After the heart attack...

If your parent has recently been hospitalized for a heart attack, the future may seem very uncertain. Now is the time to organize medical care and figure outhow to make the transition from hospital tohome as smooth as possible.

Ask your parent's physician (s) the following:
How serious was the heart attack?
Some heart attacks are worse than others. Knowing how badly your parent's heart was damaged will give you a clearer sense of his prognosis and timeline for recovery. The extent of damage will also determine any complications your parent might have.
What complications should we watch for?
If your parent suffered a very mild heart attack, you might not need to worry about complications at all. But if the attack was more severe, your parent could develop complications, such as an arrhythmia, congestive heart failure, or stroke. Ask the doctor about your parent's risk for these complications and how to recognize them if they develop.
How much care will my parent need -- and for how long?
If your parent will need more care than you can provide, now is the time to make plans. The doctors and nurses should be able to give you an idea of how badly and how long your parent will be disabled.
When can my parent resume normal activities?
How much and what type of activities your parent can do will depend on the condition of his heart. In most cases, heart attack survivors can get back to normal activities within a few months; others may need to take it easy for a longer period of time. Depending on his state's laws, your parent may be able to start driving within a couple of weeks. The doctor can help you and your parent set a realistic timetable for recovery.

What exercises should my parent do?
Physical activity strengthens the heart muscle and is important for overall health. Exercise can help your parent reduce his cholesterol level, lose weight, and lower his blood pressure. But it's important not to overdo it, especially soon after a heart attack. Ask the doctor if your parent could benefit from a cardiac rehabilitation program, in which an exercise specialist will help him develop a program he can continue on his own.

What kinds of dietary restrictions are necessary?
You probably already realize that your parent will need to make changes to his diet, but the thought of implementing those changes may daunt you. The doctors and nurses can help you figure out the best diet for your parent. Ask what foods are good for heart health, what foods he should limit, and how to control portion size. If you need more help, ask for a referral to a nutritionist who specializes in cardiac patients.

What medications will my parent need to take -- and what are the likely side effects?
The doctor has probably prescribed a bewildering array of different medications for your parent. Make sure you understand each medication and its potential side effects.

 For each medication, ask:

• What does it do?
• How often should my parent take it?
• Should my parent take this medication with food?
• Is there anything my parent should not eat or drink with this medication?
• What side effects might we expect?
• What doctors should my parent see?

If your parent's heart attack was fairly mild, he may be able to continue to see only his primary care physician. But if his heart was badly damaged, he'll probably need to see a cardiologist as well. Ask what doctors he'll need to visit and whether your insurance will cover those appointments.

 

What's my parent 's risk for another heart attack, and what signs should we watch for?
Most heart attack survivors are at a higher risk for a second attack. Ask the doctor how you can tell the difference between angina and a heart attack. Be aware that the second heart attack may not exhibit the same symptoms as the first. With that in mind, ask the doctor for a list of signs to watch for and what to do if you see them, including where you should seek emergency care.

Family history is key factor in fighting heart disease

Doctors often gloss over a key question for assessing a person's risk for coronary heart disease, according to a new study: What is the patient's family history of cardiovascular illness?

Detailed family information could help doctors better predict who is at risk and more accurately target patients for preventive care that may help avert the disease altogether, according to a recent study, published in the Annals of Internal Medicine. Routinely tracking family history sharply boosted the number of people in the study considered at high risk for heart disease.
A widely used scorecard for measuring heart risk, the Framingham Risk Score, fails to take family history directly into account. And while many doctors currently collect some information about the health of their patients' families, the data often lack the detail to be clinically useful for assessing risk and prescribing care.

"Family history remains one of the most important predictors of an event for an individual," says Donna Arnett, a genetic epidemiologist at the University of Alabama at Birmingham and president-elect of the American Heart Association. Still, "most of the family history that we're collecting is just the presence or the absence of heart disease, not the age of onset or the type of disease," says Dr. Arnett, who wasn't involved in the latest research.

Guidelines for heart-risk screening, issued by the heart association in late 2010, encouraged doctors to take family histories into account. Doctors sometimes make judgment calls to treat people as high risk because of family history, even if it isn't part of the patient's risk score.

Family history has been linked to higher risk for a number of illnesses, including cancer and diabetes. Unlike some other diseases, however, clear genetic markers for coronary heart disease, which accounts for 1 in 6 U.S. deaths, remain elusive. Family histories can be used as a proxy for detailed genetic work that may someday be used to help predict heart-disease risk, researchers say.
Another risk-measurement tool, known as the Reynolds Risk Score, developed by Harvard University researchers in the 1990s, does consider if a patient's parent had a heart attack and at what age. However, many medical practices don't yet use the tool, which became available in 2007.
Using the Reynolds system, the researchers tracked 25,000 initially healthy patients over a decade. They found that a 50-year-old male patient who, among other things, smoked, and had high blood pressure and cholesterol, but no family history of heart disease, had a 12%, or moderate, chance of having a heart attack in the 10-year period. But a similar patient with a parent who had a heart attack before age 60 had a 20% risk, putting that patient at high risk for heart disease. Heart risk wasn't significantly affected in patients with a parent who had a heart attack at the age of 60 or older.

Still, many medical practices continue to rely on the older Framingham Risk Score, which became available in the 1990s. Researchers believed that other factors, including blood pressure and cholesterol levels, provided all the information needed to determine a patient's risk for heart disease.

Primary-care doctors say there are obstacles to gathering family histories from patients, including competing priorities for time in the examination room. And patients often don't know many details about their family members. In the Annals of Internal Medicine study, patients were mailed questionnaires and instructed to gather the material before seeing their doctor.
"It's a little bit of detective work," says Charles Cutler, a primary-care doctor in Norristown, Pa. Patients should make a point of knowing the health histories of their parents, siblings and grandparents, he says. To identify clues about specific diseases, however, Dr. Cutler says he sometimes asks patients questions like: "What do you remember about Grandpop's hospitalization? Were his legs swollen?"

Dominic Francis, a 37-year-old high school teacher and wrestling coach in Delaware, says his family history has forced him to be an advocate for his own health. Mr. Francis says he watches his diet and exercises regularly. Although he currently does not suffer with heart disease or heart related problems, he has discussed his paternal family history of heart disease with his doctor.

"I went to the cardiologist and said, 'I may look healthy and my numbers are all good. But my dad and his brother both had a heart attack when they were 40. For my uncle it was a fatal attack. I need to know whether I have any other risk factors that I should be aware of,' Francis says.

February is National Heart Health Month

While much early research on heart disease was done on men, more recent data is revealing just how differently heart problems affect women. Here's what you need to know.

Heart disease is the leading cause of death for both men and women in the United States, according to the U.S. Centers for Disease Control. And while nearly the same number of women die from heart disease every year as men, many Americans still mistakenly perceive heart problems as a “man’s disease.” In fact, only half of women surveyed by the American Heart Association (AHA) correctly identified heart disease and heart attacks as the leading cause of death among women, according to a report released in 2010.

An earlier AHA survey revealed that a third of women remain unaware of symptoms, treatment, and risk for heart disease. So continues a negative cycle: If women don’t consider themselves at risk, they may ignore early warning signs and end up at even greater risk for developing serious heart disease. Making matters worse, heart disease tends to hit women later in life than it does men, so women’s bodies may be less physically able to recover

Signs of a heart attack for a woman:

While pressure, tightness, and squeezing in the chest are all telltale signs of heart attack in men, many women don’t know they could have a heart attack without having any of those classic symptoms. According to the AHA, a woman having a heart attack is more likely to feel symptoms like shortness of breath, nausea and vomiting, and back or jaw pain.

Women often don’t think they’re having a heart attack and waste time before calling an ambulance, or worse, don’t seek medical treatment at all. It’s important to know the symptoms and get to the hospital fast.

Emotions play a big part:

A recent study published in the Archives of General Psychiatry found a link between depression and heart problems and death. In women with a history of depression, they found that the risk for cardiovascular disease, an overarching term used interchangeably with heart disease, was three times higher than in men.

When you think about it, this makes sense. Depressed women may be more likely to pick up unhealthy habits (like skipping the gym, eating poorly and smoking) to deal with their emotions. Additionally, the AHA recommends depression screening as part of risk evaluation for preventing heart disease in women because depression may affect whether women follow their doctor’s advice, according to an AHA media release about the guideline changes.

Smoking Effects

Cigarette smoking is 25 percent more likely to lead to heart disease in women than in men, according to a recent study published in The Lancet. CDC statistics from 2008 counted 21.1 million female smokers.

While the study authors couldn’t determine whether the gender difference in smoking rates and heart disease risk was biological or behavior-related, they speculated that women’s bodies may absorb more carcinogens from smoking the same number of cigarettes as men. A physiological answer would make sense, given the regular yearly increase in risk they found for women compared with men

Can you die from a broken heart?

There really is such a thing as heartbreaking grief, suggests new research that finds losing a loved one can increase the risk of heart attack.
Within a day of a significant other's death, heart attack risk was 21 times higher than normal, said researchers who looked at data on nearly 2,000 heart attack patients. And within the first week after death, the heart attack risk for the bereaved was still six times greater than usual.

"Extreme grief can trigger heart attacks," said lead researcher Dr. Murray Mittleman, director of the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
"For at least a month the risk remains elevated and likely stays up even longer," he added.

The stress and anxiety of losing someone close can trigger heart-damaging biological processes, Mittleman explained.
"All of this can cause a physiologic response with an increase in heart rate and blood pressure, and also can cause changes that makes blood a little bit more sticky," he said. "This can increase the risk of having a heart attack."
After a death, it is important for immediate family members and friends to be aware of this connection and watch for signs of distress, Mittleman suggested.

"When an individual is grief-stricken, they often ignore their own needs and may not be as compliant with medication, may not take care of themselves as well," he said.

If the bereaved individual develops unusual physical symptoms, "don't assume it's just stress and anxiety; it may be a heart attack and should be taken very seriously," Mittleman warned. These symptoms include chest or stomach pain, shortness of breath, nausea, lightheadedness or a sudden, cold sweat.