I always thought that having a heart attack was the end of the story. Now you give me the good news that nearly everyone recovers nowadays. Is this true?

The short answer is not everybody recovers, but the good news is that most people do. Indeed most people make a complete recovery and only a small number are left with a disabling limitation, such as chest pain on effort (angina) or excessive breathlessness. We can help most people get back on their feet, but sadly a small number, less than one in 10 cases, have suffered too much damage even for all the modern technology to overcome.

A friend of mine had a heart attack recently and is still in hospital. She rang me to say that she was coming out soon. Will she be completely dependent and unable to look after herself? What can she do for herself after leaving hospital?

Don't panic! The danger period has passed but, of course, going home means a change of environment with no friendly nurses immediately to hand to provide security and reassurance. Not surprisingly, I expect that she will feel uncertain, anxious and depressed for a while.

It is important for her not to be alone for the first 2 weeks after discharge from hospital so, if she normally lives alone, it is best for her to stay with relatives or friends who can provide the necessary support and, of course, be there to talk to. The hospital should have ensured that her doctor knows she is coming home so that a visit can be arranged by either the family doctor or practice nurse, to see how she is getting on. This may be worth confirming with the doctor's surgery. Special cardiac liaison nurses do home visits in some localities, providing an important link between patient and their family, family doctor and hospital.

I had a heart attack over a month ago and I now feel completely better. I am frustrated that my doctor wants me to vegetate at home! When will I be allowed to lead a normal life again after my heart attack?

Most people are back to normal 6-8 weeks after a heart attack and back at work within 2-3 months. Some people take early retirement because a favourable financial package has been offered, and they are getting close to retirement age anyway. This makes good sense. Women who were working part-time are less likely to go back, as their work was invariably an additional job to their other commitments. Career women, however, can get back to work as successfully as men do: of those who want to work, 80-90% will do so. If your heart was badly damaged, your doctor may advise you not to work, and you will also need to take into account how demanding your job was.

If you do go back to work, make sure that you maintain a healthy lifestyle with plenty of exercise, an active social and leisure life, and a good night's sleep to help recharge your batteries.

What should I do to help my recovery after my heart attack?

There are several important aspects to helping the recovery and these include:

• making sure that you take your medication, understanding why you have been given it, and taking it in the correct dose;

• losing weight if you need to;

• enjoying plenty of fresh fruit and vegetables;

• increasing physical activity sensibly;

• learning to relax and getting a good night's sleep; and

• avoiding cigarette smoking (active or passive).

I am on the mend after a heart attack - a nasty shock! How will I feel in myself when I return home?

After a heart attack it is common for both you and your family and friends to worry and be a bit fearful. The fears most people have are that:

• they might die;

• they will lose their sex life;

• they might have to give up work;

• they might have a physical disability. They might also feel:

• angry about why it happened;

• guilty about not taking advice; and

• depressed that life, as you have known it, is finished and somehow you will be less of a person.

These feelings and fears are discussed more fully below. Most of them pass quickly as you make progress and recover, but it is always good to express any anxieties and worries to the hospital staff or your family doctor when you are home, because they can nearly always be explained and this will help you to overcome them.

Joining a rehabilitation programme is a very important means of coming to terms with what has happened and helping you to be positive about the future. Your spouse or partner is welcome to attend and the education, understanding and support provided soon restore your confidence, enabling you to return to a normal sex life and work.

Am I likely to get more chest pain after I have recovered from my heart attack?

Most people do not, but just a few do get angina. An exercise test will be organised for you and treatment arranged (see Chapter 3). Always tell your doctor if you get any pain. You don't have to put up with it - there are lots of things that your doctor will be able to do for you.

I am home from hospital after having had a heart attack. Will I need surgery or angioplasty in the future?

The first priority is to let your heart heal up. An exercise test may suggest that you have further problems and, if so, an angiogram will be arranged for you (see the section Tests in Chapter 3). If you have serious further trouble, you may be advised to have surgery or angioplasty so that these problems do not get worse. It is better to prevent further heart attacks by changing your lifestyle and taking the right medicine and treatment.

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