Coronary Artery Disease (CAD)

Coronary artery disease (CAD) is the number one killer in America. It affects over five million Americans each year. If you have CAD, understanding this disease and its treatment can help you make informed health care decisions. If you are at risk for CAD, learn how to protect yourself from future heart disease events.

Understanding Your Coronary Arteries

Your heart is a muscle that pumps blood to all parts of your body. Like all your organs, it is made of tissue and must be supplied with oxygen-rich blood and nutrients at all times. Although the inside chambers of the heart are full of blood, the heart tissue itself is fed from a network of blood vessels traveling on their surface. These are called coronary arteries.
 
There are three major coronary arteries, two on the left side of the heart that share a common trun, and one on the right side of the heart.  They all branch off from the aorta near the point where the aorta and left ventricle meet. 

• Left main  – main trunk, splits into two branches
• Left anterior descending (LAD) –main artery going down the front of the heart
• Left Circumflex (LCx) –main artery going around the side or back of the heart
• Right coronary artery (RCA) – main artery going to the bottom of the heart
 
These arteries and their branches supply all areas of the heart muscle with blood

What is coronary artery disease?

Coronary artery disease is a narrowing or blockage of the coronary arteries.  It is a gradual process caused by fatty substances in the blood sticking to the inner walls of the arteries .  
When the fatty matter starts to build up, the inner diameter of the artery becomes narrow and blood cannot flow as well as it should. 
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When the blood flow is slowed, the heart doesn't get enough oxygen and nutrients. This usually results in chest pain called angina. When one or more of the coronary arteries are completely blocked, the result is a heart attack (injury to the heart muscle).

What causes the coronary arteries to narrow?

Coronary arteries become narrowed or clogged by plaque build-up in the artery walls. Plaque is made of excessive cholesterol and other substances, such as inflammatory cells, proteins and calcium, that are present in your blood. Over time, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are hard on the outside and soft on the inside. The hard surface can crack or tear, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. The artery narrows further and, in turn, decreases the area for blood to flow through the arteries. Plaque build-up in the arteries is called atherosclerosis (atha-row-skla-row-sis), also known as "hardening of the arteries."

The process of coronary artery disease

• Your coronary arteries are shaped like hollow tubes. Inside, they are smooth and elastic, allowing blood to flow freely.
 
• Coronary artery disease starts when you are very young. Before your teen years, fatty deposits start streaking the blood vessel walls.

• As you get older, the fatty matter builds up. This causes slight injury to your blood vessel walls. In an attempt to heal itself, the cells release chemicals that make the walls stickier. Other substances floating through your bloodstream start sticking to the vessel walls, such as inflammatory cells, proteins and calcium. The fat and other substances combine to form a material called plaque or atherosclerosis. The plaque builds up and narrows the artery.

• A condition called ischemia occurs. This is when the heart muscle becomes starved for oxygen because it’s not getting enough blood. It happens most often at times of peak exertion, like during exercise or stress. When ischemia occurs, you begin to have symptoms (such as angina). When ischemia lasts less than 10 minutes, there is no permanent damage to your heart. You may be told you have "stable coronary artery disease." 

• Over time, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are hard on the outside and soft and mushy on the inside.

• The hard surface can crack or tear, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. The artery narrows further. 

• Sometimes, the blood clot breaks apart by itself, and blood supply is restored. 

• The blocked vessel may develop a collateral circulation: small capillary-like branches of the artery that form over time in response to narrowed coronary arteries. The collaterals "bypass" the area of narrowing and help to restore blood flow. However, during times of increased exertion, the collaterals may not be able to supply enough oxygen-rich blood to the heart muscle.

• In other cases, the blood clot may totally block the blood supply to the heart muscle, called a coronary thrombus or coronary occlusion - causing an acute coronary syndrome.

What are the symptoms of coronary artery disease?

The most common symptom of coronary artery disease is angina or "angina pectoris" - also known as  chest discomfort.

Angina can be described as:

• Discomfort
• Heaviness
• Pressure
• Aching
• Burning
• Fullness
• Squeezing
• painful feeling
• It can be mistaken for indigestion.

Angina is usually felt in the chest, just beneath the sternum (breastbone), but may also be felt in the left shoulder, arms, neck, throat, jaw or back.

Angina usually lasts a minute or two. If you have symptoms that last for more than 5 minutes, SEEK EMERGENCY TREATMENT (CALL 9-1-1) WITHOUT DELAY.

Angina is a symptom of a condition called myocardial ischemia

Other symptoms that can occur with coronary artery disease include:

• shortness of breath
• palpitations (irregular heart beats, skipped beats or a "flip-flop" feeling in your chest)
• a faster heart beat
• weakness or dizziness
• nausea
• perspiration

Silent ischemia:

Ischemia (cramping), and even a heart attack, can occur without any warning symptoms (angina). This is called silent ischemia. This can occur among all patients, though it is more common among diabetics.

What should I do if I have chest pain?

• If angina occurs and you have been prescribed nitroglycerin (a medication):
• Stop what you are doing and rest.
• Take one nitroglycerin tablet and let it dissolve under your tongue, or if using the spray form, spray it under your tongue. Wait 5 minutes.
• If you still have angina, take another dose of nitroglycerin. Wait 5 minutes and if angina is still present, take a third dose.
• If you still have angina after 15 minutes, call for emergency help (dial 911 in most areas) or have someone take you to the local emergency room.
 
Learn to recognize your symptoms and the situations that cause them.

Call your doctor if you begin to have new symptoms or if they become more frequent or severe.

If you have angina that lasts more than 5 minutes - and you DO NOT have a prescription for nitroglycerin - call for emergency help.

If you think you are having a heart attack, DO NOT DELAY. Call for emergency help (dial 911 in most areas). Quick treatment of a heart attack is very important to lessen the amount of damage to your heart. Emergency personnel may tell you to chew an aspirin to break up a possible blood clot, if there is not a medical reason for you not to take aspirin.

Symptoms of coronary artery disease in women:

Studies show that women's symptoms are less likely identified as heart disease related. The symptoms of coronary artery disease and heart attack can be different for women than they are in men. Women are also less likely to recognize the symptoms of a heart attack and seek treatment. By learning and recognizing the symptoms, women can become assertive in their treatment.

The most common symptoms of heart disease in women are:

• Pain or pressure over the chest that travels to the arm or jaw
• A burning sensation in the chest or upper abdomen
• Shortness of breath, irregular heartbeat, dizziness, sweating, fatigue and nausea.

On average, symptoms of heart disease appear 10 years later in women than men. Women tend to have heart attacks 10 years later than men do.

What is ischemia?

When plaque and fatty matter narrow the inside of the artery to a point where it cannot supply enough oxygen-rich blood to the heart muscle, ischemia occurs.

Ischemia of the heart can be compared to a cramp in the leg when one is exercising. When someone exercises for a very long time, the muscles in the legs can become starved for oxygen and nutrients, and a cramp may occur. Your heart, also a muscle, needs oxygen and nutrients to keep working. If its blood supply is inadequate to meet the heart muscle’s needs, ischemia occurs, and you may feel symptoms of heart disease. This is called a supply-demand mismatch.

Ischemia is most likely to occur when the heart demands extra oxygen. This is most common during one or more of the four E’s:

• Exertion (activity)
• Eating
• Excitement
• Exposure to cold

Three types of angina

• Stable angina
• Unstable angina
• Variant angina (coronary spasm)

Stable angina: A type of angina brought on by an imbalance between the heart’s need for oxygen-rich blood and the amount available. It is "stable," which means the same activities bring it on; it feels the same way each time; and is relieved by rest and/or oral medications. Stable angina is a warning sign of heart disease and should be evaluated by a doctor. If the pattern of angina changes, it may progress to unstable angina.

Unstable angina: This type of angina is considered an acute coronary syndrome. It may be a new symptom or a change from stable angina. The angina may occur more frequently, occur more easily at rest, feel more severe, or last longer. Although this angina can often be relieved with oral medications, it is unstable and may progress to a heart attack. Usually more intense medical treatment or a procedure is required. Unstable angina is an acute coronary syndrome and should be treated as an emergency.

Variant angina (also called Prinzmetal's angina or coronary spasm): A coronary artery can go into spasm,disrupting blood flow to the heart muscle (ischemia). It can occur in people without significant coronary artery disease. However, two thirds of people with variant angina have severe disease in at least one vessel, and the spasm occurs at the site of blockage. This type of angina is not common and almost always occurs when a person is at rest - during sleep. You are at increased risk for coronary spasm if you have: underlying coronary artery disease, smoke, or use stimulants or illicit drugs (such as cocaine). If a coronary artery spasm is severe and occurs for a long period of time, a heart attack can occur.
 
Acute Coronary Syndrome is a name given to three types of coronary artery disease that are associated with sudden rupture of plaque inside the coronary artery:

• unstable angina
• non-Q wave MI (myocardial infarction or heart attack)
• Q wave MI (heart attack)

The length of time that blood flow is blocked and the amount of damage that occurs determines the type of acute coronary syndrome. An acute coronary syndrome can be caused by a small plaque, not necessarily detected by stress testing or cardiac catheterization. Prior symptoms may or may not be present. These life-threatening conditions require emergency medical care.

What is collateral circulation?

Collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. When the coronary arteries narrow to the point that blood flow to the heart muscle is limited (coronary artery disease), collateral vessels may enlarge and become active. This allows blood to flow around the blocked artery to another artery nearby or to the same artery past the blockage, protecting the heart tissue from injury.

What should you do if you have coronary heart disease?

When you have coronary artery disease, it is important to take care of your heart. This is especially true if you have had an interventional procedure or surgery to improve blood flow to the heart. Procedures do not cure coronary artery disease. It is up to you to take steps to stop the disease from progressing.

1. Know the symptoms for coronary artery disease

• Chest discomfort (described as numbness, heaviness, dull aching, or burning; may radiate to left shoulder, arms neck, back or jaw)
• Shortness of breath
• Palpitations (a fluttering feeling, skipped beats)
• Faster heart rate
• Dizziness
• Nausea
• Extreme weakness

Call your doctor if symptoms become more frequent or severe.

Call for emergency assistance if rest and/or medications do not relieve symptoms within 15 minutes. DO NOT WAIT TO GET HELP.

2. Reduce your risk factors

Medical research has helped identify certain conditions, called risk factors, which place people at increased risk for heart disease.

Non-modifiable risk factors (those that cannot be changed)

• Male
• Older age - Heart disease is more likely to occur, as you get older.
• Family history (including race)

Modifiable risk factors (those you can control)

• Cigarette smoking
• High blood cholesterol
• High blood pressure
• Uncontrolled diabetes
• Physical inactivity
• Obesity or overweight 
• Uncontrolled stress or anger
• Diet high in saturated fat and cholesterol
• Drinking too much alcohol

If you have more than two of the risk factors listed, you should discuss your risk factors with your doctor. Your goal is to decrease your risk factors and lessen your risk for future heart disease events. This is true if you do not have heart or blood vessel disease, if you are being treated medically for heart or blood vessel disease, or you have undergone a procedure (angioplasty, stents, bypass surgery) for heart or blood vessel disease.

3. Take your medications

Medications are used to control your symptoms and help your heart work more efficiently. Follow your doctor's instructions when you take your medications.

It is important to know:

• The names of your medications
• What they are for
• How often and at what times to take your medications
• Keep a list of your medications and bring them to each of your doctor visits. If you have questions about your medications, ask your doctor or pharmacist.

4. Have procedures or surgery – if necessary

Invasive procedures (such as balloon angioplasty or stents) or coronary artery bypass surgery may be needed to treat your narrowed or blocked artery.  These procedures increase blood supply to your heart but they are not a cure for coronary artery disease.  You will still need to focus on reducing your risk factors to prevent future disease development or progression.  If these procedures are or have been necessary, your cardiologist or surgeon will discuss the specific procedure with you. 

5. See your cardiologist for regular visits

Schedule regular appointments with your cardiologist (even if you have no symptoms). Your appointments may be spaced once a year, or more often, if your doctor feels you need to be followed more closely. Your appointments should include a medical exam and diagnostic studies (such as an electrocardiogram).
Call your doctor sooner if your symptoms worsen or become more severe or frequent
How is coronary artery disease diagnosed?

Your cardiologist (heart doctor) can tell if you have coronary artery disease by

• talking to you about your symptoms, medical history, and risk factors
• performing a physical exam
• performing diagnostic tests

These tests help your cardiologist evaluate the extent of your coronary artery disease, its effect on the function of your heart, and the best form of treatment for you.

They may include:

• Electrocardiogram
• Stress Tests
• Cardiac Catheterization (cardiac cath or angiogram)
• Radionuclide Scans
• Radiographic Tests
• Intravascular Ultrasound
• Echocardiogram

For more information about any of these tests click on the test

MYOCARDIAL INFARCTION

What is a heart attack?

The heart muscle requires a constant supply of oxygen-rich blood. The c oronary arteries provide the heart with blood.

If you have coronary artery disease, the inside of your coronary arteries may look like this:
 
Plaques (made of fatty matter, calcium, and stray cells) of different sizes attach to the walls of the arteries. Many of the plaques are hard on the outside and soft and mushy on the inside. The plaque builds up and narrows the artery. 

When the plaque’s hard, outer shell ruptures (cracks or tears), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque.
If a blood clot totally blocks the artery, the heart muscle becomes "starved" for oxygen and nutrients (called ischemia) in the region below the blockage.

Within a short time, death of heart muscle cells occur, causing permanent damage.

This is called a myocardial infarction (MI) or heart attack.  
 
A heart attack can also occur less frequently by a spasm of a coronary artery.

During coronary spasm, the coronary arteries constrict or spasm on and off, causing lack of blood supply to the heart muscle (ischemia).

It may occur at rest and can even occur in people without significant coronary artery disease. If coronary artery spasm occurs for a long period of time, a heart attack can occur. 

                           

The amount of damage to the heart muscle depends on the size of the area supplied by the blocked artery and the time between injury and treatment.

Quick treatment to open the blocked artery is essential to lessen the amount of damage.

Healing of the heart muscle begins soon after a heart attack and takes about 8 weeks. Just like a skin wound, the heart’s wound heals and a scar will form in the damaged area. The new scar tissue does not contract or pump as well as healthy heart muscle tissue. So, the heart’s pumping ability is lessened. The amount of lost pumping ability depends on the size and location of the scar.

Are there different types of heart attacks?

The location of the blockage, the length of time the blockage persisted and the amount of damage will determine the type of heart attack that occurs.

Non-Q-wave MI: a MI or heart attack that does not cause changes on the electrocardiogram (ECG) however, chemical markers in the blood indicate that damage has occurred to the heart muscle. In non-Q-wave MI, a clot may block the coronary artery for a period of time, and then break up by itself or collateral circulation may help to restore blood flow to the area of ischemia (lack of blood supply). The size of damage is fairly small; therefore, overall function of the heart is usually maintained.

Q-wave MI: a MI or heart attack that is caused by a prolonged period of blocked blood supply. A large area of the heart muscle is affected, causing changes on the ECG as well as chemical markers in the blood.

Terms associated with a heart attack:

Stunned myocardium: If blood flow is returned to an area of heart muscle after a period of ischemia (lack of blood supply), the heart muscle may not pump normally for a period of days following the event. This is called "stunned" heart muscle or myocardium.

Hibernating myocardium: After a heart attack, some areas of heart muscle do not pump as they should. Some areas will have permanent damage. Other areas are able to return to their normal function if blood flow is returned to that area (by medications or a procedure). Hibernating myocardium is heart muscle that is "resting" and may possibly return to normal function.

Unstable angina: This type of angina is considered an acute coronary syndrome. It may be a new symptom or a change from stable angina. It may come more often, occur at rest, or feel more severe. Although this angina can be relieved with oral medications, it is unstable and may progress to a heart attack. Usually medical treatment or a procedure is required in the near future.

What are the symptoms of a heart attack?

Ask your doctor about your risk of heart attack and how to reduce this risk.

Share this information with your family members and caregivers so they learn to recognize the symptoms of a heart attack and when to help you seek emergency treatment.

If you are having any one of the symptoms described below that lasts for more than 5 minutes, SEEK EMERGENCY TREATMENT (CALL 9-1-1) WITHOUT DELAY. These symptoms could be the signs of a heart attack and immediate treatment is essential.

Symptoms of a heart attack include:

• Chest pain or discomfort in the center of the chest; a “squeezing,” heaviness” or “crushing” feeling that lasts for more than a few minutes or goes away and comes back
• Pain or discomfort in other areas of the upper body including the arms, back, neck, jaw, or stomach
• Difficulty breathing, shortness of breath
• Sweating or “cold sweat”
• Fullness, indigestion, or choking feeling (may feel like “heartburn”)
• Nausea or vomiting
• Light-headedness
• Extreme weakness or anxiety
• Rapid or irregular heart beats
• Do not wait for your symptoms to “go away.” Early recognition and treatment of heart attack symptoms can reduce the risk of heart damage and allow treatment to be started immediately. Even if you’re not sure your symptoms are those of a heart attack, you should still be evaluated.

Some people have a heart attack without having any symptoms (a "silent" myocardial infarction). A silent MI can occur among all patients, though it is more common among diabetics. If you have a silent MI, your heart attack may be diagnosed during a routine doctor’s exam.

The best time to treat a heart attack is within the first one to two hours from the first onset of symptoms. Studies show that the people who have symptoms of a heart attack often delay, or wait to seek treatment, for longer than seven hours.

People who delay tend to be older, female, African-American and to have a history of angina, high blood pressure or diabetes.

Waiting just a couple hours for medical help may limit your treatment options, increase the amount of damage to your heart muscle, and reduce your chance of survival.

Know in advance: 

• The symptoms of a heart attack.
• Who to call for emergency help. Do not call a friend or family member. Call for an ambulance to take you to the nearest emergency room ( Dial 911 in most areas).
• Treat all chest discomfort as angina or a heart attack unless your doctor has told you otherwise.

Treatments (medications, open heart surgery and interventional procedures) do not cure coronary artery disease. Having had a heart attack or treatment does not mean you will never have another heart attack; It CAN happen again.

How is a heart attack diagnosed?

Once the emergency care team arrives, they will ask you about your symptoms and begin to evaluate you. The diagnosis of the heart attack is based on your symptoms, ECG and the results of your blood studies. The goal of treatment is to treat you quickly and limit heart muscle damage.

• 12-lead ECG

The 12-lead ECG (also known as EKG or electrocardiogram) can help to tell how much damage has happened to your heart muscle and where it has occurred.

            

In addition, your heart rate and rhythm can be watched. You will also be connected with leads (wires) to a bedside monitor for continuous monitoring of your heart rate and rhythm.

• Blood studies

Blood may be drawn to measure levels of biochemical markers. These markers are found inside your body's cells and are needed for their function. When your heart muscle cells are injured, their contents --including the markers -- are released into your bloodstream. By measuring the levels of these markers, the doctor can determine the size of the heart attack and approximately when the heart attack started. Other blood tests may also be performed.

Other tests/procedures that may be done during the early stages of an MI:

• Echocardiography (echo)

Echo can be used during and after a heart attack to learn about how the heart is pumping and identify what areas are not pumping normally. The echo is also valuable to see if any structures of the heart (valves, septum, etc.) have been injured during the heart attack.

• Cardiac catheterization (cath)

Cardiac (cath) may be performed during the first hours of a heart attack if medications are not relieving the ischemia or symptoms. The cardiac cath can be used to directly visualize the blocked artery and guide the choice for which procedure (such as angioplasty, stent placement or coronary artery bypass surgery) may follow.

How is a heart attack treated?

Once your heart attack is diagnosed, your treatment begins immediately -- possibly right in the ambulance or emergency department.

• Medications

• Thrombolytic medications are used to break up clots blocking the artery 
  The knowledge gained in the past years regarding acute coronary syndromes and what happens in the artery during a heart attack has helped guide medical treatment. The goals of medication therapy are to break up or prevent blood clots, prevent platelets from gathering and sticking to the plaque, stabilize the plaque, and prevent further ischemia,

These medications must be given as soon as possible (within one to two hours from the start of your heart attack) to decrease the amount of damage. The longer the delay in starting these drugs, the more damage that occurs and the less benefit they can provide.

Mediations for this purpose may include:

• aspirin
• heparin
• thrombolytic therapy ("clot busters")
• other antiplatelet drugs
• any combination of the above
• Other drugs, given during or after a heart attack lessen your heart's work, improve the functioning of the heart, widen or dilate your blood vessels, decrease your pain, and guard against any life-threatening heart rhythms. Your doctor will prescribe the appropriate medications for you.

• Interventional procedures

During or shortly after a heart attack, you may go to the cardiac catheterization laboratory to directly evaluate the status of your heart, arteries and the amount of heart damage. In some cases, procedures (such as angioplasty or stents) are used to open up your narrowed or blocked arteries.

These procedures may be combined with thrombolytic therapy to open up the narrowed arteries, as well as to break up any clots that are blocking them. Click here to learn more about interventional procedures

• Coronary artery bypass surgery

If necessary, bypass surgery may be performed to restore the heart muscle's supply of blood. Click here to learn more about coronary artery bypass surgery

What can I expect after a heart attack?

Returning home after a heart attack can be frightening. Keep in mind it takes about two months for your heart to heal. 

 Activity

The first week you return home, you may feel tired or weak. This is because of the damage to your heart muscle and the bedrest you had in the hospital.

For the first few weeks:

•  
  • Get dressed each morning. You should be able to take care of all your personal hygiene (bathing, shaving, dressing).
  • Pace yourself. Spread your activities throughout the day. If you become tired, rest and schedule unfinished activities for another day.
  • You may climb stairs at home as part of your daily activity, unless your doctor told you not to. Try to arrange your activities so that you do not have to climb up and down stairs several times during the day.
  • Walk every day as prescribed by your doctor. A regular walking program is a good way to regain your energy. Ask your doctor about the right amount of exercise for you.
  • When you feel stronger, you may return to light household chores, such as folding clothes, cooking, light gardening, dusting and washing dishes.
  • Do not lift, push or pull very heavy objects until your doctor tells you that you may resume these activities.
  • Your doctor will advise you as to when you can return to work, drive a car and begin more vigorous activities

Feelings after a heart attack

About one fourth of patients after a heart attack feel depressed, angry and afraid. These are normal responses that usually go away with time, as you get back to your regular activities. To help relieve the emotional blues:

• Get up and get dressed every day. Do not stay in bed all day
• Get out and walk daily. Daily activity will help you have a healthy mind and body.
• Resume hobbies and social activities you enjoy.
• Share your feelings with your family, a friend, a clergyman, or support group
• Get a good night's sleep. Lack of sleep can cause you to feel tired or irritable. Be careful not to nap too much during the day, or you will not be able to sleep at night.
• Limit visits with friends and family at first, to avoid feeling over-tired. Increase them depending on how you feel. With time, these visits can be helpful to lift your spirits.
• Join a cardiac rehabilitation program – emotional support is just one benefit to a guided activity & education program.
• If you have questions, ask your health care team! You can avoid much stress for yourself and your family if you know about your heart disease and what you can and cannot do.
• If you do not feel like your emotions are improving or you are concerned about feeling of depressed call your doctor. Medications and counseling is available to help you through this time.

Diet

Eating a heart healthy diet is very important to prevent future complications of heart disease. Six strategies to reduce coronary artery disease include:

• Eat more vegetables, fruits, whole grains, and legumes
• Choose fat calories wisely
• Eat a variety, and just the right amount of protein foods
• Limit dietary cholesterol
• Use complex carbohydrates for energy, and limit the intake of simple carbohydrates
• Place less emphasis on sodium and increase your intake of potassium, magnesium and calcium

Sexual activity

Sexual activity can usually be resumed shortly after leaving the hospital. The amount of energy it requires to perform intercourse with a spouse or regular partner is similar to climbing about one or two flights of stairs or walking about one-half mile (0.8 km) at a brisk pace. If you cannot perform these activities without getting angina, short of breath, or becoming over-tired, please discuss this with your doctor before resuming sexual activity.

Keep in mind that a sexual relationship has both physical and emotional aspects

•  
  • Talk openly with your partner 
  •  Have sex when you are rested and physically comfortable 
  •  Be caring, honest and loving with each other
  • Anxiety on the part of either partner, as well as some medications, may interfere with sexual arousal and performance. So discuss any difficulties with your doctor.

How you can prevent heart attack from occurring in the future

Following a heart attack, the goal is to keep your heart healthy and reduce your risks, to prevent future damage to your heart.

•  
  • Take your medications
  • Change your lifestyle
  • See you doctor for regular heart checkups

Take your medications

Medications are prescribed after a heart attack to

• prevent future blood clots 
• lessen the work of your heart and improve your heart’s performance and recovery
• lower cholesterol
• Other medications may be prescribed if needed. These include medications to treat irregular heartbeats, lower blood pressure, control angina (chest discomfort) and treat heart failure.

It is important to know:

•  the names of your medications
• what they are for
•  how often and at what times to take hem.
• Your doctor or nurse should review your medications with you. Keep a list of your medications and bring them to each of your doctor visits. If you have questions about your medications, ask your doctor or pharmacist.

Change your lifestyle

There is no cure for coronary artery disease. In order to prevent the progression of this disease, you must follow your doctor's advice and make necessary lifestyle changes:

• Stop Smoking : Smoking is directly related to an increased risk of heart attack and its complications.

• Lower high blood cholesterol : A high-fat diet can contribute to increased fat in your blood. Follow a low-fat, low-cholesterol eating plan. When proper eating does not control cholesterol levels, medication is prescribed. A registered dietitian is a good source for dietary information.

• Control high blood pressure:High blood pressure can damage the lining of your coronary arteries and lead to coronary artery disease. A healthy diet, exercise, medications, and controlling sodium in your diet can help control high blood pressure.

• Maintain tight diabetes control:High blood sugars are linked to the progression of coronary artery disease. If you have diabetes, it is important to control high blood sugar through diet, exercise, and medications.

• Follow a regular exercise plan: A regular exercise program helps to regain or maintain your energy level, lower cholesterol, manage weight, control diabetes, and relieve stress. Check with your doctor first before beginning an exercise program.

• Achieve and maintain your ideal body weight : Obesity is defined as being very overweight (greater than 25 percent body fat for men or 30 percent body fat for women). When you are obese, your heart work harder, and you are at an increased risk of high blood pressure, high cholesterol, and diabetes. A healthy diet and exercise program aimed at weight loss can help improve your health.

• Control Stress and Anger : Uncontrolled stress or anger is linked to increased coronary artery disease risk. You may need to learn skills such as time management, relaxation, or yoga to help lower your stress level.

Cardiac Rehabilitation

After a heart attack, a cardiac rehabilitation program provides a medically supervised setting to help you recover from your heart attack, learn about heart disease, and learn strategies to change your lifestyle to prevent further progression of your disease. Click here to learn more about cardiac rehabilitation

See you doctor for regular heart check-ups

Make a doctor's appointment four to six weeks after you leave the hospital. Your doctor will want to check the progress of your recovery.

Your doctor may ask you to undergo diagnostic tests (such as exercise or pharmacological stress tests or cardiac catheterization) at regular intervals. These tests can help detect the presence or progression of blockages in your coronary arteries and help your doctor plan appropriate treatment.

Call your doctor sooner if you have any of the following symptoms:

• angina that becomes more frequent, increases in intensity, lasts longer, or spreads to other areas
• shortness of breath, especially at rest
• dizziness
• irregular heartbeats.

What should you do if you have angina?

Angina can be described as discomfort, pressure, heaviness or pain in the chest, back, jaw, throat or arm, or as a fullness, indigestion or choking feeling. Symptoms vary from person to person, but they are usually consistent for each individual.

Treat angina symptoms quickly

• If angina occurs:

• Stop what you are doing and rest
• If you have been prescribed nitroglycerin (a medication), take one tablet and place it under your tongue (it must dissolve under your tongue) or spray nitroglycerin into your mouth, under your tongue. Wait five minutes.
• If you still have angina, take another dose of nitroglycerin. Wait five minutes and if angina is still present, take a third dose.
• If you still have angina after resting and taking three doses of nitroglycerin within 15 minutes, get immediate attention. Call for emergency help (dial 911 in most areas) or have someone take you to the local emergency room.
• If you suspect you are having a heart attack, DO NOT DELAY . Call for emergency help (Dial 911 in most areas). Consider taking an aspirin. Quick treatment of a heart attack is very important to lessen the amount of damage to your heart.
• Do not drive yourself to the hospital. Call for emergency medical help. When the ambulance arrives, the emergency personnel can begin to administer  heart-saving care including an IV, certain important drugs, and oxygen to help improve the flow of oxygen-rich blood to your heart. Should problems occur, they are there to provide life-saving help as well.
• Remember: carry nitroglycerin with you at all times.
  • Nitroglycerin comes in tablet or spray forms.
  • Nitroglycerin must be kept in a dark container.
  • Keep it away from heat and moisture.
  • Check the expiration date on the container.
  • Once the container of nitroglycerin is opened, it must be replaced every six months