Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What is a heart attack?

A heart attack occurs when blood to some part of the heart muscle is blocked, causing loss of the muscle function and replacement by scar tissue.

How do I recover from a heart attack?

Your doctor can help you plan the steps to take for your recovery from a heart attack. The amount of activity you can do will be based on the condition of your heart. Most people can return to work and the activities they enjoy after having a heart attack. Others may have to limit their activity somewhat if their heart muscle is very weak.
Taking charge of the things that put you at risk for another heart attack (see below) and beginning an exercise program can help you feel better faster and can help you get back to your normal activities.

Risk factors for having another heart attack

	Not exercising
	Being overweight
	High cholesterol levels in your blood
	High blood sugar levels if you have diabetes
	High blood pressure
	Smoking
	Too much stress in your life

Why is exercise so important?

Exercise has many benefits for people who have had a heart attack. It can strengthen your heart muscle. It may also help you feel more energetic, help you feel more in control of your health, and help you lose weight and keep it off. Exercise may also lower your blood pressure and reduce your cholesterol levels.

How do I know if exercise is safe for me?

Your doctor can find out how much exercise you can do by giving you an exercise test, also called a stress test. To do the test, you'll exercise on an exercise bike or treadmill while an EKG measures your heart's response to the exercise.
Patches will be put on your chest to the EKG. A blood pressure cuff will be put on your arm. You'll then begin exercising, first at an easy pace and then faster. Your doctor will watch your blood pressure, heart rate and EKG.
As part of the exercise test, your doctor may want to take a scan of your heart with a special camera after giving you a shot of thallium or another substance that will show up on the scan. This will give your doctor even more information about your heart.
The test takes 10 to 20 minutes. You may need an exercise test before you're given an exercise plan.

What will the results of the exercise test tell my doctor?

How you do on the exercise test is used to check your risk for having another heart attack. The results will help your doctor plan an activity program for you to follow.
If your heart was strong during the exercise test, you'll probably have no trouble. If the results show that your heart had problems during the test, you doctor may suggest that you exercise only in a supervised program or limit your activity.
Your doctor may also want to get some more tests. Heart problems after a heart attack often can get better if you work to become more active.

How do I begin exercising after a heart attack?

You will need to start slowly. For the first few days after your heart attack, you may need to rest and let your heart heal. As your heart heals, you'll be ready to start moving around again.
A few days after your heart attack, your doctor may want you to move around more. You may do stretching exercises and get up and walk. You'll then slowly add to how much you do based on advice from your doctor.
Once you've gotten through the early period after a heart attack, your doctor may talk to you about how to be active within your limits.
Your doctor may suggest that you get involved in a rehabilitation program. Rehabilitation programs are supervised by exercise specialists. Some hospitals sponsor these programs to get people started with a safe program of exercise after a heart attack.
After a while, you'll probably be able to exercise on your own. If you have any of the symptoms listed in the box to the right, call your doctor. You may be working too hard.

How often should I exercise?

This depends on your exercise plan. You'll probably start slowly and gradually add to how much you do. Your doctor may want you to exercise three or four times a week for about 10 to 30 minutes at a time. Be sure to warm up before exercising by stretching for five minutes or more.

What kinds of exercise are good?

The best types of exercise are often those that involve your whole body, such as walking, cycling, jogging, rowing, cross-country skiing or swimming. These use your heart muscle, as well as other muscles.
Your physician may also talk to you about what heart rate you should try to have during exercise. This rate may be determined by the result from your exercise test.
You may need activities to increase your strength and flexibility. Exercises may also be prescribed to help you return to work or leisure activities.
It is always good to have warm-up and cool-down periods of 10 - 15 minutes, where the exercise intensity is less and stretching is done.

Symptoms to call your doctor about

	Shortness of breath for more than about 10 minutes
	Chest pain or tightness or pain in your arms, neck, jaw or stomach
	Dizzy spells
	Pale or splotchy skin
	Very fast heart beat or irregular heart beat (palpitations)
	Cold sweats
	Nausea and vomiting
	Weakness, swelling or pain in your legs

What is a "MET*"?

You may hear your doctor talk about METs when he or she discusses your activity level. Different activities are given different MET levels depending on how much energy they take to do (see below). The higher the MET level, the more energy the activity takes. Your doctor may ask you not to do things that take more than about 3 or 3.5 METs right after your heart attack.

METs for activities

	Sitting in a chair 1.0
	Sweeping the floor 1.5
	Driving a car 2.0
	Ironing 3.5
	Showering 3.5
	Bowling 3.5
	Sex 3.7-5.0
	Golfing 4.0
	Gardening 4.5
	Playing tennis 6.0
	Mowing lawn by hand 6.5
	Shoveling 7.0
	Skiing 8.0

* A MET (or metabolic equivalent) is the amount of calories burned per minute while at rest.

When can I start working again?

Most people go back to work within one to three months after having a heart attack. The amount of time that you stay off from work depends on the condition of your heart and how strenuous your work is. You may have to make some changes in how you do your work, or you may have to change jobs, at least for a short time, if your job is too hard on your heart. You should not be driving a motor vehicle for at least one month after a heart attack. Check with your doctor.

What about sex?

You can probably start having sex again in three to four weeks after your heart attack. As with other types of activity, you may need to start out slowly and work your way back into your normal patterns.
Don't be afraid of sex because of your heart attack. Sex only uses about 3.7 METs before and after orgasm, and only up to 5 METs during orgasm. Use different positions if one position seems to make you uncomfortable. Let your partner be on top to reduce the amount of energy you use during sex.
Try to feel comfortable talking with your doctor and your sex partner about any concerns you have.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.