CONTENTS:
- Structure and function of your heart
- Coronary arteries
- What causes arteries to narrow?
- Angina
- Heart Attack
- How is a heart attack diagnosed?
- Treatment for a heart attack and angina
- Emotional reactions
- Risk factors
- Methods to help control high blood pressure
- Methods to reduce cholesterol
- Exercise and physical activity
- Exercise in hospital
- Exercise at home
- Home walking instructions
- Things to remember
- Resuming daily activities
- Methods to reduce stress
- Medications
- Contacts
1. Structure and function of your heart
The top chambers are known as atria, and connect to the lower chambers - the ventricles.
which direct the flow of blood within the heart.
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2. Coronary arteries
which branch off from the aorta.
the left anterior descending artery and the circumflex artery.
The left coronary artery supplies the majority of the left ventricle with oxygen and blood.
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3. What causes arteries to narrow?
This roughens and narrows the inside of the artery reducing blood flow.
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4. Angina
Angina is temporary pain/discomfort arising from the heart muscle when it is not getting enough oxygen and blood.
It is a warning sign and at this point no damage has occurred to the heart muscle.
Location of pain/discomfort
or both shoulders/arms/hands, to the jaw, neck and upper back.
shortness of breath and reduced exercise tolerance.
Click here for information on the management of chest pain at home.
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5. Heart Attack
A heart attack is usually a sudden increase of chest pain/discomfort that occurs when the blood supply to an area of the heart muscle has been blocked. In the majority of cases, blood supply is blocked off by a blood clot lodging on a fatty plaque. Other known causes of heart attack include spasm of the coronary arteries and trauma to the chest.
A heart attack causes permanent muscle damage.
A scar will form within a few days and the healing process takes 6-8 weeks.
Depending on the size of the heart attack, the heart's ability to pump blood can be affected.
Location of pain/discomfort
shoulders/arms/hands, to the jaw, neck and upper back.
REMEMBER
Any pain/discomfort is a message from your heart to be taken seriously.
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6. How is a heart attack diagnosed?
When a heart attack is suspected, it is diagnosed and confirmed by the following methods:
These levels are an indication of the extent of heart muscle damage.
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7. Treatment for a heart attack and angina
There are a variety of ways to treat your pain/discomfort, some of which may have been started in the ambulance.
Oxygen therapy increases oxygen in the blood and will help ease the chest pain.
In hospital a continuous supply of nitrates can be delivered via a drip.
Nitrates help ease or prevent the pain by dilating the arteries and allowing more blood and oxygen to the heart muscle.
Morphine relieves chest pain and helps ease your anxiety.
It can be given through the drip or as an injection into your stomach.
blood clot which has caused the blockage in the artery.
your heart and treat risk factors.
Your Cardiologist may also insert a stent that will help support the artery wall.
If an angioplasty is performed during a heart attack it will reduce the amount of heart muscle damaged.
For patients with angina, an angioplasty may be performed (if required) during your hospital stay.
Or it may be performed as an elective procedure.
so any changes can be detected and treated promptly.
until the results of your blood test are available.
If your blood test results are normal and you have experienced no further pain/discomfort, you will be encouraged to resume normal activities.
If your blood test results indicate a heart attack, you will be required to rest in bed for 24 hours. Your cardiologist will then advise you when to resume normal activities.
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8. Emotional reactions
Following your heart event, there are a number of emotional reactions you may experience.
These include:
It is also normal to worry about things such as:
It is also common for your family to have similar concerns.
The best way to deal with these important issues is to talk about them.
In hospital - let your doctor or nurse know how you feel. If required, they can refer you to the appropriate personnel (cardiac rehabilitation team, social worker or Heart Support Australia) for additional support.
When you return home - let your family, local doctor or Cardiologist know of any ongoing concerns.
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9. Risk factors
Research has identified risk factors that can increase your chance of developing and/or increase the progression of heart disease. The more risk factors a person has, the greater their risk. Research has also proven that changing your risk factors by medication and lifestyle/behaviour change reduces your likelihood of having further heart problems.
Risk factors for heart disease can be divided into two categories - those that can be altered by a change in lifestyle and those that can not be altered.
SEX - if you are male, your chance of developing heart disease is greater than if you are female. However, after menopause, a woman's risk for heart disease becomes equal to that of men.
AGE - the older you are, the greater the risk of developing heart disease.
FAMILY HISTORY - if a close relative has developed heart disease at an age less than 60 years, your risk of heart disease is increased (if you have heart disease, members of your family also may be at higher risk).
DIABETES - diabetes increases the risk of heart disease.
SMOKING - is the biggest risk factor for heart disease. Cigarette smoke contains nearly 4000 different substances, the three most harmful being nicotine, carbon monoxide and tar.
It increases your heart rate and blood pressure.
This increases the workload on the heart and the oxygen it requires.
This happens every time you smoke and lasts for up to two hours.
in the blood and because of this the heart beats faster.
making them unable to function properly.
Smoking contributes to the development of atherosclerosis and causes your blood vessels (including the blood vessels of the heart) to constrict.
Smoking also increases the chances of developing blood clots.
The good news about nicotine addiction is that after three to five days of quitting, the nicotine and its by-products are out of your system. Therefore while you have been in hospital, you have already been getting over your nicotine addiction.
If you quit smoking, you reduce the risk of having another heart event by 50 per cent or more. It improves your ability to exercise and increases your chance of surviving your heart condition.
Quit smoking resources are readily available.
The Quit line phone number is 13 18 48.
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High Blood Pressure (Hypertension)
Blood pressure is the pressure the blood exerts against the walls of blood vessels. This is an indication of how hard your heart has to work. The higher the blood pressure, the harder the heart is working. If high blood pressure is not treated, the heart may weaken due to the constant extra demand and it will not be able to work as efficiently.
Systolic - blood pressure (the top number) is the pressure when the heart is contracting.
Diastolic - blood pressure (the bottom number) is the pressure when the heart is resting.
The followng figures are the National Heart Foundatin guidelines for blood pressure.
| Normal BP | Less than (<) 130/85 |
| Normal - High BP | 130/85 - 140/90 |
| High | Greater than (>) 140/90 |
| Very High | > 180/110 |
10. Methods to help control high blood pressure (hypertension)
- No added salt
- Low saturated fat intake, as this helps reduce weight
- Limit caffeine intake to two to three drinks per day
- Limit alcohol to one to two drinks per day
REMEMBER: High blood pressure usually has no warning symptoms. This is why you must have regular blood pressure checks with you local doctor.
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Cholesterol
Research has proven a direct link between high cholesterol levels and the development of atherosclerosis. The higher the cholesterol level, the higher the risk.
Cholesterol is a fatty substance produced naturally by the body and found in our blood. It is used for building cell walls, making bile acids used for digestion and making hormones.
Extra cholesterol comes from eating too much saturated fat and your family history also plays a part.
The National Heart Foundation recommends a total blood cholesterol less than 4.0mmol/l, however, this is something you should discuss with your Cardiologist or local doctor.
There are three components to cholesterol - 'the good', 'the bad' and 'the ugly'.
HDLs: HDLs are the 'good cholesterol'.
They transport excess cholesterol from the blood vessel back to the liver where it is broken down and excreted.
Therefore high levels of HDLs help to decrease the risk of developing heart disease.
The National Heart Foundation recommends a HDL level greater than 1.0mmol.
If you maintain a healthy weight, exercise regularly and quit smoking, you can help to increase your HDL levels.
LDLs: LDLs are the 'bad cholesterol'.
They transport cholesterol from the liver and deposits it in the walls of blood vessels.
Therefore, high levels of LDLs increase your risk of developing heart disease. The National Heart Foundation recommends an LDL of less than 2.5mmol.
If you reduce your saturated fat intake and exercise regularly this can help to decrease your LDL levels.
Triglyceridess: Triglyceridess are the 'ugly'.
They are another type of fat present in the blood.
High triglycerides also increase the risk for developing heart disease.
The National Heart Foundation recommends a Triglyceride level of less than 2.0mmol.
Triglyceride levels can be reduced by weight control, regular exercise, controlling blood sugar levels and reducing alcohol consumption (no more than two standard drinks per day).
| Type of Cholesterol | Goal |
| Cholesterol | <4.0 |
| Triglycerides | <2.0 |
| HDL | >1.0 |
| LDL | <2.5 |
11. Methods to reduce cholesterol
Healthy Lifestyle
Medication - whilst following a healthy lifestyle
your Cardiologist may still recommend cholesterol-lowering medications.
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Overweight
People who are overweight have an increased risk of heart disease because it is often associated with high blood pressure and high cholesterol levels. Being overweight makes the heart work harder. Weight reduction by healthy eating and regular exercise can help to improve both these risk factors:
Healthy Eating Tips
(choose a no added salt alternative and
do not add salt in cooking or at the table)
(it is recommended not to have more than two glasses
of alcohol a day and two alcohol free days per week).
Diabetes - increases the risk of heart disease. However, ensuring your blood sugar is within recommended limits can help reduce the risk. The recommended blood sugar levels are 4-7mmol.
Sedentary Lifestyle
12. Exercise and physical activity
Regular exercise helps keep the body in good physical condition and reduces the risk of many diseases, including heart disease. Research shows that people with an existing heart condition who exercise regularly, have a better quality of life, live longer and experience less heart problems than those who are inactive.
Some of the specific benefits of exercise include:
thus maintaining your independence
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13. Exercise in hospital
Light exercise, such as gentle walking around the ward, should be started before you leave hospital. Before discharge from hospital remember to ask your doctor about starting exercise at home.
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14. Exercise at home
It is important to exercise regularly. The National Heart Foundation recommends at least 30 minutes of light to moderate physical activity on most days, preferably every day. If you get excessively tired, short of breath or have joint pain, reduce the duration and level of intensity. Remember some exercise is better than none.
Walking is an excellent form of exercise that most people can perform. Walking is an aerobic exercise, which means it helps the heart and lungs operate more effectively.
15. Home walking instructions
Remember to start with three to four minutes of light walking, to warm-up the muscles, followed by at least five minutes of stretching.
Begin at stage one and progress to the next stage when the walking becomes easy.
As a guide, younger patients and those who have been active prior to coming to hospital should aim to spend about a week at each stage. Older patients and those with continuing heart problems should spend longer at each stage and may find they don't go past stage three or four. Keep in mind that people who are not used to walking often experience some muscle stiffness for a day or two after the first few sessions and when they move to a new level. This is perfectly normal and usually disappears after a couple of days. Remember to include time for the return journey in your walking time.
Stage 1: Walk slowly (light intensity) for 10 minutes, three times per day.
Stage 2: Walk slowly (light intensity) for 15 minutes, twice per day.
Stage 3: Walk at a moderate pace for 15 minutes, twice per day.
Stage 4: Walk at a moderate pace for 30 minutes each day.
Stage 5: Walk briskly for 30 minutes daily.
Stage 6: Walk briskly for at least 30 minutes daily.
Lifting light to moderate weights is also valuable for keeping the muscles in good shape and can be started four weeks after a heart event (wait 10-12 weeks after you've had surgery). Heavy weights that cause straining should be avoided.
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16. Things to remember
Follow these steps when exercising at home:
exercise and cool down gradually decreasing the intensity after exercise
If you feel unwell, have chest discomfort, dizziness or shortness of breath at rest you should not exercise. If any of these feelings develop during exercise, stop and have a break. If the symptoms continue seek medical attention.
There is only a very small risk of developing serious heart problems during light to moderate exercise, however, the long term benefits of regular exercise far outweigh any slight risk.
Remember, exercise should not be too hard and you should still be able to carry out a conversation whilst exercising.
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17. Resuming daily activities
This is a general guide for resuming activities after leaving hospital:
discussed with your Cardiologist or local doctor
discussed with your Cardiologist or local doctor
Ask your doctor for specific advice for your situation.
For further information on exercise or for a supervised exercise program, please contact the Cardiac Rehabilitation Program on (08) 9386-8833.
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Emotional Factors
Stress is the way we react physically and emotionally to a situation (short or long term). Although not proven as a cardiac risk factor or cause of coronary artery disease, it is recognised as a contributing factor as it increases heart rate and blood pressure, which increases how hard your heart has to work.
Social isolation, lack of social support and depression have also been shown to affect your recovery from heart disease.
Remember to talk to your family, doctor or a health professional if you have any of these concerns.
18. Methods to reduce stress
deep breathing exercises and meditation)
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19. Medications
Your Cardiologist will determine what medications you will need at home.
On discharge you will be given a supply of medications and information specific to each one.
A nitrate (nitrolingual) spray is usually recommended for treating your chest pain if it occurs at home.
Follow these steps to ensure you use the spray correctly.
When you have chest pain:
Nitrolingual spray under your tongue.
Nitrolingual spray under your tongue.
Call for an ambulance (Dial 000)
Remember
your Cardiologist's guidance and approval.
for additional information.
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20. Contacts
If you have any questions related to the information contained on this web page "Counter Attack", please contact:
Coronary Care Unit
on (08) 9346-6021
on (08) 9389-9655
All enquiries (08) 9386-8833
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First compiled 1998: L. Hilder and A. Gibson
Revised January 2003: T. Swanson, N. Venville and C. Cheetham
Acknowledgements: Royal Perth Hospital Cardiac Rehabilitation Program