Surviving a Heart Attack - After the First Day

A heart attack (also called a myocardial infarction, or MI) is always a life-changing event. The acute MI itself can produce severe heart damage, cardiac arrest, and death. But with modern medicine and some luck - especially if you and your doctors acted quickly during the first few hours - you have a very good chance of living for a long time in relatively good or even excellent health.

But your work is just beginning. There is a lot you must do to optimize your chances of long-term survival.

Unfortunately, this is where doctors all too often drop the ball. In the rush to discharge the "uncomplicated" heart attack patient, usually a couple of days after hospital admission, all too often vital steps are being neglected. In this series of brief articles, we will review the important steps that you need to take to assure that, now that you have survived the acute phase of your MI, you will become a long-term survivor as well. If you or a loved one has had a heart attack, you need to make sure that your doctors pay careful attention to all these steps.

An acute MI is caused by a sudden occlusion in a diseased coronary artery, causing some or all of the heart muscle supplied by that artery to die. So, now that you've successfully negotiated the first 24 hours of your heart attack, you know at least three things that you may not have known before:

1. You have coronary artery disease (CAD), which is a chronic, progressive medical condition.
2. Some portion of your heart muscle has been damaged, and your remaining normal heart muscle is working overtime to pick up the slack.
3. By virtue of the fact that you now have scar tissue on your heart muscle, you may be at higher-than-normal risk for sudden death from heart arrhythmias.

Knowing these things, it's obviously too early to pat yourself on the back with a "Job well done!" You've still got a lot of work ahead of you. So here's what you and your doctor need to do:

• Take steps to prevent another heart attack, which means reducing immediate as well as long-term risks.
• Accurately assess the amount of heart damage that has already occurred, and take steps to prevent heart failure.
• Assess your risk of sudden death, and institute preventive therapy if necessary.

In addition to using the information above to educate yourself on long-term survival after a heart attack, use this A Post-Heart-Attack Checklist to stay on track. Review these steps with your doctor, to make sure you are both hitting the essential steps.

_Sources:

_{Newby, LK, Eisenstein, EL, Califf, RM, et al. Cost effectiveness of early discharge after uncomplicated acute myocardial infarction. N Engl J Med 2000; 342:749.}

_{Smith, SC Jr, Allen, J, Blair, SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006; 47:2130.}