After a Heart Attack: Transitioning to Survivorship
Not long ago, suffering a heart attack was a death sentence — if not immediately, then in the years just afterward from heart disease complications. Mortality rates of patients arriving at hospitals with myocardial infarctions (MIs) have decreased to less than 10 percent today, compared with approximately 40 percent in 1970.
An MI is still a common condition, though, and heart disease remains a cause of 25 percent of all deaths annually in the United States: a million people experience a heart attack every year, a quarter of them the most severe kind, called a STEMI. Today, the heart attack picture is changing dramatically because of better and faster treatments as well as improved patient education.
What happens during a heart attack?
When the heart muscle fails to receive the oxygen it needs, it becomes damaged and can die, especially if the blood-carried oxygen supply is completely cut off for a prolonged time. In addition to clogged arteries and clots that limit or entirely stop blood flow, coronary artery spasms or weakened arteries as a result of other health conditions contribute to heart attacks. As researchers learn more about the causes of MIs, the patient population has grown to include younger people, even some who are seemingly heart healthy but have hidden genetic risks.
All heart attacks are not equal: different types of MIs are named by the part and extent of the heart muscle affected. For example, STEMIs are observed as ST changes on ECGs — a way to read muscle activity in different parts of the heart. STEMIs result from completely blocked blood flow at any of the three large coronary arteries. NSTEMIs occur when blood is only partly blocked and are associated with less damage than any STEMI.
Recovering after a heart attack
When patients survive after serious MIs, long-term risks include stroke from additional clots, arrhythmias when the heart muscles don’t work in sync during recovery, and heart failure. Early treatment during the heart attack is essential to reducing these risks. Learn to identify heart attack symptoms that warrant a 911 call; seconds do count for timely hospital care.
Diagnosis and treatment guidelines for MIs have evolved along with the changing patient populations. Patients are arriving at hospitals earlier and being treated faster; the American Heart Association measures treatment goals in terms of door-to-needle time for clot-busting medicines or door-to-skin time for angioplasty, which uses a catheter to open blocked arteries. Upper limits for treatment times are within 60 to 90 minutes of emergency room arrival.
After successful angioplasty or other interventions, patients can be discharged home after just a few days. The challenges do not stop after this initial care, though.
Recommendations for early recovery after a heart attack vary widely across different patients and disease severities. In general, driving and low-impact exercise are considered reasonable within 1-2 weeks for many patients. Bed rest, an outdated recommendation, is now recognized as a contributor to potentially lethal blood clots. Tapered, guided exercise programs like cardiac rehabilitation are now part of standard care.
Three broad issues can make recovery seem too challenging for many patients: these are physical, psychological, and social hurdles of moving forward.
- Physically, a heart attack survivor faces the need to take better care of the heart muscle through diet and exercise. When diet changes seem scary or overwhelming, a nutritionist can guide survivors to incremental improvements: from reducing portion sizes to selecting healthier ingredients and new recipe ideas. Likewise, many heart attack survivors qualify for cardiac rehabilitation to improve exercise habits slowly and durably. Motivation to continue physical activity doesn’t need to focus on heart disease and can come from within—like finding the joy in an active hobby — or from external supports.
- The emotional toll of a heart attack is becoming more understood, especially as patients cope with longer lives as heart patients. After a heart attack, additional office visits to primary care and new cardiology offices, as well as confusing new medications, can feed anxiety about being a "heart patient.” Fear of future heart events, or depression about being less healthy, can change personalities and affect life choices, too. Self-care after the upheaval of a heart attack is essential but often is a new journey. It can involve private journaling and positive self-talk, public sharing of heart stories, and more.
- Finally, the social impact of a heart attack can be overlooked by survivors and their caregivers. A return to “normal” life after an MI can help emotional and physical recovery, but that doesn’t mean that it’s easy to do. Heart attack survivors can have lower work stamina, less availability for social commitments because of new doctor’s appointments, and difficulty enjoying meals or sport activities as they learn to adjust to heart-healthy foods or new endurance levels. Adjusting to these changes is best done with familiar supports. For example, re-entering the workplace on a tapered schedule can add familiarity without becoming a burden during early rehab and doctor visits. Ultimately, small improvements can set a new balance that supports a long-term heart-healthy lifestyle.
You are not alone: survivorship resources
If you are a heart attack survivor of any age, you are not alone. Support groups for all types of patients have a hub with the American Heart Association; their free patient magazine features a Heart Attack Recovery Series, too. Other professional or nonprofit organizations like SecondsCount or the Sudden Cardiac Arrest Association offer educational outreach and sharing outlets for survivors, too.