How to minimise the risk of a second heart attack

In the UK, there are more than 100,000 hospital admissions every year due to heart attacks - which is around one every five minutes. Around 1.4 million people alive in Britain have survived a heart attack.

In 2015, Nick Entwhistle was driving home from playing in a football match when he began to feel unwell. He felt exhausted, had discomfort in his chest and began to have aching pains in his arm. He dismissed these signs because he was only 26.

When he finally got home, he called a friend who took him to hospital. Tests showed he had a blood clot blocking one of the arteries supplying blood to the muscles of his heart - a heart attack. After two weeks of treatment, he was finally allowed to go home.

"I went for seven weeks to weekly cardiac rehab. Stepping up my exercise slowly but surely," Entwhistle says. "As I was young, diet wasn't too much of an issue to have caused the attack but I made sure I ate healthier and tried to avoid too many takeaways.

"I got myself back into playing football fairly quickly to build up my confidence and fitness," he adds. "I try to get between 6,000 and 10,000 steps in every day as my work is mainly on a laptop."

What causes a heart attack?

A heart attack, known as a myocardial infarction, is a serious medical condition which happens when the blood supply to part of your heart gets blocked. Your heart muscle then becomes damaged because of lack of oxygen.

Symptoms of a heart attack vary from person to person. However, common signs include:

• Pain or discomfort in your chest that happens suddenly and doesn't go away.

• Pain that spreads to your arms, neck, jaw, back or stomach.

The pain or tightness can be severe, but it can also be a feeling of sickness, sweatiness or light-headedness or feeling short of breath.

It's important to know that not everyone experiences severe chest pain, particularly women. The pain can be mild and mistaken for indigestion.

Obviously having a heart attack is scary and in the short term, your main focus is likely to be on the treatment you're given during your admission. But it's also crucial to look to the future - people who have had a heart attack are more likely to be readmitted to the hospital for a second one within five years. The good news is that this risk can be greatly reduced by a combination of lifestyle precautions and medication.

Avoiding a second heart attack - practical steps

Dr Sarah Jarvis has looked after hundreds of patients who've had a heart attack in the 30 years she has been a GP. "My top tips for the short term are to make a note of important dates in terms of your treatment and to make sure you understand everything you need to do to keep your risks to a minimum", she advises. "For instance:

Before you leave hospital

• You should be given a discharge letter from the hospital that includes details of your medication. If you don't get this, make sure you contact your GP within a few days to go through this letter with them.

• You'll usually be discharged with enough medication to last two weeks. Take a few moments when you're given this to make sure you understand how often you're supposed to take each medicine, any other details (with or without food etc) and what it's for.

• Check with your team how long you'll need to take each medicine for. For instance, you'll need to continue on cholesterol-lowering and blood pressure medication for the foreseeable future. Unless there's a medical reason for you not to take it, you'll also be given aspirin (an antiplatelet medicine to reduce harmful clotting) to take long-term. You will also usually be advised to take a second antiplatelet treatment, usually for up to a year.

• You should be given information about lifestyle changes, a cardiac rehabilitation programme to strengthen your heart. If you don't get these, ask your team for these before you leave.

• Check you have a follow-up appointment with your cardiologist.

Once you get home

• Set reminders (for example, on your phone) for when you need to take your medication.

• Make a note in your diary of the stop date for any medicine you won't be taking permanently.

• Set some time aside to read through your discharge letter and any literature you were given in detail.

Within 2 weeks

• Make an appointment with your GP before your 2-week supply of discharge medicine runs out, so that your GP can monitor your progress and arrange future medication in line with your discharge instructions.

• Contact your cardiac rehabilitation centre to arrange starting a rehabilitation programme.

Within 2 months

• If you haven't received an outpatient appointment for follow-up with your cardiologist, contact your GP or speak to your consultant's secretary at the hospital to find out when you'll be seen.

Every 3-6 months

You'll usually need a check with your GP either every 3 or 6 months after a heart attack. Do make sure you make a note in your diary, especially at 1 year after your heart attack, as your medication may need to be reviewed."

After 12 months

Your GP may want to adjust your medication at this stage.

Avoiding a second heart attack - lifestyle and medicines

If you've already had a heart attack, your risk of having another one can be greatly reduced with the correct treatment. It's really important to take any medicines your doctor has provided and to follow a healthy lifestyle.

"There are plenty of lifestyle changes you can adopt to improve your recovery and reduce your risk of having a second heart attack," says Julie Ward, senior cardiac nurse at the British Heart Foundation.

"Quitting smoking, keeping physically active, eating a healthy Mediterranean-based diet, reducing alcohol consumption, keeping stress levels low and maintaining a healthy weight will all help to manage your condition better. It's also important to manage pre-existing risk factors such as diabetes, high blood pressure and high cholesterol."

The British Heart Foundation points out that there are certain risk factors outside of your control, including family history, a previous heart attack or age.

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What does a doctor do when they have a heart attack?

Heart attack

Managing your risks

High blood pressure and high cholesterol

Your blood pressure - the pressure of blood in your arteries - goes up and down and it's normal for it to go up while you're active. But when your overall blood pressure is consistently high, even when you are resting, it can be a risk.

Cholesterol, a fatty substance found in your blood, is something we all have - but high cholesterol can increase your risk of heart and circulatory diseases such as heart attacks and strokes.

"Speak to your doctor about medication to help lower your blood pressure or cholesterol levels," Ward says. "It's likely that you will already be prescribed medications which are often used to lower blood pressure and cholesterol, such as ACE inhibitors and statins. These medications are very important for cutting your risk of a second heart attack, even if your blood pressure or cholesterol levels are in the normal range." You'll need to have blood tests, usually at least once a year. If your cholesterol levels or blood pressure change, your doctor will adjust your medicine.

Antiplatelet medicine

Heart attacks happen because of an abnormal blood clot blocking one or more of your coronary arteries - the arteries which supply blood to your heart. You will usually be prescribed two antiplatelet medicines after your heart attack, to prevent new dangerous clots forming.

How long you continue these treatments depends on your other risk factors, such as whether you've had more than one heart attack; how many coronary arteries are affected; whether you have diabetes or kidney disease; or whether you're over 65. It's very important to keep taking your antiplatelet medicine as recommended by your doctor to keep your risk of another clot to a minimum.

Physical activity

Being active not only helps to reduce your risk of heart and circulatory disease, it can also help you control your weight, reduce blood pressure and cholesterol and improve your mental health.

"Making simple, long-term changes to your lifestyle - such as keeping physically active, eating a healthy diet and quitting smoking - will also go a long way to bringing your blood pressure and cholesterol into a healthy range," explains Ward.

"Try to do some moderate-intensity activity every day and aim for at least 150 minutes per week. You can spread this out over the week and even do short bursts of activity - every minute counts."

Healthy diet

We should all focus on eating a healthy, balanced diet as this will help to lower the risk of heart and circulatory diseases. Aim to eat plenty of fruit and vegetables, whole grains, beans, lentils, nuts and seeds.

"Eating a lot of red and processed meat is linked to a higher risk of heart and circulatory diseases and so people who eat more than 90 g of red and processed meat a day should reduce this to 70 g a day or less," Ward says.

If you are at risk of diabetes or have been diagnosed, it is very important to keep your blood sugar levels under control. A healthy diet and exercise will help but some people will need medications to maintain healthy blood sugar levels.

Quit smoking and cut down alcohol

Smoking cigarettes makes the walls of your arteries sticky from the chemicals, so fatty material can stick to them. If the arteries that carry blood to your heart get damaged and clogged, it can lead to a heart attack.

"If you're a smoker, quitting smoking is one of the single most important things you can do to help your heart," Ward says.

"If you want to quit, you'll find it helps to have some extra support so ask your GP surgery if there is a nurse or counsellor in your area who can help. Alternatively, look for a local stop-smoking service. You could also ask your doctor or pharmacist about nicotine replacement therapy (NRT) or medicines that can help you quit." Many services are now available online and you can refer yourself for help.

Drinking too much alcohol can lead to weight gain, as well as abnormal heart rhythms, high blood pressure, damage to your heart muscle and other diseases, such as stroke. We shouldn't drink more than 14 units of alcohol each week and we should have several alcohol-free days a week.

What is a cardiac rehabilitation programme?

Cardiac rehabilitation is a crucial part of recovering from a heart attack. It's there to get you back on your feet - both physically and psychologically - and an opportunity to meet people who've shared a similar experience.

"Cardiac rehab programmes are usually run by a team which includes experienced cardiac nurses, physiotherapists and exercise specialists to help you recover as well and as quickly as possible so you can return to everyday life," Ward says. "Research suggests people who don't attend rehab are at greater risk of further heart problems in the future so it's vital that patients take it seriously."

Each programme is different, but they usually consist of regular pulse and blood pressure checks, advice from healthcare professionals such as dieticians and clinical psychologists, exercise sessions, group discussions and relaxation training.

How to handle anxiety

Having a heart attack can cause a spectrum of emotions, such as anxiety, fear, low mood and anger.

"The anxiety never fully goes away but I try to avoid stressful situations," Entwhistle says. "For example, if someone cuts me up on a motorway, I'd have got annoyed before but now I just let it slide. I take measures like going for walks and try to switch off from social media to watch a film or do some personal art projects."

"It's important to talk about these feelings, either to a trusted loved one, your GP, a cardiac rehab nurse or a mental health professional," Ward urges. "You can also seek support and information through our Heart Helpline, where you'll be connected to one of our cardiac nurses. You may also find it comforting to join our online community to talk to other people who have had a heart attack and to read about their experiences."