After the heart attack - Magazine - La Vanguardia
Acute myocardial infarction is a serious medical condition that occurs when a coronary artery becomes blocked by a blood clot, preventing the flow of oxygen to the heart muscle. This blockage is caused, in most cases, by an atheroma plaque that ruptures, leading to the formation of a thrombus. The area of the heart that depends on the blocked artery begins to undergo necrosis, i.e. tissue death, which determines the severity of the infarction.
Although myocardial infarction may seem like an unexpected event, in many cases it is related to the presence of risk factors such as hypertension, high cholesterol, smoking or diabetes. However, unlike angina pectoris, myocardial infarction is not necessarily triggered by physical exertion or an obvious external event. It can occur at rest and without clear prior signs.
A FIRE FOREST FIRE
"Talking about a heart attack is like talking about a forest fire: there are devastating ones and there are small ones. Dr García-Dorado's comparison, who continues: "The first thing to do is to prevent them, the second is to put out the fire quickly: "The first thing to do is to prevent them, and the second is to put out the fire quickly: heart cells are like trees that are dying in a forest fire. Hours count in putting out the flames. The sooner it is treated, the less serious it can be, and the third thing is to prevent further outbreaks: a small heart attack is a big warning. To prevent new cardiovascular accidents, García-Dorado explains, "you have to follow the doctor's instructions to the letter, taking all the necessary medication, and change your lifestyle". A heart attack or angina pectoris occurs when one of the arteries that oxygenate and nourish the heart becomes blocked. When the obstruction is partial and no heart cells die, it is angina, but if it is total and there is cell death, it is an infarction, which leaves permanent damage to the heart, and we normally call infarction an acute myocardial infarction, but this obstruction can occur in other organs. It is estimated that in Spain there are about 70,000 heart attacks and angina pectoris each year.
FOLLOWING A NOTICE LIKE THIS IS LEARN TO SET LIMITS AND PRIORITIZE
"I have learned to love life and to seek the support of others", says José Luis Jiménez, 69, who suffered a heart attack more than ten years ago. Imma Buñuel, 50, suffered angina pectoris two years ago: "It forced me to stop. I am learning to regulate my levels of self-demand, to set limits and to prioritise". Joan Manils, 56, had a heart attack on Epiphany 2008. "Now I have a completely different way of life," he explains. 58-year-old Víctor López, who had a heart attack on 29 October, is happy to be able to talk about it. And Mariano Hernanz, 78 years old and with three heart attacks under his belt, says: "The heart attack helped me to reorganise my life".
Dr David García-Dorado, clinical director of the heart department at Vall d'Hebron Hospital in Barcelona, believes that being able to ask the question of what a heart attack is for is a precious second chance. "Having to deal with recovering from a heart attack is fortunate, because more than a third of those who suffer a heart attack do not make it to hospital alive. Dr Almudena Castro, coordinator of the cardiac rehabilitation unit at La Paz hospital in Madrid, explains: "We always tell them: 'You have had time to get there and be treated. This is how Ángel Jara, 52, who suffered a heart attack on 31 October, sees it: "It was a warning that marks a before and an after, because the next warning could be the pine box".
After a cardiovascular accident such as a heart attack or angina pectoris, the patient is treated in hospital and, once they are discharged, they go home with a report on the repercussions of their heart attack. A stress test is performed," explains Dr García-Dorado, "medication is prescribed and the patient is given information on how to control risk factors and advice on how to improve their lifestyle. In principle, the patient can lead a normal life within a short period of time. Depending on the severity, the patient can return to the daily routine alone, progressively, or with specialised help. Cardiac rehabilitation units play an important role here, which are widely available in other countries but are not yet widely offered here.
Dr Dorado explains: "If you sprain your ankle, you immediately receive rehabilitation sessions with a physiotherapist, but not with the heart, a vital muscle that has broken down. Dr Castro explains: "The philosophy is to do cardiac education, that is, to help the patient change their lifestyle. Dr Muriel Binia, from the Institute of Cardiovascular Health and Cardiac Rehabilitation (Inscor), agrees: "Lifting your leg is not enough, you have to change the way you live. Rehabilitation lasts about four months and the improvement is spectacular. It is calculated that with good rehabilitation the risk of subsequent cardiovascular accidents is reduced by 30%". Exercise, emotions and diet
After suffering a heart attack, recovery is based on three main pillars: physical exercise, psychological treatment to manage stress and emotions, and improving and adapting the diet. Exercise has to be incorporated gradually so that the patient listens to his or her body. There are patients," says Castro, "who leave the hospital with a lot of doubts, with fear, and they hardly move from their homes.
This is what happened to 68-year-old Pilar Sanz, who had a heart attack and two cardiac arrests on 29 September. When she returned home from La Paz, she felt uneasy: "My daughter came to do the housework and cooking for me. My son and my husband protected me and pampered me, but after taking care of yourself so much, you think you are no longer worth anything. I was sent to cardiac rehabilitation and there I felt well again. I've always been a homebody, sewing, crocheting... but now I'm getting a taste for exercise".
In cardiac rehabilitation, exercise is initially carried out with electrodes on the chest, which allow the state of the heart to be monitored at all times in order to detect any abnormalities. Afterwards, a pulse meter is used to monitor the heart rate. Inscor's physiotherapist, Lourdes Vila, explains that they offer "very personalised training, teaching them to detect what they can do and with what intensity". Two types of patients come to them: "Those who did sport to work out at the weekend and those who didn't do any sport at all. We teach them how to do healthy physical activity, how to handle a heart rate monitor, how to measure heart rate, how blood pressure reacts.
Víctor López is an example of a sportsman. In fact, ironically enough, the heart attack struck him in the changing rooms of the gym. "I've always been a sportsman and I go to the gym from Monday to Friday, but I always go fast and don't stop. Now, they make me work out at La Paz, and I ask them to give me a good workout. I guess I still have to make myself aware that I have to stop the machine a bit! Healthy diet José Luis Jiménez recalls that he had several risk factors. "I was obese, had a bit of high blood pressure and had been a smoker for many years. Even though I had quit, the damage was already in my arteries. Obesity is one of the most common cardiovascular risk factors, as well as hypertension, hypercholesterolemia, smoking, diabetes and stress.
Inscor dietician Bárbara Romano points out how important it is to maintain a good weight. "We explain to them that in order to eat a healthy diet they have to change some habits. There are some common mistakes, such as believing that from now on they can only eat boiled foods, or going on such a draconian diet that they stop it immediately, or thinking that if they eat something light they can eat it in large quantities. It is better to control the quantity of what they eat, to remember the Mediterranean diet and to emphasise that if the patient eats healthy, the whole family eats healthy too. Little by little, they learn to weigh the pros and cons of the new situation. Manils says: "I had a better time before, I ate what I wanted, but maybe I wouldn't be here to talk about it".
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