HEART ATTACK & ANGINA

( By Dr. Natoobhai J.Shah & Dr. Sailesh N. Shah )

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How To Rest, Mobilize And Rehabilitate After Heart Attack

These days one hears and even reads a great deal about the beneficial value of early activity in a heart patient. "Out of bed and back to work soon " is the dictum. Generally speaking, this principle is acceptable. Let the specialist, however, decide this for you, not your well- meaning friends. It is wise to remember that each patient is different from the other.

The speed, degree and quality of recovery will depend on the interplay of a variety of factors which are best studied and understood by the physician.

Some of these factors to be considered are your symptoms, heard sounds, lung sounds, swelling of legs, pulse, heart size, state of blood pressure, diabetes, previous history of heart disease, family history and mental attitude of the patient.

These are some of the guidelines that are used in the assessment concerning the period of rest, activity and exercise. There are some patients in whom physical exercise, in fact, may do more harm than good. Do not compare your heart with someone elseís heart. Mr. Ambalal cannot be like Mr. Banerjee. They are two different individuals.

The suggestions are tentative, and can be modified by your doctor as and when your condition changes. The key words during the first phase is bed rest and the second phase is gradual, steady but progressive mobilization, observing moderation in everything around. Average period of bed rest is for 2 to 3 weeks and similar period is required for convalescence.

After about two or three weeks of bed rest, if the pulse, blood pressure, heart size, heart sounds and the patientís symptoms are satisfactory, and if there is no evidence of weakening of pumping action of the heart, mobilization program can start progressively.

Active sitting in the bed as well as movement in bed may be started in about four to seven days of the uncomplicated attack. If no complications arise at this stage, then getting out of bed and sitting on a chair by the side of the bed, walking in the same room, making use of the bathroom, etc. will be allowed. This phase of slow activity in or around the bed is completed in about two or three weeks. After three weeks of modified bed rest, all the usual necessary activities within the confines of a room will be permitted. For a further period of three weeks, normal gradual activities confined to oneís house will be encouraged. At the end of six weeks from the heart attack, the patient will ordinarily be permitted to go out of the house and instructed to build up his activities. It should be made clear that any undue or uncalled for physical exercise at this stage will not strengthen the heart. The heartís scar, though healed, is still not very firm. It might, on the contrary, lead to a weak, dilated, irregular heart or to repeated attacks of anginal pain. This is not the time to attempt to acquire an "athleteís heart. "

In an uncomplicated case, after first two or three weeks of modified bed rest, the patient should get out of bed more often every day, spend a minute or two every hour walking around in the house and gradually increase the time duration for physical activity. He should sleep or rest for at least ten hours at night and lie down for about one hour after lunch. The major part of the day should be spent in sitting and walking, as mentioned above, rather than lying in bed. The patient should not climb stairs during first few days. Thereafter, he can try climbing stairs, but only if his walking activity has been comfortable.

Activity during the later stages can be gradually increased, assuming that the patient is free from chest pain and shortness of breath. The walks should be of a longer duration and, weather permitting patient can go outside the home. However, extremes in temperature must be avoided. During this period, the worst thing is to overdo activities and the next worst thing is doing too little. Any activity that gives pain in the chest while doing it is to be avoided. Any activity which does not make the patient feel breathless or give him chest pains or which does not make him feel exhausted or fatigued, can be indulged in. It is better to start with five minutes of rather slow walking. The duration and the speed of walking can be increased by two minutes every three days. Walking at a normal pace for a total of 15 to 20 minutes can be achieved in about a monthís time.

During the first month, patient should be examined by his doctor and specific types and levels of activity discussed with him. In general, his return to limited work may begin in about two months after the occurrence of the heart attack. During the latter part of the convalescence period, the amount of activity that you undertake in a day should be less than that which makes you exhausted. It is also desirable that you should be pleasantly tired.

In general, physical activity is beneficial when done in the right dose but can be harmful when overdose. Depending upon a number of factors, such as heart rate, rhythm, heart size, blood pressure, mental attitude etc. different activities are prescribed for each patient. It is advisable never to engage in an activity which gives one chest pain, discomfort, sweating or undue breathlessness. As long as these symptoms are avoided and the physician finds that the patientís heart has normal sounds, size and rhythm, physical activity may be increased.

It would be advantageous if some regular pattern of outdoor exercise is undertaken. Walking, for example, is an excellent exercise and should be gradually increased as the patientís exercise tolerance improves. Other more vigorous activities and sports will depend on his interest, but must be structured by the doctor. The benefits as well as the harmful effects of a given activity are better analysed by a medical man than by well-meaning friends.

Rest and Relaxation Plan for the Future

While the patient should establish a fixed daily routine, he must not forget to take a pause. Sleep or rest every night for nine to ten hours is advisable. Every afternoon, a nap for an hour after lunch should ideally be taken. It is best to avoid telephone calls at this time. The patient should relax if he cannot fall asleep.

All office work should be finished at the place of work and not at home. On reaching home, it is best to get happily involved with family. Also, some hobbies are recommended. Hobbies are the spice of life and will add to oneís vitality. They eliminate boredom and lessen the effect of the monotony of routine work on the nervous system.

Every Sunday, one can try forget the world and relax with family.

Vacations

Vacations are important. Two 15-day vacations in a year can be more rewarding and less boring than a full monthís vacation once a year.


Follow-up

There are no specific rules for follow-up examinations. Each patient Ďs condition creates its own demands. In general, beginning from six weeks after the attack, it is better to have a complete cardiac check-up once every four weeks until the patient is put back on a part-time work schedule. Usually, at the end of two or three months it is better to have a check once every 2 months for about a six month period. Later on, if things are going well, one would need a check-up two or three times a year. Should, however, some symptoms occur, an early out-of-turn check is imperative.

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