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Heart attack patients are monitored in the
hospital for three or more days prior to discharge home. Rhythm disturbances,
shortness of breath due to heart failure, or recurrent chest pain are reasons
for further therapy such as balloon angioplasty or coronary stenting, additional
medications, or bypass surgery.
Patients gradually increase their activity
under observation. Before discharge, a low-level exercise stress test may be
performed to detect important residual narrowing in the coronary arteries,
exercise-induced cardiac rhythm abnormalities, and heart muscle failure, and to
help guide the doctor in prescribing an activity regimen after hospitalization.
An abnormal stress test prior to hospital discharge following a heart attack
predicts a high risk for subsequent cardiac events; if the patient has not yet
had a coronary angiogram, an abnormal pre-discharge stress test is a strong
reason for doing angiography. Since most patients usually receive angiography
early, the use of pre-discharge stress testing has declined.
Before resuming full activity or work, several
weeks may be needed for the heart muscle to heal. After a small heart attack
(little damage to heart muscle), patients usually can resume normal activities
after two weeks. These activities include returning to work as well as normal
sexual activity. A moderate heart attack (moderate damage to heart muscle)
requires limited, gradually increasing activity for up to four weeks, while a
large heart attack (much damage to heart muscle) may result in a recovery period
of six weeks or longer. These time frames are necessary in order for the dead
heart muscle to substantially complete the scarring process. During this healing
period, patients should avoid vigorous exertion and heavy lifting (over 20
pounds) or any strenuous activity that causes shortness of breath or undue
fatigue.
Cardiac rehabilitation typically begins during
hospitalization and continues during the months following a heart attack.
Cardiac rehabilitation programs provide a helpful transition to a safe and full
return to a normal lifestyle. In addition, cardiac rehabilitation allows the
prescription of a long-term exercise program tailored to each patient and helps
patients and their families adjust to lifestyle changes and the difficult and
conflicting emotions that often follow a heart attack
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