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After A Heart Attack: Preventing More Heart Attacks

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Updated November 13, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Once you have had a heart attack (also called a myocardial infarction, or MI), a key goal will be to prevent any more MIs from occurring. You and your doctor will need to address two separate issues in achieving this goal - preventing re-rupture of the plaque that caused your original MI, and delaying the progression of your underlying coronary artery disease (CAD).

Reducing The Immediate Risk

Unfortunately, patients who survive an MI may have an increased risk of experiencing either another MI, or a less severe form or Acute Coronary Syndrome (ACS), within a few weeks or months. These "early" recurrences of ACS are thought to be caused mainly by the re-rupture of the same plaque that caused the original MI. The risk of an early recurrence is increased when the "culprit" plaque is still producing a significant partial blockage in the coronary artery.

If your acute MI was treated by the invasive approach (i.e., with immediate angioplasty and stenting), then the culprit plaque likely will already have been evaluated and dealt with. But if you were instead treated with non-invasive thrombolytic therapy (which dissolves the acute blood clot, but does not affect the plaque itself), then before you leave the hospital it will be important to evaluate whether a significant partial blockage is still present. This evaluation can be done either with a cardiac catheterization, or a stress/thallium study.

If it is determined that a significant blockage remains, your doctor will discuss with you the options for therapy aimed at preventing an early recurrence of ACS - options which will include medical treatment, angioplasty and stenting, or coronary artery bypass grafting.

Reducing the Longer-Term Risk

Too often after an MI, patients are left with the impression that, yes, they had a significant medical problem, but now it has been dealt with, and they can just go on with their lives as if not much has changed.

Nothing can be further from the truth. Unfortunately, atherosclerosis, which causes CAD, is a chronic, progressive disease. So once you have had an MI (which almost always means that you have significant CAD), then you need to do everything you can to slow or halt the progression of the underlying disease process. No less than the patient who finds out he has cancer, you need to refocus and reprioritize your life to optimize your odds of long-term survival. This will require a major committment on your part, and your doctors'.

There are two general areas you and your doctor will have to address - drug therapy and lifestyle changes. The easy one is drug therapy.

To help prevent future MIs, you should be given the drugs that have been shown to either slow the progression of CAD, or prevent the sudden occlusion of a diseased coronary artery (by preventing the acute clotting phenomenon that causes the occlusion). These drugs are statins and aspirin.

Statins: Several clinical trials now show that taking a statin drug after an MI significantly reduces the risk of having another MI, and also the risk of death. This result applies even to patients whose cholesterol levels are not especially high. So unless you simply cannot tolerate statins, you should be taking one after your heart attack.

Aspirin: Aspirin reduces the "stickiness" of the blood platelets, and thus reduces the chance of developing a blood clot at the site of an atherosclerotic plaque. Aspirin has been shown to significantly reduce the risk of death in patients with known CAD, and should be prescribed in every MI unless there are strong reasons not to.

Your doctor may also decide to give you medications aimed at preventing angina. These medications may include nitrates, or calcium channel blockers.

In addition to these drugs, you should also receive beta blockers and ACE inhibitors to help prevent heart failure .

Just as important as drug therapy are the lifestyle changes that will reduce your long-term risk after an MI. These include achieving and maintaining an optimal weight, beginning a heart-friendly diet, ending tobacco use, achieving excellent control of diabetes and hypertension (if present), and engaging in regular exercise. Everyone understands that making these lifestyle changes is a lot more difficult than taking a pill. But remember: receiving a diagnosis of CAD is really a call to arms. You have a disease that will get worse over time unless you attack it like you would attack a diagnosis of cancer. The treatment is not easy, but it is usually quite effective. So steel yourself, get focused, and make the lifestyle changes that you need to make.

An important aspect of helping you achieve these critical lifestyle changes is for your doctor to refer you to a good cardiac rehabilitation program. Too many doctors, unfortunately, neglect this important step. If yours forgets, remind him or her.

You will also want to ask your doctor specifically when it's safe for you to resume driving, sexual intercourse, and any other activities that you'll wish to resume as soon as it's safe.

Here's More On What You Need To Do After an MI

Sources:

Nissen, SE. High-dose statins in acute coronary syndromes: not just lipid levels. JAMA 2004; 292:1365.

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.

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