What to do in a heart attack

1. Recognise the warning signs of a heart attack.
2. Call 995 for an ambulance.
3. Do inform someone of the situation and have someone keep watch on the patient.
4. Get the patient to stop all activity, sit or lie down, and wait for transport to the nearest hospital.
5. The patient should not drive to the hospital.
   
   

What to do after a heart attack

The doctor may recommend a cardiac rehabilitation programme, diet modification and medication to help the patient gradually resume a normal lifestyle and reduce the risk of another heart attack.

1. Cardiac Rehabilitation
   This is a structured programme aimed at helping the patient gradually improve his cardiovascular fitness, and enhance his psychological well-being so as to resume a normal lifestyle. It also aims to modify his risk factors and reduce the risk of another heart attack.
   
   A team of healthcare professionals including doctors, nurses, physiotherapists, psychologists, dietitians and pharmacists will work closely with the patient. They will be available to teach, guide and encourage the patient on the road to recovery.
   
   This programme begins in the hospital from the time of diagnosis. It is continued after discharge from hospital, and by the patient eventually. This programme has various components including:
   
   
   1. Exercise training: A customised exercise programme to safely improve cardiovascular fitness.
   2. Health education: To provide the patient and family members with information on heart attack, its signs and symptoms and its risk factors.
   3. Risk factor and behaviour modification: Practical steps in risk factor and behaviour modification will be taught. People who smoke are strongly encouraged to stop and given advice on how to do so. Stress management is also important.
   4. Dietary modification: The patient will be advised to adopt a healthy diet. For instance, food high in cholesterol and saturated fats such as animal fats, whole milk products, eggs, red meats (beef, lamb), coconut oil and palm oil are to be avoided. Healthy alternative foods will be introduced, for example, low fat milk or lean meats. Healthy food preparation alternatives will be introduced to the patient or family members. For example, the use of canola or olive oil for cooking, baking, boiling or steaming food instead of frying.
      
      
2. Medicines
   Medicine will be prescribed to a heart attack patient to:
   
   
   • Reduce the risk of another heart attack (such as anti-platelet medication like aspirin, clopidogrel or ticlopidine).
   • Relieve chest pain.
   • Control risk factors like diabetes, high blood pressure or high cholesterol.
   
   The patient should follow the medication regimen as prescribed even if he feels well. He should tell the doctor if he has any side effects from the medication. The patient should also tell the doctor if he finds the dosing inconvenient or if he finds it difficult to take his medication regularly.

When can a heart attack patient return to normal activities

Every patient is different and should consult their doctor on when to resume various activities. Here is some general advice which applies to patient with uncomplicated heart attacks.

1. Work
   This depends on the nature of a patient’s work. If the work is not physically demanding, the patient can resume work in a few weeks. For a physically demanding or stressful job, the patient may need up to three months away from work. The patient should consult his/her cardiologist regarding specific fitness for resuming work.
   
   
2. Driving
   The patient should consult with his/her cardiologist regarding specific fitness for driving, especially if one drives commercial vehicles.
   
   Many patients will be able to drive within three to five week after the heart attack if they recover well with no complications. However it is best for someone to accompany the patient initially.
   
   
3. Sports
   After a heart attack, a patient is advised to have adequate rest. The road to recovery of cardiovascular fitness is gradual. The intensity of exercise should be gradually increased.
   
   The patient may start exercise walking on flat ground in the third week after the heart attack, may start climbing and gentle uphill walking from the fourth week. Normal brisk walking can usually resume in about three months.
   
   If a patient experiences chest pain, discomfort or shortness of breath while walking, slow down and stop. Report the symptoms to the doctor. The patient should consult his/her cardiologist regarding the specific time frame for resuming normal sporting activities.
   
   

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