After a Heart Attack: Recovery at Home

What happened and what the hospital should tell you

Before discharge, ask the cardiology team and write down:

• What kind of heart attack, which artery, how much damage, what treatment (clot-busting medicine, angioplasty and stent, bypass surgery, medicines only).
• How well the heart is pumping (ejection fraction from an echocardiogram), and whether there is heart failure or rhythm problems; see heart failure at home and atrial fibrillation and blood thinners.
• The medicine list: what each is for, how long to take it, and which must never be stopped suddenly, particularly those that keep a stent open.
• Restrictions: activity, lifting, driving, bathing, returning to work.
• Wound care for the groin, wrist or chest.
• Follow-up: dates for visits, tests, and the cardiac rehabilitation referral.
• Warning signs and an action plan.
• Who to call, day and night.
• Insurance and paperwork; see health insurance for senior citizens in India.

Medicines: the cornerstone

After a heart attack, people usually take several medicines for long periods or for life: to prevent clots, protect the heart, lower blood pressure and cholesterol, and ease the workload. They work silently, so people often feel they are unnecessary. Stopping them is one of the commonest causes of a second heart attack or stent blockage. This guide names none and gives no doses. Rules for families:

• Take every medicine every day, exactly as prescribed, at the same times.
• Never stop, skip, halve or change any medicine without the cardiologist, even if you feel well, have bruising or a side effect, or cost is a concern. Call first; there are often solutions.
• Medicines to keep a stent open must not be missed, particularly in the first months; if you must have dental work or surgery, tell the dentist or surgeon and ask the cardiologist before any change.
• Use a pill organiser, alarms and a log; see pill organiser guide and medicine reminders for forgetful parents.
• Report side effects: bleeding, black stools, easy bruising, dizziness, fainting, slow pulse, cough, swelling, muscle pain, rash; see medicine side effects families should watch.
• Do not add painkillers, cold remedies, herbal products or supplements without asking; see painkillers and older adults and supplements and medicine interactions.
• Carry the list at all times, and show every doctor and dentist; see emergency contact card and medical summary.
• Plan refills and have a spare supply for travel.

Cardiac rehabilitation

Cardiac rehabilitation is a supervised programme of exercise, education, risk-factor management and emotional support, recommended after a heart attack. It reduces the risk of another event and improves confidence and fitness. Ask the cardiologist to refer you to a programme at a hospital; if none is available, ask for a written home plan, and use tele-rehabilitation where offered. See exercise with heart disease.

Activity at home: gentle and gradual

The doctor's advice for your parent overrides general guidance. Typical principles:

• First days and weeks: rest when tired, but do not stay in bed all day; short walks in the house several times a day, increasing slowly, as the team advises.
• Walking: start with five to ten minutes at an easy pace, once or twice a day, adding a few minutes every few days if no symptoms; see walking programme for older adults. Use the talk test: you should be able to speak in sentences.
• Pace tasks; sit to dress and cook; avoid rushing.
• Avoid: heavy lifting, pushing or pulling, straining on the toilet, carrying heavy buckets, strenuous exercise, extreme heat and cold, until cleared. After open-heart surgery, follow chest precautions for weeks.
• Stairs: slowly, with rests and a rail.
• Stop and rest for chest discomfort, breathlessness, dizziness, palpitations or unusual tiredness; call 112 if it persists (see below).
• Heat: exercise in cool hours; see exercising indoors in Indian summer and monsoon.
• Sexual activity, driving and travel: ask the cardiologist when it is safe; many can resume in a few weeks.
• Work and hobbies: resume gradually.

Food and weight

A heart-healthy diet reduces risk. See nutrition for heart health after 60.

• Cut salt: avoid pickles, papad, packaged foods and added salt.
• Choose healthier fats: less ghee and vanaspati, no deep-fried foods; use small amounts of cooking oil; include fish, nuts and seeds as suits your diet; see omega-3 guide for seniors.
• Eat more vegetables, fruit, pulses and whole grains.
• Limit sugar and refined foods, especially with diabetes; see nutrition for diabetes after 60.
• Keep a healthy weight; weigh weekly; see weighing scale and weight loss in seniors. Older adults who are underweight or frail need adequate nutrition, not a diet; see malnutrition in older adults.
• Limit alcohol, and avoid tobacco in every form.
• Keep hydrated unless fluid is restricted.

Risk factors to control

• Blood pressure: home checks and logs; see hypertension home care guide and how to measure blood pressure at home.
• Cholesterol: regular tests, with medicines as prescribed.
• Diabetes: good control; see diabetes at home after 60.
• Tobacco: stopping smoking or chewing tobacco is the single biggest step; ask for help.
• Stress and sleep: practise relaxation, prayer, hobbies and good sleep; see sleep problems in older adults.
• Pollution: reduce exposure on bad air days; see pollution season plan for seniors.
• Vaccines: flu and pneumonia vaccines as advised; see vaccines for older adults in India.

Emotions after a heart attack

Fear, anxiety, low mood and loss of confidence are very common. People may fear every twinge, avoid activity or feel they are "no longer the same". Depression after a heart attack raises the risk of further problems and is treatable. Encourage conversation, rehabilitation, social contact and a gradual return to normal life. Tell the doctor about persistent low mood, sleeplessness, hopelessness or constant fear; see depression in older adults and anxiety in older adults. Carers also feel frightened; support groups help.

The chest pain plan

Have a clear, written plan, agreed with the cardiologist.

• Know the symptoms of a heart attack, which may differ in older adults, women and people with diabetes: chest pressure, tightness or heaviness; pain spreading to the arm, shoulder, neck, jaw or back; breathlessness; sweating; nausea or vomiting; light-headedness; unusual fatigue; or sometimes only indigestion-like discomfort or breathlessness.
• If symptoms start: stop activity, sit or lie in a comfortable position, call 112 immediately if the pain is severe, lasts more than a few minutes, is not relieved by rest or by the emergency medicine your doctor has prescribed (use only as instructed), or is accompanied by breathlessness, sweating, fainting or nausea. Do not drive yourself. Unlock the door and have someone meet the ambulance. Follow the operator's instructions; do not take extra medicines unless the doctor or emergency service tells you to.
• Tell the ambulance crew the history, medicines and the time symptoms began.
• Do not wait to see if it passes, and do not take it as indigestion if the person has heart disease.

See ambulance and emergency numbers in India. A pendant or watch is useful for those who live alone; see panic pendant buying guide. Keep a medical summary ready; see emergency contact card and medical summary.

Warning signs to report the same day

• Chest discomfort that is new, more frequent or comes on with less effort.
• Increasing breathlessness, needing more pillows, or ankle swelling and weight gain; see heart failure at home.
• Palpitations, fast or irregular pulse.
• Dizziness, fainting or very low pulse.
• Bleeding, black stools, or large bruises.
• Wound redness, swelling, pus or pain at the groin, wrist or chest incision.
• Fever.
• Unusual tiredness.

Family and carers

Learn the warning signs and plan; learn basic life support; attend the first rehabilitation visits; support healthy cooking; encourage but do not over-protect; help with medicines; look after your own health; see caregiver burnout signs and prevention.

When to ask a professional

A cardiologist directs treatment and follow-up. A cardiac rehabilitation team guides exercise. A dietician helps with food. A pharmacist reviews medicines. A counsellor helps with fear and mood. For senior services, call Elderline 14567. In an emergency, call 112.