Recovery from heart attack is physical, emotional

Cardiologists favor group program of cardiac rehabilitation

February 18, 2010|By Sandy Alexander | Special to the Baltimore Sun

For two days in July, Marcelette Lee thought she was coming down with the flu.

When she started vomiting, she headed to her doctor's office. By the time she arrived, she was short of breath. It turned out she was having a heart attack and needed triple-bypass surgery.

In the six months since, Lee, 54, of Randallstown, has been taking medication, exercising and watching what she eats. She said those efforts have been focused on more than increasing her time on the treadmill or lowering her cholesterol levels. They have been about reclaiming her life.

"I had no control," Lee said of the attack and the hospitalization that followed. "For a person who is used to being independent and assertive, that was humbling. … It was wonderful to get pieces and pieces of control back. When I could drive myself again, or go pick up some groceries, it just made such a difference."

After the initial trauma and medical intervention surrounding a heart attack, patients are faced with the challenges of recovering physically and emotionally. They also have an opportunity to make life changes that can protect their hearts. According to data from the National Heart, Blood and Lung Institute, 16 percent of men and 22 percent of women who have a first heart attack between the ages of 40 and 69 will have another heart attack or develop fatal coronary heart disease within five years.

Along with medications, the most common prescriptions after a heart attack are exercise, improving one's diet, reducing stress and stopping smoking. Those familiar recommendations "carry a lot more weight" after a person has been through a serious health event, said Dr. Duncan Salmon, a cardiologist at Sinai Hospital. "It is a teachable moment."

Individuals differ in the severity of heart damage and have a variety of lifestyle factors, but generally the first six weeks are a time to take things slow and easy, Salmon said. People should avoid being sedentary and focus on gentle activities such as walking, he said. They should stop if they are lightheaded or short of breath.

After a patient's first month out of the hospital, Salmon and many other cardiologists recommend a cardiac rehabilitation program.

Like others in the region, the cardiac rehabilitation program at Northwest Hospital Center in Randallstown is a comprehensive one, said Lisa Gerberg, a registered nurse and program manager there. Staff members are familiar with clients' histories and monitor them closely during exercise. Patients can also learn how to deal with stress, cook healthful meals, read food labels and change their behavior in other ways.

Gerberg said another reason rehabilitation is beneficial is "because of the constant support of the staff and the camaraderie of the other patients going through it. It is social support and a whole group dynamic."

Lee found that part of the Northwest program particularly helpful when she agreed to have a cardioverter-defibrillator implanted in her chest in December. "We're all like a family," she said. "We share our experiences, we give helpful hints."

Support systems of all kinds are important because, along with shortness of breath and fatigue, anxiety and depression are common symptoms during recovery.

Maria Johnson, 42, of Parkville, said she felt the emotional symptoms acutely after she survived two cardiac incidents.

She said the first, which included tightness in her chest, nausea, and jaw and back pain, was misdiagnosed as early labor because she was seven months' pregnant. She delivered her son by Caesarean section and then, eight days later, had the symptoms again. That time, she received a correct diagnosis and emergency care, but she said it was several years before she really felt she had recovered. "For six months, I was afraid of going to bed, of closing my eyes," she said. "I was afraid I wouldn't open them again. I couldn't even take a few steps, I was so afraid of exerting the effort that might cause a heart attack. … Emotionally and mentally, I was a wreck."

After a year and a half, with support from her family and help from medication, she started walking at the mall every day. When she started, she was tired after a few steps. But, she said, "Ten minutes became 25, became 30." Two and a half years later, she could walk outdoors for 4 miles at a time.

She still worries when she feels a flutter in her chest or has jaw or back pain, but, she said, "I am not going to let this win over me. I'm on a mission here to take care of my family."

"A heart attack can be a life-changing event because [the patient] is faced with their mortality," Salmon said. "In cardiac rehabilitation, one thing we try to do is reassure them they will be able to live good, productive, healthy lives."

If they stick to the program, he said, "they may discover their quality of life has improved."


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