Advice For Patients Recovering From

A Heart Attack

This leaflet has been produced for patients

recovering from a heart attack,
and their families.

Produced: February 2009

Review: February 2012

Contents
Page
Introduction
What is Acute Coronary Syndrome?
How does your heart work?
What is a heart attack?
What is angina?
Action plan for chest pain
Road to recovery
Driving
Returning to work
Holidays
Feelings and relationships
Activities on returning home
Exercise on discharge
Exercise after 6-8 weeks
Tests for heart conditions
Cardiac rehabilitation courses
CHD risk factors
Hereditary
Hypertension
Smoking
Stress
Emotions
Healthy eating
Body weight/waist measurement
Medications
Payment of NHS prescriptions
Cardiac support groups
Useful Contacts
Patient telephone help lines/websites

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Introduction
This booklet has been compiled to give you information following your heart attack.
It will also be useful for your family in answering some of their questions.
During your hospital stay you will be visited by members of the cardiac rehabilitation
team who will assess and discuss your rehabilitation needs with you.
Cardiac rehabilitation aims to: Help you understand what a heart attack is and what has happened to you.
Help you to regain confidence and return to as active a life as possible.
Help you become aware of the risk factors that might have contributed to your
heart problems, and make relevant changes to your lifestyle to reduce them.

Following discharge
If you wish to speak to someone concerning your recovery, or if you have a general
enquiry contact:

Cardiac Rehabilitation Offices

Chorley and South Ribble District General Hospital 01257 245635
Royal Preston Hospital 01772 522311
If no one is in the office, leave your name and telephone number and your call will be
returned as soon as possible.

If you need to speak to someone when there is no one available in the cardiac
rehabilitation office please contact:
Coronary Care Unit, Chorley and South Ribble District General Hospital - 01257
245630
Coronary Care Unit, Royal Preston Hospital - 01772 522330

What is Acute Coronary Syndrome?

When someone is admitted into hospital with chest pain it can sometimes be difficult
for the doctors and nurses to tell if they are having a heart attack or a bad angina
attack. Acute coronary syndrome is the term used to describe chest pain caused
either by a heart attack or unstable angina. Acute coronary syndrome is caused by
narrowing or blockage of the blood vessels to the heart muscle.
On admission to hospital you will have had an assessment which included;
A doctor assessing your symptoms and medical history.
A physical examination including measuring your blood pressure and heart
rate.
An ECG tracing of your heart the nurses and doctors will be looking for
specific changes.
Blood tests to check for any damage to the heart muscle.
One of the blood tests will be a Troponin Test. Troponins are proteins, which are
normally found in the heart muscle cells but not in the blood. If the heart muscle is
damaged troponin will leak into the blood and it will be detected in the bloodstream.
If the troponin in the blood is above a certain level it means that the test is positive
and indicates that there has been some damage to the heart muscle = heart attack.
If the troponin test is negative there is no damage to the muscle and the doctors will
probably tell you that you require further tests and investigations.

How does your heart work?

The heart is a muscle that pumps blood to all parts of the body. The blood carries
oxygen and nutrients that are the bodys fuel.
The heart receives its blood supply from the coronary arteries, which lie on the
surface of the heart.
There are 3 main coronary arteries: Right Coronary Artery
Left Anterior Descending Artery
Circumflex artery
The coronary arteries can start to fur up from childhood onwards, this is known as
ATHEROSCLEROSIS the build up of fatty materials on the inner lining of an artery
causing thickening, narrowing and reduction of blood flow.
Normal coronary arteries of the heart

The process of coronary heart disease

Normal artery

Furred up artery

Blood clot

What is a heart attack?

The medical term for a heart attack is Myocardial Infarction.
A heart attack occurs because one of the coronary arteries becomes blocked,
usually when part of the fatty material ruptures and a build up of blood occurs,
leading to a blood clot.
The blockage deprives part of the heart muscle of blood and oxygen. This results in
damage.

The heart showing an example of where damage may occur as in a heart attack

Some patients will be given a clot-buster drug on admission to hospital with a heart
attack.
The clot-buster drug you have been given is: - .
This drug is given to break up the blood clot blocking the coronary artery and can
help to reduce the amount of damage to the heart muscle.
However, this treatment is not suitable for everyone.

The healing process

Healing takes place over approximately 6 to 8 weeks during which time scar tissue is
formed at the site of the heart attack.
Physical activity should therefore be increased gradually over this period. The
cardiac rehabilitation staff will discuss this with you.

What is angina?
After a heart attack some people experience angina pain/discomfort, similar to, but
often not as severe as, the pain that brought them into hospital.
Angina occurs when the heart muscle does not receive the amount of oxygen rich
blood it needs, due to narrowed coronary arteries.
Angina does not damage the heart, but is a warning that you should stop what you
are doing, use your GTN spray, and rest until the discomfort has gone. The
discomfort should pass off within 15 minutes. If it does not, dial 999.

Angina may be triggered by exercise/exertion/activity

getting angry, upset or excited
cold and/or windy weather
after a very hot bath, or following a heavy meal

Heart attack and angina may be similar

Pain or discomfort is usually experienced in the central chest area and may radiate
to the neck, jaw, shoulders, arms or through to the back. It may vary in severity from
nagging discomfort to very bad pain. Pallor, nausea, vomiting, breathlessness, or a
cold, clammy sweat often accompanies heart attack pain.
Both may occur during activity or during rest or sleep.
Some people do not get pain but may have any of the symptoms described.
Pain /discomfort may occur in any of these places

Other symptoms to be aware of: - If you become unduly or increasingly breathless,

experience palpitations, or feel dizzy, then you should see your GP.

Action plan for chest pain/discomfort (angina)

Stop activity, sit down and use GTN spray x 2 under tongue
Wait 5 minutes

Chest pain gone

Chest pain still there

Continue activity

Repeat GTN spray x 2 for a

2nd time. Wait 5 minutes more

Chest pain gone

Chest pain still present

Resume activity
at a slower pace

Repeat GTN spray x 2

for a 3rd time. Wait 5
minutes more

If pain is still present

take 300mg aspirin
and dial 999 for an
ambulance
without delay

Although the pain of a heart attack and angina may be similar, heart attack pain or
severe angina pain will not be relieved by GTN and you must ring 999 if pain is still
present after 15 minutes.

The road to recovery everyday activities

Driving
You cannot drive for 4 weeks after a heart attack. However, if you have undergone
successful angioplasty and fulfil certain criteria of the DVLA medical standards of
fitness to drive you may be able to recommence driving after one week. The
cardiac rehabilitation nurses will discuss the criteria with you.
You should notify your insurers of your heart attack before you re-commence driving.
If you experience angina whilst driving then you must stop.
If you are experiencing angina at rest then you must stop driving until it is controlled.
Holders of LGV and PCV licences are restricted and you must inform the DVLA. You
may be able to re-apply for your licence 6 weeks after your heart attack provided that
you can pass an exercise test confirming you are able to meet national
recommended guidelines.
Returning to work
Most people will be able to return to their previous occupation.
When you return will depend upon your recovery and the type of work you do.
Generally, you will be able to return to work 6 to 12 weeks after a heart attack.
People who work long hours, find their job stressful, or who are employed in hard
physical work should consider reducing their commitment.
You should discuss your individual circumstances with your Consultant, GP and your
employer. If a change of employment is suggested, then the Employment Advisor at
the Job Centre may be able to help you.
Holidays and flying
Restful holidays in this country may be taken as soon as you feel well enough to
travel.
Flying will depend on individual recovery. You should be allowed to fly three to six
weeks after an uncomplicated heart attack, with your doctors permission.
During long flights walk up and down the aisle every hour or so to keep the
circulation in your legs moving.
Take enough tablets to last your holidays, be aware of security arrangements at
airports and only carry essential medication in your hand luggage. All other
medication should be packed in the luggage that you will be checking-in.

During long journeys by car or coach have regular stops to get out and stretch your
legs.
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Pace your activities to avoid doing too much, particularly in hot countries.
It is important that you check your travel insurance before travelling.
The British Heart Foundation has a list of insurance companies, which has been
compiled from the feedback received from heart patients, www.bhf.org.uk

Feelings and Relationships

Following a heart attack, sexual activity can be resumed 2 to 3 weeks after discharge
from hospital.
As a guide, if you are able to climb two flights of stairs without any problems, you
should be able to resume sexual activity.
People often experience a loss of interest in sexual intercourse in the early weeks
following a heart attack and this is quite normal. If, however, you are still
experiencing difficulties or anxieties three to four months after your heart attack you
need to speak to your GP.
If you suffer an angina attack during sexual intercourse, use your GTN spray. If this
becomes a regular problem try taking your GTN spray before you have sex. If you
have persistent angina during sex speak to your GP.
Occasionally, beta-blockers can cause impotence. If this problem is experienced
speak to your GP as this can be treated.
If, prior to your heart attack, you were using sildenafil (viagra) you should check with
your GP or Pharmacist if it is safe for you to continue taking. You should not take
sildenafil if you are taking GTN, isosorbide or other medications containing nitrates.
Taken together these medications can dramatically lower your blood pressure,
making you feel dizzy or even collapse. Sildenafil may also interfere with nicorandil.
.

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Activities on returning home

Remember that these are guidelines only, and each person must reach their own
level of recovery and fitness at their own pace.
While some people will recover very quickly, others will take much longer. Use
common sense and allow yourself the best chance of a smooth recovery.
In the early stages of recovery, you may find that you are more tired than usual but
this should pass as you regain fitness and confidence.

First week at home:

Stay around your home and garden. Walk in the garden if the weather permits.
Take things easy around the house light washing up or making a snack is fine.
Eat light meals.
Avoid heavy housework, such as cleaning or vacuuming or cooking a large meal.
Rest on the bed after lunch and have early nights.
Take the stairs gently in the first few days, stopping to rest if you become short of
breath or experience any pain/discomfort.
No moving or lifting of heavy objects.
Have visitors but not too many and not for too long.
Resume gentle hobbies such as sewing, painting and puzzles.
Second Week at home:
Become more active around the house.
Begin short periods of light housework such as dusting and washing up.
Take shorter afternoon rests in the chair.
Continue to have visitors as long as you are able to cope with them.
No moving or lifting of heavy objects.
Walk to the local shops, if nearby, for light shopping, but avoid supermarkets.
Avoid public transport, but you may be taken out in the car for a drive.
Start going for daily gentle walks outside and gradually build these up.
Remember: You should avoid going out if you feel tired or unwell, or if it is very cold
or very windy.
Third week at home:
Increase household tasks to include mopping floors, light hand and machine washing
and ironing.
Begin light social activities such as going out for a meal, or to the pub, but do not
stay out too long or go out too often.
Rest as necessary.
Visit friends or relatives.
You can go to the supermarket and make short visits into town, but do not carry
heavy shopping.
Begin light gardening such as pruning and weeding, if weather permits.
Make beds but do not strip and change sheets.
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Fourth week at home:

Household tasks can now include vacuuming in stages i.e. one room a day. Ask
someone to carry the vacuum upstairs to avoid lifting or moving heavy objects.
Trips to the cinema and other social events.
Rest as necessary.
You can take children/grandchildren out in a pushchair.
Normal supermarket shopping may now be carried, but do not overload your bags.
Access public transport.
Gardening can now include light digging, hoeing and raking.
Light D.I.Y.
Weeks five to six:
By this stage you should be doing most of your normal day-to-day activities.
Playing with your children or grandchildren, but not lifting or carrying them.
Washing and polishing the car in stages, with regular breaks.
Heavier gardening such as mowing the lawn and hedge cutting can be undertaken.
General D.I.Y jobs such as light decorating, with regular breaks, can be commenced.
Cleaning windows indoors, with regular breaks, can now be started.

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Exercise on discharge general exercise

Your heart takes 6 to 8 weeks to recover following a heart attack, so however well
you feel, your heart is still in a state of recovery.
Do not begin exercise other than walking until advised.
Week 1
Mobilise gently around the house, or garden if weather permits.
Take the stairs gently in the first few days.
Week 2
You can commence gentle walking outdoors after your first week at home, as long as
you feel well enough. Walk every day if you can, weather permitting.
Take your GTN spray with you. Stop if you get chest pain/discomfort and use your
spray as advised.
Begin with a short walk outside on the flat; start with an easy distance for you, 200
yards (or 5 minutes) once or twice a day is sufficient for the first couple of days,
increasing slowly by 200 yards at a time (or 5 minutes), as the week progresses.
Week 3
Build on the distance walked in week 2, steadily. e.g. a further 200 yards, (or 5
minutes) at a time. Do not attempt too much too soon.
Be aware that gradients or cold or windy weather can affect the effort involved, but
this should not stop you going out.
By the end of week 3 you should be able to manage up to approximately half a mile.
Weeks 4-5
Depending on previous mobility, gradually increase your walking if you feel able to.
Weeks 6-8
You could now be back to your normal level of mobility, but please remember that
some people take longer to recover than others. Activities such as golf and bowls
may be resumed. You may lift heavier objects such as shopping bags.
Types of activities to avoid are those that are static in nature, requiring contraction of
the muscles against resistance e.g. abdominal exercises, press-ups, lifting heavy
weights or pushing or pulling.
Never:
Push a car if your car breaks down, get help.
Prise open a jammed window.
Lift and carry very heavy weights e.g. heavy furniture.
Shovel snow in bitterly cold weather.
Undertake sustained overhead arm work e.g. painting a ceiling.

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Exercise after 6-8 weeks - cardiovascular

By this stage you should be commencing the cardiac rehabilitation exercise
programme.
Type of exercise
The type of exercise which benefits your heart is Cardiovascular/Aerobic exercise.
This means that you should feel pleasantly breathless and sweaty.)
Your pulse rate should rise and should be sustained for approximately 30 to 60
minutes.
Exercise must be increased slowly and gradually, both in intensity and duration
particularly for those who have previously undertaken very little exercise.
Examples of Cardiovascular/Aerobic exercise are: Walking
Swimming
Cycling
Dancing
Golf and bowls are not classed as aerobic exercise as they are stop/start in nature.

Sports and activities that are highly competitive/demanding impose a rapid increase
in heart rate and blood pressure and should be avoided.
Examples of exercises to be avoided are:
Squash
Heavy digging
Weight lifting
Activities such as housework, gardening and DIY do not cause a significant rise in
heart rate over a prolonged period of time as they are stop/start in nature, and do not
benefit the heart in the same way as prolonged exercise.

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You should not exercise:-

You should stop exercising if you:-

During an angina attack until it has

settled.

Are suffering from chest pain/discomfort

until it has settled.

If you have a high temperature.

Are having a cold sweat.

If you are feeling tired or ill.

Are sweating profusely.

If your doctor has advised you not to.

Are extremely short of breath i.e.

unable to talk.

If you have uncontrolled diabetes.

Are nauseated/vomiting.

For at least 2 hours after you have eaten

a heavy meal.

Are feeling faint/dizzy.

Benefits of regular exercise: Increases the efficiency of the heart.

Gives a feeling of well-being.

Decreases anxiety/stress levels.

Helps you to lose weight.

Helps to lower cholesterol levels.

Helps to reduce angina and

breathlessness.

Helps to lower blood pressure.

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Tests for heart conditions

Exercise ECG
An exercise ECG or exercise treadmill test (ETT) is an electrocardiogram that is
recorded while you are walking on a treadmill. Your blood pressure will also be
monitored throughout the test. If you get chest pain or feel uncomfortable when you
are physically active, this test can help to tell if your symptoms are caused by
coronary heart disease.
Echocardiogram
A recorder (probe) is placed on your chest and a pulse of high-frequency sound is
passed through the skin of your chest. Lubricating jelly is rubbed on your chest first,
to help make a good contact with the probe. The recorder then picks up the echoes
reflected from various parts of the heart and shows them as an echocardiogram a
picture on a screen. It gives information about the condition of your heart muscle; it
can also be used to assess the valves of the heart.
Angiography (cardiac catheterisation)
An angiogram is used to show where there are any narrowings in the coronary
arteries, and how severe they are. It can also give information about how well the
pumping chambers and valves of the heart are working. The test is done in an X-ray
room and takes approximately 20-30minutes.
A catheter, a long, flexible, hollow plastic tube about the width of the lead in a pencil
is passed into an artery either in the groin or wrist. You will have a local anaesthetic
to numb the area where the catheter is put in, so it should not be painful. The
Cardiologist then uses x-ray screening to help direct the catheter through the blood
vessels and into the correct position in the heart. You will not feel the catheter
moving around inside your chest. You can watch the procedure on the screen if you
wish.
X-ray films are taken by putting a fluid down the catheter and taking a series of
pictures called angiograms. The fluid sometimes causes a flushing sensation which
lasts a few seconds. You may notice a warm feeling in your groin and may think you
have wet yourself, even though you have not.
Following the procedure you will need to rest for a few hours. The Cardiologist will
advise you of the results of the test. You may be advised to take medication, to have
angioplasty and stents, or to have heart surgery.
Angioplasty and stents can be used to open up a narrowing in a coronary artery.
The procedure is similar to an angiogram although it takes longer. A catheter, a fine,
flexible, hollow tube with a small inflatable balloon at its tip is passed into the
coronary artery to the narrowed or blocked section. The balloon is then gently
inflated so that it squashes the fatty tissue responsible for the narrowing. As a result,
this widens the artery. The catheter contains a stent which is a short tube of mesh.
As the balloon is inflated, the stent expands so that it holds open the narrowed blood
vessel. The balloon is then let down and removed, leaving the stent in place.
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Cardiac rehabilitation courses

What are they?
The programmes involve attending either Royal Preston Hospital, Chorley District
Hospital or one of our community programmes for a course of exercise.
The supervised exercise sessions take place in a gym with Physiotherapists,
Exercise Physiologists, Fitness Instructors and Nurses. The course is twice weekly
for 6 weeks.
You will also be invited to attend a series of 6 educational lifestyle talks. You have
the choice of attending any of the talks that interest you. They are held weekly in
both Royal Preston Hospital and Chorley District Hospital and last about an hour.
You are invited to bring your partner or other family member with you to the talks. It
will increase their knowledge of your condition and confidence in what you can do.
Why is it important?
Cardiac Rehabilitation aims to improve your quality of life.
It can increase your confidence to exercise regularly in order to strengthen your
heart.
It will provide you with more information about the process of heart disease, its
contributory factors, and what you can do to improve your health.
When does it start?
The exercise classes usually start 4-6 weeks following a cardiac event.
The lifestyle talks can be started as soon as you feel ready to attend.
How do you join the programme?
Whilst you are in hospital you will be seen by a cardiac rehabilitation nurse who will
discuss the programme with you.
If you are able to do the exercise component, and you agree to join, you will need to
have an echocardiogram (ultrasound scan of the heart) and undertake a walking
assessment, i.e. exercise treadmill test, 6 minute walking test, or a shuttle walk.
What do the health education sessions consist of?
The following topics are covered:
How the heart works and how it is affected by heart disease.
Stress and anxiety management, and relaxation techniques.
Healthy eating.
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 The dos and donts of exercise.

Cardiac medications, effects and possible side effects.
Coronary heart disease risk factors
Once the programme is completed
Once you have completed one of our exercise programmes it is important to keep up
the good work that you have achieved.
You can be referred to various organisations that offer programmes of exercise.
These include:
Active Health - Garstang Leisure Centre.
Activity for Life programmes run by NHS Central Lancashire at Penwortham
Leisure Centre and Leyland Leisure Centre.
Bolton Council Phase IV programmes held at Horwich Leisure Centre and
Bolton Arena.
Exercise Your Options run by NHS Central Lancashire at Fulwood Leisure
Centre and West View Leisure Centre.
Heartbeat they run classes at Heartbeat, Fulwood; University of Central
Lancashire, Preston; Clayton Green Sports Centre, Clayton le Woods;
Bamber Bridge Leisure Centre and Ribby Hall, Wrea Green.
Ribble Valley Heartwatch run classes at Longridge Sports Centre.

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Coronary heart disease risk factors and lifestyle changes

Hereditary (family history)
It is not certain how the likelihood of having a heart attack is passed on through the
genes.
Some of the risk factors, i.e. high blood pressure and high blood cholesterol are
partly inherited, whilst other risk factors, i.e. smoking and over eating might be the
result of shared environments.
It is important to remember that even though you may inherit a tendency towards
coronary heart disease, prevention may be possible if you take steps to reduce the
risk factors under your control.
High blood pressure (hypertension)
Blood pressure is the force that the moving blood applies to the artery walls to
maintain a flow of blood to every part of the body, especially the brain.
When blood pressure is high, there is added pressure on the artery walls. This can
result in damage to the artery, attracting cholesterol and other material to form fatty
plaques (atherosclerosis).
Raised blood pressure increases the risk of heart problems and strokes.
Treatment for high blood pressure may include:
Medication
Stopping smoking
Weight reduction
Salt restriction
Exercise
Reducing alcohol intake

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Smoking
If you are a smoker you need to think seriously about stopping or stop now.
Why?
Smoking increases the tendency of the blood to clot in the blood vessels, especially
in arteries that are already furred up.
Carbon monoxide in cigarette smoke increases the oxygen needs of the heart.
Nicotine increases the heart rate and blood pressure.
Once you have stopped smoking you halve the chance of a further heart attack.
Help is available
Whilst you are in hospital, if you are finding it difficult because you are unable to
smoke, talk to the nursing staff.
You can contact NHS Central Lancashire Stop Smoking Team on 08003286297
You need to think about a day when you are going to stop smoking. Most people use
the day of their heart attack.
The sooner you stop the better. It is never too late.
Identify any smoking patterns you may have, and this will help you to deal with
different smoking situations.
We do understand that stopping smoking is hard. We are here to support and
encourage you, but it has to be your decision to stop.
If you do not feel ready to stop, you need to talk to a smoking cessation advisor in
order to gain the support you will need to help you quit.
A smoking advisor will discuss the use of Nicotine Replacement Therapy (NRT) with
you. NRT is available on prescription and provides nicotine that is safer and less
addictive than cigarettes. Unlike tobacco smoke, it does not contain tar or carbon
monoxide.

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Stress
Stress is difficult to define or measure, as what is stressful to one person may not be
stressful to another. Also each individuals causes of stress can alter.
Stress is a necessary part of everyday life. Indeed, a certain amount of stress is
considered to be a good thing as it can motivate and help you perform at the peak of
your ability. Too much stress, however, affects your health and well being and can
cause emotional, psychological and physical problems.
Although it is difficult to prove, stress does seem to contribute towards high blood
pressure, angina and coronary heart disease.
It is useful to recognise the causes of your stress and realise that almost any event
can cause stress. Some causes are obvious, for example redundancy, bereavement,
divorce or illness in the family, whilst other causes will require careful thought to
bring them out into the open.
Stress can also be caused by events that are thought of as pleasant, like getting
married, moving house, going on holiday.
You may also need to take into account the fact that events tend to be particularly
stressful when they are: Unpredictable
Unfamiliar

Major
Intense
Unavoidable
Inevitable
People deal with stress in different ways; they find their own ways of tackling stress
and learn ways of coping in different situations. There are many ways of coping with
stress some of these deal with the stress and others simply make you feel better.
Here are a few suggestions that may help you to deal with stress and hopefully
improve your quality of life: Take regular exercise
Learn a relaxation technique
Eat healthily; avoid too much caffeine and alcohol
Stop smoking
Pursue hobbies and leisure activities
Enjoy time with family and friends
Try to keep things in perspective
Take on less responsibility delegate tasks, learn to say No
Make time for yourself
Take short breaks throughout the day
Make small, regular changes to your lifestyle
Dont hesitate to seek medical help if you are worried about your health
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Emotions
A heart attack represents a major life threatening event which affects emotions
considerably during the recovery period, as can many major illnesses or operations.
It is not unusual to be faced with fear and uncertainty when you first arrive home.
Indeed, some people feel very unsafe away from the hospital environment.
Apprehension about the future can cause mood changes with periods of irritability
and frustration mixed with feelings of elation and optimism.
Sometimes there is a tendency to feel weepy, often for no apparent reason.
Concentration may be reduced and sleep disturbed.
These feelings are considered normal reactions to the physical and emotional
trauma you have experienced and will not last. However, if these symptoms persist,
they may interfere with your recovery and you should talk to a member of the cardiac
rehabilitation team or your doctor.
Boredom is another common feeling following a heart attack, due to restrictions on
your activities; therefore it can be beneficial to have a hobby or pastime to pursue.
Family members tend to be over protective when you first go home. Remember
they have had a shock too and need time to realise that you can undertake certain
activities. Talk to your partner/family about how you feel, be open and honest about
your feelings.

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Healthy eating
Healthy eating is an important part of looking after the heart.
It is a good idea to look carefully at what you eat, as often what we eat can affect our
health. This is one area where the whole family can benefit from changes which may
be made.
The easiest way to make sure that your diet is healthy is to eat as wide a variety of
foods as possible.
Cholesterol
Cholesterol is naturally produced in the liver.
It is essential to help make cell walls and substances such as hormones.
Problems arise when the liver makes more cholesterol than the body needs, or the
body is unable to get rid of the excess cholesterol. This extra cholesterol in the
blood can build up on the inside of the blood vessels causing them to become
narrowed, or even blocked.
Your total cholesterol is a combination of good and bad types of cholesterol.
Your present total cholesterol is ..................................
HDL or high-density lipoprotein is the good cholesterol as it helps to clear the
excess cholesterol from the body.
LDL or low-density lipoprotein is the bad cholesterol, which is largely responsible
for the blocking of blood vessels.
Please recheck your fasting lipids (cholesterol test after having nothing to eat or drink
overnight) at your GPs in:.
Triglyceride
This is another type of fat found in the blood. Like cholesterol, it will narrow and
block blood vessels if levels become too high. High levels of triglyceride can make
the blood stickier and more likely to clot.
To help improve your triglyceride levels you need to look at: Achieving and maintaining a healthy weight
Reducing alcohol intake
Reducing sugar intake
Increasing your omega-3 intake from oily fish
Fat
One of the most important things we can do to reduce the risk of heart disease and
to lower cholesterol is to look at our fat intake.

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We should consider the total amount of fat in our diet, especially if being overweight
is an issue. It is also important to look at the type of fat that we eat.
Saturated fat
This comes from animal fat and should be avoided.
This is the type of fat that will build up in arteries and sources include cheese, butter,
cream, lard, full fat milk, visible fat on meat, pies and pastries.
Where fat is needed a suitable vegetable alternative should be used. These are
healthier types of fat and can be divided into two types: monounsaturated fats and
polyunsaturated fats.
Monounsaturated Fat
Used in very small amounts it can actually help to lower cholesterol but must be
used sparingly in order to have this effect.
It is found in olive oil and margarines made from olive oil. It is also found in
rapeseed oil.
There may be a protective effect from including a little in the daily diet.
Polyunsaturated Fat
Again, if used sparingly, this will not increase blood cholesterol or clog up arteries.
It is found in sunflower oil, corn oil, soya oil and safflower oil and the margarines
made from them.
Do not use a huge amount of these fats or they will increase your body weight.
Avoid excess fats when choosing foods.
Use healthier cooking methods. Some suggestions to try are to grill, dry roast,
casserole, boil, poach, steam or use a microwave, pressure cooker or slow cooker.
Include a variety of chicken, turkey, fish and red meat. It is useful to include some
red meat, as it is a good source of iron, but buy smaller amounts of lean meat and
trim off visible fat. Use poultry and fish as an alternative.
Oily fish contains a type of oil called Omega-3 which is thought to be protective
against heart disease. It is found in fish such as mackerel, herrings, pilchards,
kippers, sardines, salmon, tuna and trout. Eating one of these fish twice a week is
helpful.
Look for the lower fat alternatives especially for foods such as milk, cheese,
yoghurt, fromage frais etc. Semi-skimmed milk is much better than full cream milk.
Cottage cheese is a low fat alternative to hard cheeses. Similarly, it is much better to
use diet or light yoghurts than thick and creamy versions.

24

Carbohydrate
Carbohydrate is found in starchy and sugary foods.
The largest part of your food should come from the starchy foods. These include
bread, rice, pasta, potatoes and breakfast cereals.
These foods provide a lot of nutrients, which are important to us.
Everyone will need different amounts depending on appetite, activity and body
weight, but the largest part of the food that we eat should be the starchy part.
Fibre
Increase or maintain a high fibre intake. Fibre may help to reduce the risks of heart
disease by lowering cholesterol levels.
Fibre is found in fruit and vegetables and also in wholemeal bread and other foods
made from wholemeal flour. Try some of the many high fibre breakfast cereals.
Soluble fibre is found in oats and beans including baked beans, peas, lentils,
granary bread and fruit and vegetables. It is thought to be more effective at helping
to control blood cholesterol levels than other types of fibre.
Fruit and vegetables are particularly important because they provide vitamins,
minerals and antioxidants, which will help to protect you from heart disease.
An ideal intake of fruit and vegetables is to have five portions a day. One portion
might be one piece of fruit such as an apple, orange or banana, one glass of fruit
juice, a small dish or side plate of salad or 2 tablespoons of cooked vegetables.
Include a variety of different colours to increase the variety of vitamins.
Sugar
Avoid excess sugar, as it is high in calories and will increase weight. It is easy to eat
too many sweet foods, as they do not fill you up. Cutting back on sugar is a simple,
healthy way of controlling your weight.
Too much sugar can also raise triglyceride levels in the blood. Triglyceride is a
sticky substance that can clog up blood vessels causing increased blood pressure.
Alcohol
Drinking some alcohol in moderation is not thought to be harmful in heart disease.
However, alcohol contains a lot of calories and can cause weight gain.
Spread the alcohol over the week; do not drink the whole allowance in one go!
Too much alcohol can also raise triglyceride levels.
Have 1 2 alcohol free days each week.

25

Daily safe alcohol

limits (units)
34

Men

Women

Weekly safe alcohol

limits (units)
21

2-3

14

Binge drinking is
8 or more units
on any one
occasion
6 or more units
on any one
occasion

One unit of alcohol is equal to: 1 small glass of wine

1/2pt of regular beer or lager (not the strong varieties)
1 measure of spirits (25ml)
1 pub measure of sherry or port
Salt
Common table salt is made from sodium chloride and the sodium part of salt may be
a factor in high blood pressure.
We tend to eat far more than we actually need. Many foods have a natural salt
content so we should be very careful about adding any salt in cooking or at the table.
Those people with raised blood pressure should be taking active steps to avoid
excess salt.
All processed foods contain salt or sodium in other forms especially foods such as
bacon, processed meats, cheese and packets of dried foods such as soups.
Use herbs and spices as an alternative to flavour foods.
It is not recommended to use salt substitutes.
Guide to food labelling
A lot*
10g of sugars
20g of fat
5g of saturates
3g of fibre
1.5g of salt
0.6g of sodium

A little*
2g of sugars
3g of fat
1g of saturates
0.5g of fibre
0.3g of salt
0.1g of sodium

* Per 100g of product. E.g. 10g of sugars per 100g of product would be a lot

26

Body Weight
It is important to try and achieve and maintain a healthy body weight.
Being overweight or obese is closely related to other risk factors, such as raised
cholesterol, raised blood pressure and diabetes.
The most common reasons for being overweight are eating more food than the body
needs, and lack of exercise.
Reaching and maintaining an ideal weight will help to reduce high blood pressure
and high cholesterol and triglyceride levels. If you need to lose weight, aim to lose
1 or 2 pounds per week until you reach your ideal weight. Follow a regular exercise
programme and adopt a healthy balanced diet.
If your weight is not a problem, still cut down on fatty and sugary foods but increase
the amount of high fibre foods you eat to maintain your weight. The balance of your
diet is still important.
Hip to waist measurement
Hip to waist measurement is said to be the most effective way of measuring coronary
heart disease risk and obesity. Fat deposited on the stomach (classic beer gut) is
more dangerous than extra pounds on the thighs. In general terms larger hips are
better than a large waist.
Measure the smallest part of your waist and the widest part of your hips.
Divide the waist measurement
------------------------- = your ratio
hip measurement
The ideal ratio is 0.80 or less for women and 0.95 or less for men.
For example, a 30 inch/76cm waist and 38 inch/96 cm hips for a woman equals a
ration of 0.79, which is desirable. A 36inch/91cm waist with 40inch/102cm hips
results in a ration of 0.90 which is not.
Waist Measurement
Your body shape, as much as your weight, can affect your health risk. Body fat that
accumulates around the stomach area poses a greater health risk than fat stored in
the lower half of the body.
The more apple-shaped you are, (typically men where fat collects around the waist
and stomach area) rather than pear shaped (typically women where fat tends to
collect on hips, buttocks and thighs) the more at risk of coronary heart disease you
are.
Measure your waist, without holding the tape too tightly or loosely.

27

Women:
Waist measurement greater than 32 inches (80cm) indicates slight
health risk.
Waist measurement greater than 35 inches (88cm) indicates an
increased health risk.
Men:
Waist measurement greater than 37 inches (94cm) indicates slight
health risk.
Waist measurement greater than 40 inches (102cm) indicates an
increased health risk.

Body Mass Index

Obesity can be measured using a body mass index (BMI). The body mass index is a
weight/height ratio which provides a measure of obesity. It is calculated when your
weight in kilograms is divided by your height in metres squared.
Example: weight = 90kgs, height = 1.80m
90
----------------1.80 x 1.80

= BMI of 28

A BMI of 20-25 is within normal limits, 25-30 is overweight, greater than 30 is obesity
and greater than 40 is extreme obesity.

28

Medications
It is normal to be prescribed several types of tablets after a heart attack.
Why?
Firstly, to treat any problems caused by the heart attack you have had.
Secondly, to reduce your risk of having another heart attack.
There are different groups of drugs used in the treatment of heart disease.
The doctor decides which combination of drugs is best for you.
You should always know what tablets you are taking and when to take them.
What is the tablet called?
What is it for?
Are there any side effects I should be aware of?
You should keep an up - to - date list of all your tablets and dosages with you
at all times.
Never stop taking them without contacting your GP.
If you are unhappy about any of your tablets, you must discuss this with your
GP, who will advise you.
When you leave hospital you will be given a supply of the tablets you have
been prescribed. You will then need to contact your GP surgery for a repeat
prescription before the tablets run out.

The following section contains a list of the drugs that are commonly used to treat
heart disease.

Antiplatelets These make the blood cells less sticky which helps to reduce the
chance of a blood clot forming inside the arteries. This helps to lower the risk of a
further heart attack.
Possible side effects include stomach problems.
Aspirin should always be taken with food, unless enteric-coated aspirin, these
should be taken one hour before food.
Clopidogrel is usually given as a course after angioplasty and stent insertion
into a coronary artery. It may also be given in place of aspirin if aspirin upsets
your stomach.
Aspirin and Clopidogrel should be taken in combination after a heart attack.
You will be advised how long to take this combination for.

29

Betablockers
Atenolol
Bisoprolol
Metoprolol
These are usually given to protect your heart after a heart attack. The heart rate will
be slowed down and the force of the contraction of the heart muscle is reduced.
They help to prevent angina and lower blood pressure by reducing the work the
heart has to do.
Possible side effects include tiredness, cold hands and feet, impotence, nightmares
and wheeziness.
Ace inhibitors
Ramipril
Perindopril
Lisinopril
Enalapril
These reduce the amount of work the heart has to do by widening the blood vessels.
They can help to lessen the effect of the damage caused by a heart attack. They
can also be used to treat high blood pressure and heart failure.
Possible side effects include persistent cough, dizziness and altered taste.
ACE II
Losartan
Valsartan
Irbesartan
Candesartan
These act in a similar way to ACE inhibitors and can be used as an alternative to
ACE inhibitors, especially if a dry cough is a problem.
Cholesterol lowering drugs (statins)
Simvastatin
Atorvastatin
Pravastatin
These reduce the amount of cholesterol in your blood, which can help to reduce the
further build-up of fatty deposits in the coronary arteries. They should be used in
conjunction with a low fat diet.
Possible side effects include muscle pains and stomach upsets.

30

Omega-3 fatty-acid ethyl compounds

Omacor
You may be prescribed omega-3-acid ethyl ester treatment particularly if you are not
able to eat 2-4 portions of oily fish per week. Omega 3 is thought to be protective
against heart disease and helps lower cholesterol levels.
Possible side effects include stomach upsets
Nitrates
Glyceryl trinitrate (GTN) sprays/tablets short acting (lasts for up to half an
hour). Sprayed or placed under the tongue it is used to quickly relieve
pain/discomfort during an attack of angina, or to prevent angina from
occurring if taken before activity. Always sit down or lie down before use.
Isosorbide mononitrate - long acting. Used to prevent angina attacks occurring
(works over approximately 20 hours). Usually taken as a single daily dose.
These widen the coronary arteries, which improves the blood and oxygen supply to
the heart muscle. Some nitrates have a short action and some have an effect over a
long period.
Possible side effects include headache or dizziness when standing up.
Diuretics
Furosemide
Co-amilofruse
Bendrofluazide
Bumetanide
These are sometimes called water tablets. They increase the amount of urine
produced by the kidneys, which removes excess fluid from the body. This helps to
reduce the strain on the heart. Some diuretics are used to lower high blood pressure.
Possible side effects include low blood pressure, tiredness and low potassium levels.
Anticoagulants
Warfarin
Sinthrome
Used to thin the blood where there is a possibility of blood clot formation or evidence
that blood clot may be present. The dose may vary according to the thickness or
thinness of the blood, and this will be determined by regular blood tests at the
anticoagulant clinic at the hospital, or your GP surgery.
Possible side effects include bruising and increased bleeding time.

31

Anti-arrhythmics
Digoxin
Amiodarone
Verapamil
These help to control fast or irregular heartbeats.
For possible side effects refer to each tablets information leaflet.

Prepayment of NHS prescription charges

Patients who have to pay for more than five prescription items in four months or 14
items in 12 months may find it cheaper to buy a pre-payment certificate (PPC).
Details of the current prescription charge and pre-payment certificate costs are
available from leaflet HC12.
You can buy a PPC online, by post or by phone. Ring 0845 850 0030 to buy one
over the phone using your credit or debit card.
You can only use the PPC for your own NHS prescriptions. The PPC will start from
the date your on line application, phone call or postal application is received unless
you ask for a different start date. This can be up to one month earlier or one month
later than the date of your on line application, phone call or the date your postal
application was received.
Remember to apply for a new PPC in good time; otherwise you will have to pay
charges when your old PPC runs out.
If you have to pay a prescription charge while you are waiting for your PPC, you
cannot get a refund unless you have an NHS receipt. The pharmacist or dispensing
doctor can only issue an NHS receipt (form FP57) at the time you pay a prescription
charge, they cannot give you one later. You can claim the prescription charge(s)
back, up to 3 months after paying.

32

Your local cardiac support group

Preston cardiac support group
Meeting 1st Monday of each month
7.30pm 9.30pm at
St Cuthberts Church
Lytham Road
Fulwood

The aims of the group are:

To offer mutual support and friendship
To provide pleasant, informal and non-committal meetings for you and your partner
or family.
To provide the opportunity to meet people with similar problems.
To be able to share anxieties and fears with others in a similar situation.
To provide helpful advice and information from a variety of sources.
There will be an invited guest speaker at most meetings.

33

Useful Contacts
Alcohol Information Centre
&
Alcohol Teams

Welfare Rights
(Help & Advice)

22 St Thomas Road
Chorley
01257 230222

The Information & Advice Centre

35-39 Market St
Chorley
01257 517272

81a Manchester Road

Preston
01772 561300

Welfare Rights Service

Freepost
Preston
PR1 8BR
01772 533610

Citizens Advice Bureau

35-39 Market Street
Chorley
01257 279807

Smoking Cessation

Town Hall Annexe

Birley Street
Preston
01772 822416

NHS Central Lancashire Stop Smoking

Service 0800 328 6297
Website: www.smokefree.nhs.uk

176 Towngate
Leyland
01772 424282

Benefits Enquiry Line

Social Services

2nd Floor
Red Rose House
Lancaster Road
Preston
PR1 1HB
0800 882 200

Peter House
Peter Street
Chorley
01257 51600
58-60 Guildhall Street
Preston
01772 533689

34

4/5 Balfour Court

Leyland
01772 904600

Patient telephone helplines and websites

British Heart Foundation
Website: www.bhf.org.uk
Main telephone number: 020 7554 0000
Heart helpline: 0300 330 3311

Lifestyle advice
Heart conditions
Medicines
Angioplasty/stents/bypass surgery/pacemakers
Links
NHS Smoking
Website: www.smokefree.nhs uk
NHS Free Smoking Helpline: 0800 022 4 332
Stop Smoking Service
NHS Central Lancashire 0800 328 6297
Diabetes UK
Website: www.diabetes.org.uk

Lancashire Teaching Hospitals NHS Foundation Trust is not responsible for the content of
external websites. All website addresses and telephone numbers correct at time of going to
print.
Acknowledgements
We would like to thank the Blackpool Victoria Hospital cardiac rehabilitation team for
allowing us to use extracts from their Advice for patients recovering from a heart attack
booklet.
Cardiac Rehabilitation Team Directorate of Medicine
O1772 522311 or 01257 245635
Lancashire Teaching Hospitals Foundation Trust

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36