Heart attack recovery: What you should know

Heart attacks used to be a ticket to several weeks in the hospital, at best. Now, advances in medicine are allowing more people to survive heart attacks and quickly get back on their feet.

But a heart attack is still a serious medical crisis, and Long Island doctors say that patients boost their chances of recovery when they focus on protecting and improving their health. Here's what you need to know:

1. Keep expectations realistic

Not all heart attacks are the same, and you shouldn't expect to recover instantly, even if you leave the hospital in two to three days.

Recovery can take a few weeks to a month to get back to normal activities in people who were relatively healthy and had a heart attack with a moderate to low degree of severity, said Dr. David Friedman, chief of Heart Failure Services at the North Shore-LIJ Health System's Franklin Hospital in Valley Stream and an assistant professor of cardiology at Hofstra North Shore-LIJ School of Medicine.

People with poorer health or chronic medical conditions might take four to eight weeks or more, he said.

2. Get ready to take multiple pills

Patients should expect to be prescribed various medications after a heart attack -- aspirin and other blood-thinning drugs, anti-cholesterol drugs (given even if cholesterol levels aren't high) and medications to lower blood pressure and pulse rate, Friedman said.

Dr. George Petrossian, director of interventional cardiovascular procedures at St. Francis Hospital in Roslyn, said, "Compared to where we were 20 years ago, the medicines we have are pretty amazing and do a tremendous job treating the underlying problems."

Petrossian added, "We're not done yet, and there's more research to be done, but we've come far in being able to affect the prognosis of patients."

3. Take advantage of cardio rehab

Cardiac rehabilitation programs have become more common in recent years. Research suggests they reduce the likelihood of death in the first year after a heart attack by 20 to 25 percent, and they also lower the risk of having another heart attack, said Dr. William Lawson, co-director of the Heart Institute at Stony Brook University Medical Center.

Cardiac rehab helps heart attack patients get rid of unhealthy habits such as smoking, being a couch potato and failing to eat properly. "We work to get them to lose weight, get their blood sugar under control and combat depression," Lawson said.

A typical program consists of an hourlong session three times a week for four to six weeks, Petrossian said.

However, fewer than half of those who have a heart attack take part in cardiac rehab programs, according to Lawson. When patients leave the hospital within two to three days, it's "easy to forget the bad things that got you there in the first place," he said. "Sometimes, the patient just wants to get back to work and deny anything happened, or the program is too far away."

There can be other obstacles, too. Insurers may refuse to cover cardiac rehab, he said, and the number of cardiac rehab programs might be limited.

4. Be cautious about overexertion

One thing not to expect after a heart attack: bed rest at the hospital. In the not-too-distant past, heart attack patients were told to rest in bed, but that's changed.

"We usually try to have patients walk and do basic activities very soon after a low- to medium-grade heart attack," Friedman said.

Still, more extensive kinds of exercise aren't recommended right away. "Typically, I tell patients not to resume aerobic exercise for perhaps up to a month after the event," Petrossian said.

Doctors may also caution patients against activities like driving in the initial days after a heart attack, although that kind of recommendation depends on many factors. As for sex, Friedman said, "my usual recommendation to patients is that nonvigorous, low-level sexual relations are recommended as tolerated if you are able to do light housework and activities around the house without problems such as chest pains, shortness of breath on exertion or other concerning symptoms."

As for other activities, Petrossian said that he cautions heart attack patients against the extreme exertion of shoveling snow or going scuba diving.

5. Beware of anxiety and depression

People who've had a heart attack often experience such mental health issues as anxiety and depression.

"The biggest challenge is adjusting to the fact that they had a heart attack," Lawson said. "This can have a significant impact in terms of how you view your vulnerability."

Friedman said it's important to consult physicians about problems such as anxiety, anger and depression. Medications and changes in behavior can help, he said, and emotional support from family, friends, religious organizations and the community can also be useful. One thing to keep in mind, he said, is that long-term mental health issues, which can develop without treatment, can make heart problems worse.