Once you recognize that you have coronary artery disease, you should be aware of the fact that you have a higher risk of recurrence. The more risk factors you have the greater the probability of your having another myocardial infarction. This is a reality that you have to accept but by following a programme to change your lifestyle and personality you will be able to reduce the risk considerably. The programme will help you feel more energetic and psysically active. Moreover you should begin to experience a sense of emotional wellbeing.
MAKE LIFESTYLE CHANGES IMMEDIATELY
Your first priority should be to reduce the risk of another attack, so start the programme of lifestyle changes as soon as possible as this can save your life. More importantly, it will prevent invalidism. Stop smoking. Switch to a low fat diet and start a stress management programme. In addition to this, start the drills to reduce and modify hostility and any Type A traits that you have. Compliance is the secret of success. Aim to start with a bang and religiously follow the programme daily. The greater your compliance, the lower the risk of your having another heart attack. Remember that with a coronary prone person, denial is a major problem.
It is easy to deny that one is stressed or needs to make major changes in ones lifestyle and personality.
PREPARING FOR AN EMERGENCY
Once you have coronary artery disease you should be prepared for the probability of having a heart attack in the future. The chances of an infarction are much higher if you do not change your lifestyle. The first few hours after a heart attack are critical, as mortality from arrhythmias are highest in this period. Getting to the hospital as soon as possible will increase your chances of survival and of reducing the amount of damage to your heart muscle. Anticipating the possibility of an infarction can save a lot of time and anxiety in a crisis and it may even save your life.
I would advise you to discuss the possibility of a myocardial infarction with your cardiologist. Ask him what precautions you can take. It is a good idea to carry a synopsis of your past medical records and a photocopy of your latest electrocardiogram. This synopsis should mention if you have been given streptokinase in the past as it could be dangerous for you to have it twice. It should also include information about previous or other illnesses and the address and telephone number of your doctor, cardiologist and next of kin. keep spare copies of the synopsis in your office, car and briefcase. If you are travelling to another city carry a copy of your medical papers and gets the name of a doctor in advance.
Keep a small amount of fresh medicines, especially nitrates, in your pocket and is an many safe places as you can think of so that they are easily accessible in an emergency. Get detailed instructions about how to take the medication. Again, other at home and in the office should know the location and how they are to be administered in a crisis. When having an attack a person is often anxious and confused and unable to deal with the situation himself.
COPING WITH AN EMERGENCY
Check with your doctor about what to do in an emergency. Apart from nitrates your doctor may also advise you to chew on a tablet of aspirin. Do not take aspirin without your doctor advice, as you may have some condition that makes it dangerous. Aspirin, if taken soon after the pain starts, can stop the progression of the clot and reduce the amount of damage to the heart muscle. Your doctor may teach you how to take your own pulse and if your pulse is over 60 beats per minute he may advise you can take a tablet of a beta blocker in case of symptoms suggestive of an infarction. Remember it is better to the safe than sorry, therefore call your doctor if you have any symptoms, especially pain, breathlessness, sweating or nausea. The earlier you get help the better. With clot busting medication such as streptokinase, time is important.
The important thing is to remain calm and call your doctor immediately. Alternatively you may ask someone to drive you to the hospital. Do not try to walk or drive your own car to the hospital. The exertion and stress can cause a fatal arrhythmia or you may collapse and have an accident. It is best that you lie down till the ambulance or doctor comes, this will minimize the chance of shock. If you find yourself feeling breathless, sitting up might help. Panic will lead to an increased amount of catecholamines being released into the blood stream. The catecholamines increase the heart rate and its oxygen consumption, which causes damage to the myocardium. These hormones can also trigger off arrhythmias as they stimulate the heart.
Panic is the ultimate enemy at this time. If you are prepared and have worked on reducing your fear of death, your chances of panicking are minimized. Once you have practised the techniques of self-hypnosis or meditation it is possible to trigger deep states of relaxation in a short time period and this can prevent panic.
INVOLVING YOUR FAMILY
Every member of your family and regular co-worker should know about your medical condition and what to do in an emergency including the principles of cardio-pulmonary resuscitation. If your spouse or grown-up children are knowledgeable about the symptoms, they can help by encouraging you to take action immediately. Many people tend to deny the significance of symptoms. There are times when you could deny the onset of an infarct, playing down the pain sensation and ascribing it to indigestion etc. Aware members of your family or co-workers can cut through such denial and prevent delay in getting aid. Being prepared in advance, they will know what to do, who to call and how to get you to the hospital in the shortest possible time.
Talk to your cardiologist about whom to call in an emergency. Unless your general physician has a portable ECG machine, it might be better to go directly to a nearby hospital. Frequently at hospitals there are no beds available. Enquire as to what would happen if there were no beds available when required in the Intensive Care Unit. It is not uncommon for patients to be sent from one hospital to another. It would be better for your doctor to arrange admission before you leave for the hospital.
It is also a good idea to know the admission requirements at hospitals in the vicinity of your home and office the advance or deposit they need and whether they accept credit cards. These precautions will streamline your admission. You should also find out about ambulance services and the length of time they take to attend to an emergency. Often your specialist or family doctor are not easily accessible either because of having their clinics far away from your home or office. In these cases, it is always practical to see one or two general practitioners in the area for small complaints or to have your blood pressure taken. Otherwise, in an emergency more so at night or during holidays many doctors refuse to accept a new patient.
Lastly, ensure that at all times in the office, at home and on your person you carry a list of emergency telephone number of your general practitioner, cardiologist, ambulance services, hospitals and of course immediate family member. This will help anyone who is with you at the time, to take prompt action. The number, at home or in the office should be easily accessible and displayed either on your tackboard or any other convenient place.
IN THE HOSPITAL
The importance of being calm and relaxed in an emergency must be re-emphasised. You can make the most of a difficult situation by practising your skills of deep relaxation and getting as much rest as possible. Doing something is the best antidote for worry. A good way is to use healing visualisations and to imagine being in a peaceful place. Remember that your beliefs will influence the outcome of your illness. If you feel hopeless or helpless you will get depressed or anxious. So if you notice negative thoughts, diffuse them by disputing them.
Once you go back home after a heart attack your doctor will prescribe certain medication. It is important that you take it regularly, Many patients change the dose or forget. This can be dangerous. Look on medication as a friends rather than an enemy that reminds you of your illness. It is also important that you immediately start on a programme of lifestyle changes. While it may seem difficult at first to change the habits of a lifetime it can be a pleasant challenge.
The first few weeks after a heart attack is an opportune time for one to be able to make the changes much more easily. When it comes to dietary fat most doctor do not go far enough. In all likelihood you will be asked to cut down on fats and lose some weight. Most physicians will prescribe a diet which provides 20 to 30% calories from fat. To reverse coronary artery disease you need to cut this to 10%. Remember the warning that a single high fat meal can cause sludging of blood cells and precipitate another attack. So avoid any large meals that contain a high percentage of fat. If you are overweight you may need to lose weight. Even if you are not, be very careful not to put on any more weight. Weight gain is common after an infarction since physical activity is likely to be reduced and caloric requirements also decrease. If you are not careful the extra calories will be deposited as fat more so, if you have stopped smoking recently. Keep a careful watch over your diet. low fat,low refined sugar and little or no alcohol. Ask your doctor about your return to normal activity and follow his advice. If you smoke then you need to permanently stop NOW. While you may be tempted to have an occasional cigarette, remember that this is how people restart the habit. The human mind has an infinite capacity to fool itself and therefore you need to involve your friends and family in your effort to stop smoking.
Practise your stress management and personality modification techniques religiously Some people procrastinate, telling themselves that they will start next week or after they return to work. You can use the free time to build new healthy habits. So when you return to normal activity, you will have already instituted new habits. This will enable you to get back to work and clear the backlog of work, without feeling pressured.
RETURNING TO WORK
It is important that you return to work after you have rested adequately and your heart muscle has had an opportunity to heal. Initially you will need to take things easy, work for a few hours with plenty of breaks. Learn to delegate, defer and reassign the work to others. Gradually increase the amount of work that you do.
Remember to avoid the Type A trait of trying to slow the world that you are normal now and can do as much as before. It is good for you to get back to work within a few months. Otherwise you may not feel like going back to work at all. The perfectionist trait in some Type A persons causes them to refuse to work if they are not able to function the way they were able to before their illness.
Once you have heart disease you should restrict yourself to walking and mild aerobic exercise. Starting a programme of vigorous exercise soon after a heart attack can be dangerous. Gradually increase the amount of exercise according to your doctor advice. There are people who go on to run a marathon. However, this is undesirable in people who have a competitive attitude or need to slow other that they are invulnerable. There is some evidence to indicate that vigorous exercise is associated with the release of free radicals and could be damaging. It is imperative that you develop the habit of listening to your body. It is a good idea to rest at the first sign of discomfort, tiredness or stress.