A heart attack can be a nasty and frightening experience, particularly for those who have enjoyed excellent health previously. It is not surprising that many patients react to this situation with fear and anxiety, which may be aggravated by the severity of the pain, the evident distress of the family, and by being transported into an unfamiliar environment. Some may also be daunted by the “hi-tech” of the coronary care unit, but for most people, this is a reassuring place where they are being closely observed by highly qualified nurses,’ who can respond to any problems with speed and life-saving equipment.
When the risk of the early hours of the heart attack is safely over, the patient has usually settled down well, but anxiety may surface again on transfer to the general ward when the close relationship
that has been built up with nurses is lost, there are many new people to get to know and there is not the same intense observation. However, progression to the ward is evidence that the doctors feel that the period of danger is past and that there is good reason for optimism. Another period of anxiety occurs on going home. Away from medical care, the patient may worry about being left alone or what to do if the pain comes back. But at this time the most likely psychological problem is that of depression. Patients return to the familiar world outside and find that they cannot, or are not allowed to, undertake their normal activities. It is particularly distressing to housewives to find that they are unable to do their normal household duties (but perhaps even more galling to find that their family has managed quite well without them!). Patients often become withdrawn and are prone to outbursts of bad temper and irritability. Others get excessively tired, feel useless, or even contemplate suicide. These emotional reactions are “normal after a heart attack, but can be hard for relatives to recognize as being due to depression and may be difficult to cope
with. Happily, with returning physical well-being, anxiety and depression diminish and most patients adapt satisfactorily as they get back to normal life. However, it may take months for patients to “become themselves” again.
This early period at home is particularly difficult for spouses, who have to steer a middle course between “wrapping the patient up in cotton wool” and allowing them to do too much. This is a time for detailed talks with hospital staff and with the general practitioner about what the patient may be permitted to do. Everyone is different in personality and physical ability and it is vital to get advice that relates to the specific individual. Attendance at a rehabilitation center can help progress back to the right level of activity at an appropriate speed.
Will heart attack happen again?
Once the first few days are over, the chances of a second attack are not great and with time they become less and less. Nevertheless, the risk does exist but it can be greatly diminished by adopting healthy habits and taking medicines such as aspirin and beta-blockers which greatly reduce it (NB these drugs are not suitable for every patient). For those who have been smokers the most important single step is to stop completely; a healthy diet and plenty of the right forms of exercise are important for everyone.
