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So you’ve had a heart attack ó now what?

Editorís note: NFH writer Deb Risden is writing a first person account of her experience having had a heart attack.

Heart disease is the No. 1 killer of both men and women in the United States with almost 700,000 deaths a year. Cancer is the No. 2 killer, followed by COVID-19.We have all heard the numbers, the risk factors and what we need to do to combat heart disease and avoid a heart attack. And even with those sobering statistics, a significant heart event can take a person by surprise and ill-prepared for what happens next.I was one of those people. It was 5 a.m. on a snowy morning a week before Christmas. I woke up with symptoms, one at a time, stacked on top of each other. It started with profuse sweating and then came back pain, diarrhea, extreme shortness of breath and finally a 100% limp right hand. It was time to call 911. In fact, because I thought I had no risk factors for heart disease and had no signs leading up to the event, it took me over an hour to realize this was not something else. It never occurred to me I was having a heart attack. And it was past time to make that call.It was hard to believe the EMT when he said, ìMaíam youíre having a heart attack. What hospital would you like to go to?î I was barely conscious during the ambulance ride and had no idea what was happening once I arrived at Penrose Hospital. They took me directly to a procedure room. I knew I wasnít in the emergency room. Once the procedure was completed and I was feeling alert and present, the doctor showed me on a video screen that I had a 100% blockage of my coronary artery. A stent had been placed in the artery, and I was on my way to recovery followed by the coronary care unit.Fortunately, with the technology of today, about 90% of heart attack victims survive their first heart attack. Even better news for me was that I survived the STEMI (ST-elevation myocardial infarction), also known as the ìwidow maker.î It has only a 12% survival rate.The hospital stay and back home againTwo days in the hospital were filled with frequent testing and constant monitoring. A medication regimen began ó blood thinners, an ACE inhibitor and a beta blocker ó all to keep the blood flowing and the blood pressure down. Add to those a statin for lowering cholesterol. To say the experience and aftermath was overwhelming is an understatement.Once home, the real work began. Everything changed. The hospital sends you home with instructions and information about medications, diet and exercise. The message is all about prevention ó take medications, attend follow-up visits with a cardiologist and participate in cardiac rehabilitation.Cardiac rehab is about three months, three sessions a week of exercise and education on heart health. Full disclosure: I never was one for exercise, and I have to admit that cardiac rehab was another surprise. For exercise haters like me, rehab helps you ease into exercise and develop a pace that is doable and beneficial, all the while having your heart hooked up to a monitor. The three months is sprinkled with information about good nutrition, including a private session with a dietitian. I was already eating in a healthy manner but learned a few more helpful things along the way. Education was provided on other lifestyle changes that are heart healthy, such as quitting smoking. They touched on depression during a couple of education sessions, but only briefly.Along came depression and anxietyIf all the medications and lifestyle changes werenít enough of an adjustment, there can be depression, anxiety and cognitive impairment to deal with. In my experience, friends and family donít talk about it and medical professionals only give it an honorable mention.A study published in the Jan. 29, 2020, issue of Frontiers in Psychology found that 43% of people who had heart attacks suffered from anxiety that started immediately, 28% six months later and 27% between six months and one year. Depression rates were 22% at first, 17% at six months and 15% between six months to one year.Depression and anxiety are not just side effects of having a heart attack. They are risk factors for another heart attack and premature death. A European Society of Cardiology study in 2019 reported that patients who felt depressed or anxious one year post cardiac event were 46% more likely to die from cardiovascular and non-cardiovascular causes. The good news is that anxiety and depression experienced during the first two months that dissipates after that do not correlate with premature death.There were other factors found to be associated with increased anxiety and depression in the 2019 study: a history of depression, financial strain, poor self-rated health, low socioeconomic status, younger age (under 55 years) and smoking. Obesity, diabetes, and social isolation were identified as important but less significant. Neither gender nor cardiac event type were predictive of anxiety or depression.The impact of an acute heart event on the brain is recognized and discussed even less. I recall coming home from the hospital and lacking the capacity to fill a pillbox or perform work that once came easy to me. I was told that most people go back to work after two weeks. It was longer for me. When I told a nurse practitioner in my cardiologistís practice about my cognitive issues, she told me that it sometimes happens and to see my primary care physician if it continues. ìWe only deal with hearts; we donít do brains here,î she said.Neuropsychologist Dr. Jessica Zamzow, University of Colorado at Colorado Springs Aging Center, said that the vascular system does not only impact the heart but also the brain. ìThe brain needs healthy blood flow to keep the neurons alive,î Zamzow said. ìAnything that increases the risk for heart attack can increase the risk for stroke. Buildup of plaque in the blood vessels constricts blood flow to the heart. The same process happens when there is a stroke. Even tiny blockages will lead to accumulated brain damage over time, which can cause vascular dementia. When doctors recommend heart health practices such as good nutrition and exercise, the benefit is for the entire vascular system.îZamzow said a heart attack can cause cognitive impairment from oxygen depletion. ìIn the event of a heart attack there can be loss of blood and oxygen to the brain. Depending on the severity of the event, for example, a need for resuscitation or a prolonged time before treatment, the impact to the brain increases in severity.îWhen depression, anxiety and/or lack of sleep, all known to impact cognitive ability, are factored into the mix, the risk factor for cognitive impairment and dementia is more heightened. ìIf they go on chronically, it can take a toll on your body in a lot of ways,î Zamzow said.She said most of the patients who come to her for neuropsychological testing do not come in after a heart attack noting cognitive changes. ìThey are experiencing slow changes over time and a history of a heart attack is more of an indicator of overall vascular health and what might be going on as far as blood flow to the brain,î Zamzow said. ìSometimes patients report that it seems that problems started after they had a heart attack and have gotten worse over a period of time.î In testing, she finds that most impairments that surface are executive functioning followed by processing speed and memory. Executive functioning refers to higher level skills such as planning, reasoning and problem-solving.All that said, there are tools available to help avoid another heart event. There are the well-publicized actions, scientifically backed, to include managing the risk factors ó controlling high blood pressure, high cholesterol and diabetes; taking medications; quit smoking; eat healthy; and be active.The American Heart Association is a resource that I turn to. They have an online support network through their website, Itís where I found that others suffer from anxiety and depression. Many cardiac patients make several trips to the ER after a cardiac event out of anxiety and fear over every twinge, pain or symptom that is out of ordinary. AHA advises heart attack survivors to get support.†ìItís normal to feel scared, overwhelmed or confused after a heart attack. Getting support from loved ones or from people who have also experienced a heart attack can help you cope.îThis is a brief snippet of my personal journey. It is a complicated process and is likely different for you or your loved one. I recently celebrated my two-year anniversary of surviving. It gets easier but depression and anxiety still rear their ugly heads more frequently than I would like. Cognitive impairments have improved but remain. If you are the patient, my best advice is to accept help when someone offers and seek help from the medical community and support groups (see the sidebar for some suggestions). If depression and anxiety feel overwhelming, or if someone in your life observes it and mentions it, donít hesitate to seek counseling. It could save your life, literally. And if you have a friend or loved one who has had an acute heart event, reach out and insist on helping. Donít accept ìIím OKî for an answer. Helping can be dropping off a home-cooked meal, picking up groceries or prescriptions, taking the dog for a walk, suggesting that therapy might be helpful, or just calling to check in and chat. Moving past that acute event is not always a smooth road. Support could make all the difference.More factsEvery year, about†805,000 people in the United States†have a heart attack.††Of these, ï 605,000 are a first heart attack ï 200,000 happen to people who have already had a heart attack ï About†one in five heart attacks are silent ó the damage is done, but the person is not aware of it.Source: https://www.cdc.govRisk factorsTraditional risk factors†for heart attack include ï Smoking ï High blood pressure ï High cholesterol ï Diabetes ï Overweight or obesityRisk-enhancing factors†include ï Family history of early atherosclerotic cardiovascular disease (men under age 55, women under age 65 years) ï High cholesterol (LDL-C 160-189 mg/dL; non-HDL-C 190-219 mg/dL) ï Metabolic syndrome ï Chronic kidney disease ï Chronic inflammatory conditions (e.g., rheumatoid arthritis, psoriasis, HIV/AIDS) ï History of preeclampsia or early menopause ï High-risk ethnicity (e.g., South Asian ancestry) ï Higher than normal triglycerides (175 mg/dL or higher), ankle-brachial index (ABI) and other lab testsSource: https://www.aha.orgSymptoms of a heart attack: ï Chest pain or discomfort.†Most heart attacks involve discomfort in the center or left side of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness or pain. ï Feeling weak, light-headed or faint.†You may also break out into a cold sweat. ï Pain or discomfort in the jaw, neck or back. ï Pain or discomfort in one or both arms or shoulders. ï Shortness of breath: This often comes along with chest discomfort, but shortness of breath also can happen before chest discomfort.Although some women have no symptoms, others may have ï Angina (dull and heavy or sharp chest pain or discomfort) ï Pain in the neck, jaw, or throat ï Pain in the upper abdomen or backThese symptoms may happen when you are resting or when you are doing regular daily activities.Women also may have other symptoms, including ï Nausea ï Vomiting ï FatigueSource: https://www.aha.orgResourcesThere are many resources available; these are some that I have found helpful: ï American Heart Association, ï Centers for Disease Control, ï Blog for women with heart disease: (Owner Carolyn Thomas is a graduate of Mayo Clinicís WomenHeart Science and Leadership Symposium for Women with Heart Disease and a published author.) ï Your insurance company to locate a therapist ï (a virtual therapy resource) ï Meditation ñ Calm and Headspace apps

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