Discharge Instructions for Heart Attack

You have had a heart attack (M.I. or myocardial infarction). A heart attack occurs when a vessel that sends blood to your heart quickly becomes blocked. This causes your heart not to work as well as it should. To work on getting better or taking charge of your health, follow these steps for home care and lifestyle changes.

Home care

• Take your medicines exactly as directed. Don’t skip doses. Talk with your doctor if your medicines aren't working for you or if you have questions about symptoms or side effects. Together you can come up with another treatment plan.

• Remember that healing after a heart attack takes time. Plan to slowly increase your activity over 4 to 8 weeks while you heal. Then return to normal activity when your doctor says it’s OK.

• Ask your doctor if you qualify for cardiac rehabilitation (“cardiac rehab”).

  • Cardiac rehab is a professionally supervised program designed by your health care team. It will help you get better from your heart problem and cut your risk of future heart problems. Along with a tailored exercise program, cardiac rehab gives education and counseling to improve health.

• Tell your doctor if you are feeling depressed. Feelings of sadness are common after a heart attack. It is important to speak to someone or seek counseling if you are feeling overwhelmed by these feelings.

• Call 911 right away if you have chest pain or pain that goes to your shoulder, neck, or back. Do not drive yourself to the hospital.

• Ask your family members to learn CPR. This is an important skill that can save lives when it's needed.

• Learn to take your own blood pressure and pulse. Keep a record of your results. Ask your doctor when you should seek emergency medical attention. He or she will tell you which blood pressure reading is dangerous.

Medicines for your heart

Common medicines

Aspirin

• Helps prevent blood clots.

• Take your aspirin as directed by your doctor. 

Antiplatelet medicine 

• Helps prevent blood clots by keeping platelets from sticking together. Platelets are the part of your blood clot that forms clots and stops the bleeding.

• Take your antiplatelet medicine such as Clopidogrel (Plavix), Prasugrel (Effient), or Ticagrelor (Brilinta) as directed by your doctor.

• If you have a stent, do not stop taking this medicine for any reason unless you talk to the cardiologist who put in the stent.  Do not have any dental procedures or any surgeries that are not an emergency for the next 12 months unless you talk to the cardiologist who put in the stent. If you stop taking this medicine too early, you can raise your risk of a heart attack and death by clogging your stent.

Caution: If you take aspirin and an antiplatelet medicine, do not take any other Nonsteroidal Anti-inflammatory Drugs (NSAIDs) for pain management or headaches.  NSAIDs such as Ibuprofen, Naproxen, or Celecoxib can raise your chances of bleeding.

Beta-blocker  

• Helps stop chest pain and control chest pain, also called angina. 

• May help to lower blood pressure.

• Do not suddenly stop taking this medicine unless told to do so by your doctor.

• Take your beta-blocker as directed by your doctor.

ACE Inhibitor

• Helps lower blood pressure.

• Helps make it easier for your heart to pump and makes blood flow better. 

• Take your ACE inhibitor as directed by your doctor. 

• It is best to take this medication in the evening or at bedtime.

Statin 

• Helps lower your bad cholesterol and raise your good cholesterol. 

• Take your statin as directed by your doctor.

Nitroglycerin (nitrate)

• Helps stop and treat chest pain. 

• Take your Nitroglycerin as directed by your doctor.

  • Place the pill under your tongue. Do not chew, crush or swallow the Nitroglycerin pill.  

  • You may have a headache after you take the Nitroglycerin pill.   

  • If the chest pain does not go away, call your doctor or go to the ED.

Caution: You can raise your risk of low blood pressure and death if you take phosphodiesterase inhibitors such as Viagra (sildenafil citrate), Levitra (vardenafil), or Cialis (tadalafil) and take nitrates at the same time.  You can take a nitrate 24 hours after taking Viagra (sildenafil citrate) or Levitra (vardenafil) and 48 hours after taking Cialis (tadalafil).

Look out for drug interactions

Other

Women on hormone therapy should talk to your OB-GYN about these medicines and your heart problem. 

Lifestyle changes

Your heart attack might have been caused by cardiovascular disease. Your health care team will work with you to make changes to your lifestyle. This will help the heart disease from getting worse. These changes will most likely be a combination of nutrition and exercise.

Diet/Nutrition

Your health care team will tell you what changes you need to make to your diet. You may need to see a registered dietitian for help with these diet changes. These changes may include:

• Staying away from high amounts of unhealthy fats (saturated and trans fats), that are mostly solid at room temperature and limiting cholesterol from animal products.

• Staying away from foods high in salt, especially if you have high blood pressure or issues with fluid retention.

• Eating more fresh or plain frozen vegetables and fruits.

• Eating lean proteins such as fish, poultry, beans, and peas, and eating less red meat and processed meats.

• Using low-fat dairy products.

• Using vegetable and nut oils in limited amounts.

• Limiting how many sweets and processed foods such as chips, cookies, and baked goods you eat.

• Limiting how often you eat out and when you do eat out so you can make better food choices.

• Not eating deep fried foods.

Exercise

Your health care team may tell you to get more exercise if you haven't been physically active. Depending on your case, your doctor may recommend that you get moderate physical activity for at least 3 to 4 days each week. The goal will be to work towards 30-40 minutes each day of exercise. A few examples of moderate activity include:

• Walking at a brisk pace, about 3 to 4 miles per hour

• Swimming or water aerobics

• Hiking

• Dancing

• Martial arts

• Tennis

• Riding a bicycle or stationary bike

Other changes

Your doctor may also recommend that you:

• Lose weight. If you are overweight or obese, your doctor will work with you to lose those extra pounds. Making diet changes and getting more exercise can help. A good goal is to lose 10% of your body weight in one year.

• Stop smoking. Sign up for a stop-smoking program to make it more likely for you to quit for good. You can join a stop-smoking support group or ask your doctor about nicotine replacement products.

• Learn to manage stress. Stress management techniques help you deal with stress in your home and work life. This will help you feel better emotionally and ease the strain on your heart.

Follow-up

Make and attend follow-up appointments as directed or needed.

Call 911

Call 911 right away if you have:

• Chest pain that goes to your neck, jaw, back, or shoulder

• Abnormal/ unusual shortness of breath

When to call your doctor

Call your doctor right away if you have:

• Lightheadedness, dizziness, or fainting

• Feeling of irregular heartbeat or fast pulse