January 25, 2012

After a Heart Attack

My husband recently had a heart attack. He’s home now, but I would like you to suggest a plan to prevent another one. He reads your column and is more likely to follow your advice than mine.

The first thing we want to emphasize is the importance of his following his doctor’s advice, because he or she knows your husband best. Do not substitute our advice for his doctor’s.

Most heart attacks leave part of the muscle wall of the heart damaged, so there is now less muscle to continue the work of the heart. The heart needs compensatory strengthening.
A heart attack occurs because of a blockage in the coronary arteries, usually caused by atherosclerosis, or fatty plaque in the blood vessel’s wall. There are genetic predispositions to atherosclerosis, but our lifestyle also contributes a great deal.
The single most important factor in both the prevention of and the rehabilitation from a heart attack is appropriate exercise. Following a heart attack your doctor should monitor the amount of your husband’s exercise to ensure he is getting enough—but not too much. During the course of a few months your husband should notice great improvement in cardiac reserve. One indicator of cardiac improvement is the heart rate recovery (HRR). This is the number of beats per minute that a person’s heart rate slows in the two minutes following peak exercise rate. If it slows more than 12 beats per minute, the heart is doing well.
2012 1503 page25Exercise must be structured and consistent, representing at least three workouts per week for some 50 minutes per day. Patients who have a good HRR of greater than 12 have a much lower chance of a recurrent heart attack. Of course, their exercise must raise the resting heart rate to an appropriate level, which—as a rule of thumb—would be 180 minus their age.
Besides exercise, diet can be extremely important. Reducing saturated fat to almost zero is advisable, but we now know that the older recommendations of extremely low total fat intake are not the best, as omega-3 fatty acids are both reparative and beneficial. Such fatty acids are found in flaxseed, fish oils, olive oil, and especially in avocado pears. The oils in nuts, such as almonds, walnuts, and even peanuts, are healthful too, but contain a high amount of calories. One can have too much of even a good thing and become obese eating “good” foods—so we recommend weight reduction to an appropriate body mass index of between 22 and 24.
Weight loss usually requires a reduction in daily caloric intake to about 1,200 to 1,400 kilocalories. It becomes important to ensure a high level of fiber, lots of fruits, vegetables, and whole grains, and legumes within this restricted caloric intake. Maintenance calories range around 1,800 to 2,000 per day, depending on several factors such as type of work, regional temperatures, a person’s size, and so forth. Most of us eat far more than we actually need, and most of us (60 percent of the population) are overweight.
Loving relationships play a role in recovery from heart attacks; in fact, people whose spouses “show them” they love them actually have half the recurrence rate of others. One way to show such love is to exercise with a spouse to give them emotional support.
Finally, we would like to encourage a hopeful, optimistic outlook on life. The wise man wrote, “A merry heart does good, like medicine” (Prov. 17:22, NKJV).* Hope is buoyant and braces the soul for every difficulty.
* Texts credited to NKJV are from the New King James Version. Copyright © 1979, 1980, 1982 by Thomas Nelson, Inc. Used by permission. All rights reserved.
Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health.
Allan R. Handysides, a board-certified gynecologist, is director of the health ministries department of the General Conference. Peter N. Landless, a board-certified nuclear cardiologist, is an associate director of the health ministries department of the General Conference. This article was published January 26, 2012.