David Lee Scher: Five Things to Know After Your Heart Attack

Dr. David Lee Scher is a former cardiac electrophysiologist and is an independent consultant and owner/ director at DLS Healthcare Consulting, LLC. Twitter: @dlschermd, Dr. Scher blogs at http://davidleescher.com.

These five points are important because they address the seriousness of a heart attack. Feeling better after a heart attack is an experience all are grateful for. However, the journey as a cardiac patient is just beginning and knowledge is a powerful tool to have. An engaged and informed patient has a better outcome. Asking the right questions can sometimes save or prolong one’s life. Do not assume that what you’ve been told is all you need to know.

  1. Your medications aren’t just to make you feel better. They will make you live longer. Most medications that people take are given for relief or prevention of symptoms. After a heart attack, especially if, as is common, you receive a coronary stent, a medical regimen is prescribed, some drugs of which, according to studies, increases your long-term survival. One of these is a beta-blocker. The mechanism of action of this class of medication is to blunt the heart’s response to naturally circulating adrenaline. It decreases both resting and exercise heart rates. Another type of drug is an angiotensin converting enzyme (or ACE) inhibitor. This medication, as the beta-blocker, decreases cardiac stress. Aspirin is the third drug, usually given as a baby dosage. The last medication is a ‘statin’, a cholesterol-lowering drug. Most patients receiving a stent will be placed on the medication clopidogrel (Plavix), which decreases the risk of the artery containing the stent from closing again with a clot. It has been discovered that some people are genetically resistant to clopidogrel, for which they require a much higher dose. The genetic (blood) test is readily available and is paid for by insurance. Ask your cardiologist if you should have this test.
  2. You will eventually resume most of your everyday activities. You should expect that prior to discharge from the hospital, you will receive explicit instructions about what types of activities you may perform and a timetable for each. Ask about resuming work, exercise, sexual activity, and driving.
  3. You should know your EF. The ejection fraction, or EF, is the percentage of blood pumped out of the heart to the rest of the body with each beat. A normal EF is greater than 55%. The EF may be determined at the time of a catheterization, or might be evaluated non-invasively with a sonogram of the heart (echocardiogram). An EF of less than or equal to 30% after a heart attack, or 35% if you have congestive heart failure (CHF; see item 5) indicates that you might be at an increased risk of sudden cardiac arrest and may benefit from the implantation of an implantable defibrillator, or ICD. If you received a stent or had bypass surgery after your heart attack, your EF may improve, for which it should be reevaluated after three months. If your EF is determined to be low immediately following your heart attack or stent or surgery, you might be recommended by your cardiologist to wear an external defibrillator in the form of a vest, to protect you from sudden cardiac arrest until your EF is repeated or until you receive an implantable device. Ask your cardiologist what your EF is. If it is low, ask if you are a candidate for an ICD.
  4. A stent or bypass surgery is not a cure for coronary artery disease (CAD). If you are overweight, smoke cigarettes, sedentary, or do not follow a healthy diet, you need to change your lifestyle regardless of what kind of treatment regimen you received. CAD is not curable (not with stents, bypass surgery, or anything else), but may be significantly slowed with exercise, medications, and other lifestyle changes.
  5. If you have CHF, in which you experience shortness of breath and/or leg swelling, you have special needs. These include significantly reducing salt intake, the requirement of additional medication, and evaluation for a special kind of ICD which might significantly improve symptoms as well as EF. Whether you are a candidate for this device called a CRT (cardiac resynchronization therapy) defibrillator may be determined by your cardiologist from looking at your electrocardiogram or ECG.

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