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When you left hospital you will have been given a spray (or tablets) called glyceryl trinitrate. You need to carry this with you at all times so you can use it to relieve the pain and discomfort of your angina. If you did not receive this, you should speak to your GP.
If you do get chest pain, stop what you are doing and sit down (if possible). Use your GTN as you were told and shown on the label. You can repeat this dose up to three times, waiting five minutes between each dose, until the pain is relieved.
If the pain is not relieved after the third dose, dial 999 for an ambulance. You will have to go to hospital to have your pain investigated further.
This may be a symptom of angina, even if you are not actually having any pain. Try using your GTN spray or tablets to see if this helps.
If you are struggling to breathe when you are resting, dial 999 for an ambulance.
If you can manage the breathlessness but it is getting worse, make an urgent appointment to see your GP.
A heart attack (also known as a myocardial infarction) means that part of your heart has been damaged by a lack of oxygen. This damage is permanent.
Angina is a term used to describe the symptoms you have when the heart is not receiving enough oxygen. This does not cause permanent damage.
There is evidence that stress, anxiety and depression can contribute to coronary heart disease. Other risk factors include smoking, being overweight, drinking too much alcohol, lack of physical activity and high blood pressure.
Symptoms of anxiety include sadness, lack of enjoyment, low self-esteem, poor concentration, sleeping problems, feeling frustrated, tense and angry, headaches, butterflies in the stomach and a racing heart.
If you are stressed or anxious, speak to your GP or cardiac rehabilitation nurse.
People with coronary heart disease are advised to take moderate exercise. At this level of exercise, the heart muscle is not strengthened, but the circulation becomes more efficient. This means the heart does not have to work so hard to do its job.
More intensive exercise causes the heart to become bigger and stronger, but this level of exercise is associated with abnormal heartbeats or abnormal heart rhythms (including sudden death). This is especially true for people with coronary heart disease.
Your risk of heart disease does depend on your lifestyle. Risk factors include lack of exercise, high blood pressure, high cholesterol levels, smoking, being overweight, too much alcohol and too much salt in your diet.
Knowing your risk factors may encourage you to deal with them and help you feel more in control of your heart disease.
Rest is important after a heart attack, and will be encouraged while you are in hospital and for the first few days at home.
However, it is important to exercise as this will help you to get stronger and help your heart work more efficiently. Exercise also helps you feel good about yourself, relieves anxiety and gives you confidence to carry on doing your previous activities including working and playing sport.
The cardiac teams are keen for you to carry on doing your previous hobbies, return to work and plan your holidays.
When you left hospital you would have been given advice on exercise. Walking is strongly advised and you can do other activities when you are feeling stronger. In the first six weeks after a heart attack or heart surgery, you should not lift anything weighing more than five to 10lbs. This includes grocery bags, suitcases, pets and children.
After your heart attack or heart surgery it is safe to drink alcohol, but you need to limit the amount of alcohol you drink. One unit (one glass of wine or ½ pint of beer) will do you no harm, but avoid drinking too much. The recommended maximum limit for alcohol each week is 14 units for a woman and 21 units for a man. It is important that you do not drink more than this.
If you are on warfarin, too much alcohol can interfere with it. If you do drink alcohol, it is better to have a small amount on a regular basis and not 'binge drink'.
When you had heart surgery your heart would have been stopped so the surgeons could operate on it. Because your body still needs a constant blood supply, the blood is put through a machine that acts as a pump circulating the blood.
This machine can cause side effects that affect your taste, smell and sight. It can also affect mood and you may have vivid dreams. This is all normal and should reduce within six weeks. (Do not get your eyes tested during the first three months following surgery as some changes may occur during this period.)
You need to see your GP, who may refer you back to the cardiac team. You may also need a short course of antibiotics if the wound has become infected.
Try to keep the wound as clean and dry as possible, and do not apply any creams or lotions to it. If you need to keep it covered, use a clean dry dressing until your GP has seen it.
Most people will return to work after a heart attack or heart surgery. If you make a good recovery, you may be able to return to work after six weeks. For many people, when they can return to work depends on the type of the work they do. Your GP, cardiac rehabilitation nurse and the medical team at the hospital will be able to give you advice on this.
Some employers have an occupational health team who will recommend when it is safe for you to return to work.
After a heart attack or heart surgery, or simply after being diagnosed with a heart condition, you may be worried about starting to have sex again. If so, you are not alone – this is common in both male and female patients, and their partners.
People worry for several reasons, both physical and psychological. For instance, there is a myth that sex is more strenuous than other types of exercise. In fact, sex is no more strenuous than a number of activities.
For many people, sex is an important part of a relationship, but it may seem daunting. You may also have problems such as not feeling relaxed and comfortable enough to have sex. This can affect general sensations such as arousal and confidence, and may lead to misunderstandings between partners. Other problems could be vaginal dryness and erectile dysfunction (not being able to get or keep an erection).
You and your partner may be anxious about having sex. Like any physical activity, sex increases your heart rate and blood pressure. This can lead to breathlessness and chest pain in someone whose heart disease is not under control.
It is usually safe to have sex once you can walk approximately 250 metres or climb a flight of stairs briskly without getting chest pain or being out of breath.
If you have had a heart attack, you can usually start having sex two to three weeks later, as long as your recovery is not complicated. If you have had heart surgery, you need to be careful of your chest wound and avoid positions which put undue pressure on your chest. It is best to try lying on your side to start with and avoid positions which involve you being on top until several weeks into your recovery.
Sex poses a small degree of risk to any person’s heart, and this risk is not significantly higher in people with stable heart conditions. And what's more, the risk is reduced by regular exercise.
To answer this question, it is useful to compare sex to other activities.
We measure how much energy a person uses by looking at a person's metabolic rate. This is expressed as 'METS'.
Sex usually uses 2 to 6 METS, depending on how vigorous it is. You can compare this with other activities in the table below.
Activity
METS
Ironing
2 to 3
Cleaning and dusting
2 to 5
Painting and decorating
3
Climbing 20 steps in 10 seconds
Vacuuming
3 to 5
Lifting and carrying objects weighing 9 to 20 kg
4 to 5
Golf
Digging
Mowing the lawn
5
Brisk walking
6
For a more detailed comparison, see the exercise section.
Erectile dysfunction is when a man cannot get or keep enough of an erection to have sex.
Erectile dysfunction becomes more common as you get older, and it is even more common in people with a heart condition. It can be caused or made worse by certain medications, such as beta-blockers. Never stop taking any medication without discussing it with your doctor first.
There are several treatments available for erectile dysfunction, including tablets like sildenafil (commonly known as Viagra), vacuum pump devices, and more invasive treatments such as a pump that can be surgically implanted into the penis. This can be inflated by hand before sex and deflated afterwards.
If you are worried about sex, the worry alone can have an effect on your sex life. This may include vaginal dryness, leading to painful penetration. Talking to your partner about your worries may relieve some of the stress, or it may be helpful to use a lubricant.
If you have had heart surgery you may be worried about the pressure on your breastbone. Your breastbone should be healed after six to eight weeks and fully hardened by 12 weeks.
Kissing, cuddling, caressing and touching may be a good starting point to increase your confidence. Sex does not have to mean full penetration and orgasm. Discussing your likes, dislikes, fears and concerns with your partner can all help you return to a normal sex life. Some partners find visual aids such as books and films can help them get back in the mood. For other people, creating the right mood and a relaxing atmosphere can reduce anxiety.
If you have had heart surgery and are worried about the pressure on your breastbone, you could try a position that does not involve too much pressure on your arms or chest, such as lying on your back (if you are a man) or being supported in front by a chair or bed with soft cushions (if you are a woman).
In other words, it is important to communicate with your partner and make appropriate changes so you can start having a safe and happy sex life again.
If you have angina, keeping your GTN spray or tablets within reach just in case you need them may help reduce any fears.
If you are still concerned about any of the issues raised above, talk to your doctors and nurses. They won't be embarrassed as this is something that we deal with every day.
The benefits system exists to provide financial support to people who need it. This may be for various reasons, including age, dependants, low wages, ill-health, disability, caring responsibilities, pregnancy, or a combination of any of these. The benefits system is managed by the Department for Work and Pensions (DWP). However, HM Revenue & Customs are now responsible for some benefits (tax credits and Child Benefit), so some people will have to deal with more than one office for their claims. There is a wide range of benefits, so here we are going to look at the ones that are likely to be of most interest to people with heart disease.
you may be entitled to Employment and Support Allowance instead.
As your condition improves, you may reach a stage where you feel able to return to work. There are special rules, called permitted-work rules, to help you return to work gradually. This can be particularly useful if you are concerned about the stress involved in returning to work. Also, under these rules you can keep your benefits and work at the same time.
Some people may need to work in a less stressful way than before, which may involve working fewer hours or for lower pay. In these cases, you may be able to have your earnings topped up with Return to Work Credit.
There are other benefits to help with housing costs for people who receive state benefits or are on a low income. This could be to help with rent (Housing Benefit), council tax (Council Tax Benefit) or mortgage interest (Support for Mortgage Interest). You will not automatically be entitled to these benefits. They are means-tested, which means that the amount of help you are entitled to depends on your other income, savings and any investments.
For more information on the financial support and benefits you may be entitled to, click on the link below.
www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/index.htm
Travelling and working in most countries is not a problem, as long as you have made a full recovery and have enough health insurance. Most airlines allow people to travel 10 days after a heart attack, as long as they do not have any complications or symptoms, and their condition is stable and well-controlled. As a general rule, if you can walk 100 yards on the flat briskly without getting chest pain, or being too out of breath, you are fit to travel by air. However, if you are travelling as part of your job, the stress involved will probably be more than if you were travelling for a holiday. This may affect your symptoms.
If you have angina, it is safe to use your GTN spray on the aircraft. However, with the recent restrictions on taking liquids in your hand luggage you may want to check this with your airline.
If you have a device such as a pacemaker or an ICD fitted, make sure you take your identification card and tell the airport staff so you may be able to avoid going through any security systems that might interfere with your device. In some cases you may not to able to avoid the security systems. In these situations, the metal detector must not be placed directly over your device, and you should try to walk through the gateway quickly.
The chances of your device being affected by the security systems are low, but it is best to avoid standing too close to the screening system for a length of time. The security systems should not affect you if you have a coronary stent or a mechanical valve. You are free to walk through the security systems as normal.
If you are working and travelling in an underdeveloped country you are taking a risk because good medical help may not be available in an emergency. The risk is small if you are in good health. However, some tropical illnesses may have a more severe effect on you because your heart does not quite have the strength of someone with no heart problems. Before you go on the journey it is important to speak to your doctor.
Similar comments apply to working in extremely hot, cold or humid climates. A person with heart disease is a lot more vulnerable in these situations as the heart has to work harder.
The important message is to get medical advice, and to take appropriate precautions before, while and after travelling abroad.
Most people diagnosed with a heart condition will be able to drive again. How soon you can safely return to driving depends on the following.
(If you experience angina, dizziness, blackouts or fainting you must not drive and must tell your doctor. You can start driving again once your symptoms are under control.)
If you have made an uncomplicated recovery, you should be able to start driving again after approximately four weeks.
You can get more information on the medical rules for driving by clicking on the following link. www.direct.gov.uk/motoring/driverlicensing/medicalrulesfordrivers/index.htm
If you have any concerns about starting to drive again, contact your GP.
You will need to tell your motor insurance company about any changes to your medical condition to make sure your car insurance is still valid.
If you have an LGV (large-goods vehicle) or PCV (passenger-carrying vehicle) licence you will need to tell DVLA about your condition. Depending on your condition, DVLA may ask your local hospital to carry out some tests. These tests will help DVLA assess whether or not you can keep your licence.
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