Heart Attack - Changi General Hospital

Heart Attack
~
Changi
. I
II General Hosplta
..
Sing Health
The heart is a strong muscular organ ahout the size of a fist. It lies in
the left side of the chest. In a healthy adult at rest, the heart beats about
72 times per minute. It pumps blood filled with oxygen and nutrients
to all parts of the body through thin, elastic tubes called arteries. "Used"
blood from the body is returned back to the heart by veins.
Cholesterol plaque
Reduced blood
flow
Heart muscle
starved for
nutrients
• High cholesterol
High levels of cholesterol and
saturated fats in the blood
cause narrowing of blood
vessels. Narrowed blood
vessels result in reduced blood
supply to the heart.
• Age
The chances of a heart attack
increases with age.
• High blood pressure
Blood pressure is the force of
the blood against blood vessel
walls. High blood pressure
increases the force and
damages the smooth lining of
blood vessels. Cholesterol and
fat tend to deposit along the
damaged walls and cause
narrowing. As a result, the
heart has to pump harder to
push blood through the
narrowed vessels.
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• Diabetes
High sugar level in the blood
hastens narrowing and
thickening of the blood
vessels. This causes a
reduction in the blood flow to
the heart.
• Cigarette smoking
Carbon monoxide and
nicotine in cigarettes deprive
body tissues and makes the
heart work harder. Smoking
also promotes plaque deposits
in the blood vessels and
increases the risk of clot
formation.
• Lack of exercise
Lack of exercise reduces
fitness of the heart. When
your heart is unfit, you are
twice as likely to develop a
heart attack compared to a
healthy, fit person.
• Gender
Men have higher risk of heart
attack than women.
DIABETIC SCREENING
• Overweight
An overweight person is more
likely to get high blood
pressure, high cholesterol and
high blood sugar. All these in
turn increase the risk of heart
attack.
• Hereditary
The chances of you getting a
heart attack are higher if an
immediate member of your
family has a history of heart
disease.
• Stress
The body responds to stress
by producing more stress
hormones. This makes the
heart pumps harder and
faster. This excess hormone
causes the blood vessel to
tighten and become narrower.
....... . . ..
... ...... ..
Pain radiates
• Call 995 for an ambulance immediately.
• Do not drive. If you have no access to a phone to call for an
ambulance, get someone to drive you to the nearest hospital.
You may receive one or more of the following treatment:
• Clot dissolving medications
As part of your treatment, you may be given a clot dissolving
(thrombolytic) medication. Thrombolytic should be given as soon
as the diagnosis of heart attack is confIrmed.
• Coronary Angioplasty
A coronary angiogram is performed by passing a tube into the heart
arteries to view the extent of blockage. Depending on the findings
of the coronary angiogram, a balloon may be used to open up the
blocked artery that is causing the heart attack.
You may be in hospital for up to a week. Below is the outline of the care
plan for you.
Treatment and Monitoring
1
• You will be admitted for close monitoring and
treatment.
• Inform the nurse if you
• Oxygen will be given to ease your breatlllng.
experience chest pain.
• Your heart beat and blood pressure will be
monitored
• Regular blood test and EeGs are carried out.
• Medications will be given to you.
• You will be instructed to fast from midnight
for blood cholesterol test the next day.
2-3
• An ECG is done in the morning.
• You are advised to rest in bed.
• Doctors will check on you and the medications
• Inform the nurse if you
experience chest pain.
are continued
4-6
• Doctors will check you and advise further
tests and management plan
• You will be able to sit out of
bed and start slow walking.
• Medications are continued.
• Do not strain when moving
your bowels. Ask for
medication to soften your
stools. if needed.
• An echocardiogram is done to assess heart
function and extent of muscle damage.
• Inform the nurse if you
experience chest pain.
Discharge
from
Hospital
• Ifyour recovery is satisfactory. you will be
able to go home between day 4-6.
• You should be able to walk
slowly by yourself and do daily
living activities. such as bathing
and eating with minimal
assistance.
Nutrition
• Light diet.
• Light diet.
• The Cardiac Rehabilitation Programme (CRP) Team
comprising, a physiotherapist, a dietitian and an occupational
therapist, will check on you when you are well enough and
pain-free.
• You will learn about the treatment for heart attack, medicines,
suitable types of food and activities, tests and procedures. If
applicable, a smoking cessation counsellor will see you.
• You will be able to eat
food of your choice and
as recommended by the
dietician.
• You will continue to learn about your treatment, diet and
activity. This is also a good time to clarify any doubts about
your treatment programme.
• You will be able to eat
food of your choice and
as recommened by the
dietician.
• You can consult your doctor regarding fitness to resume
work.
• You will be educated on the medications prescribed.
• You will be given an outpatient appointment.
• Cardiac Rehabilitation Programme
This programme teaches you some regular exercise which help to:
a)
b)
c)
d)
e)
increase your endurance level (i.e. stamina)
lower blood pressure and blood cholesterol
relieve stress
control your weight
improve heart functions
You will be monitored by health care professionals when you exercise.
After you have completed the outpatient rehabilitation programme,
you should continue to exercise at home, such as brisk walking. You
can consult your doctor or the physiotherapist about the type of
exercises that you can safely do. Research has shown that regular
physical activity of 30-60 minutes on most day of the week will ease
stress and depression, help control weight, lower blood pressure and
cholesterol level
• Dietary modifications
Avoid food high in cholesterol, saturated fats, trans fats, salt, sugar
and alcohol. Bake, boil or steam your food. Avoid frying. Consume
more fibres, fresh fruits and vegetables.
• Take your medications
Medications are able to improve quality of life, prevent a second
attack and improve survival. Take your medications as prescribed.
Even if you have no symptoms, medications can help your heart
pump more efficiently and lower the risk of complications.
I
The pharmacist will educate you on the medications. It is important
to know the names of your medications, what they are used for, how
often and at what times to take them.
Keep a list of your medications and bring them when you visit any
doctor.
Inform your doctor if you are taking any supplements, vitamins and
over the counter medications.
Talk to your doctor or pharmacist if you have any doubt or problem
regarding your medications. Never stop taking your medications
without fIrst discussing with you doctor
Medications prescribed by your doctor may be used to:
a) relieve chest pain
b) maintain a regular
heartbeat
c) enhance blood flow
through the blood
vessels of the heart
d) lower cholesterol
e) lower blood pressure
On the following page is a list
of medications that you may be
on:
Name of
Medication
Anticoagulants
Warfarin
Coumadin
Prevent
in
sticking together.
Agents
Converting
Enzyme (ACE)
Inhibitors
Angiotensin II
Receptor Blockers
(or Inhibitors)
(Also known as ARBs)
Beta Du""""r.
Blockers
Decreases the clotting ability of the
blood.
Lisino ril
PerinIpril
Ramipril
Candesartan
Losartan
Telmisartan
Valsartan
Bisoprolol
Carvedilol
Metoprolol
Propranolol
Sotalol
resistance to blood flow.
Help the heart to work more efficiently.
Expand blood vessels and decrease
resistance to blood flow.
Help the heart to work more efficiently.
Decrease
oxygen
demand of the heart.
Lower blood pressure and make the
heart beat more slowly.
Diltiazem
Nifedipine
excess water m
Frusemide
through urination.
Hydrochlorothiazide Help to relieve the heart's workload.
Spironolactone
Increases
dinitrate
Isosorbide
mononitrate
nitroglycerin
supply of blood and oxygen to the heart
while reducing its workload.
Digitalis
Preparations
Digoxin
Improve the strength and pumping
action for the heart resulting in better
circulation.
Statins
Cholesterol
lowering drugs
Atorvastatin
Lovastatin
Pravastatin
Simvastatin
Lower cholesterol in your body.
Keep the plaques in your arteries stable
and less likely to cause heart attacks.
Reason for Medication
Precautions and Advice
Prevent harmful clots from
forming in the blood vessels.
May prevent the clots from
becoming larger and causing
more serious problems.
This medication needs to
be monitored closely with
regular blood testing.
Reduce likelihood of clot
formation.
Best to take with food.
Look for increase in
bleeding or bruising.
Treat high blood pressure.
Prevent and treat heart
failure.
Dry-cough
Dizziness
Changes in
taste
Do not take additional
potassium supplements.
Avoid use of salt substitute.
Treat high blood pressure.
Dizziness
Prevent and treat heart failure. Changes in taste
Do not take additional
potassium supplements.
Avoid use of salt substitute.
Treat high blood pressure.
abnormal heart rhythms
and chest pain.
Prevent future heart
attacks and heart failure.
The side effect of tiredness
wears off over time.
Inform your doctor if you
have asthma. fainting or
near fainting spells.
Tiredness
Dizziness
Cold hands and feet
Slow heart beat
Breathlessness
Used to treat high blood
Headache
pressure. chest pain and some Flushing
abnormal heart rhythms.
Dizziness
Palpitations
Swelling of feet
Used to help reduce swelling Nausea
(edema) and excess buildup Muscle cramp
of fluid in the body e.g heart Muscle weakness
Dizziness
failure.
Do not take later than 7pm
to avoid waking in the night
to go to the toilet.
Used to ease chest pain
(angina).
Nitroglycerin tablets are
placed under the tongue for
immediate relief of pain.
Headache
Flushing
Dizziness
Treat heart failure and
some types of irregular
heart beat.
Nausea and vomiting Contact a doctor if any side
Diarrhoea
effect occurs.
Headache
Dizziness
Visual changes
Used to lower LDL ("bad")
cholesterol, raise HDL
("good") cholesterol and
lower triglyceride levels.
This medication must be
monitored to check effectiveness
and how well the liver is
tolerating the medication.
•
Quit cigarette smoking
If you smoke after a heart attack, your chances of having a second
heart attack is doubled. You can quit smoking by gathering support
from family and friends or joining a smoking cessation clinic. You
may contact the following
CGH Smoking Cessation Counselling
Tel: 6850 1889
Health Information Centre (Level 3)
Health Promotion Board (HPB)
3 Second Hospital Avenues
Singapore 168937
Tel: 6435 3954
Fax: 6536 1277
Refer to the following website for the quit smoking services in
Singapore: http://www.hpb.gov.sg/hpb/default.asp?pg_id=2569
•
Learn to relax
You can learn to relax by
a) Deep breathing
Sit or stand with your hands on your
stomach. Breathe in slowly through
your nose and feel your stomach
expand. Breathe out slowly through
pursed lips. Repeat several times.
b) Muscle relaxation
Tighten, then relax one group of
muscles at a time, working up from
your feet to your face. You will notice
that your muscles will feel lighter.
•
Limit Alcohol
Excessive alcohol weakens the heart and can lead to abnormal heart
rhythms and high blood pressure.
I
1. Can I walk or climb stairs?
After your heart attack, you are advised to have adequate rest. You
may start slow walking on flat ground after your discharge from the
hospital and gradually increase your pace and duration of the walk.
You can start stair climbing and uphill walking in the third week and
resume normal activities in about four to six weeks. If you experience
chest pain and shortness of breath while walking, slow down and
stop. Report your symptoms to your doctor.
2. When can I return to work?
This depends on the nature of your work. You can resume work in
4 to 6 weeks if it is not physically demanding. You may need to rest
up to 3 months for a physically active job.
3. When can I return to sports?
If there are no complications, you should be able to participate in
sports after three months.
4. When can I start driving again?
You should be able to drive within three to five weeks after the heart
attack. It would be best ifyou have someone to accompany you during
the initial period. If you drive a commercial vehicle, consult your
doctor first.
5. Can I have sex?
Most people can begin to have sex in about four to six weeks after
a heart attack. If you experience chest pain, you should stop and rest.
6. Is it normal to feel depressed?
Mter a heart attack, it is common to feel a wide range of emotions
for about 2 to 6 months. It is normal to feel depressed, afraid, angry
or even irritated with others. Resentment is common. Should your
emotion interfere with sleeping, eating, self-esteem or if you have
suicidal thoughts, talk to your doctor and those close to you. Do not
be afraid to ask for help as recovery is faster with a trusted support
team of healthcare professionals, family members and friends.
7. Is chest pain normal after a heart attack?
Some patients may have brief light pain or pressure on the chest
typically during or right after exertion, straining or eating a heavy
meal. See a doctor immediately if the chest pain becomes worse over
time or occurs after very little exercise. Make sure you know the
symptom of a heart attack (See page 4). If chest pain is severe, or
worsen 5 minutes after a nitroglycerin under the tongue, call the
ambulance immediately.
8. Can I take dietary supplements?
In general, supplements have not been proven to have any additional
benefit for heart attack patients on regular medications. However
should you be taking them, you can consult this list of common dietary
supplements and their side effects and possible drug interactions. If
you are taking products not listed here, please check with your doctor
or pharmacist.
Pregnant women should not take any of these products without consulting
their doctors
Possible Drug
interactions
Common uses
Coenzyme
Treat heart
failure, angina
and high blood
pressure
Stomach upset,
headache, nausea
and vomiting
Statins
Warfarin
Doxorubicin
Dong Quai
Treat menstrual
disorders
Fever, intestinal
distress, bleeding
Warfarin
Asprin and plavix
Estrogens
Garlic
Lower cbolestrol
Allergic reactions,
rash, bad breath and
body odour, upset
stomach
Warfarin
Asprin and plavix
Ginger
Treat nausea and
vomiting
Do not take if you
have gallstone
problem.
lJpsetstomach, rash
Large doses may
increase effects of
warfarin, asprin and
plavix
Gingko
Treat dementia
and improve
blood flow
Do not take if you
have a seizure
disorder.
Stomach upset,
headaches, allergic
Warfarin, asprin,
nicardipine,plavix
Increase adverse
effect from drugs
that treat depression
QIO
reactions, increased
bleeding after surgery;
increased risk of
selZures
Ginseng
Increase stamina
Insomnia,
headache, low blood
sugar
Diabetic
medications,
digoxin,warfarin
and estrogen
Mild stomach upset
Warfarin
nervousness,
Glucosamine
Relive pain and
improve function
of joints
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1+' I
II II Changi
General Hospital
SingHealth
2 Simei Street 3 Singapore 529889
Tel: 6788 8833 Fax: 6788 0933
www.cgh.com.sg
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