Khalid seemed visibly upset and was trying to hold back his tears. He was in his early forties and had just entered his pratical life. He had two small kids and a very lucrative job. He had many dreams and many unfulfilled plans. He was perfectly healthy so far and it had not occurred to him in his wildest dreams that he will end up in CCU one day. But as luck would have it, he suffered a heart attack one morning, and here he was in CCU on the second day of his admission.
I could see a hot of questions written all over his face. Is it the end of his career and will he lead a nearly crippled life? Does it imply that he will be confined to his house for the rest of his life? Does it mean that he necessarily has to go for a bypass operation< Will he not be able to enjoy golf again? Does he have to remain content with a boiled diet without any meat? Should he pursue his MBA degree? Should he still consider an addition in his family?
Heart attack can mean different things to different people. For most patients it is an important event but it passes off like another event and the person can go back to normal life. There is a definite mortality attached to it. Half of the persons who die of heart attack die within first hour and that too because of irregular beating of heart. In a few cases, it is not even recognized as a heart attack. Later, once patient is stable in CCU and has received definitive treatment then the death rate does down. Ninety percent of patients will leave CCU and hospital alive on their feet.
There was a time when patients were kept in the hospital for weeks and they were not allowed to lave the bed for a month. Things have changed for the better! Patients who are otherwise stable are mobilized after forty eight hours. They are discharged if they are otherwise stable on third or fourth day. If they have any problems – mechanical or electrical, they are kept under observation for as long as necessary. Patients who undergo angioplasty after heart attack may be discharged the next day and allowed to return to work much earlier. Patients are advised rest and leave from work for four weeks. Gradual mobilization is recommended after discharge. Starting from ten minutes on an empty stomach at a leisurely pace morning and evening and then building it up slowly to thirty minutes twice a day. Most patients can expect to go to work after four weeks.
When and what tests does one require after a heart attack? The basic philosophy is firstly to document the extent of damage in terms of function of left ventricle – main pump. Secondly, determine the extent of blockages in vessels supplying heart – coronary arteries, and thirdly look for all risk factors and try to improve them. Most patients will be required to undertake tests like effort tolerance test and echocardiography. This is to identify patients who will be requiring further tests like coronary angiography and hence requiring interventions like angioplasty and bypass operation. Not every patient who suffers from heart attack needs angiography or bypass surgery. Patients on very demanding and physically tough jobs or those who are young are advised coronary angiography irrespective of the result of effort tolerance test.
Big question for the family is what to allow the patient to eat? Many patients on their first visit after heart attack bring their youngest child who demands a list of forbidden food. This young lad turns out to be mama’s detective on a special duty. Depending on other risk factors like diabetes, high blood pressure and high cholesterol, there is not a lot that a patient should be denied. Preferably, food should be low in cholesterol within no ghee, butter, fat, egg, and internal organs. Small quantity of chicken and meat are allowed and fish is encouraged. No bar on bread or rice unless the patient is fat and calories have to be watched. Soups are allowed but should not replace normal food. Some roughage in the form of salad and fresh or boiled vegetables should be encouraged as it prevents constipation. Half cream or skimmed milk may be consumed. Juices especially fresh may be encouraged if the patient is not diabetic. Fresh fruits are always welcome.
Most patients are able to retain their job and follow their pursuits unless it is very risky and demanding. A few months down the lane most people will have forgotten about the event and gone back to their old life styles. Competitive sports and jobs in armed forces may be difficult to retain. Most intellectuals and bureaucrats have had a heart attack by the fifth decade but they continue to follow their jobs and hobbies.
Can one have another heart attack after the first one? Why not! So one has to put in efforts to correct one’s risk profile. For those who are diabetic, blood sugar level has to be meticulously controlled by keeping a very vigilant watch on diet and taking prescribed medicines regularly. Patients with high blood pressure have to bring their blood pressure to normal range or lower than that. Salt has to be restricted and treatment plan adhered to. Cholesterol has to be brought down regardless of the baseline levels. Strict control on diet is required and nowadays we are very liberal in prescribing cholesterol lowering drugs like statins. They have been shown very convincingly to reduce deaths and requirement of angiography and interventions like bypass and angioplasty in treated patients with salutary effects on lipid profile.
With modern treatment, like clot dissolving drugs and angioplasty – opening of vessels with balloons and stents, the outlook has improved remarkably. Most patients can go back to their original job and life style in four weeks. Regular exercise, discretion in diet and adherence to treatment are the golden rules to follow. For the majority of patients who sustain a heart attack, it is not the end of the world!
_____________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
I could see a hot of questions written all over his face. Is it the end of his career and will he lead a nearly crippled life? Does it imply that he will be confined to his house for the rest of his life? Does it mean that he necessarily has to go for a bypass operation< Will he not be able to enjoy golf again? Does he have to remain content with a boiled diet without any meat? Should he pursue his MBA degree? Should he still consider an addition in his family?
Heart attack can mean different things to different people. For most patients it is an important event but it passes off like another event and the person can go back to normal life. There is a definite mortality attached to it. Half of the persons who die of heart attack die within first hour and that too because of irregular beating of heart. In a few cases, it is not even recognized as a heart attack. Later, once patient is stable in CCU and has received definitive treatment then the death rate does down. Ninety percent of patients will leave CCU and hospital alive on their feet.
There was a time when patients were kept in the hospital for weeks and they were not allowed to lave the bed for a month. Things have changed for the better! Patients who are otherwise stable are mobilized after forty eight hours. They are discharged if they are otherwise stable on third or fourth day. If they have any problems – mechanical or electrical, they are kept under observation for as long as necessary. Patients who undergo angioplasty after heart attack may be discharged the next day and allowed to return to work much earlier. Patients are advised rest and leave from work for four weeks. Gradual mobilization is recommended after discharge. Starting from ten minutes on an empty stomach at a leisurely pace morning and evening and then building it up slowly to thirty minutes twice a day. Most patients can expect to go to work after four weeks.
When and what tests does one require after a heart attack? The basic philosophy is firstly to document the extent of damage in terms of function of left ventricle – main pump. Secondly, determine the extent of blockages in vessels supplying heart – coronary arteries, and thirdly look for all risk factors and try to improve them. Most patients will be required to undertake tests like effort tolerance test and echocardiography. This is to identify patients who will be requiring further tests like coronary angiography and hence requiring interventions like angioplasty and bypass operation. Not every patient who suffers from heart attack needs angiography or bypass surgery. Patients on very demanding and physically tough jobs or those who are young are advised coronary angiography irrespective of the result of effort tolerance test.
Big question for the family is what to allow the patient to eat? Many patients on their first visit after heart attack bring their youngest child who demands a list of forbidden food. This young lad turns out to be mama’s detective on a special duty. Depending on other risk factors like diabetes, high blood pressure and high cholesterol, there is not a lot that a patient should be denied. Preferably, food should be low in cholesterol within no ghee, butter, fat, egg, and internal organs. Small quantity of chicken and meat are allowed and fish is encouraged. No bar on bread or rice unless the patient is fat and calories have to be watched. Soups are allowed but should not replace normal food. Some roughage in the form of salad and fresh or boiled vegetables should be encouraged as it prevents constipation. Half cream or skimmed milk may be consumed. Juices especially fresh may be encouraged if the patient is not diabetic. Fresh fruits are always welcome.
Most patients are able to retain their job and follow their pursuits unless it is very risky and demanding. A few months down the lane most people will have forgotten about the event and gone back to their old life styles. Competitive sports and jobs in armed forces may be difficult to retain. Most intellectuals and bureaucrats have had a heart attack by the fifth decade but they continue to follow their jobs and hobbies.
Can one have another heart attack after the first one? Why not! So one has to put in efforts to correct one’s risk profile. For those who are diabetic, blood sugar level has to be meticulously controlled by keeping a very vigilant watch on diet and taking prescribed medicines regularly. Patients with high blood pressure have to bring their blood pressure to normal range or lower than that. Salt has to be restricted and treatment plan adhered to. Cholesterol has to be brought down regardless of the baseline levels. Strict control on diet is required and nowadays we are very liberal in prescribing cholesterol lowering drugs like statins. They have been shown very convincingly to reduce deaths and requirement of angiography and interventions like bypass and angioplasty in treated patients with salutary effects on lipid profile.
With modern treatment, like clot dissolving drugs and angioplasty – opening of vessels with balloons and stents, the outlook has improved remarkably. Most patients can go back to their original job and life style in four weeks. Regular exercise, discretion in diet and adherence to treatment are the golden rules to follow. For the majority of patients who sustain a heart attack, it is not the end of the world!
_____________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
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