After A Heart Attack: Preventing More Heart Attacks

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If you have had a heart attack (also called a myocardial infarction, or MI), you now know something about yourself you may not have known before. You know that you have coronary artery disease (CAD). This is important information. 

(While heart attacks can be caused by other conditions, CAD is overwhelmingly the most common cause. Talk to your doctor to confirm that you have CAD.)

CAD is a chronic disorder that most often affects the coronary arteries in more than one location, and that tends to progress over time.

This means that you need to take steps to reduce your odds of having another MI in the future.

To prevent another heart attack, you and your doctor will need to address two separate issues. First, you will need to take action to prevent re-rupture of the atherosclerotic plaque that caused your MI. Second, you will need to do everything you can to slow or halt the progression of your underlying CAD.

Reducing The Immediate Risk

Patients who survive an MI may have an increased risk of experiencing a recurrence of acute coronary syndrome (ACS) within a few weeks or months. ACS - caused by the rupture of a plaque - produces either unstable angina or another MI. 

These "early" recurrences of ACS are usually caused by the re-rupture of the same plaque that caused the original MI. The risk of having an early recurrence is higher when the "culprit" plaque is still producing a significant partial blockage in the coronary artery.

If your acute MI was treated by the invasive approach (that is, with immediate angioplasty and stenting), then the culprit plaque likely will already have been dealt with.

The story is different if instead you were treated non-invasively with thrombolytic drugs. These drugs - also called “clot-busters” - open the occluded artery by dissolving the acute blood clot that occurs with ACS.

However, the culprit plaque remains an issue. So, before you leave the hospital it will be important to evaluate whether a significant partial blockage is still present. This evaluation can be done either with a cardiac catheterization, or a stress/thallium study.

If it is determined that a significant blockage remains, your doctor will discuss with you the options for therapy aimed at preventing an early recurrence of ACS - options which will include medical treatment for CAD, angioplasty and stenting, or coronary artery bypass grafting.

Reducing the Longer-Term Risk

Too often after an MI, patients are left with the impression that, yes, they had a significant medical problem, but now it has been dealt with, and they can just go on with their lives as if not much has changed.

Nothing can be further from the truth. It cannot be stressed too strongly that atherosclerosis is a chronic progressive disease that most often affects several locations within the coronary arteries.

Any atherosclerotic plaque - regardless of its size - can rupture and produce ACS.

So once you have had an MI, then you need to do everything you can to slow or halt the progression of that underlying disease process. This will require a major commitment on your part, and on your doctors'.

There are two general areas you and your doctor will have to address - drug therapy and lifestyle changes. The easier one is drug therapy.

Drug Therapy After a Heart Attack

To help prevent future MIs, you should be given the drugs that have been shown to either slow the progression of CAD, or prevent the sudden occlusion of a diseased coronary artery (by preventing the acute blood clotting that causes the occlusion). These drugs are statins and aspirin.

Statins: Several clinical trials now show that taking a statin drug after an MI significantly reduces the risk of having another MI, and also the risk of death. This result applies even to patients whose cholesterol levels are not especially high. So unless you simply cannot tolerate statins, you should be taking one after your heart attack.

Aspirin: Aspirin reduces the "stickiness" of the blood platelets, and thus reduces the chance of developing a blood clot at the site of an atherosclerotic plaque. Aspirin has been shown to significantly reduce the risk of death in patients with known CAD, and should be prescribed in every MI unless there are strong reasons not to.

Your doctor may also decide to give you medications aimed at preventing angina. These medications may include nitrates, or calcium channel blockers.

In addition to these drugs, you should also receive beta blockers and ACE inhibitors to help prevent heart failure .

Lifestyle Issues After A Heart Attack

Just as important as drug therapy are the lifestyle changes that will reduce your long-term risk after an MI. These include achieving and maintaining an optimal weight, beginning a heart-healthy dietending tobacco use, achieving excellent control of diabetes and hypertension (if present), and engaging in regular exercise

Everyone understands that making these lifestyle changes is a lot more difficult than taking a pill. But remember: receiving a diagnosis of CAD is really a call to arms. You have a disease that will get worse over time unless you attack it like you would attack a diagnosis of cancer. The treatment is not easy, but it is usually quite effective. So steel yourself, get focused, and make the lifestyle changes that you need to make.

An important aspect of helping you achieve these critical lifestyle changes is for your doctor to refer you to a good cardiac rehabilitation program. Too many doctors, unfortunately, neglect this important step. If yours forgets, remind him or her.

You will also want to ask your doctor specifically when it's safe for you to resume driving, sexual intercourse, and any other activities that you'll wish to resume as soon as it's safe.

Here's More On What You Need To Do After an MI

Sources:

O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:e362.

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.

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