, as a member of the cardiologist fraternity, the sometimes we are guilty of getting preoccupied with “ticking” the boxes while “instructing” these patients about lifestyle modifications and compliance with medications. The usual “parhaizi khanay aur warzish” rhetoric is all too familiar for most if not all of these patients already .We dash through these really important life saving modifications and forget the time tested practice of “sitting down with patients and explaining the actual reasons behind the advised changes” .I believe that once the patients understand the significance and implications of these adjustments, half the battle is already won. A little time spent at this stage, not only helps build a patients’ trust in his or her doctor but will also make them feel compelled to make meaningful healthy lifestyle transformations “for their own good”. This approach works better than the usual intimidation with “impending future heart attacks” that failure to follow advice portends.

Following a heart attack, most patients are typically kept in the hospital for 3-5 days. This duration varies according to the condition and type of treatment the patient receives (which usually involves certain medications either alone or in combination with stents or bypass surgery).

Recovery starts in the hospital where one of the initial changes patients notice is in their medication regime. The doctors start medicines that will not only treat and control symptoms (such as chest pain) but also contributing factors (such as high blood pressure, diabetes or elevated cholesterol) .Blood thinning medications like Aspirin are added to prevent future heart attacks. Compliance with these medications is pivotal and the primary step towards a heart-friendly lifestyle. Strategies such as reducing the number of daily doses of medications, organizing medications in pill boxes, using motivational interviewing (by doctors or nurses), and educating patients on the importance of medication adherence have been successful at improving patient compliance rates.

Some of these medications, as mentioned above, might be aimed at controlling other contributory diseases like high blood pressure, cholesterol and blood sugar levels.

Controlling blood pressure: High blood pressure puts a strain on your heart and blood arteries and can lead to worsening of the blockages in your coronaries (arteries that supply blood to the heart muscle). Exercising, eating a low salt diet and losing weight (if you are overweight) in addition to taking the prescribed medications would usually take care of that for most patients.

Maintaining low “bad” cholesterol levels: High levels of cholesterol in blood can lead to atherosclerosis (fatty plaque buildup and narrowing of arteries).This can lead to a higher risk of subsequent heart attacks. Eating a heart-healthy diet, an appropriate exercise program to keep your “bad” (LDL) cholesterol low and your “good” (HDL) cholesterol high and strict adherence to anti cholesterol medications should provide ample control of this condition. High doses of anti-cholesterol medications can actually cause “regression” of the plaque which has accumulated over the years.

Strict control of blood glucose levels: Uncontrolled diabetes increases the risk of heart attack and stroke in addition to its effects on other body systems such as kidneys, eyes and nerves. After a heart attack, need for a tight blood sugar control becomes paramount .Regular exercise routine ,a healthy diet plan and adherence to medications are again some of the key factors which help manage this disease

Once a patient understands the importance of managing other co-existent diseases the next step for a cardiologist must be to help them understand how these lifestyle changes make the difference and tips to improve adherence to the agreed lifestyle modifications.

The three main lifestyle changes that patients are usually advised to instill in their lives are to

  • avoid smoking
  • eat a healthy, balanced diet
  • follow an active lifestyle and maintain a healthy weight

So why should someone stop smoking when they have been doing it all their life?

Tobacco use is a major risk factor for heart disease. Smoking increases the heart rate and blood pressure, contributes to atherosclerosis (build-up of plaque in your blood vessels), decreases oxygen supply to your heart and makes the blood “sticky” and form clots more easily (which can create a predisposition to further heart attacks). In addition to not smoking, trying to avoid secondhand smoke is something we all need to strive for. Secondhand smoke is a combination of the smoke that smokers exhale and the smoke that comes from the burning end of a cigarette and causes more damage than actual smoking.


How does maintaining a healthy weight and exercise help the heart patients?

Regular aerobic exercise (20-30 minutes on most days of the week) can help make the heart stronger, lower the cholesterol level and improve blood pressure and diabetes control. Examples of aerobic exercise include brisk walking, jogging, running, bicycling and swimming. A combination of regular exercise and a healthy diet can also help you lose weight. If you are overweight, losing just 10% of your body weight can lower your risk of diabetes and heart disease significantly. One of the less publicized, but significant, benefits of regular exercise is its critical role in creation of natural tiny “collateral” blood channels in the heart. These important “natural bypass blood conduits” can open at the time of a heart attack and supply blood to the area whose blood supply has been severed due to a clot in the blocked coronary artery.

In 2004, Swiss researchers, found that regular enhanced physical exertion (like running) can cause the body to make the tiny collaterals in people with no prior heart disease which can help at the time of extreme stress such as strenuous exercise.

How does eating a heart-healthy diet actually help the patients?

The food,we consume, affects how well the blood flows through our heart and arteries. A diet that is high in “bad” fats (saturated and trans fats) can gradually cause plaque buildup in the heart arteries. This buildup slows blood flow to the heart and can eventually block the arteries. Our diet,also, directly impacts on our blood pressure, cholesterol and blood sugar levels.

A heart patient should, therefore, eat less red meat and fewer high-fat dairy products, cut down on salt, and avoid fried and processed foods. Oily fish (such as salmon, tuna, trout etc)should be consumed atleast once a week. Olive oil should be used instead of butter and “ghee” for routine cooking .

A good cardiac rehabilitation program (where available) can provide education and counseling services to help heart patients regarding all the above mentioned important lifestyle modifications.

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