What medications should I expect to be on following a heart attack?
Following the acute treatment of a heart attack, which is primarily restoring the blood supply to the heart muscle, a patient is placed on several medications to reduce the chance of another heart attack and reduce mortality.
The standard therapy consists of the use of a beta blocker that has been shown to reduce heart failure and arrhythmias and prevent stretching and dilatation of the heart muscle following a heart attack.
In addition, the patient is expected to be on a statin, which is a cholesterol-lowering medication that has also shown to substantially prevent the chance of another heart attack.The use of blood thinners, such as aspirin and clopidogrel (Plavix), has become standard therapy to also reduce the chance of another cardiac event. The use of an angiotensin-converting enzyme (ACE) inhibitor in patients following a heart attack and reduced left ventricular function is also now a standard to prolong life and reduce the chance of further cardiovascular events.
With the use of a beta blocker, an ACE inhibitor, aspirin, clopidogrel, and a statin, one would expect that the chance of recurrence of a heart attack should be reduced to less than 3% per year on this preventative therapy.
In addition to pharmacologic therapy, the patient will be strongly advised to adhere to strict dietary restrictions, weight control, exercise, and a no-smoking policy. All these changes require significant lifestyle modifications, which at times can be challenging. However, a patient striving for better health and prevention of another heart attack generally adheres to these guidelines.
How important is cardiac rehabilitation after a heart attack or a bypass surgery?
Cardiac rehabilitation in a structured format, with the patient being monitored, has been shown to substantially improve quality of life. Data also suggest an improvement in survival. Cardiac rehabilitation allows patients to gain confidence in their ability to do things, gradually increases their fitness level, and helps them develop a habit to exercise routinely on a long-term basis.
The importance of exercise is mostly in its cardiovascular fitness and conditioning that allows a stronger ability of the body to extract oxygen from the blood, as well as improve the overall efficiency of the heart. A trained and fit individual tends to have a slower heart rate at rest and a lower adrenaline blood level. These are very protective elements overall to the heart.
Cardiac rehabilitation is very strongly recommended to cardiac patients after an angioplasty, a heart attack, or bypass surgery. Many patients see a tremendous improvement in their sense of well-being and an improvement in their depression after a heart attack. This, in itself, also has significant protective effect to their overall health as well as cardiovascular health.
The second phase of cardiac rehabilitation is the outpatient phase that follows a heart attack and is generally monitored under the guidance of cardiac rehabilitation nurses or technicians. The patient is generally placed on a monitor, and different kinds of exercises are encouraged, with close monitoring of the heart rates and the blood pressure,as well as the heart rhythm. A gradual increase in the target heart rate is done under the guidance of the primary cardiologist.
The third phase of cardiac rehabilitation is a less-monitored phase where a person joins a group of heart patients and exercises on a routine basis. Phase III provides significant group support to the heart patient and allows uninterrupted, continued exercise with minimal supervision but with some form of continued guidance.
