Heart Attack and Acute Coronary Syndrome

Description

Alternative Names

Rehabilitation

Lifestyle measures, particularly dietary factors, are equally important in preventing heart attacks and must be strenuously adhered to.

Physical Activity and Rehabilitation

Physical rehabilitation is extremely important after a heart attack. It has been associated with a 25% reduction in mortality rates at three years. Rehabilitation may involve the following:

• Leg exercises may start as early as the first day. The patient usually sits in a chair on the second day, and begins to walk on the second or third day.
• Most patients undergo low-level exercise tolerance tests early in their recovery. One study suggests that exercise testing within three days after a relatively minor attack may allow patients to go home earlier.
• After eight to 12 weeks, many patients, even those with heart failure, benefit from supervised exercise programs. Health professionals should provide the patient with schedules for low-level aerobic home-activity. Strength (resistance) training is also important. (Tai Chi, a Chinese martial art, appears to be very beneficial and safe for people after a heart attack.) It should be noted that the risk for serious heart events during rehabilitation is very low. In one survey, cardiac arrest was 1 per 112,000 patient-hours and nonfatal heart attack rates were 1 per 294,000 patient-hours.

Patients generally return to work in about two months, although timing can vary depending on the severity of the condition.

Sexual activity after a heart attack carries a very low risk and is believed to be safe, particularly in people who had exercised regularly before the attack. In any case, the feelings of intimacy and love that accompany healthy sex can help offset depression, a far greater risk for a future attack.

Emotional Rehabilitation

Major depression affects between 15% and 23% of patients with ACS and heart attacks. Many studies are showing that depression is a major predictor for increased mortality in both women and men. Depressed patients are less likely to comply with their heart medications. Although it is not clear if treating depression has any effect on survival. Psychotherapeutic techniques, especially cognitive behavioral therapies, are very helpful.

Physicians have been reluctant to prescribe antidepressants after ACS or a heart attack, however, because older forms have adverse effects on the heart. Studies on sertraline (Zoloft), one of the selective serotonin reuptake inhibitor (SSRI) antidepressants, however, have not reported harmful effects for heart attack patients. It is not yet clear, if other SSRIs are equally safe and effective.