At this point, you will most likely be moved to another part of the hospital for general recovery. You will be allowed to shower, and most physicians will permit wetting the incision. Blood pressure and temperature will continue to be monitored, and increased activity will be encouraged. Walking is recommended to augment normal gastrointestinal tract activity and reduce constipation. Hospital discharge may occur sometime within one week of surgery, depending on a patient's progress and their prior condition. (See Bypass Surgery: A Patient Guide for detailed information about bypass surgery.)

Angioplasty recovery

Because it is less invasive, angioplasty patients will experience a much quicker recovery than bypass patients. If you are treated with angioplasty, with or without the insertion of a stent, you will be closely monitored, and possibly discharged within 24 to 48 hours of the procedure. (See Angioplasty: A Patient Guide for detailed information about angioplasty.)

Getting the information you need

A social worker is usually involved in discharge planning to check for family support, financial resources for medications, transport for follow-up appointments, and details such as architectural barriers in the home. Sometimes home health care is prescribed if additional instruction is needed for IV therapy, central line care or for bandaging incisions. Home health care is usually scheduled before you are discharged.

Before you leave the hospital, a doctor will discuss the critical issues of your recovery. You should consider having a spouse, friend, or relative take notes for you because the information provided can be overwhelming. Your spouse, friend, or relative can play a significant role in recovery.

Your doctor will likely give you information to read. It is important to fully understand your condition and feel comfortable asking questions prior to your hospital discharge and realize that you can always telephone your doctor or the hospital if you have additional questions at any time.

III. Rehabilitation and long-term recovery

If you have heart disease and have experienced a heart attack, try to view it as a wake-up call, not a death sentence. Patients who see their illness as an opportunity to modify lifestyle and bad habits can live with the changes for a long time.

Some of the most important things your doctor will discuss with you are the following lifestyle changes: diet; exercise; medication; blood pressure, diabetes, and cholesterol control; smoking cessation; and stress management. These topics also will be discussed during the series of doctor visits you will have throughout the first year following your heart attack.

Doctor visits

You can expect to see your doctor within the first month after leaving the hospital and again at two- to four-month intervals for the first year following your heart attack. The doctor will conduct a physical exam, check incisions and perform blood tests that might include: chemistries (if on diuretics and/or electrolyte supplements, kidney function, diabetes control), CBC (for inflammatory responses, anemia), cholesterol levels, INR (prothrombin time or pro time is now called INR) if on coumadin, digoxin levels if on digoxin, and liver function tests (to evaluate if any medication liver-related side effects).

The doctor will also perform an electrocardiogram (ECG or EKG) to measure your heart's electric impulses, and repeat the ECG on a regular basis. It is common to perform an exercise tolerance test about two or three months after discharge from the hospital and to repeat this if symptoms recur. This will be a good chance to show just how much you have progressed. It is also common to recheck an echocardiogram in the first few months after discharge from the hospital. After that, you can expect to visit your cardiologist every four to six months for the rest of your life.

Depression

Anxiety, depression, or a combination of both can accompany a heart attack. Because physicians can sometimes overlook it, family members should be especially careful to watch for signs of excessive worry and/or depression. Heart attack patients often feel that a part of them has died and they are mourning both its loss and the loss of their former life. People often expect their lives to be changed immeasurably – and for the worse – after a heart attack. Not knowing what to expect can create anxiety. This also might be your first serious hospitalization or illness. Feelings of fragility and vulnerability might be difficult to accept. Support groups for you and your family members, as well as patient education programs, are available to help manage this transition. Families often feel more comfortable if they are educated about what to do in emergencies and first responder courses are available all over the country through the Red Cross.

Even after having resumed full strength (determined by stress tests at your doctor's office), you and your family members often feel hesitant to resume physical activities. Patients often wonder when it is safe to resume sexual activity. Generally, normal activities can be resumed over time. Depending upon you condition resumption of sexual activity anywhere from one day to eight weeks after returning home from the hospital can be anticipated. For your emotional reassurance, speak with your doctor regarding any concerns you have about physical and sexual activity.

After two to four months, most heart attack patients can return to their jobs (this is dependant upon our condition and the requirements of the job). Some people can return to work in less time. Job-related stress, however, must be considered when returning to work.

Lifestyle modifications

Diet. Heart attack patients must restrict their fat and cholesterol consumption. People with high blood pressure must restrict salt, and people with diabetes must monitor sugar intake. Your physician can recommend a book that defines heart-healthy dietary guidelines, or provide you with a list of items to avoid. Some doctors refer patients to a nutritionist for dietary counseling.

Above all, saturated fats from meats and dairy products should be limited. More fruits and vegetables should be added to your diet. While dietary changes are difficult to initiate, you can adjust well to your new diet and learn to enjoy healthier eating.

Family members should support you in all aspects of your new habits. Studies show that family support can help heart disease patients achieve and maintain a healthy lifestyle, and thereby reduce future, recurrent heart attack risk. This is especially true with smokers. Smokers who do not quit have triple the risk of death in the following year than those who do quit.

Exercise. Exercise and increased physical activity is important in recovering from a heart attack. Studies show a sedentary lifestyle contributes to heart disease. Recovery also is quicker for patients who were active before their heart attack. Before leaving the hospital, you will be monitored to make sure you can function with limited physical activity. When you return to visit your doctor (anywhere from one to six weeks after you return home), you will likely be given another stress test to ensure your safe return to normal physical activity.

Cardiac rehabilitation. Many hospitals that perform bypass surgery have cardiac rehabilitation programs or can refer you to a conveniently located program. As part of cardiac rehabilitation, patients treated with bypass surgery usually attend monitored exercise programs. This is especially important for high-risk patients and those with other diseases.

In cardiac rehabilitation, you are monitored with machines and supervised by trained medical personnel. In addition to helping you improve physical strength, cardiac rehabilitation can improve your outlook and provide needed support to make important lifestyle changes.

It is important to ask your physician when you can begin an exercise program so that you can exercise safely. Your doctor will tell you what your target and maximum heart rate should be when exercising.

According to national guidelines issued by the American Heart Association, the American College of Sports Medicine and the International Health, Racquet and Sports Clubs Association, persons with heart disease should choose a facility that employs a nurse and other health/fitness instructors trained to recommend and supervise exercise regimens. (See HeartInfo article: Health Clubs Should Screen for Heart Disease) Consider using a supervised rehabilitation exercise program for the first few months following surgery. You can move to a local gym or YMCA to continue your cardiovascular training after discussing your health with your doctor.

After receiving approval for an exercise regimen from your doctor, begin your exercise program. Warm up slowly before participating in vigorous aerobic activity, and allow three to five minutes to cool down. When you feel your heart racing or you get tired too quickly, stop and rest. Remember to monitor your heart rate so it does not pass the training zone determined by your doctor. Patients often find that within four months of having a heart attack, their level of physical activity will be as good or better than it was before the heart attack.

Medication. Some of the medications your doctor prescribes might be taken only for the first few weeks or months after your heart attack. Some of these medications might be warfarin (for blood thinning), amiodarone (for arrhythmias), Lasix or other diuretics, potassium supplements, and beta-blockers. Others, such as cholesterol-lowering drugs, ACE inhibitors, and aspirin, will be taken for the remainder of your life.

Because you will likely take several medications in combination, your doctor might need to test various strengths and combinations before determining the optimum drug therapy for you. If there are any medications that cause disturbing side effects, discuss them with your doctor immediately. Do not discontinue any medication without first discussing it with your doctor. Some medications, such as certain hypertension medicines, must be gradually lessened to prevent dangerous complications.

Stop smoking. Smoking cessation is one of the most important steps heart attack patients can take to prolong their lives. By stopping smoking, you greatly reduce your risk of suffering further heart damage. Ask your doctor about ways to stop smoking, such as programs and/or medications. Many local hospitals offer smoking cessation classes that are helpful for people needing support when quitting.

Smoking cessation should begin immediately at the time of your heart attack. Medications such as bupropion, varenecline or numerous formulations of nicotine replacement can be started in the hospital if pharmacologic assistance to quit is necessary. Research shows smokers are more successful at cessation when supported by their doctors, family members, friends and co-workers. Because second-hand smoke is also conclusively harmful, the entire family benefits when a smoker stops smoking. Family member who smoke are exposing the patient to second hand smoke. It would be helpful to limit this exposure.