What medications and lifestyle changes are prescribed after a heart procedure?
Before leaving the hospital after a heart attack or heart procedure, your doctor will discuss with you how to reduce and control your heart disease risk factors. You will receive prescriptions for several medications (if you’re not already taking them) such as aspirin to help prevent blood clots from forming, and a cholesterol-lowering medication (usually a statin) to lower your LDL (bad) cholesterol. You will also need to make certain lifestyle changes, such as quitting smoking, eating healthier, and exercising regularly. Your healthcare provider may recommend cardiac rehabilitation, a program that includes structured and monitored exercise. All of these medications and lifestyle changes will lower your risk of having another heart attack and prevent your heart disease from becoming worse. Research studies suggest that these medications are under prescribed, particularly in women and elderly patients.
How do women fare after a heart attack?
After having a first heart attack at age 40 or older, 23% of women die within one year compared with 18% of men. Within 5 years, death rates jump to 43% of women and 33% of men. Despite these statistics, many women who have had a heart attack or heart procedure do not take their prescribed medications or make the necessary lifestyle changes. Some people stop taking their medications because they feel better; others may experience side effects. It is very important that you talk to your healthcare provider before stopping any medication. You may be able to take a different dose of medication or one with fewer side effects. You may not have the information you need to make some lifestyle changes such as eating healthier. Strategies that help you commit to making healthy lifestyle changes include:
- A signed contract between you and your healthcare provider
- Learning more about your disease (e.g., dietary advice or quitting smoking aids)
- Keeping a written log of your progress (e.g., weight loss, cholesterol levels)
- Involving your spouse, or friends and family
- Signing up for telephone or mail follow-up (e.g., reminders about medication refills)
Should my family members learn cardiopulmonary resuscitation (CPR)?
The rate of sudden death is much higher in people who have had a heart attack that for the general population, so you and your family members may be advised to learn CPR. It’s also important that everyone learns to recognize the signs and symptoms of a heart attack of a heart attack; these include chest pain, shortness of breath, indigestion, nausea, and pain in the back, neck, or jaw. You also need to know what to do if these symptoms arise.
Physical Recovery – Return to Activities
When will I be able to return to work?
After an uncomplicated heart attack (meaning you did not need CPR or have low blood pressure, heart rhythm problems, or heart failure), most people are able to return to work within 6 to 8 weeks. One small study even showed that very low risk patients could return to normal activity (including work) in 2 weeks with no ill effects. If you have a job that involves heavy labor, you may need to wait longer; in some cases, it may be necessary to find a less physically demanding job. People with diabetes or chest pain before their heart attack are less likely to return to full-time employment.
It is often psychological and socioeconomic issues, rather than medical issues, that keep people from returning to work sooner. Experiencing depression after a heart attack, angioplasty, or bypass surgery makes you less likely to return to full-time work. Other psychological variables such as trust, job security, and whether you have positive or negative feelings about disability affect your likelihood of returning to work. One study found that after a heart attack, women were four times more likely than men to work less than they did before their heart attack. A heart attack or heart procedure is a life-changing event and many women may choose to work less even though they are medically fit for work.
People who have undergone balloon angioplasty can usually return to work as soon as they feel able about a week after leaving the hospital. After bypass surgery, you can usually return to work after 6 weeks, but it may take up to 12 weeks, depending on your recovery and the physical demands of your job. If your breastbone is cracked open during the surgery it usually takes about six weeks to heal.Your healthcare provider will tell you when it’s safe for you to return to work. One study found that after four years, people who had bypass surgery were just as likely to still be working as people who had an angioplasty, even though the angioplasty group returned to work sooner than the bypass surgery group.
Returning to work has been shown to benefit heart patients; those who return to work report less physical and mental complaints and tend to have a more positive outlook than heart patients who do not return to work. When deciding if you’re ready to return to work, be sure to take into consideration how stressful your job is. Studies in men suggest that heart attack patients who return to stressful jobs have an increased risk of heart problems and dying from heart disease. Most cardiac rehabilitation programs include classes on coping with stress and relaxation techniques.
When will I be able to drive again?
Most people who have had an uncomplicated heart attack (meaning you did not need CPR or have low blood pressure, heart rhythm problems, or heart failure) can resume driving within a week, providing you are in compliance with state laws. Each state has different criteria that must be met following a serious illness; for instance, you may need to be accompanied when driving or you may need to avoid stressful driving situations such as rush hour, night driving, hazardous weather conditions, or high speeds. If you had a complicated heart attack, you’ll probably have to wait about 2 to 3 weeks or more until your symptoms have completely gone away before you can resume driving. Generally, you can drive one week after angioplasty or stent placement, the time it takes for the catheter insertion site to heal properly. After bypass surgery, you need to wait about six weeks for the breastbone to heal completely before driving.
If you are a commercial driver, you’ll need to wait at least two months after a heart attack before you can drive a commercial vehicle, and you must be re-certified.
When is it safe to return to sexual activity?
Stable heart attack patients can generally return to sexual activity with their regular partner within a week to 10 days of their heart attack. Bypass patients may have to wait longer and they should avoid positions that put pressure or weight on the breastbone for the first six to eight weeks. If you’ve had angioplasty or stent placement for a non-urgent condition, your doctor will probably advise you to wait a day or two before returning to sexual activity. There are few studies on sexual activity with a new partner shortly after a heart attack, but it may cause increased anxiety and should probably be delayed longer.
Anxiety about returning to sexual activity is very common among heart patients and their partners. One study of women who had heart attacks found that 51% of women were anxious about resuming sexual activity because they were afraid they would die during intercourse a fear that was echoed by 44% of their husbands. In reality, sudden death during sex is extremely rare.16 Less than 1% of heart attacks are attributed to sexual activity. In fact, for a high-risk person engaging in weekly sexual activity over the course of 1 year, the increase in risk is only 0.1%.
The amount of exertion it takes to have sex is roughly the same as climbing one or two flights of stairs, or walking half a mile at a brisk pace. If you develop chest pain or feel short of breath after performing these activities, you may need to wait a bit longer before returning to sexual activity. There are also emotional and psychological factors that can raise blood pressure and heart rate more during sexual activity more so than other types of physical exertion.
You should talk to your healthcare provider about when it is safe to return to sexual activity. Studies have shown that physicians may be reluctant to initiate such discussions, so it may be necessary to bring it up on your own. There is less information about sexual problems in women with heart disease than in men. A study of nearly 2,800 postmenopausal women with heart disease found that nearly 40% of the women were sexually active. Of these, 65% reported at least one of five sexual problems: lack of interest, inability to relax, difficulty in arousal or orgasm, and discomfort with sex.
What physical activities are safe after a heart attack?
In the old days, heart attack patients were often confined to bed, but now we know that exercise is an important part of recovery. After a heart attack, your healthcare provider will probably advocate a gradual return or start (if you didn’t exercise much before your heart attack) to exercise. You may be referred to a cardiac rehabilitation program where supervised exercise will play a major role in your recovery process. Also, you will most likely be encouraged to walk short distances daily. Gradually you can add on all the activities that were part of your daily routine. It’s important to speak with your healthcare provider before beginning or resuming an exercise regimen. You may need to have an exercise stress test to determine what level of activity is safe for you. The table below details how much energy is required to perform certain activities by metabolic equivalent levels (METs). If you have a stress test, your doctor can tell you what MET level and thus what activities are safe for you to perform.
Energy Levels Required to Perform Some Common Activities
Less than 3 METs
Above 9 METs
Driving a car
Carrying objects (15 to 30 lb)
|Easy digging in garden
Climbing stairs (slowly)
Carrying objects (30-60 lb)
Climbing stairs (moderate speed)
Carrying objects (60 to 90 lb)
|Climbing stairs (quickly)
Shoveling heavy snow
Standing (Store clerk)
Volleyball (6 people)
Snow skiing (downhill)
|Walking (2 mph)
Very light aerobics
|Level (no hills) walking (3-4 mph)
Level biking (6-8 mph)
|Level walking (4.5-5.0 mph)
Bicycling (9-10 mph)
Swimming, breast stroke
Swimming (crawl stroke),
Bicycling (12 mph)
|Running > 6mph
Bicycling (>13 mph)
Walking uphill (5 mph)
|Reproduced with permission from: Haskell. Rehabilitation of the Coronary Patient. In: Wenger and Hellerstein, eds. Design & Implementation of Cardiac Conditioning Program. 1978|
What physical activities are safe after angioplasty or bypass surgery?
Physical activity especially heavy lifting should be avoided in the first day or two after angioplasty or stent placement. Your doctor will probably advise against strenuous exercise. Although you will already be up and walking about six hours after the procedure, complete recovery takes about a week.
After bypass surgery, it generally takes about six weeks for your breastbone to completely heal. Your doctor will tell you what activities are allowed, such as light walking, and which are not, such as lifting heavy objects, or pushing or pulling a heavy object (e.g., snow shoveling). You are your best monitor and should only do what you feel you have the energy for. Within the first two weeks after surgery, you will likely be able to do light household chores including folding clothes, cooking, dusting, and washing dishes. You can perform activities above shoulder level, such as brushing your hair or reaching for something off a shelf, but you shouldn’t hold your arms above shoulder level for a longer period of time. After about six weeks, you can take on activities that require more effort, including vacuuming, ironing, walking your dog, and light aerobics. The proper balance of rest and exercise is also important after bypass surgery. You should plan to rest between activities and to take short naps when necessary.
Physical Recovery – Physical Recovery in Women
How do women fare in terms of recovery of physical functioning?
Women heart patients are often less fit and in poorer overall health than male heart patients because they are usually older and more likely to have other conditions (such as diabetes or high blood pressure) when they develop heart disease. This may be why women have lower levels of physical activity and more disruption in physical function after heart attacks and heart procedures. Nonetheless, female heart patients usually resume household activities more quickly than men, likely due to their traditional role as homemakers. Most studies find that women and men experience similar improvements in physical functioning after these events.