TMC CVC Patient Partnership CENTER FOR PATIENT PARTNERSHIP Empowering our patients to be our partners in the management of their health Note: This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment. If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help. For any questions, please contact any of our accredited physicians. Call the Center for Patient Partnership at 6356789 loc 6444. CARDIOVASCULAR CENTER 2/F, Podium Bldg., Ortigas Ave., Pasig City, Philippines Tel.No. (632) 635-6789 Loc. 6243 or 6244 / (632) 635-9301 E-mail: mail@medicalcity.com.ph www.themedicalcity.com Source: American Heart Association Owned & Operated by Professional Services, Inc. (PSI) Life After Heart Attack
Education Weekly patient and family education classes are provided. They include topics such as nutrition, risk factors for heart disease, cardiac anatomy and the emotional challenges of heart disease. Individual education is also provided to help you optimize your quality of life and attain your individual goals. How do I enter a Phase II/III Cardiac Rehab program Your doctor's approval is usually all that is necessary to enter the program. After the referral is made, the rehab staff can arrange your exercise test (for optimization of the exercise plan), ECG and blood work if necessary. This information, along with your medical history, interests, and rehab goals, will help us develop your individualized program. The goals of your program are incorporated into the ongoing care offered by your referring physician. Following your participation in the rehab program, your risk factors for cardiovascular disease can be managed through the Preventive Cardiology Clinic or your personal physician. These health care professionals proved and monitor individualized lifestyle adjustments including lipid management, nutrition, exercise, smoking cessation and weight loss. How is my primary care provider included in my Cardiac Rehabilitation program Cardiac rehabilitation specialists will closely work with you and your cardiologist to design a program which fits your overall health profile. The Cardiac Rehabilitation Program will focus on helping you reach your target goals on all your risk factors. We will track your progress and report this information to you and your doctor. The Cardiac Rehab staff will refer you back to your regular physician for annual exams, acute episodes of illness and for testing related to other health care problems. Atherosclerosis is a complex process and develops through time. It begins as an injury to the inner protective lining of the artery according to scientists. When this ensues, cholesterol, fats, and other substances in the blood slowly build up in the arterial walls forming a plaque. The diameter of the artery inside becomes small and narrow and impedes blood flow. If a plaque inside the artery ruptures, blood clot develops which blocks the delivery of blood into the heart muscle. This causes heart attack. Blood flow to the heart muscle is shut off causing damage or death of muscle supplied by the segment of the artery that was blocked, which is termed as myocardial infarction. What is sudden cardiac death Sudden cardiac death (cardiac arrest) results from an abrupt loss of heart function. An injured or broken heart is prone to develop irregular rhythms or electrical activity. A life threatening arrhythmia may cause sudden cardiac death. The most common heart rhythm irregularity that is fatal is ventricular fibrillation. In ventricular fibrillation, the lower chamber of the heart, the ventricles beat chaotically and ceases to pump blood. If this very abnormal rhythm is not treated promptly with an electrical shock or defibrillator, sudden cardiac death happens. Unexpectedness is the key aspect to sudden cardiac death. Death occurs within minutes after the heart ceases to pump. It may be reversed with cardio-pulmonary resuscitation (CPR) and defibrillation (giving electrical shocks to the heart) when available to restore normal heart beat. Time is of great value and very essential to sudden cardiac death than for heart attack. Any patient with heart attack is watched closely at intensive or coronary care unit in the hospital so that any potential rhythm 13 2
Why did I not feel any warning that I am having a heart attack Plaque build-up or atherosclerosis often do not present symptoms. Absence of warning signs in an artery that has narrowed may be explained by a process called collateral circulation. This phenomenon happens when nearby arteries (of a blocked vessel) expand to help compensate. A detour is created to re-route blood to the other areas in the heart. It helps protect some patient by helping the heart get the blood it requires. Collateral circulation in some cases, develops after a heart attack and helps muscle to recover. How was my heart injured and how will this affect the way it works When heart attack happens, part of the heart dies because blood supply it shut-off. But the heart is a very strong and resilient organ. The rest of the heart keeps working even if part of it is disabled. As would be expected, after any injury, until the muscle recovers and heal, its effectiveness is reduced. Since heart is muscle, after the heart attack it is weak and cannot contract to pump blood as usual. It needs to be given time to heal. That is why it is important to take every activity gradually. When your heart is fine and your cardiologist signals you to resume activity then you may resume progressively to your lifestyle. A scar forms as your heart undergoes healing. It continues to from after you feel from a heart attack. It usually takes about 4 to 6 weeks for the process to take place. Of course, length of healing depends on extent of injury and your body's rate of healing. And therefore, different activities are prescribed by physicians depending on these factors. What are the different phases of cardiac rehab Cardiac rehabilitation begins in the hospital and continues throughout recovery. There are three phases: Phase I: While in the hospital, the Phase 1 cardiac rehab staff will direct your early activity program. They will teach you about the recovery process and tell you how to reduce your future risk of heart problems. Phase II: Soon after you leave the hospital, you can enter the outpatient Phase II Cardiac Rehab Program. Phase III: is a life long cardiac rehab maintenance program. PROGRAM DESCRIPTION Risk Factor Evaluation Prior to entering Phase II or III Cardiac Rehab programs, your risk factors for cardiovascular disease are evaluated. We will develop a personal plan with you and your family, directed at strategies to decrease your risks and help you maintain a healthy lifestyle. Activity Classes Your activity is designed to help you r e c o v e r f r o m y o u r r e c e n t cardiovascular event or procedure and to help you return to your daily activities, your job and hobbies. Your program will be tailored to your personal needs, abilities and interests. All sessions are medically supervised and are led by nationally certified rehabilitation specialists and nurses. State of the art monitoring equipment and a variety of exercise equipment are available for your safety and convenience. 3 12
One of the best offers you can do for yourself is to get in a cardiac rehabilitation program. Everything you would require to get and stay healthy is in one place, and medical staff is on hand at all times. Rehabilitation can do a lot to speed up recovery and reduce chances of future problems. During your rehabilitation program you will asked to exercise using a treadmill, bike, walk or jog track. You will be monitored by a nurse or another health care professional for a change in symptoms. You will be guided to start slowly, following a safe exercise program that helps you to develop strength over time. Progressively, you will be able to move into a more intensive program that allows you work longer and harder. What is Cardiac Rehabilitation A successful cardiac rehabilitation program promotes optimal lifestyle changes and medical management to: Improve your cardiovascular health Prevent the occurrence and/or progression of cardiovascular disease Reduce the risk of a heart attack, stroke or need for future surgery. Bitterness or resentment is common after a heart attack. You may lose your patience; your friends and family may irritate you. But before you snap them, remember that it is normal to resent a heart attack. Your misfortune is not their fault. Being angry is one stage in your recovery, so accept it. There is no reason to take it out on your loved ones. You may have the blues. You may feel down in the dumps and think you are hopelessly damaged or crippled. You may have thoughts like, What's the use or Life is over. This, too is normal. You may be concerned that you will not be the same person you were before your heart attack. You may be afraid you will not be able to work as hard or be a helpful spouse or parent. You may even think that now it is too late to do all the things you have dreamed of doing. To some extent everyone in your situation feels this way. But try not to expect the worst. Be patient, and give yourself a chance to recover. Finally, you may be worried about sex. Perhaps you think others will think you are weak, incomplete person. Again, your fears are normal, but they are not necessarily true. Most people can continue their same pattern of sexual activity after they recover from heart attack. If this question worries you or your sexual partner, talk to your doctor. If you get angina when you exert during sex, your doctor may prescribe nitroglycerin for you to take before having sexual relations. Your moods will vary widely from day to day, and your thoughts will reflect your moods. Try not to take them seriously. Some symptoms, such as depression or suicidal thought should be taken seriously. If things do start bother you, tell someone you trust how you feel. Do not just pretend nothing is wrong. Time will cure most of your unpleasant feelings, but you do not have to suffer. 9 6
How do family members feel It's likely your heart attack had a big emotional impact on you family also. Like you, they are sacred when your were in the hospital. Now they may be resentful, thinking that your heart attack came at a bad time. This is expected. They are not blaming you even though it may seem like it sometimes It is also common for family members to feel guilty. They may feel they are somehow responsible for doing something that gave you a heart attack. Teenagers, in particular, may feel this way. Talk to them about their feelings and reassure them that even though heart attacks happen suddenly, the conditions that cause them take years to develop. If there are fears and angers in your family, it is better to bring them out into the open. Do not let bad feelings smolder they are destructive. If you think counseling would help your family deal with your heart attack more quickly, ask your doctor or nurse to refer you to a good source for this service. How long will I be depressed Be patient. After a heart attack it is almost impossible not to be scared, or irritable or feel self-pity. In fact it usually takes 2 to 6 months before these feelings fade away completely. Because this is trying time, you and your family and friends need understanding and sympathy. If you are constantly irritable, depressed or drinking heavily, tell your doctor, and follow his or her advice. How do I recognize if I am experiencing serious depression The following are several warning signs that indicate serious depression has ensue: Sleep problems unable to get good sleep or has been sleeping all the time Appetite problems loss of appetite or food does not taste good anymore or both Fatigue no energy or feels tired easily Emotional stress irritable or agitated, listless and apathetic, tense at most times Loss of alertness trouble concentrating Apathy loss of interest in old hobbies or activities Low self esteem feeling of worthlessness or inadequacy Despair having repeated thoughts of death or suicide Sloppiness unkempt appearance, carelessness clean up oneself If you have any of these symptoms, consult with your doctor. He or she can differentiate whether your symptoms are normal, or whether you are going through depression. What kind of physical activity and exercise can I do Most heart attack survivors can take walks, play golf, fish, swim, and enjoy similar activities without problems. Actually, physical activity is healthy and is recommended for most heart attack survivors. However, do not engage in exercise until you first consult with your doctor to find out how much physical activity and exercise is right for you. Your doctor can find the right amount of physical activity for you by giving you special tests on a treadmill, exercise bicycle, or steps. You may be tested in a Cardiac Rehabilitation Unit as part of a program or in your doctor's office. 7 8
Will I still need to rest when I go back to work A reasonable amount of rest is always advised. Leisure and recreation, some sports or physical activity and socialization are as good for you as they are for everyone else. Moreover, doctors recommend and encourage that heart attack survivors to have more physical activity than they do before their attack. Getting a good night's rest is important for everyone, but especially for heart attack survivors. Sometimes a nap or shot rest period during the day is helpful, too. Heart patients should rest before they get too tired. Your doctor can tell you what he or she thinks that will best fit your needs. Most heart attack patients find they have plenty of energy for both work and leisure activities. What feelings are normal after a heart attack After your heart attack you will probably have a wide range of emotions. Three of the most common are fear, anger and depression. Fear may be the most common emotion. If you are like most people, you have probably had thoughts like: am I going to die/ an I living on borrowed time Will my chest pain come back These are troubling thought, but as time passes your worries will go away. Physical symptoms may cause fear too. For instance, before your heart attack, you probably never gave small, fleeting pains a second thought. Now the tiniest twinge in your chest worries you. That is normal. The passing of time will ease these fears too. Who can benefit from Cardiac Rehabilitation Cardiac rehab programs benefit patients who have or are recovering from heart or vascular or procedures, such as: Cardiovascular disease, angina or heart attack (myocardial infarction) Heart surgery: coronary artery bypass graft (CABG), valve repair or replacement, aortic aneurysm repair or replacement, heart transplant, other types of surgery Interventional procedures, such as angioplasty, PTCA, atherectomy, rotoblation, or stents Heart Failure Arrhythmia (abnormal heart rhythm) Hemodynamic disorders, such as syncope Device implants, such as pacemakers or internal defibrillators (ICDs) Other forms of heart or vascular disorders The Cardiac Rehabilitation Program was founded in 1985 and helps to promote the health and wellness of cardiac patients in the hospital and during recovery. Anger is another common emotion. You have probably thought, why did this have to happen to me And why did it have to happen now, at the worst possible time 5 10
What are the goals of cardiac rehab Is heart damage the reason why I feel weak now that I am home The goals of cardiac rehabilitation are to: All patients admitted and who stayed in hospital and in bed feel weak. It is not the damage that has happened to your heart as the only reason. Weakness happens because your skeletal muscles have been inactive and have lost approximately 15% of their strength. Exercise will help regain skeletal muscle strength. That's why there is cardiac rehabilitation and exercise program given to you by your doctor. It usually takes 2 to 6 weeks to get back muscle into shape even if you do regular exercises. Improve your overall heart health Enhance your return to a healthy lifestyle Increase your understanding about your heart or blood vessel disease and treatment Direct you in making the right lifestyle changes to decrease your risk of future cardiovascular problems Increase your ability to perform your job and your daily or recreational activities Dr. Carlos Esguerra Provide you and your family with the Head, Cardiac Rehabilitation support and motivation you need to make important lifestyle changes Who is the Cardiac Rehab clinical team The Cardiac Rehab Team is dedicated to your success. You will work with: Cardiologist Physiatrist Registered physical therapist Registered nurses Registered dietitians These health care professionals proved and monitor individualized lifestyle adjustments including lipid management, nutrition, exercise, smoking cessation and weight loss. 11 What are my chances for leading a normal life again Most heart attack survivors can go back to their previous activities in a few weeks. The scar that has formed is usually not large enough to interfere with heart's ability to pump. It follows then that you do not have to reduce your activities too much, if at all. A little change in lifestyle is encouraged, though. Majority of patients who suffered heart attack survive their first heart attack. Most patients fully recover and enjoy years of fruitful life. When can I go back to work Approximately 88% of heart survivors below 65 years old are able to return to work. Return to work somehow is dependent on two factors: Extent of heart damage or heart attack and the nature of job. Some people consider to switch to a new job that is not as strenous on their heart. Cardiac rehabilitation units are available in many hospitals. Your cardiologists may recommend you to enroll to know how much and what kind of work you can do. For more information about these programs, talk to your doctor. 4
Life After Heart Attack After a heart attack, you and your family members definitely would have a lot of questions. And it is the aim of this booklet to help answer those questions. The more you know about your condition, the better you will feel as it lessens worries and anxieties. There might be questions still that will not be covered in this booklet, and a visit to your doctor is advised since your physician is your best source of information. What could be a more frightening experience than to have a heart attack. It would be expected that even if your cardiologist says you will be fine, you would still be anxious. Statistics in the US show that every year thousands of Americans survive heart attack. Majority of those who have had it go back to work again and keep enjoying life. Be hopeful and confident because you have as the others had, every reason that you will recover. Why did I experience a heart attack Heart attack can happen anytime. It may happen at work, during play or rest. Usually it occurs suddenly but setting is set for these patients for years. Heart attacks starts from fatty build-up in the coronary arteries which carries blood and nutrients to heart muscle, termed as atherosclerosis. What are the benefits of a Cardiac Rehabilitation Program There are many benefits to a cardiac rehab program. Here are some of the results taken from literature: Sedentary lifestyle (lack of exercise) : A 28 percent increase in functional capacity, which mean it will be easier for you to do your daily activities and hobbies! Hypertension (high blood pressure) : A 12 percent decrease in systolic blood pressure (the top number, or the amount of pressure against the artery walls during each contraction of the heart) this means better blood pressure control. Hypercholesterolemia (High Blood Cholesterol) : a 16 percent decrease in LDL ( bad ) cholesterol. Cardiac rehab can also help manage triglycerides and raise HDL ( good ) cholesterol. Diabetes or Impaired fasting glucose: A 46 percent decrease in fasting blood glucose. Cardiac rehab help you control your blood sugars and manage your diabetes. Overweight: An average 2 percent decrease in weight. This, along with increased muscle tone, will help you control your weight, improve your heart health, and look great too! Smoking: 55 percent of recent ex-smokers stayed smokefree throughout the program. The Medical City CardioVascular Center offers a comprehensive and specialized Cardiac rehabilitation Program. We offer a customized program of exercise and education. The goals are to help you regain strength, to prevent your condition from getting worse and to reduce your risk for future heart problems. These can add up to a better QUALITY OF LIFE. 1 (inside front) 14 (inside back)