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Heart attack

Preventing another heart attack

People can do a lot to reduce their chances of having another heart attack. As well as taking the medicines their doctor has prescribed and the treatments they have had in hospital, making some lifestyle changes can help the heart to recover and can improve future health.

Stopping smoking, eating well and exercising regularly will help the heart to recover. Reducing stress and making time for relaxation will also help.

How much the people we interviewed changed their habits depended on their previous lifestyle. Some made small changes, others changed more. One man said that plenty of activities combined with rest, diet and exercise helped to keep him fit and healthy.

 

She made little change to her diet.

She made little change to her diet.

Age at interview: 63
Sex: Female
Age at diagnosis: 63
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Well I'm certainly eating more fish but I find it difficult to make a great deal of change because I was already having skimmed milk and fruit and veg and [eating carefully]. What else can I change? Very little in the diet. We have increased the fish. We never really ate a great deal of red meat anyway. 

We've probably reduced it a little but it's kind of from not much to a little and the fish from not too often to more often. But still, I still look at the fat content of the food that I buy. I never fry, I never cook in oil. I haven't for twenty, thirty years. 

We don't go to [fast food venue's], we don't eat fish and chips and things [laughs] and we don't have big English Breakfasts so it just seems a bit unfair, however who says life's fair?

 

He recommends a varied lifestyle combined with rest, diet, exercise and sleep.

He recommends a varied lifestyle combined with rest, diet, exercise and sleep.

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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Well I enjoy being active and I know that the best thing to get back on your feet, the more active you can be, the better your body's going to respond. Make sure you eat all the right food. Meet a lot of people and eat particularly the right food and I feel all those ingredients, plus when you feel like a sleep then get down and have a good sleep. 

Now I always have a very good quality of sleep, I sleep very well at night. Quite often I sleep a half an hour in the daytime and I feel all those ingredients mixed together; good sleep, good food, good exercise, meeting good people, a varied lifestyle. 

They contribute to the overall package and there's nothing in isolation, I think you need every one of those segments to propel you forward and keep you fit and healthy.

Many people who had been smokers were surprised at how easy they had found it to quit. A few men did not stop smoking until after their second heart attack.

 

He quit smoking after his heart attack to help his recovery.

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He quit smoking after his heart attack to help his recovery.

Age at interview: 63
Sex: Male
Age at diagnosis: 62
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You said you were smoking up to your heart attack.  How did you manage to stop?

Yes, although for several years previous to it I had more than halved my consumption to twenty or so a day. Well, a week in hospital without so much as a crafty drag was a good start. Thereafter I just put cigarettes out of my mind. I did not need anything to help with the transition. 

Despite what is said about the powerful addictive nature of nicotine, if you have a strong enough motivation then giving up smoking is not at all difficult. If on the other hand you are applying will power to something you don't really wish to succeed at, then neither chewing gum, patches nor hypnotism are going to be much help.

In my case the motivation was the threat to physical activity  I've never been remotely athletic, or a regular player of sport, but I do like walking and I positively seem to need the more active aspects of gardening and DIY. The immediate consequence of a heart attack made me realise how much I prized this sense of physical freedom and how much it was threatened. 

On that basis anything that might restrict or delay recovery was automatically out, and smoking was the most prominent candidate.

 

He continued to smoke and didn't reduce his workload until he had a second heart attack.

He continued to smoke and didn't reduce his workload until he had a second heart attack.

Age at interview: 63
Sex: Male
Age at diagnosis: 40
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I still hadn't got over the, if you like, I know I was 40 but as a younger man, as with most younger people, you consider yourself immortal, you're not ever going to die, nothing can hurt you. 

I suppose there was still an element of that in my behaviour. In fact you tend, I tended to go the other way, that 'don't be silly, I can't have had a heart attack, I'm going to prove them wrong.'  

Hence you carry on smoking, hence you don't reduce your workload and you, you tend effectively to continue, once you get over the initial trauma, you tend to continue your lifestyle exactly as it was. 

I found the second attack much more of a pull up, I did take heed of that one. And the fact that I had a really good GP as well, who calls a spade a spade, he doesn't go around corners, who said, 'you have two choices,' he said, 'you can go back to work and you can die or you can seek medical retirement and hopefully continue a good standard of life.'  

So I took notice of him as well. I found it very depressing realising that I was not immortal, but as I say we fought through that and came out of the other end, which was wonderful.  

Some people said they had changed their diet to keep their cholesterol level low. They ate less saturated fat, ate more fruit and vegetables and no longer drank coffee. One younger man found his new diet strange at first, but his taste soon changed and he enjoyed new recipes.

 

He changed his diet to keep his cholesterol level low.

He changed his diet to keep his cholesterol level low.

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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My cholesterol level was about 7.5. The accepted figure is 5 and my cholesterol is now 4 and that was achieved through looking carefully at what I was eating and 20mg of simvastatin every night. 

So cholesterol is the thing to bear in mind and everybody should look at their cholesterol, get it measured and take action. And the action is, look carefully on what you're eating. Cut down on the saturated fats, cut down your dairy products, your crisps, anything with salt. Look carefully at the packaging on any meals that you have and if it's high in saturated fat; don't take it.

So what sort of things, foods did you have to change specifically?

Well I decided to give up cheese because my little dog and I, every night used to have cheese [laughs]. He still has a little bit of cheese. I don't have cheese. I don't have crisps. I've given up coffee as well actually. Tea instead. Drink lots and lots of water. 

When I was in hospital recovering from my surgery, I drank a lot of water and I'm convinced it helps. I also looked up the effect of alcohol and came to the conclusion that red wine was one of the best alcoholic drinks you can have. I'm told it's to do with the skin of the grape, which has got beneficial by-products. 

So I decided if I want a glass of red wine, I'll have a glass of red wine. And if I go out to a function or party now, I won't refuse the food that's offered, I'll take it. So in moderation take what you want, but be a little bit careful of the saturated fat and salt.

 

He follows a Mediterranean style diet and still enjoys his food.

He follows a Mediterranean style diet and still enjoys his food.

Age at interview: 58
Sex: Male
Age at diagnosis: 57
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Eating. Low fat is the key with eating and surprisingly enough that isn't as difficult as it sounds. It's cost me one of my weaknesses, it's cost me the cheese but they do low-fat cheeses. Low fat, eating of low fat and it isn't really that difficult once you've got over the initial change of eating. 

I enjoy eating now as much as I did before my heart attack and my intake of saturated fats is a lot less than it ever was before my heart attack and it's not a problem it really isn't. And the only tip I give to people who've got to be on it, I'm sure they all know this is always be aware of the claims on the packs of the food you buy. 

Like these reduced fat, well it could be 80% reduced to 75% as it were. You need to look and read labels but there's quite a range of food on the market, which fall within that context. 

The eating of fruit and vegetables really is not difficult because I enjoy fruit and veg and there's a lovely book they've got at the hospital, it's the 'French Connection.' How in Mediterranean countries they have far smaller incidence of heart attacks than we do and it's five reasons; garlic, olive oil, fresh fruit and veg, oily fish and red wine and I can live with that. 

 

Changes to his diet were easier than he imagined and as his taste changed, he found it enjoyable.

Changes to his diet were easier than he imagined and as his taste changed, he found it enjoyable.

Age at interview: 46
Sex: Male
Age at diagnosis: 42
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Well we didn't eat tons of red meat, we didn't eat particularly badly but we didn't really watch what we ate. But suddenly looking at sort of vegetarian dishes. I mean I'd never eaten a lentil in my life, I couldn't stand the sight of them. It was one of those things that I assumed I didn't like, even though I'd never had it.  

But it was amazing that once I'd started fiddling around with different spices and we bought a wok for stir frying. And I'd always liked Indian and Chinese food and I've always enjoyed cooking and suddenly I was cooking all this new stuff and having to follow recipes and for a while I was following the recipe, you know well I bought some new scales and I was following and measuring everything to the absolute microgram and millilitre. 

But the stuff that was coming out wasn't too bad apart from the fact that we had no salt in anything. And that was probably harder to get used to than a nice fatty steak [laughs]. But it did say in some of the things that we'd read that would become easier as your taste adjusted, which it did. 

But it seemed quite hard at the start because it was such a great big sea change but it was pretty enjoyable. That was a real positive out of it.

Some tried to lose weight by exercising more. A few reduced their alcohol intake.

Others took more exercise. Some people had got involved in fund raising events, such as fun runs and walks, which they had never done before.

Some tried to reduce the amount of stress in their life or made time for relaxation in their daily routines. Combining daily exercise with relaxation was considered important in preventing another heart attack (see 'Complementary therapies and approaches after a heart attack').

 

He makes time for relaxation during his day.

He makes time for relaxation during his day.

Age at interview: 51
Sex: Male
Age at diagnosis: 51
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I try to relax once in the morning or at least lunchtime and then once in the evening, so that fits in two a day quite nicely. That's coming on for an hour each day that I'm relaxing, giving your heart a chance, open up your arteries and letting everything slow down and I'm beginning to like that. 

I feel very indulgent, I'm not a couch potato, I'm not an inactive sort of person and it was a real hardship to start with, to actually relax. But you begin to enjoy it. If anybody tries it, I would thoroughly recommend it. You really do enjoy it.

Do you feel the benefits from it?

Oh yes. It's marvellous, yes. And I've told colleagues at work and they've been absolutely fascinated because I can see them just rushing around and trying to do everything and fitting the most in a day, which is wonderful I loved doing it as well but actually for your heart and for your body generally, you do need to slow down occasionally and I've done that and it really does pay off. 

 

He plans to reduce his out of work commitments so that he can spend time at home relaxing.

He plans to reduce his out of work commitments so that he can spend time at home relaxing.

Age at interview: 54
Sex: Male
Age at diagnosis: 54
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I mean we're both very busy but I did all the cooking, and ironing and those domestic tasks. And I suppose I was, characteristically I'd work, come home, do those sort of things and then probably not really actually relax until about ten o'clock. I've been forbidden from doing those sort of things and my wife who hadn't really cooked for about sixteen years, has started cooking, assisted by my son. 

My son's started doing the ironing. I mean these are only probably temporary but I think what it will probably do is reduce the, I mean both of us are probably going to strip off some of the, as well as being very busy at work, we also have quite a lot of other committees and school governorships and those sort of things.  

This sort of brings you up with a shock about what's important so I think both of us, well I am going divest myself of a chair of governors that I am at a school. My wife's taken six months leave of a voluntary organisation with the homeless that she does quite a lot with. And I think generally we'll probably try and make some adjustments to lifestyle that way. 

And I've set my, it's been really nice, if unusual to, I normally read lots of books on holiday and don't get much of a chance to do that when I'm not on holiday. But I've been reading a lot obviously since I came out of hospital and indeed when I was in hospital. But I'm going to set myself a sort of project of probably trying to make sure I read a book a week, because to do that will involve carving space to do so. 

 

Combining exercise with relaxation is important.

Combining exercise with relaxation is important.

Age at interview: 72
Sex: Male
Age at diagnosis: 49
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The art of relaxation is probably underplayed by a lot of people but they don't really realise the importance of learning to relax properly. That is emphasised during this rehabilitation course.

Is that something that you had experienced before your heart attack?

Not really, it's only in the last five years that I began to realise what relaxation was about and the importance of it and how it does help, particularly on top of doing a bit of exercise; the marriage of the two's important.

What do you do to relax?

You've got an option; whilst you're in the hospital doing it, you have sheets to lie on and a headrest and music is played, words are spoken which you need to take in initially but initially. But after you've learnt to do this, you can relax anywhere you want, sitting or lying down in your own house and just relax from the head down to the toes. 

There's an art in it. It's not all that easy but it comes natural after a while. It's like anything, if you want to do it, you'll do it and you'll do it well. It will come natural.

Many said they felt fitter and healthier than before their heart attack.

Most people said they had found it easier to change their lifestyle when their partner or the whole family was involved. One young mum made her family take more exercise and eat better since her heart attack.

 

She changed her family's lifestyle after her heart attack.

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She changed her family's lifestyle after her heart attack.

Age at interview: 42
Sex: Female
Age at diagnosis: 37
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You've changed your lifestyle quite a bit. How easy was it to do that?

I suppose it was quite easy. We didn't do as much exercise as what we do now. We didn't go on bike riding holidays. We go camping now, and we go on bike riding holidays. We do a lot of walking, where I suppose we did a lot of driving. I suppose we eat healthier. Then we'd perhaps eat chips, and fry-ups, and we don't eat things like that now. I suppose it's quite easy to turn the family round, slowly. 

The older girls used to come and say, "What is that?" I was always one of these parents who if I'm cooking and eating it, then I'll do it for everybody. I'm not just doing my own. You'll all come with me. We'll all change to the green milk, and we'll even go down to the red milk. My husband was good though. 

What I ate, he'd eat. He'd come with me, but then he'd come to rehab, we did a lot of games on the floor with the packets of food, what we could and couldn't eat. 

Another man mentioned that it was hard to reduce his intake of saturated fat when his wife's diet had not changed. One woman said she found it difficult to exercise as much as she wanted to because she did not feel confident about doing it on her own.

 

He found it hard to reduce his intake of saturated fat when his wife's diet had not changed.

He found it hard to reduce his intake of saturated fat when his wife's diet had not changed.

Age at interview: 71
Sex: Male
Age at diagnosis: 70
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So I said to her "It's very difficult sitting here watching you eating chocolate and cake," and she'll come in with a big chocolate sponge sandwich, cream with chocolate on top and I said "Well I can't really," you see I don't feel I can allow any fat now to build up. 

And I said "It's no point in me taking a statin every night if in the day time I'm eating chocolate, chocolate cake and what have you. I have milk still, I buy the green top milk which she hates and if she went for milk, which she doesn't, but if she did she'd come back with blue top. And I said "Well no I have to cut down." 

Now since this girl has said to her, this surgeon said to her "Oh yeah that will give him about eight years," she's, she's paid a bit more attention to what this girl has said because she's family. And I said to her "Well I said, "That's why I'm not taking any fat."  

And you know, but she doesn't see why she should give it up so I have to sit here and watch her eating which is difficult because I like chocolate the same as her. When she was at home there last month she was home for two weeks and I, looking in the cupboard one day, you see if she's not here and I'm feeding myself that's fine I won't even buy anything that's fattening.

 

She finds it difficult to exercise as much as she wants to because she lacks the confidence to...

She finds it difficult to exercise as much as she wants to because she lacks the confidence to...

Age at interview: 63
Sex: Female
Age at diagnosis: 63
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And you'd think wouldn't you, knowing that you'd have a heart attack you'd be out there every day at the gym.

But it's frightening going on your own.

Yeah. I'm terrified.

Can you explain that a bit more?

What, being frightened? Well I would, I will say I get, I wake up in the morning and I think right now today I will go for a swim.  Right, I get my bathing costume, towel, bag, right who can I phone to come with me so then I phone my sister's husband, no he can't come. 

Right, there's nobody else I can phone is there, right, so I think well I won't go, I'll go tomorrow. And then for the rest of the day I feel guilty because I haven't been but I can't go because I'm scared, what if anything happens to me in the baths. Who's gonna be there. 

Whose gonna take me home. You know if I'm going to die I want to die at home in my bed. I don't want to  go to a hospital and I don't want to have an operation. So if I'm gonna  have this heart attack, I'm gonna die at home in my bed, so I'm not going out am I?.

Support from their partner, family or friends when making lifestyle changes was very important. One single man said that the cardiac rehabilitation nurses encouraged him and helped him to make changes.

Last reviewed June 2017.

Last updated September 2010.

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