Dear patient,
We'd like to direct your attention to some important points which can influence your recovery and the quality of your life, before discharging you from the hospital following, your heart attack.
Please feel free to contact us with any questions you may have.
The Heart Institute Staff
General background:
When there is a narrowing in one or more of the heart's arteries, usually because of an accumulation of fats and calcium on the artery walls i.e. atherosclerosis, the supply of oxygen-rich blood to the heart muscle is reduced, and the heart and its function are damaged. This condition is known as ischemic heart disease ("ischemia"). (1)
If there is a drastic lack of blood supply due to a blockage in an artery, the result may be a myocardial infarction, a heart attack. The specific area of heart muscle which is deprived of blood is damaged, may undergo necrosis and scar. The scarred area loses the ability to contract and pump blood out to all parts of the body.
In order to improve blood flow through the narrowed artery, or restore blood flow through a blocked artery, your doctor may have performed a catheterization. A catheter(2), a thin, flexible tube which has an inflatable balloon at the tip, is threaded into the narrowed or clogged artery. The balloon is inflated (3) to widen the narrowed area and allow blood to flow through. After the catheterization, the balloon is removed and a stent (4), a metallic screen-like spring whose function is to keep the artery open, is positioned to prevent the blockage from recurring
Instructions for continued care:
The puncture site:
By the time you go home, the puncture site will be closed and not bleeding, but will still require supervision. Keep it clean.
Note! When healing is progressing well, pain at the puncture site will lessen from day to day and the hole in the skin will heal. If there's a black and blue area around it, that will fade, shrink and disappear over time.
If there are signs of infection around the puncture site, such as redness, local warmth, secretions, or swelling, please consult your doctor in your Health Fund clinic / Kupat Cholim.
List of medications:
We recommend that you keep a list of your daily medications, and a copy of your most recent ECG, with you at all times. Store them in your phone or with your identity card so they will be accessible if you ever need urgent medical care.
Continuity of care:
In order to assure the smooth transition of your medical care, contact your family physician shortly after leaving the hospital. Show your doctor your hospital discharge letter, catheterization report, and list of prescribed medications. Your doctor will guide you along the process of returning to routine life.
Cardiology follow up:
Make sure to visit a cardiologist 1-3 months after your release from the hospital to check the progress of your recovery, identify any signs of recurring illness, and to adjust your medications if necessary.
Medications:
The medications you've been prescribed help strengthen your heart muscle, improve its function, and protect the stent, if one was placed, from being blocked by a blood clot. They also help prevent the progression of your heart disease and future heart attacks. You must continue to take your medications as prescribed, even when you feel good. If you think you are experiencing side effects from the medications, DO NOT stop taking your medications without a doctor's instructions.
It's very important to fit your medications into your daily routine. To avoid forgetting to take your medications, we suggest you use a pill-organizer, set reminders on your phone, or put your medications in a place where they will easily be seen. Be sure you understand the purpose of your medications, their possible side effects, proper time to take them, whether they can interact with food or other medications, and any other pertinent instructions. We believe that being well informed will help you take your medications properly.
Instructions for resuming routine life:
Entitlement to ‘sick days’:
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Catheterization with intervention: If you've undergone catheterization with intervention, you're entitled to seven sick days.
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If your job entails physical exertion, you're entitled to 14 sick days.
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Myocardial Infarction: After a myocardial infarction (heart attack), you are entitled to four weeks of sick leave.
Your doctor will provide you with the necessary ‘sick days’ document.
Rest:
Rest at home: When we say, "rest at home", we want you to abstain from work, engage in activities without physical exertion, and avoid stressful situations. A gradual return to everyday routine should include exercise. (details to follow)
Convalescent home:
You may be entitled to five fully covered days in a convalescent home starting from discharge from the hospital. This entitlement varies among the various Health Funds / Kupot Cholim, and you should check the details with your Fund / Kupa before your discharge.
Cardiac rehabilitation:
You are entitled to three months of fully paid cardiac rehabilitation. In that setting, you will get individual and professional guidance about exercises specifically tailored to the rehabilitation of heart muscle, and guidance on how best to go forward and prevent the recurrence of heart disease.
We recommend Hadassah's Heart Rehabilitation Center.
Contact information: 02-5844056
Exercise:
Rehabilitative exercise strengthens the heart muscle, improves blood flow through the coronary arteries, and encourages the development of new blood vessels to bypass existing blockages. It also helps maintain proper body weight, and contributes to self-confidence and a positive frame of mind.
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Type of exercise - The exercise must contain an aerobic component which raises the heart rate above the resting rate.
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Duration and rate of exercise - The recommended duration and rate exercise of exercise will vary from person to person. In general, one should start slowly and increase gradually. We recommend starting with a brief 15- minute walk daily, and increase the duration each week until reaching 45 minutes a day, 5 days a week. Individuals who find it difficult to be active for 20-30 minutes at once should start with 5-10 minutes of moderate activity daily and gradually increase the duration and intensity of the activity as their fitness improves.
Sexual relations:
The accepted instruction is that a person who can rapidly climb two flights of stairs without chest pain or shortness of breath is ready to resume sexual activity. Usually, this is about 4 weeks after the heart attack. Sexual activity does not increase the risk of having another heart attack.
Thirty percent of men who have suffered a heart attack report sexual dysfunction, usually difficulty achieving or maintaining an erection. A majority of these difficulties are a result of anxiety and stress, and the fear of having another heart attack. Rarely, erectile
dysfunction may be due to use of medications from the class of drugs known as beta-blockers.
Note!
Never take medication for erectile dysfunction if you are taking medication from the class of drugs known as nitrates. In case of erectile dysfunction, consult your doctor before starting any new medication.
Reducing the risk of heart disease:
Weight loss:
Excess body weight stresses the heart, and causes difficulty with daily activities and exercise. We recommend seeking guidance from a dietician to help you adopt healthy nutritional habits suited to your individual dietary needs.
Some basic principles for an improved diet:
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Eat regular meals
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Avoid snacking between meals
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Minimize intake of animal fats
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Eat plenty of vegetables
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Minimize consumption of sugary foods
Fats and cholesterol:
High levels of blood lipids are a major risk factor in the development of atherosclerosis, and a reduction of those levels is important to prevent the recurrence of heart disease.
*Check your LDL a month after discharge from the hospital. Aim for a level under 55 mg\dl.
*A dietician can help you formulate an appropriate diet to lower your cholesterol.
*Your cardiologist will prescribe and adjust cholesterol-lowering medication as needed.
Quitting Smoking:
Nicotine in cigarettes causes contraction and destruction of the lining of the blood vessels supplying the heart. Active and passive smoking can speed up the development of atherosclerosis in the heart and brain.
WE RECOMMEND QUITTING SMOKING IMMEDIATELY
Ask your doctor about medications like nicotine patches and about joining a support group to help you stop smoking.
High blood pressure and diabetes:
Comorbidities like hypertension and diabetes may injure blood vessels and harm the heart muscle and its function. It is extremely important to keep these diseases as well regulated as possible. Towards that goal, be sure to:
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Maintain regular and ongoing medical supervision
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Adopt a healthy lifestyle
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Take your medications as instructed
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Monitor your HBA1C, aiming to keep it below 7%
Stress:
Prolonged emotional stress can negatively influence heart disease. Your recent heart attack may cause you increased anxiety and fear. Be aware of your feelings and seek the help you need when necessary. It can be beneficial to engage in relaxing activities such as yoga or hobbies and consult a psychologist if warranted.
We wish you a complete recovery!
The Heart Institute Staff
Written by:
Miriam Kastel, Deputy Head Nurse, Cardiology Department
Shiri Denis Peleg, Nurse, Cardiology Department
Reviewed by:
Professor Ofer Amir, Director, Heart Institute
Professor Eyal Herzog, Medical Directors, Cardiology Department
Dr. Refat Jabara, Medical Directors, Cardiology Department
Dr. Bruria Hirsh Raccah, Clinical Pharmacist
Noga Meidan, Social Worker
Content Editor:
Tal Atzmon, Coordinator of Content Development, Quality and Safety Team
Translated by:
Sara M. Oren, Nurse, Cardiology Department
Necha Toba Selengut, Nurse, Cardiology Department
The information appearing in this publication is for educational purposes only and does not constitute a medical opinion and in any event, is not a substitute for professional medical advice. All rights reserved to Hadassah © Do not photocopy, duplicate or make any commercial use without written permission from Hadassah. The booklet is intended for both men and women. 2022. Additional informational material can be viewed at the Hadassah web site: www.hadassah.org.il : "Patient Information Sheets"