As a rule, the more you know, the better you'll feel because you'll have less to worry about.

This booklet also has a glossary at the back. It defines some words you may have heard but don't know.

If you have questions that aren't covered here, write them down. Then ask your doctor. He or she is your best source of information.

If you've had a heart attack, you've had a very frightening experience. Your life was threatened, and that's scary for anyone. Now, even though your doctor says you're going to be all right, you're probably still anxious.

After what you've just been through, feeling apprehensive is normal. But remember that your heart is healing every day. With each passing day, you'll get stronger and more mobile. The worst is behind you.

Remember, you're not alone. Every year tens of thousands of Americans survive heart attacks. The vast majority of them go back to work again and keep enjoying life. You have every reason to be confident that you'll recover.

I wasn't doing anything unusual. Why did I have a heart attack?

A heart attack can occur anytime: at work or play, while you're resting or in the middle of a strenuous workout. Heart attacks occur very suddenly, but the stage is set for them over many years. Heart attacks result from atherosclerosis in the arteries that carry blood (and thus food and oxygen) to the heart muscle.

Atherosclerosis develops slowly and is a complex process. Many scientists believe it begins because the inner, protective lining of the artery becomes injured. When this happens, fats, cholesterol and other substances in the blood may gradually become deposited in the artery wall. This causes buildups to form. As these fatty deposits build up over time in the artery wall, the insides of the arteries narrow, and it becomes harder for blood to flow.

If a blood clot forms in a narrowed artery, it blocks the channel and shuts off blood flow to the heart muscle. This causes a heart attack. The medical term for this is coronary thrombosis or coronary occlusion. The injury to the heart muscle that results from a decreased blood supply is a myocardial infarction.

What's sudden cardiac death?

A damaged heart may develop an abnormal electrical activity. This can keep it from beating normally. If this happens, sudden cardiac death may occur.

The most common heart rhythm in sudden cardiac death is ventricular fibrillation. In it, the heart suddenly stops working as it should (in other words goes into cardiac arrest). Most cardiac arrests occur when the heart starts beating chaotically. If ventricular fibrillation isn't treated right away, sudden cardiac death will occur.

A key aspect of sudden cardiac death is that death occurs unexpectedly and within minutes after the heart stops. Cardiac arrest usually can be reversed if it's treated within a few minutes with a defibrillator. A defibrillator shocks the heart and restores a normal heart rhythm. Time is even more critical for sudden cardiac death than for a heart attack.

Heart attack patients are watched around the clock in the hospital so that any such threatening complication is treated at once.

Why didn't I have any warning?

Atherosclerosis often develops over many years without any symptoms. The reason there may be no warning signs is that if a coronary artery becomes narrowed, other nearby vessels (that also bring blood to the heart) sometimes expand to help compensate. In effect, a detour forms to reroute blood to the heart. This is called collateral circulation.

Collateral circulation helps protect some people from heart attacks by helping the heart get the blood it needs. In other cases it develops after heart attack and helps the heart muscle recover.

How was my heart injured, and how will this affect the way it works?

When a heart attack occurs, a small part of the heart dies because its supply of oxygen-carrying blood is cut off. But the heart is a remarkably tough organ. Even though a part of it may have died, the rest still keeps working.

Your situation is much like that of an athlete with a torn leg muscle. Until the muscle heals, his or her effectiveness is reduced. Likewise, because your heart has been damaged, it's weak and can't pump as much blood as usual.

During the first few days after a heart attack, rest is essential. But even after that you should limit your activities until your heart has had time to heal. When your heart is healthy again, you can return to your normal lifestyle.

As the damaged part of your heart heals, a tough scar forms. This takes time: it's still forming after you've begun to feel good again. Usually in a month or six weeks you heart has repaired itself. The length of time depends on the extent of your injury and your own rate of healing. That's why doctors recommend different amount of activity for each heart attack patient.

What feelings are normal after a heart attack?

After your heart attack you'll probably have a wide range of emotions. Three of the most common are fear, anger and depression.

Fear may be the most common emotion and the most understandable. If you're like most people, you've probably had thoughts like: "Am I going to die? Am I living on borrowed time? Will my chest pain (or shortness of breath) come back?" These are troubling thoughts, but as time passes your worries will diminish.

Physical symptoms may set your fear in motion, too. For instance, before your heart attack, you probably never gave small, fleeting pains a second thought. But now the tiniest twinge in your chest worries you. That's normal. The passing of time will ease these fears too.

Anger is another common emotion. You've probably though, "Why did this have to happen to me? And why did it have to happen now, at the worst possible time?"

Bitterness or resentment is common after a heart attack. You may lose your patience; your friends and family may irritate you. But before you snap at them, remember that it's normal to resent a heart attack. Your misfortune isn't their fault. Being angry is one stage in your recovery, so accept it. There's no reason to take it out on your loved ones.

Finally, you may have "the blues." You may feel down in the dumps and think you're hopelessly damaged or crippled. You may even have thoughts like: "What's the use?" or "Life is over." This, too, is normal.

One of your biggest fears may be that you won't be the same person you were before your heart attack. You may be afraid you won't be able to work as hard, be as vigorous, or be a helpful spouse or parent. You may even think that now it's too late to do all the things you've dreamed of doing. To some extent everyone who has had a heart attack feels this way. But try not to anticipate the worst. You haven't given yourself a chance to recover yet, so it's too early to jump to conclusions.

Finally, you may be worried about whether you'll be able to perform sexually. Perhaps you think that others will think you're a weak, incomplete person. Again, understand that your fears are normal for someone in your situation, but they're not necessarily true.

Your moods will vary widely from day to day, and your thoughts will reflect your moods. Don't take them too seriously. Concentrate on resting. And if things do start to bother you, tell someone you trust how you feel. Don't just pretend that nothing is wrong. Time will cure most of your unpleasant feelings, but until then you don't have to suffer. You're not abnormal for feeling the way you do.

What do family members feel?

It's very likely that your heart attack had a big emotional impact on your family. That's usually the case. Your family members were probably very scared when you were in the coronary care unit. Now they may feel resentful, thinking that your heart attack came at a bad time. This is normal. They're really not blaming you, even though it may seem like it sometimes.

It's also common for family members to feel guilty. They may feel that they're somehow responsible for doing something that gave you a heart attack. Teenage children, in particular, may feel this way. Talk to them about their feelings and reassure them that even though heart attacks happen suddenly, the conditions that cause them take years to develop.

If there are fears and resentments in your family, it's better to bring them out into the open. Don't let bad feeling smolder - they're destructive. If you think counseling would help your family deal with your heart attack more quickly, ask your doctor or nurse for a referral to a good source for this service.

How long will I be depressed?

Be patient. After a heart attack it's almost impossible not to be scared, irritable or down in the dumps. In fact it usually takes 2-6 months before these feeling fade away completely.

Because this is a trying time, you and your family and friends need understanding and sympathy. If you're constantly irritable, depressed or drinking heavily, tell your doctor, then follow his or her advice.

How do I recognize an abnormal depression?

Several warning signs indicate that a serious depression has developed. These include:

1. Sleep problems. You have trouble sleeping; or you want to sleep all the time.
2. Appetite problems. Food doesn't taste good anymore and/or you've lost your appetite.
3. Fatigue. You tire very easily and have no energy.
4. Emotional stress. You're tense, irritable or agitated, or you feel listless and apathetic.
5. Loss of alertness. You have trouble concentrating.
6. Apathy. You lose interest in your old hobbies (theater, reading, sports, etc.).
7. Low self-esteem. You feel worthless or inadequate.
8. Despair. You have repeated thoughts of death or suicide.
9. Slovenliness. You don't keep up your appearance or clean up after yourself.

If you have any of these symptoms, tell your doctor. He or she can decide whether your symptoms are normal, or whether you're slipping into a depression. If your doctor thinks you may be depressed, he or she may prescribe medication to help you feel better.

Why do I feel weak now that I'm home? Is it heart damage?

If you rested al lot in the hospital and stayed in bed, you'll feel weak when you get home. The main reason for this is not damage to your heart from your heart attack. You feel weak because inactive muscles lose their strength very quickly. Without activity muscles lose 15 percent of their strength in just one week.

Muscles regain strength only through exercise. That's why your doctor has given you a program of gradually increasing activities you can do at home. But even with regular exercise, it normally takes 2-6 weeks to get muscles back into shape.

Another point to remember is that the more athletic you were before your heart attack, the longer it will take to regain your former level of conditioning.

What are my chances for leading a normal life again?

Most people who've had a heart attack can resume their former activities in a few weeks or months. When you heart has healed, the scar usually isn't big enough to interfere with your heart's ability to pump blood. That means you won't need to curtail your activities very much, if at all. You may need to make some lifestyle changes, though.

The vast majority of heart attack victims survive their first heart attack. Most fully recover and enjoy many more years of productive activity.

When can I go back to work?

Between 80 and 90 percent of heart attack victims return to work in 2-3 months. Usually they can return to their former jobs. Of course this depends on two things: how badly their heart was damaged, and how demanding their job is. Some people switch jobs and take a new job that's less taxing on their heart.

Cardiac Rehabilitation Units are available in many communities. Your doctor may send you to one to find out how much and what kind of work you can do. Most communities have some type of rehabilitation program for vocational guidance, training and placement of heart patients who can't return to their former occupations. For more information about these programs, contact your local American Heart Association.

When I go back to work, will I still need to rest whenever I'm not working?

A reasonable amount of rest is necessary, of course. But recreation, exercise and social life are as good for you as they are for everyone else. May times doctors recommend that people who've had heart attacks get even more exercise than they got before.

Getting a good night's rest is important for everyone, but it's even more important for people who've recently had a heart attack. Sometimes a nap or short rest period during the day is helpful, too. It's important for heart patients to rest before they got too tired. Your doctor can tell you what he or she thinks will best fit your needs. Most heart attack patients find they have ample energy for both work and leisure activities.

What kind of exercise can I do?

Most people who recover from a heart attack can take walks, play golf, fish, swim and enjoy similar activities with no trouble at all. In fact, exercise is healthy and recommended for most heart patients. Still, don't exercise until you first talk to your doctor to find out how much exercise is right for you.

By giving you special tests on a treadmill, exercise bicycle or steps, your doctor can find the right amount of exercise for you. You may be tested in a Cardiac Rehabilitation Unit as part of a program or in your doctor's office.

Am I likely to have chest pain?

Not everyone has chest pain (angina pectoris) after a heart attack. In fact, many people don't. But it's possible that you will. Angina is a light pain or pressure in the chest that occurs when part of your heart muscle doesn't get enough blood (hence oxygen) for the work it has to do. That's why angina usually occurs during or right after physical exertion, intense emotion or eating a heavy meal. If you do have anginal attacks, tell your doctor. He is she can prescribe medication to ease or prevent the pain.

Besides medication, another treatment for angina is exercise. After you've been on an exercise program for awhile, you may find that you can exert yourself for longer than before. Angina attacks, if they occur at all, will take much longer to occur. This is because your heart will get more oxygen and blood than it could before because of collateral circulation.

If your angina gets more painful over time or starts to occur after very little exertion, see your doctor right away.

I've lost some weight, which my doctor says is good. Do I have to stay on a reduced-calorie diet?

To keep your weight where it needs to be, you may have to east less than before. It's important for people with heart disease to keep their weight normal (or even a little below normal). It's also important to eat a well-balanced diet that contains healthy amounts of protein, vitamins and minerals, and enough energy food to fuel your activities.

Your diet should also be consistent with the American Heart Association Diet, which is low in total fat, saturated fat, cholesterol and sodium. It's described below.

If you've been big eater in the past, now is a good time to revise your eating habits to keep your weight down. Heavy meals make big demands on your heart, and that's something you don't need. It will be better to have several fairly light meals a day instead of three heavy ones. If this isn't practical, eat three moderate-sized meals instead of three big ones.

What's a fat-controlled diet, and why is one recommended?

A fat-controlled diet is an eating plan to help you cut down on calories from fat, particularly from meat, high-fat dairy products and saturated fats. It will also lower your intake of dietary cholesterol from egg yolks, organ meats and other animal products.

The goal of a fat-controlled diet is to reduce the cholesterol and other fatty substances in your blood, and thus lower your risk of heart attack.

Polyunsaturated and monounsaturated fats and margarines made with no more than two grams of fat per tablespoon are used as partial substitutes for saturated fats such as butter, lard and hardened margarines, which are so prominent in the average American diet. The reason is that unsaturated fats tend to reduce the level of blood cholesterol.

The basic points of the American Heart Association dietary guidelines are:

· Total fat intake should be less than 30 percent of calories.

· Saturated fatty acid intake should be less than 10 percent of calories. Saturated fatty acids are found primarily in animal fats, but also in palm, palm kernel and coconut oil.

· Polyunsaturated fatty acid intake should be no more than 10 percent of calories. Corn, soybean and sunflower oil are examples of polyunsaturated fatty acids.

· Monounsaturated fatty acids make up the rest of total fat intake, about 10 to 15 percent of calories. Canola and olive oil are examples of monounsaturated oils.

· Cholesterol intake should be no more than 300 milligrams per day. Cholesterol is found in foods from animals: beef, pork, mutton, poultry, fish, dairy products, eggs.

· Sodium intake should be no more than 3000 milligrams (3 grams) per day. To cut down on salt, substitute herbs and spices. Read food labels to find compounds that contain salt.

If you're overweight, losing weights may help you reduce your blood cholesterol level, lower your blood pressure and improve your glucose tolerance. Getting a blood test from time to time will show how effective changing your diet (and losing weight) has been. If some cases, you may have to modify your diet even more to reach the goal your doctor has set for you.

Your doctor also may prescribe medicine to lower your blood cholesterol.

What about carbohydrates?

You'll probably be reducing the amount of fat in your diet to less than 30 percent of total calories. (Right now, if you're like most Americans, your diet contains about 37 percent fat.) To make up for the decrease, you'll need to eat slightly more carbohydrates. Ideally, your carbohydrates should come from vegetables, fruits and cereals.

Can I still have an alcoholic drink or two?

Your doctor may tell you that it's all right to drink moderate amounts of alcohol. But if you're trying to lose weight, remember that alcoholic beverages are high in calories.

Is there anything else I should watch out for?

Scientists are studying other dietary factors such as fiber, coffee, trace minerals, water hardness, and vitamins to see if they play a role in the development of heart disease. But right now scientists don't know enough to make any firm recommendations.

Should I stop smoking?

YES! Smoking is unhealthy for everyone! And it's an even bigger risk for people who have coronary disease. In fact, if you resume smoking after having had a heart attack, your chances of having a second one are doubled.

Smoking increases the strain on your heart because it causes blood vessels to constrict, and some of them are already narrowed and damaged. Smoking also causes your heart to beat faster. Finally, smoking increases the level of carbon monoxide in your blood and thus deprives your heart of the oxygen it needs. If you smoke, by all means, QUIT.

What about my blood pressure?

High blood pressure is a risk factor for heart attack and stroke. That's why your doctor will want you to have your blood pressure checked regularly.

If you blood pressure is high, your doctor will want you to take steps to lower it. Usually some combination of diet, exercise and medication is recommended to bring blood pressure under control.

Many people with high blood pressure are also overweight. If that's true for you, a diet may be prescribed to help you cut down on calories and lose weight. If you're given a diet, follow it closely, including any advice about drinking less alcohol.

Sometimes reducing the amount of sodium you eat can help lower blood pressure. If your doctor thinks this might help you, he or she will suggest a sodium (salt) restricted diet. You'll have to avoid salty foods, cut down on how much salt you use in cooking and at the table, and read package labels regularly to learn how much sodium is in prepared foods.

Exercise can also help you lose weight and lower your blood pressure. Check with you doctor before you start an exercise program, though.

For some people, losing weight, reducing sodium and making other lifestyle changes doesn't lower blood pressure enough. Medication is prescribed for them. If your doctor prescribes medications for you, take them as directed. If you don't feel well after taking the medication, tell your doctor exactly how you feel. He or she can adjust your medication so you won't have unpleasant side effects.

It's very important to keep your blood pressure under control, so be sure to follow your doctor's advice.

Is sexual activity permitted?

Most people can continue their same pattern of sexual activity after they recover from a heart attack. If this question worries your or your sexual partner, talk to your doctor. If you get anginal chest pain when you exert yourself during sex, your doctor may prescribe nitroglycerin for you to take before having sexual relations.

Will I have to take medicines to keep my blood from clotting?

It's possible. Your doctor may decide to prescribe anticoagulant drugs depending on the circumstances surrounding your heart attack. In some cases such drugs are beneficial; in others, they're not needed or even potentially harmful. Only your doctor should decide if anticoagulants are right for you.

Can coronary artery surgery be helpful?

Right now your heart is healing on its own. In some cases, surgery can be helpful, particularly when certain complications result from the heart attack. Whether or not you need surgery is a question that only your doctor can answer.

Since I've had one heart attack, I can expect another one, can't I?

Not necessarily. Of course no one can say for sure whether you'll have another heart attack. But if you follow your doctor's recommendations regarding your weight, diet, work, medicine, exercise and rest, you'll have a better chance of living comfortably and avoiding future attacks.

Research into coronary disease is uncovering new insights into heart attack every day. The outlook for coronary patients is better today than it was only a few years ago. And it will continue to improve. There's a lot to be hopeful about.

Glossary

Here are some terms your doctor may use when he or she is talking to you about your heart.

Angina Pectoris or Angina: Literally "chest pain," this is a condition in which the heart muscle doesn't get enough blood to fuel the work that it's doing. Pain in the chest - and often in the left arm and shoulder - results. The most common cause is atherosclerosis, which has narrowed the coronary arteries and restricted the flow of blood.

Anticoagulant: A drug that prevents blood from clotting. When such a drug is given in cases where a blood vessel is plugged up by a clot, it tends to prevent new clots from forming or the existing clot from enlarging. It does not dissolve an existing clot.

Aorta: The main trunk artery that receives blood from the lower left chamber of the heart. It begins at the base of the heart, arches up over the heart like the handle of a walking cane, and passes down through the chest and abdomen in front of the spine. It branches off into many lesser arteries that conduct blood to every part of the body (except the lungs).

Arteriogram (Coronary): X-ray films of the coronary arteries made by injecting an X-ray opaque dye into the veins to trace the flow of blood through the heart's arteries.

Arteries: Blood vessels that carry blood away from the heart to the various parts of the body. They usually carry oxygenated blood, except for the pulmonary artery, which conducts unoxygenated blood from the heart to the lungs where it's oxygenated.

Arteriosclerosis: Commonly called hardening of the arteries, this is a generic term for a variety of conditions that cause the artery walls to become think and hard and lose elasticity.

Atherosclerosis: A type of arteriosclerosis in which the inner walls of an artery become coated with thin, irregular deposits of a fatty substance. These deposits decrease the diameter of the blood vessel and restrict the blood flow.

Cholesterol: A fat-like substance in animal tissue. In blood tests the ideal level for Americans is below 200 milligrams per 100 cubic centimeters. A higher-than-normal level of cholesterol increases the risk of coronary atherosclerosis.

Collateral Circulation: Detoured circulation of the blood through smaller vessels when a main vessel has been blocked off.

Coronary Arteries: Two arteries, arising from the aorta, that arch down over the top of the heart, branch and conduct blood to the heart muscle.

Coronary Artery Disease or Coronary Atherosclerosis: A build-up of fatty materials inside the arteries that conduct blood to the heart muscle. The diameter of the inner walls of these (coronary) arteries is narrowed and the blood supply to the heart is reduced.

Coronary Occlusion: An obstruction (usually a blood clot) in a branch of one of the coronary arteries that hinders blood flow to part of the heart muscle. This part of the heart muscle then dies because of the reduced blood flow. Also called a coronary heart attack, coronary or heart attack.

Coronary Thrombosis: A form of coronary occlusion, this is the formation of a clot in a branch of one of the coronary arteries that conduct blood to the heart muscle.

Electrocardiogram: Often abbreviated ECG or EKG, this is a graphic record of the electric currents produced by the heart.

Ischemia: A local, usually temporary deficiency of blood in some part of the body, often caused by a constriction or blockage in the blood vessels.

Myocardial Infarction: The death of, or damage to, an area of the heart muscle (myocardium) because of an inadequate blood supply reaching that region.

Myocardium: The muscular wall of the heart. The thickest of the three layers of the heart wall, it lies between the inner layer (endocardium) and the outer layer (epicardium).

Nitroglycerin: A drug (a vasodilator) that relaxes the muscles in the blood vessels and allows them to expand, it's often used to relieve attacks of angina pectoris and spasms of the coronary arteries.

Polyunsaturated Fat: A fat that's usually a liquid oil of vegetable origin, such as corn oil or safflower oil, and which is chemically constituted to absorb additional hydrogen. Diets high in polyunsaturated fat tend to lower the amount of blood cholesterol and so to lessen the hazard of fatty build-up within the blood vessels. That's why these fats are partially substituted for saturated fat in the diet.

Saturated Fat: A fat (usually a sold fat of animal origin such as is in milk, butter, meat, etc.) that's chemically constituted so that it can't absorb more hydrogen. A diet high in saturated fats tends to increase the amount of blood cholesterol. These fats are restricted in the diet to reduce the hazard of fatty deposits building up inside the blood vessels.

Ventricle: Either of the two lower chambers of the heart. The left ventricle pumps oxygenated blood through the arteries to the body, while the right ventricle pumps unoxygenated blood through the pulmonary artery to the lungs. The capacity of the ventricle is usually about 120-130 cubic centimeters, or 8½ tablespoons of blood, although they can accommodate more during exercise.

Your contributions to the American Heart Association will support research that helps make publications like this possible.

For more information, contact your nearest American Heart Association or call 1-800-AHA-USA1 (1-800-242-8721), or online at http://www.amhrt.org

American Heart Association®
Fighting Heart Disease and Stroke

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7272 Greenville Avenue
Dallas, TX 75231-4596