Home Monitoring After a Heart Attack

The first weeks at home

After discharge, most people receive a plan covering medicines (often several: antiplatelets, statins, blood pressure and heart-rate medicines, sometimes others), follow-up visits, cardiac rehabilitation and lifestyle advice. Monitoring supports that plan. A hospital discharge summary lists the diagnosis, procedures (such as a stent or bypass), medicines, results and warnings. Keep it with the health record; see keeping a health record at home. For the wider picture, see after a heart attack: recovery at home.

What to monitor and why

Blood pressure and pulse. After a heart attack the doctor aims to protect the heart from strain and to prevent further events. Home readings help judge whether medicines are working and whether blood pressure is too high or too low. Use an upper-arm monitor with the right cuff; see the blood pressure monitor buying guide and how to measure blood pressure at home accurately. A typical request is morning and evening readings for a short period, then fewer checks, but follow your doctor's plan. Targets are individual: commonly the aim is to keep blood pressure below about 130/80 if tolerated, but the cardiologist decides, especially in older adults and those who feel dizzy.

Pulse. Medicines such as beta-blockers deliberately lower the heart rate, so a resting pulse in the 50s or 60s may be expected. Ask the doctor which pulse is too slow or too fast for your parent, and what to do if it is. A new irregular pulse, palpitations, fainting or near fainting should be reported the same day.

Weight. Weight shows fluid. A heart weakened by a heart attack can lead to heart failure, with fluid retention. Daily or regular morning weights, if the doctor advises, help detect it early. See daily weights in heart failure and weighing scales and unplanned weight loss.

Blood sugar. Diabetes is common in people with heart disease. If your parent has diabetes, follow the monitoring plan and targets set by the doctor; see how to test blood sugar at home step by step. Some people develop high sugar after a heart attack; the doctor may test.

Oxygen saturation. Not needed routinely, but the doctor may ask for it if there is breathlessness or heart failure. See pulse oximeters and pulse oximeter accuracy.

Symptoms. More important than any number. Keep a short daily note on chest discomfort, breathlessness, tiredness, swelling, dizziness, palpitations, sleep, appetite and mood.

A suggested daily routine

These are examples to discuss with your doctor:

• Morning: after waking and using the toilet, weigh; sit for five minutes; check blood pressure and pulse; write them down; take medicines as prescribed.
• During the day: gentle walking or exercises as agreed with the rehabilitation team; rest as needed; healthy, low-salt meals; plenty of rest and fluids unless restricted.
• Evening: blood pressure and pulse again if advised; note symptoms; check feet and ankles for swelling.
• Weekly: review the log with the family and plan any questions for the follow-up visit.

Keep the plan simple so that it does not become a burden. Avoid excessive checking, which can raise anxiety and blood pressure; see how often should an older adult check vitals at home.

Medicines and adherence

Taking medicines every day exactly as prescribed is one of the most important things after a heart attack. A pill organiser, a written chart and phone alarms can help. See dementia and medicines: managing safely for routines that also help people without dementia. Never stop, skip or change a medicine on your own, even if your parent feels well or readings look good, and do not add herbal products or painkillers without asking. Some common painkillers can raise blood pressure and strain the heart or kidneys; ask the doctor or pharmacist before using any. If a medicine causes side effects such as dizziness, cough, swelling or bleeding, call the doctor; see medicine side effects families should watch for.

Warning signs: what to do

Call 112 immediately if your parent has:

• Chest pain, pressure, tightness or heaviness that lasts more than a few minutes, comes back or spreads to the arm, jaw, neck, back or stomach.
• Severe breathlessness, or breathlessness at rest.
• Sweating, nausea or vomiting with chest discomfort, or sudden weakness.
• Fainting or near-fainting.
• A very fast or irregular heartbeat with dizziness or chest pain.
• Symptoms like those of the original heart attack.
• Stroke signs: face drooping, arm weakness, speech difficulty.

Do not drive your parent to hospital yourself if an ambulance can come faster; call 112. While waiting, keep your parent seated or semi-reclined and calm, loosen tight clothing, and unlock the door. Ask the cardiologist in advance what they want your parent to do in a chest pain emergency, such as whether to take a particular tablet, including aspirin or a tablet under the tongue, and write the instruction on the first page of the log. Do not give medicines that have not been prescribed to your parent, and tell the ambulance team what was taken. Have the discharge summary and medicine list ready.

Call the doctor the same day if:

• Chest discomfort that is mild, brief or different, even if it passes.
• New or worsening breathlessness, cough, swelling of the legs or abdomen, or weight gain of about a kilogram or two over a few days.
• Dizziness, light-headedness or blood pressure much lower or higher than the agreed range.
• A pulse that is much slower or faster than expected or newly irregular.
• Palpitations, unusual tiredness, poor sleep or new nausea.
• Bleeding or black stools, nosebleeds or easy bruising if on blood-thinning medicines.
• Fever, wound problems after a procedure, or pain, swelling or bleeding at the site where a catheter was inserted.

Cardiac rehabilitation

Cardiac rehabilitation is a structured programme of supervised exercise, education and support, and is strongly recommended after a heart attack. If a centre is not nearby, ask the doctor for a home-based plan. Do not start exercise without the doctor's advice. Walking, at a pace where you can talk but not sing, is a typical start. Stop and rest for chest discomfort, unusual breathlessness, dizziness or palpitations, and tell the doctor. Home readings before and after activity can help the rehabilitation team, if they ask. See fitness and exercise guidance for older adults.

Diet, salt and lifestyle

Cardiologists commonly advise a heart-healthy diet with more vegetables, fruit, whole grains, pulses and nuts, less salt, less fried and processed food, little or no sugary drinks and sweets, and no tobacco or alcohol, adapted to your family's cooking and any other conditions such as diabetes or kidney disease. A dietician can help. Hidden salt in pickles, papad, namkeen and packaged foods is a common issue. If your parent smokes or chews tobacco, stopping is among the most helpful steps; ask the doctor about support.

Mood and sleep

Many people feel low, anxious or irritable after a heart attack. Fear of another event is natural. Depression is common and treatable and can slow recovery. Tell the doctor if your parent seems persistently sad, withdrawn, not sleeping or not interested in rehabilitation. See depression in older adults and anxiety in older adults.

Indian conditions

• Heat and dehydration: very hot weather can strain the heart and lower blood pressure, especially with water tablets; ask the doctor about fluids and activity.
• Power cuts: keep monitors battery-capable and have a plan for night emergencies.
• Distance to hospital: know the nearest hospital with cardiac care and keep the route and phone number handy.
• Festivals and fasting: discuss medicines and meals with the doctor beforehand.
• Family support: a relative should know the emergency plan and where documents are kept.

When to ask a professional

Ask the cardiologist for personal targets for blood pressure, pulse and weight, which symptoms should prompt a call, what to do in a chest pain emergency, when to restart activity and when to return for tests. Ask the pharmacist about interactions and side effects. Ask for a cardiac rehabilitation referral. Call the doctor for new symptoms and 112 for emergencies.