Emotional Feelings after a Heart Attack

If there has been one theme that has taxed the medical imagination over the last quarter of the twentieth century, it has been how best to help people who have just recovered from a heart attack. Subjects have ranged from drugs to prevent a second attack, to diets and exercises to reduce blood fat levels, and ways to lower the other risk factors such as smoking and drinking.

General practitioners like myself, while appreciating the fact that such research is vital - and appreciating the hard work put into it - should be forgiven if they feel, sometimes, that the everyday worries of the patients are being overlooked in all this science.

So, before going into the details of the best ways to keep alive for the longest time after a heart attack, this is a good place to review just how most recovered heart attack victims feel about themselves.

How are you feeling?

If you have just had a heart attack, you are probably physically unfit, partly because you took little exercise before your attack, and partly because your recent enforced rest has weakened your muscles further.

You will probably be depressed. This is understandable, as your life has been threatened, and you worry about your next attack. You - probably have noticed an occasional 'missed beat', or a minor left-sided chest pain, and they have frightened you. You may have found that you are having angina at an exercise level well below that before the attack, or that you get easily breathless on relatively slight exertion.

Then, with this in the background, you find that you cannot face the return to work that is looming ahead. This is just as true for the sedentary office employee as for those doing heavy manual labour. Most jobs need physical fitness, and to be physically fit, you need an underlying mental attitude combining self-confidence with tranquil­lity about the future and lack of fear. Lying awake at nights, and sitting around the house all day, three or four weeks after a major heart attack, do not promote this desirable mental state!

The fact is that many patients feel forgotten in the weeks after they leave hospital. No matter how well-meaning their family doctors and nursing care, it is bound to be much less intensive than the hospital environment. The constant hospital round of doctors, nurses, physiotherapists, the visits to X-ray, and the company of other patients give little time for introspection.

At home it is introspection time all day - and much of the night! You may have a daily visit for a while from the district nurse and a twice weekly doctor's visit. With luck you may even be seen by a physiotherapist. Sadly, the arrangements for follow-up at home vary from place to place, and are rarely ideal. It is easy to become despondent.

In fact, most men and women recovering from a heart attack are much healthier than they think they are. They naturally tend to look on the black side, when they could be much more active, physically and mentally. Most people recover from their myocardial infarction to a good performance level, measured by treadmill and bicycle tests; it is their mental attitude that tends to hold them back. Half of those not back at work six months after the attack are suffering from cardiac neurosis (excessive anxiety about their heart), rather than physical disability.

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