Brief overview
- Consequences of a heart attack: cardiac arrhythmia, acute or chronic cardiac insufficiency, atrial or ventricular fibrillation, ruptured heart wall, aneurysms, formation of blood clots, embolisms, stroke, mental disorders (depression)
- Rehabilitation after a heart attack: three-phase rehabilitation takes place as an inpatient in the clinic or as an outpatient in a rehabilitation center; the aim is to reintegrate the patient into normal life; divided into four areas (physical, educational, psychological, social)
- Diet after a heart attack: change to a heart-healthy diet (e.g. Mediterranean or Asian cuisine) – as low in sugar, salt and fat as possible, balanced with lots of vegetables and fruit
- Exercise after a heart attack: Exercise is very important and promotes heart health. Moderate endurance sport or training in a cardiac sports group under medical supervision is beneficial.
What are the consequences of a heart attack?
Acute heart attack consequences
Many patients experience cardiac arrhythmia as an acute consequence of a heart attack. They are the most common complication after an acute heart attack. The cardiac arrhythmia often occurs in the form of a very fast, unrhythmic heartbeat (tachyarrhythmia). This sometimes develops into atrial fibrillation or life-threatening ventricular fibrillation.
Rarely does a heart attack lead to a rupture of part of the heart wall (e.g. a rupture of the ventricular septum or the free heart wall).
The first 48 hours after a heart attack are the most critical period for threatening complications. In around 40 percent of those affected, the heart attack leads to death within the first day (often due to ventricular fibrillation).
So-called “silent infarctions”, which do not cause any acute symptoms such as severe pain, are particularly treacherous. They usually only become noticeable later and result in the same complications as an acute heart attack.
Long-term consequences of a heart attack
Quite a few patients develop temporary depression after a heart attack. A healthy and active lifestyle helps to prevent a prolonged low mood.
If a lot of muscle mass dies as a result of the heart attack, chronic heart failure develops over time: Scar tissue replaces the dead heart muscle tissue, which subsequently impairs heart function. The larger the scarred area, the worse the heart pumps. Many small heart attacks also lead to heart failure over time (“small vessel disease”).
Blood clots (thrombi) form easily in this area. If the blood flow carries these thrombi with it, there is a risk that they will block a vessel somewhere in the body (embolism). If this happens in the brain, a stroke occurs, resulting in brain damage. In the worst case, a stroke can lead to paralysis or even death. The risk of such heart attack consequences can be reduced with medication that inhibits blood clotting.
How does rehabilitation work after a heart attack?
Rehabilitation (or rehab for short) helps people with heart disease to regain their health and performance – both physically and mentally. Medical specialists support patients in returning to their everyday and social lives. Rehabilitation has also been shown to reduce the risk of heart attack complications.
Rehabilitation also aims to reduce the burden on the healthcare system: for example, the care and training of heart attack patients prevents avoidable hospital stays and enables them to return to work.
Four therapeutic areas of cardiac rehab
Rehabilitation patients are cared for in four areas that are closely interlinked:
Somatic (physical) area
Individually tailored physical training also makes sense: a heart attack is often followed by a reduction in physical performance and endurance. Regular training helps to counteract this and improves the patient’s resilience and heart health. So-called aerobic endurance training is suitable for this. Doctors also recommend controlled strength training for some heart patients.
Educational area
Specialists (usually doctors and psychologists) advise heart patients on a healthy lifestyle. For example, they give tips on a healthy diet, how to lose excess weight and how to stop smoking.
In addition, patients learn why it is important to take medication regularly and what complications and side effects can occur. This point is particularly important for people who take anticoagulants. Overall, the measures are based on the motto: Promote adherence to therapy and strengthen the heart!
Psychological area
Social area
Social medical care helps patients to return to social and professional life after a heart attack. The therapists provide information and tips on various areas such as driving, air travel and sexuality. Especially with regard to partnership or family issues, it is a good idea for the partner to take part in the consultation.
How cardiac rehab works
Rehabilitation for heart patients after a heart attack is usually divided into three phases:
Phase I begins in the (acute) hospital. The aim is to mobilize the patient as quickly as possible after the heart attack. If the course is uncomplicated, the stay in the acute hospital lasts around seven days.
Phase II (follow-up treatment) takes place either as an inpatient in a rehabilitation clinic or as an outpatient in a therapy center. The program includes, for example, exercise therapy, anxiety reduction, a healthy lifestyle, preparation for reintegration into the workplace and stress testing.
How do you eat after a heart attack?
For most people who suffer a heart attack, it means changing their lifestyle. One of the factors is the diet, which should be as low in calories or fat as possible after a heart attack in order to prevent the formation of dangerous plaques that block blood vessels. It is important that the diet is balanced and contains all the necessary nutrients – so don’t go on a diet where you completely miss out on an important nutrient component.
Heart-healthy food therefore does not have to taste like something that is forbidden or boring. If you tempt your tongue with Mediterranean cuisine, for example, this food tastes like vacation and sunshine. The secret of this cuisine is that food from the Mediterranean countries contains many plant-based foods (vegetables, fruit, herbs, garlic), few animal products (little meat, but lots of fish) and high-quality vegetable fats (such as olive oil).
For a heart-healthy diet, it is also worth looking to the East: Chinese or Asian cuisine, for example, is usually prepared in a low-fat wok and is predominantly vegetarian.
Salt is another factor that plays a major role, particularly in high-risk patients with pre-existing high blood pressure. In large quantities, it raises blood pressure and therefore not only increases the risk of a heart attack, but also its consequences. The German Society for General Practice and Family Medicine (DEGAM) recommends reducing salt consumption to less than six grams of salt per day in the case of cardiovascular diseases such as a heart attack. Therefore, use herbs or vegetables such as garlic and onions for seasoning.
Sport after a heart attack
A heart attack reduces the patient’s cardiac output and therefore also their strength and stamina. Everyday tasks quickly become a physical burden: the heart muscle tissue that died during the infarction is scarred. The remaining tissue must therefore provide the pumping power alone. Slow, continuous build-up training strengthens the diseased heart again. Sport is therefore an important component of therapy after a heart attack.
However, physical activity also has a positive effect on other bodily functions. You
- improves the body’s oxygen supply,
- lowers blood pressure,
- regulates blood sugar and blood lipid levels,
- counteracts inflammatory processes,
- promotes healthy body weight,
- reduces unnecessary fat deposits and
- reduces stress hormones.
Studies have shown that exercise not only helps to prevent a heart attack in advance. Exercise also has a positive effect after a heart attack. Anyone who becomes or remains active after a heart attack significantly increases their chances of survival. This is the result of a Swedish study involving more than 22,000 heart attack patients.
One of the consequences of a heart attack is that many sufferers are afraid of overexerting themselves during sex. From a physical point of view, sex is comparable to exercise. Cardiac exercise is therefore the ideal preparation for enjoying this wonderful exertion again without fear.
Starting training after a heart attack
After a heart attack (STEMI and NSTEMI), scientific studies recommend an early start to training – just seven days after the infarction. This early mobilization supports the healing process and helps the patient to return to their everyday life more quickly.
After an operation to widen the coronary arteries (percutaneous transluminal coronary angioplasty, PTCA), patients are usually allowed to start an individual exercise program on the fourth day after the procedure. However, this only applies to operations without complications. Ideally, training should only take place under medical or therapeutic supervision.
How often should I exercise?
Experts recommend exercising shortly after the heart attack and at least twice a week – regardless of the severity of the heart attack. It is important that patients start exercising carefully at first. Gradually increase the intensity and duration of the training.
Four to five times a week for 30 minutes of moderate endurance training is recommended for heart patients.
Suitable sport after a heart attack
Endurance sport is particularly suitable for training the cardiovascular system and optimally supporting recovery after a heart attack. However, strength training and exercises for mobilization and mobility are also components of cardiac exercise.
Moderate endurance training
Endurance sports are suitable after a heart attack. They are the focus of cardiac sports, as they improve cardiopulmonary function and help to achieve higher levels of exertion without discomfort.
According to the recommendation of the German Society for Prevention and Rehabilitation of Cardiovascular Diseases, moderate endurance training four to five times a week for at least 30 minutes is ideal for heart patients.
Suitable endurance training after a heart attack is, for example:
- (Fast) walking
- Walking on a soft mat/on sand
- walking
- Nordic walking
- Cross-country skiing
- (Step) aerobics
- Cycling or cycle ergometer
- rowing
- Climbing stairs (e.g. on the stepper)
It is important that cardiac patients choose short exercise phases of five to a maximum of ten minutes at the beginning. The duration of exercise is then slowly increased over time.
Jogging after a heart attack
Walking, running, walking and jogging are the easiest ways to train the circulation after a heart attack. However, it is important to keep an eye on the intensity of the training. The attending physician will first determine the performance and exercise capacity of the heart with an exercise ECG. On this basis, he or she will then recommend an individual training intensity for the patient.
The target training zone for heart patients is 40 to 85 percent VO2max. VO2max is the maximum amount of oxygen that the body absorbs during maximum exercise. The heart rate during endurance training is best at 60 to 90 percent.
As a heart attack patient, refrain from competitions for the time being. Only take part in competitive sports after consulting your doctor.
Cycling after a heart attack
Strength training for heart patients
Strengthening exercises promote muscle building and strength. At rest, muscle mass consumes more energy than fat and helps in the fight against excess weight. If carried out conscientiously under professional guidance, strength exercises do not pose an above-average risk for heart patients.
To avoid spikes in blood pressure, it is important not to breathe under pressure during exercise. Also make sure that you relax your muscles as completely as possible between repetitions.
Gentle exercises for cardiac patients to build up muscles in the upper body include, for example
- Strengthening the chest muscles: Sit upright on a chair and press your hands against each other in front of your chest. Hold the tension for a few seconds. Then release and relax. Repeat several times.
- Strengthening the shoulders: Sit upright on a chair and clasp your hands in front of your chest. The left hand pulls to the left, the right hand to the right. Hold the pull for a few seconds, then relax completely.
- Strengthening the arms: Stand one arm’s length in front of a wall and place your hands on the wall at about shoulder height. Bend your arms and perform “push-ups” while standing – ten to 15 repetitions. The intensity increases the further you move away from the wall.
- Strengthening the abductors (extensor muscles): Sit upright on a chair, place your hands on the outside of your thighs, as close to the knee as possible. Now press against your legs from the outside with your hands, your legs press against your hands. Hold the pressure for a few seconds and then relax.
- Strengthening the adductors (flexor muscles): Sit upright on a chair with your hands between your knees. Now push outwards with your hands, your legs work against your hands. Hold the tension for a few seconds and then relax completely.
Make sure you breathe in a relaxed manner during all strengthening exercises.
Cardiac sports groups
After a heart attack, participation in a cardiac sports group is recommended. Patients train together with other affected people under professional supervision – cardiac sports groups provide more safety because there is always a doctor present. They are also a safe space that allows everyone to improve their limited fitness without shame. In this way, you slowly increase your physical fitness for everyday life, for example for climbing stairs, where your pulse rate goes up.
All exercises are adapted to the needs of heart patients.
Various playful approaches are also used in cardiac sports groups. For example, badminton, exercises with the Theraband (elastic exercise band) or ball sports exercises are integrated into the training.
Follow your instincts!
Doctors recommend the following for everyday life after a heart attack: Follow your instincts! It has long been proven that unhappy people cover up their insecurities and unfulfilled needs with substitute actions. These include, for example, eating lavishly, smoking, drinking alcohol or burying themselves in work. However, these supposed remedies for unhappiness quickly develop into habits and put your health at risk.
So listen to yourself and try to identify your true needs and desires. They can often be fulfilled almost as easily as the substitute actions. A long-postponed conversation with your partner, a vacation to your favorite country, time for yourself and others – all these things are good for the soul and help to avoid the harmful consequences of a heart attack.
