A Post-Heart Attack Checklist

What Should Happen After a Heart Attack

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After you've survived a heart attack (myocardial infarction), you've got a lot to learn about and a lot to think about. In the good old days you might have had a week or two of hospitalization to get adjusted to things — to go through all the testing, risk assessment, education, and initiation of therapy necessary to optimize your long-term prognosis. Today, however, whatever is going to get done must happen in the first three (or perhaps four, if you've got a liberal health plan) days.

Doctors and hospitals have mobilized nicely to provide adequate acute care for the person showing up with an acute myocardial infarction. But sometimes they drop the ball when it comes to giving appropriate care after those first critical hours. Most caregivers try very hard to accomplish everything that needs to be accomplished in the few days after a heart attack. Occasionally, however, “everything that needs to be accomplished” is simply overwhelming, to them and to their patients. As a consequence, all too often people with heart attacks don't receive all the assessments, education, and treatment they need to assure an optimal long-term outcome. 

What You Need To Know

The key to successfully navigating your way to a long, healthy life after a heart attack is you. You need to know what kind of testing should be done, what kind of referrals should be made, and which kinds of medications (and other treatments) should be started, or at least strongly considered.

If anything falls through the cracks, you should bring it to your doctor’s attention. 

Doctors really do want to do the right thing. It's just that, given all the pressure and constraints they're operating under, from both insurance companies and the government, sometimes you need to remind them of who they're really obligated to, and what your expectations are in that regard.

And so, you need to have the right expectations.

To this end, here is a convenient checklist of the things that should be done — ideally before you even leave the hospital — after your heart attack.

Use this checklist to make sure all the important bases are covered, and that you and your doctor are both doing all the right things to improve chances of long-term survival, and long-term good health.

Here are a few articles that explain the reasoning behind the post-heart attack checklist:

A Post-Heart Attack Checklist:

1) Lifestyle changes and other education:

  • I have been fully instructed on the warning signs and symptoms of heart attack, and the actions to take if I experience these signs or symptoms. (y/n) 
  • If I am a smoker, I have been counseled to stop, and referred to one or more smoking cessation programs. (y/n) 
  • I have been fully instructed on a heart-healthy diet. (y/n)
  • My doctor has talked to me about whether I need to lose weight, and how much weight I should lose (y/n)
  • I have received detailed activity instructions for the next 4-6 weeks, and have been referred to a cardiac rehabilitation program. (y/n) 
  • The importance of long-term exercise has been explained to me. (y/n) 
  • My doctor has talked to me about when I can resume sexual activity. (y/n) 
  • My doctor has talked to me about when I can resume driving. (y/n) 

2) Assessing the risk of another heart attack in the near future:

3) The amount of damage done to my heart has been assessed by:

  • Stress/thallium study (y/n) 
  • Cardiac catheterization (y/n) 
  • MUGA scan (y/n) 
  • Echocardiogram (y/n) 
  • (Note: at least one of these four tests should be done in order to measure the ejection fraction.)

-- I (do / do not) have some degree of heart failure.

4) Important numbers I need to know:

  • My lipid profile has been measured, and the results are: 
    • Total cholesterol: 
    • LDL cholesterol:
    • HDL cholesterol:
    • Triglycerides: 
  • My blood pressure is:
  • My fasting blood glucose is:
  • My ejection fraction is:
  • (Note: if the ejection fraction is 35% or lower, see #6 below.)

5) Names and doses of medications prescribed for me:

  • Aspirin:
  • Anti-platelet medication (such as Plavix, Brilinta, or Effient):
  • Beta blocker:
  • ACE inhibitor:
  • Spironolactone (if my ejection fraction is 40% or less):
  • Statin:
  • Note: All of these medicines have been shown to help prevent further heart attacks and reduce the risk of death. If I have not received a prescription for one or more of these medications, the reason is: 
  • I have discussed with my doctor whether I need to be treated for hypertension (y/n)
  • I have discussed with my doctor whether I need to be treated for diabetes or pre diabetes (y/n)

6) Preventing sudden death

  • If my ejection fraction is 30% or less, (or if I have had heart failure, and my ejection fraction is 35% or less) I have been referred to an electrophysiologist to discuss the possibility of an implantable defibrillator (y/n)
  • Members of my family have been trained in CPR (y/n)



Smith, SC Jr, Allen, J, Blair, SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006; 47:2130.

O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:529.

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