Sharon Murphy

GUIDANCE FOR PATIENTS

GOING HOME:

Before discharge, the patient will have been given similar advice to the following. This is a general guide and young people, after small heart attacks, may be able to speed the programme up. Older patients, and those with problems after heart attack, may need to slow it down.

• Week 1: stay indoors, but get dressed. You may climb stairs, slowly, up to four times a day. A daily bath is fine, but not too hot. Simple household chores such as washing up and laying tables are okay, but do not hoover, make beds, or carry heavy objects. Most of your time should be spent at rest, reading, watching TV, talking (but not too heatedly!) and playing cards.
  
  
• Week 2: start going out for short walks, initially taking a stroll in the garden, followed by going slowly down the street. Cooking & light housework may be started.
  
  
• Weeks 3 & 4: the daily walks can now be built up, starting about half a mile and increasing over the next fortnight to two miles. You may go out in a car, but do not drive yet. By the end of week three light gardening, such as weeding can commence.
  
  
• Weeks 5 onwards: after this time gradual resumption of full activity is a matter of common sense. The daily walk, which need not exceed two miles, can be gradually speeded up - always avoiding undue tiredness, breathlessness, or chest pain.

OTHER ACTIVITIES:

• Sexual intercourse - by three weeks after discharge sex should present no problems. The energy used is roughly the same as climbing two flights of stairs. If doing this brings on chest pain or other worrying symptoms, you should avoid sex until you have discussed it with your doctor.
  
  
• Driving - you are not allowed to drive for the first four weeks after the heart attack. After that you may drive if it causes you no problems. You do not need to inform the DVLA, but you should inform your insurance company.
  
  
• Air Travel - it is perfectly safe to travel by air any time from six weeks after the heart attack, unless you are very short of breath with exercise or are getting chest pain with small amounts of exercise. If in doubt, ask your doctor.

SYMPTOMS:

When you get home you may well get some symptoms which worry you. The common ones are:

• Niggling & sharp left sided chest pain
  
• Tiredness
  
• Light-headedness
  
• Occasional missed beats or extra beats
  
  All of these symptoms are quite normal & can be completely ignored.

The following symptoms may be more serious:-

• A tight, central chest pain, or a pain similar to the heart attack pain, brought on by exercise & settling with rest (angina). A similar pain coming on at rest and relieved by using glyceryl trinitrate (see below)
• Being very breathless with small exertions, and particularly being woken at night by breathlessness.
• Rapid thumping in the chest, particularly if it makes you feel faint.
  
  If you get any of these symptoms, (fortunately very few people do!), you should let your doctor know.

USING GLYCERYL TRINITRATE (GTN) SPRAY OR TABLETS:

• Angina: GTN is designed to relieve angina. This is a tight central chest pain, sometimes going up the throat or down into the arm. The pain comes with exercise and settles when you stop. Sometimes it comes on at rest.
  
  
• How to take them: If you get such a pain, place a GTN tablet or a puff of spray under your tongue. Do not swallow the tablet. The drug takes effect very quickly and the chest pain is usually relieved within a few minutes. If your chest pain is not relieved within five minutes of taking the first tablet or spray, take a second. If again the pain is still present after five minutes take a third tablet or spray. If this does not remove your pain after another five minutes you should call your doctor. If you regularly get chest pain with exercises (i.e. walking up a slope) try taking a GTN before starting.
  
  
• Side Effects: some people get a thumping headache with GTN - spit out the tablet if this happens (if tablets used).
  
  
• Looking After the Tablets: Always keep your GTN medication within easy reach. Keep tablets in the brown bottle they come in, with the top screwed on tight. Two months after opening the bottle they start to "go-off" and should be replaced. The spray has a two-year life span.

BLOOD TEST AT THREE MONTHS:

You are encouraged to have a blood test, to measure your cholesterol (blood fat) levels at three months after the attack.