After 25 years with the Milwaukee Police Department, Tony Hawkins has had his share of harrowing experiences. But nothing prepared him for the pain that gripped him early one morning when he had a heart attack in spring of 2008. “It felt like someone with glass gloves on was squeezing my heart as tight as they could,” he recalls. “It gives me the chills just thinking about it.”
Lucky for Hawkins, he’d asked his wife to call 911 well before the worst of his symptoms began. When he woke up with indigestion that acid reducers did nothing to relieve, he suspected something bigger was going on. An ambulance whisked him to Froedtert Hospital, where doctors treated his blocked artery and restored blood flow to his heart. Although he was back at home in a few days, his world was forever changed.
Just 46 years old, Hawkins had suddenly gone from taking no pills to six prescription medications. An avid basketball and football player in his youth, he now struggled to walk nine holes of golf. The changes were frightening and dramatic, yet he was determined this would never happen to him again. He quit smoking immediately, started eating right and implemented an exercise program.
As grateful as he is to be alive, sometimes he can’t help but feel a little down. On a recent doctor’s visit, he was frustrated to learn that in spite of his sweeping lifestyle changes, he still needed a higher dosage of a medication that makes him feel exhausted. He never should have smoked, he berates himself. Other times his thoughts turn to his father – his best friend – who died two years ago after a series of heart attacks. “It feels like I’m walking in his footsteps,” he says.
A heart attack is an enormously life-changing event. From the trauma of the attack to the altered lifestyle that follows, it’s easy to be left reeling by the experience. Some patients can’t shake the fear that another heart attack is around the corner; others feel frustrated by their sudden limitations or family members who won’t stop coddling them. Still others feel sad or even depressed by what’s happened, a reaction that may put them at greater risk of a second event. Knowing what to expect after a heart attack can go a long way toward boosting a patient’s recovery. The tips that follow – from understanding emotional pitfalls to preparing for follow-up visits – can help patients get the most out of the years ahead.
When patients are in the midst of a health crisis like a heart attack, all of their attention is focused on getting better. It’s usually not until after they’ve left the hospital that the true magnitude of what they’ve been through hits them. “You go home and think, ‘Geez, that was my heart. I could die tomorrow. It could happen again,’ ” says Dr. Monica McDonald, a cardiothoracic surgeon with the Midwest Heart Surgery Institute.
Combine that with brand new prescriptions, the sudden onset of a chronic disease the patient didn’t know he had, and frightening warnings about strokes and other events, and it’s no wonder the months after a heart attack can be a time of high emotion. Feelings of frustration, fear, anger, anxiety and sadness are all common reactions. Many patients try to minimize their normal activities in order to heal, but this impulse can bode even worse for their psychological state. “Patients think, ‘OK, I can’t do anything. I’ve got to recover.’ So they don’t see their friends; they don’t do their activities; they don’t go out to dinner; they sit in their house,” McDonald explains. Yet there’s no reason why patients shouldn’t start getting back into their routines, as long as they take it slowly.
Depression is extremely common after a heart attack. It occurs 40 percent of the time or more, and many of these patients have never experienced depressive symptoms before. Unfortunately, for reasons doctors don’t completely understand, its onset brings with it a significantly higher risk of a repeat event. Because the condition is so prevalent, Dr. Desiree Dizadji, a noninvasive cardiologist at Wheaton Franciscan Medical Group, believes patients should be educated about depression before they leave the hospital, along with tips about medications and lifestyle changes. “If patients know going into it [how common depression is], they’ll be much more open about relating those feelings in follow-up visits.”
Patients for whom depression is a problem may benefit from cognitive therapy or medication. Although studies have not shown that treating the
depression necessarily reduces the risk of another heart attack, treatment is important. Not only can it renew a patient’s sense of well-being, but it can make it easier to focus on other issues – like lowering cholesterol or exercising – that are vital to cardiac health.
Fear of physical activity is another common reaction after a heart attack, says Dr. James Kleczka, medical director of the cardiac intensive care unit for Froedtert and the Medical College of Wisconsin. “Patients are afraid they’re going to go outside and rake leaves or try to exercise and have another heart attack.” In such cases, cardiac rehabilitation can be a huge help in restoring confidence and offering patients support as they resume their daily lives. Available through most hospitals and covered by most insurance plans, cardiac rehab programs feature monitored exercise in which nurses supervise patients’ vital signs as they exercise and help them slowly increase their physical activity. Such programs also address dietary modifications, weight management, smoking cessation and emotional aspects of heart attacks or other cardiac problems. “It’s very comforting for patients to be in an environment where they’re with people who’ve had the same fears and the same problems, and they’re all going through it together,” notes Kleczka.
Follow-up and Prevention
Knowing what to expect from follow-up visits can help patients make sure they’re getting optimum care and take active roles in their recovery. Look for an initial visit to be scheduled within about two weeks of your discharge from the hospital. At this appointment, your doctor should talk with you about any symptoms you may be having, check in to see how you’re tolerating your medications, and spend time going over lifestyle changes. If you feel like your doctor isn’t listening to you, that could be a red flag. “You need to be able to have an ongoing, open dialogue and feel comfortable sharing things with your physician,” says Dizadji.
Be sure to ask questions about anything you don’t understand, and don’t hesitate to involve your family. The family is typically just as worried as the patient, so it’s important for them to stay informed. This can also help prevent situations in which a family member is overprotective, afraid for the patient to participate in activities the doctor has OK’d. If dietary changes are necessary, family members who cook for the patient need to be involved in the discussion.
Patient and family also need to be aware of the patient’s unique heart symptoms. “Not everyone has crushing chest pain,” Kleczka explains. “Some people just have shortness of breath; some people feel a little of what they think is heartburn. Whatever the patient presented to the hospital with when they had their heart attack, it’s got to be stressed to them that that’s their heart pain.” If the patient feels a return of those symptoms, he should contact his doctor.
While a patient’s genetic predisposition toward heart disease is out of his control, there are many areas – including weight loss, exercise, diet, smoking cessation and stress reduction – where he can make a real difference when it comes preventing another heart attack. Patients should expect treatment of blood pressure and especially cholesterol to be more aggressive now that their coronary disease has been discovered. “We hold people to a different standard when something like this has happened,” says Kleczka.
In focusing on such changes, it’s important patients realize they’re in this for the long haul. “This isn’t pneumonia where you go in and get an antibiotic and you’re done and it’s back to normal. These are lifestyle changes that are going to have to be incorporated for the rest of people’s lives,” says Dizadji. Most patients don’t need much convincing. When Hawkins was offered a prescription to help him quit smoking, he turned it down. “I told them the heart attack was prescription enough,” he says.
Back on the job, he now works out four days a week, running and walking on a treadmill and lifting weights at the gym. He’s come to terms with the idea of taking meds for his lifetime. And he consulted with his doctor about the medicine that zaps his energy to find a dosage they both can live with.
On the way to the hospital, Hawkins wondered whether he’d ever see his three daughters or his three grandkids again. Now, as he relates his experience over the phone, his granddaughter is heard playing in the background.
“You have to be willing to make the sacrifices. It’s hard, but you have to,” he advises other recovering heart attack patients. “So you can play with your grandkids like me.”
Caroline Goyette is the monthly health columnist for Milwaukee Magazine.
A roundup of the latest health wisdom
Get out in the sun to fight fat. Young women with insufficient levels of vitamin D in their bloodstreams were likely to have more body fat than those with normal levels, notes a study in the Journal of Clinical Endocrinology & Metabolism. Vitamin D levels are increased by skin exposure to the sun and vitamin supplements. Even though the women lived in sunny California, nearly 60 percent had insufficient vitamin D levels. More studies are needed to confirm whether vitamin D reduces the risk of body fat or greater body fat causes lower vitamin D levels.
Heart failure linked to broken bones. People with newly diagnosed or chronic heart failure may want to be screened for osteoporosis, or thinning of the bones, notes a study in Circulation. Heart failure patients were at least four times more likely to suffer a serious bone fracture in the following year than those with other cardiovascular disorders.
Either heart failure or the medications used to treat it could cause the increased risk of fractures.
Sleep disorders may cause eye problems. People with sleep disorders such as sleep apnea should be screened for eye conditions, including glaucoma, reports Mayo Clinic Proceedings. Obstructive sleep apnea is usually caused by tissue closing off the airway during sleep and stopping normal breathing for 10 to 120 seconds at a time. It’s possible that the typical treatment for sleep apnea – a mask worn over the mouth and nose that blows air into the airway to keep it open during sleep – may increase the risk for eye disorders because air may leak and affect the eyes.
Weight-loss surgery may cut pregnancy complications. Obese women are more likely to have pregnancy complications than those who undergo bariatric surgery prior to getting pregnant, reports the Journal of American Medicine. The rate of complications, such as gestational diabetes, in pregnant women who had laparoscopic lap band surgery was nearly as low as non-obese mothers. However, while gastric bypass surgery was linked to lower rates of some complications, it was also followed by higher rates of miscarriage.
Group therapy can save breast cancer patients. Group therapy led by psychologists significantly reduced the risks of breast cancer recurring and death from the disease. A study in Cancer covered women with stage 2 breast cancer who attended 26 educational and group therapy sessions in their first year after breast cancer surgery. They experienced a 45 percent lower risk of recurrence and a 56 percent lower risk for breast cancer death compared to patients who didn’t receive group therapy. Stress reduction, coping strategies and progressive muscle relaxation were part of the therapy.
– Scott R. Weinberger