EMOTIONAL PROBLEMS AFTER A HEART ATTACK

Will I be able to resume a normal sex life after a heart attack?

The answer is definitely yes! Questions about sexual and emotional problems are asked by anyone who has had any serious health upsets, not just people with heart problems. This is such an important issue that it is covered in more detail in Chapter 8.

Why do I feel so angry about what has happened to me?

Why did this happen to me?' and 'Why now?' are common questions asked. Heart attacks can occur at any time, not at a convenient time; they are always inconvenient. If you feel angry and bitter about what has happened, you are likely to be short of patience and irritable. You may take these feelings out on close friends and family; this is understandable but they too will be suffering. Remember that being angry is a stage in your recovery process and it will pass. Sometimes it is a good idea to discuss these feelings with someone who is not so close to you as family - that is why it is such a good idea to join a cardiac rehabilitation programme.

I still feel very moody at times after my heart attack. Why is this?

You may feel up and down, day by day, as you come to terms with what has happened. Don't worry about these mood swings or feeling as if you have 'the blues' - focus on resting and being positive about the future. Don't bottle your feelings up - talk to someone close, your family doctor or practice nurse. These feelings are all quite normal.

I am the one who has had a heart attack, but I now feel fine, perhaps a bit low sometimes; but my children really blame themselves over what happened. Why do they feel guilty?

Your family has been through a traumatic time also - they have been afraid of losing you and have had to put a brave face on every day. Children often feel guilty - teenagers in particular - that in some way they may have caused your heart attack. Explain to them that, although the heart attack was sudden (they all are), what caused it took years to develop and they could not be to blame. Talk a lot, don't suffer in silence or let your family suffer in silence. As the Americans say, 'let it all hang out' or these bad feelings will fester and become destructive.

I'm really depressed after my heart attack, which is unusual for me as I am usually 'bubbly'. My doctor tells me that this is normal after a heart attack. How will I know if I am 'medically' depressed rather than just 'down'?

Being down in the dumps at times is common for 2-3 months after a heart attack but this will lessen as you get back to normal. Some people may have been inclined to be depressed before a heart attack, and this can develop into a more significant medical problem. Constant irritability and heavy drinking are early signs. Other problems include:

• difficulty in sleeping;

• lack of energy;

• poor appetite;

• loss of interest in your old activities ('I can't be bothered to go visiting');

• unable to concentrate ('I pick up the paper, put it down, pick it up, forget what I have just read');

• paying less attention to your appearance.

More serious cases are associated with a feeling of no value, being worthless and having thoughts of suicide.

You must make sure that your doctor is aware of these feelings, as medication or counselling can help the way you feel. There is no need to put up with feeling depressed, nor for you and your family to suffer. If life seems desperate, phone the Samaritans or go to the hospital -seek help.

TREATMENT

What treatment will I be given when I leave hospital following my heart attack?

Some medication is prescribed as a matter of course because you will have a better chance of survival and complications can be prevented. Medication includes aspirin, clopidogrel, statins, beta-blockers and ACE inhibitors (see the section Treatment in Chapter 3). Not all medicines suit everyone and not everyone needs them, but you should be aware if you are taking them and, if not, why not. For some reason, not all people are given the medication that they need: only one-third of those people who should be on beta-blockers are prescribed them. Because you have a 25% better chance of survival if you are given beta-blockers, it is important to know why you haven't been given them. Ask you doctor why are you are not on them if you have not been prescribed these tablets.

Other tablets may be prescribed for specific problems, for example water pills (diuretics) to reduce fluid retention and help breathing, and special medication to regulate your heart rhythm if it has been upset by the heart attack.

Just as it is vitally important to know what you are being treated with, it is equally important not to discontinue any treatment without checking with the doctor first. Simply stopping medication is a dangerous policy, as you could suddenly get a rebound effect and risk another heart attack occurring. If you have side effects, tell your doctor so that your medication can be changed to another type.

If you had a heart attack whilst taking medication for another condition, such as high blood pressure or high cholesterol, it is essential to check whether treatments for these are still needed - they usually will be.

My husband has angina and I am worried that he may not survive a heart attack. What can I do if he has one suddenly -and what should I tell his friends to do?

Quick action is needed by you or his friends, as the muscle will stop working permanently if left without oxygen for 6 hours. The quicker you act, the better the chances of survival: getting help within 1 hour is better than within 2. He will have the very best chances of survival if you get help within the first 4 hours following the start of pain.

There are medications that can be used to break down the clot and open up the artery again. These are known as 'clot buster drugs' and the medical term for breaking down the clot is thrombolysis (pronounced 'throm-bo-lie-siss'). Aspirin helps break down clots as do streptokinase or tissue plasminogen activators (TPAs). As these medications thin the blood, they are not used when there is a risk of bleeding elsewhere, for example if someone has a stomach ulcer or has recently had surgery. If you think your husband has had a heart attack, and he is able, get him to crunch a 300 mg aspirin into small pieces and swallow it before the trip to hospital. Some pieces will be absorbed quickly through the lining of the mouth.

Clot buster drugs slightly increase the chances of a stroke, but this is offset by a major reduction (40%) in his chances of death from a heart attack. Streptokinase is less expensive than TPA, but TPA is more effective within 4 hours of a heart attack and the more frequently used. If he is given streptokinase, his body becomes sensitive to its effects, so it cannot be used again for at least 12 months, but TPA can be used as many times as is needed. People treated with these medications are given a card to carry with them for future reference.

Clot busters are not always successful but do work for 7 out of 10 people with heart attacks.

Is there an alternative to 'clot buster' drugs for heart attacks?

Apart from letting nature take its course, percutaneous transluminal coronary angioplasty (PTCA) is the only alternative. This is a means of unblocking arteries with a balloon and squashing the narrowings out of the way (see the section Angioplasty in Chapter 3 with Figure 3.5). PTCA can be performed if clot busters fail or the pain returns after the clot busters have been tried, if there is a reason why such medications cannot be used safely, or if you are admitted to a unit where angioplasty is routinely available. Angioplasty with a stent inserted is the most successful way of opening the blocked artery and limiting heart muscle damage and is now advocated as the preferred treatment if available (day or night).

We were so grateful that my brother did not die from his heart attack. Why do some but not others die from a heart attack?

Sometimes the attack is just too big for all the modern treatment to cope with, sometimes the treatment just doesn't work and sometimes it's left too late. No matter how clever we are, there is always going to be a bad luck factor. However, advances have increased the chances of surviving from 76 to 93% over the last 10 years.

 
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