Transcription:
Helping Patients Recover from a Heart Attack

Melanie Cole (Host):  If you or a loved one suffered a heart attack, what can help you speed your recovery? What things do you need to do so that you can get back to living a normal high quality form of life? My guest today is Dr. Helen Keeley. She’s an interventional cardiologist. Her specialties include helping patients with their post heart attack recovery. Welcome to the show Dr. Keeley. So once someone suffers a heart attack, what is the typical timetable for recovery? When can they get back to normal life?

Dr. Helen Keeley (Guest):  It usually takes several weeks. It depends, of course, on the type of heart attack and the severity of the heart attack. But in general it takes about two to three weeks for them to really start feeling back to their normal self, and then depending on the pumping function of their heart and how they’re doing in general, it might take another couple of weeks before they really feel as though they can get back into, say for instance, their exercise program.

Melanie:  Dr. Keely, back in the day, if someone would have a heart attack, they’d be in bed for three weeks. Now with the cardiac rehab and phase one, you’re really getting people up pretty quickly, aren’t you?

Dr. Keeley:  That’s right, exactly. In fact, even with some of our large heart attacks, the patient is up and around within about two days and on the floor out of the unit around that time. We encourage them to walk around with the physical therapist, and usually by day three or four, at least by day three or four, they’re discharged from the hospital, even with some of our larger heart attacks. Most of the recovery actually does happen at home and that’s why it’s still important, we believe, to really have a program set for patients when they do go home because this when all the hard work really starts for them.

Melanie:  So speak about that multidisciplinary approach for as, if you would. What are some of the key elements of that post heart attack care that your healthcare team provides?

Dr. Keeley:  Well, what we realized is that, again, a lot of the work for the patient and the patient’s family starts after discharge. We thought that maybe if we were to develop a clinic that where we would see the patient very early after discharge, within about a week to 10 days after discharge, that we would be able to really answer any questions that they had that they weren’t able to ask during the hospitalization or that they were unclear about during hospitalization. We are able to check their medications, make sure they’re on the correct medication and really get them referred properly to cardiac rehab, help them with their smoking cessation and do all this early on, because we find that when patients run into trouble after heart attack and they get readmitted to the hospital, this actually does occur, the majority of it, within about the first two weeks. So we feel though if we’re able to see them quickly after discharge, we’ll be able to catch anything that might be brewing and kind of nip it in the bud so that they do not get readmitted to the hospital.

Melanie:  Tell us a little bit about the new clinic that you’ve helped establish for patients recovering from heart attacks.

Dr. Keeley:  Well, we’re really excited about this. It is a multidisciplinary clinic. In our clinic we have an exercise physiologist, we also have a dietician and we have a pharmacist who not only specializes in arranging the patient’s medications so it’s easy to take and affordable but who also is very interested in helping patients stop smoking, and then myself. So we’re able to really, in one clinic, answer a lot of questions for the patients and, more importantly, make sure that their medications are correct, answer questions according to their medication problems that they may be having, and then also get them referred to cardiac rehab that’s close to their home. And if they, for whatever reason, cannot go to cardiac rehab which we feel though is extremely important, we try to arrange a bit of an exercise program for them to get started at least at home.

Melanie:  And how do you engage them in that lifestyle management, behavioral changes that are so important after a heart attack so that hopefully to prevent another one?

Dr. Keeley:  The last several weeks in the clinic, we have found that patients are really enjoying the clinic. A lot of them have brought their family members, they have lots of questions, they’re very motivated at this stage of the game to make some changes in their lifestyle, whether it be smoking cessation, starting an exercise program, and also monitoring their diet more closely to a heart healthy diet. They seem to be very motivated because they were just discharged from the hospital and, you know, it’s a scary thing to have a heart attack and a lot of things happen during the hospitalization. So when they come in, they’re a little bit more relaxed they’re able to focus on themselves, we give them personalized attention because each patient is obviously different and their needs are different, and we found that we’ve been able to really hopefully make some changes early on. The patients seem to be more motivated and more relaxed than when you’re trying to discuss these types of things while they’re still in the hospital.

Melanie:  What nutritional advice do you like to give them? Is there any dietary restriction or are there things that you want them to learn about nutrition after heart attack?

Dr. Keeley:  Well, our dietician Carter Buxbaum, who works with us in the clinic, is really fantastic and she has a handout about healthy heart diet. She also goes over portion control with the patients; she goes into lots of details about their specific issue. Say, for example, if someone has hypertension and she feels as though that they have too much sodium intake, she teaches them how to read the labels about the amount of sodium in their food. So truly, it’s very personalized. Some patients she recommends the Mediterranean diet for, other patients she feels as though they’re doing the right thing but gives them some little tips here and there. So in general we do teach them a heart healthy diet, but you will see that a lot of them are doing some things correctly, some things maybe not so correctly, and she monitors that and adjust it accordingly to each patient.

Melanie:  And what about exercising on their own, walking, getting a bike in their home, doing any of that sort of thing? Do you encourage that or do you like them at least at the beginning to be monitored?

Dr. Keeley:  We very much like them to be monitored at the beginning. We’re very much a pro-cardiac rehab. The problem is that not all patients are able to attend to cardiac rehab because it is something that you have to go several times a week and the reality of it is that some patients are not able to do it, even though we very much encourage it and any patient who can we certainly enroll them into a cardiac rehab program close to their home.
But short of that, we have found that our exercise physiologist Mitchell Adams and Courtney Connors are able to sit down with the patients and at least get them started. They have several handouts showing how to exercise safely in the first couple of weeks after a heart attack, and safety tips of exercise. They also have some very interesting applications that can be used on smartphones to help people be motivated to try to start an exercise program.
So in general, yes, we do like them to be monitored and we do advocate them to be enrolled in a cardiac rehab program. The reality is it’s not always possible, and when is not possible, then Courtney and Mitchell do their very best to start them on an exercise program that they can do at home.

Melanie:  When generally can people return to work and some of those activities? What about lifting and strength training?

Dr. Keeley:  Usually we ask them to wait ideally until after cardiac rehab is finished because during cardiac rehab the exercise physiologist is really able to see how they’re doing in general, especially in patients who, for example, has had a large heart attack and the pumping function of the heart is not normal any more. So we would really encourage patients to be monitored while they’re exercising, kind of do what the exercise physiologist sets out for them to do. In terms of people who have had smaller heart attacks and kind of activities of daily living, usually within the first couple of weeks, again, we advocate that patient can start walking and usually start lifting at that point probably no more than 10 pounds or so. A big exercise program involving weight probably would be something we would defer for probably a month to six weeks, again depending on the size and severity of the heart attack.

Melanie:  Dr. Keeley, in just last minute if you would, give listeners your best advice about those who have just had a heart attack or whose loved one has just had a heart attack and what you really want them to know and why they should come to UVA for their heart care.

Dr. Keeley:  Well, I think UVA provides just topnotch health care. Especially in our division, cardiology division, we advocate patients to come early whenever they have a sign or symptom of anything consistent with a heart attack. And remember, it’s not always classic chest pain; it can be any symptom. If the patient is concerned about it, they need to to call 911 and come early. So the earlier someone comes to the hospital, the earlier we’re able to take them to the cardiac cath lab, the quicker we’re able to open up the artery and establish normal blood flow and the smaller the heart attack will be. So the key is to come early. Once it happens and the patient does have a heart attack, then the next important thing is to modify any risk factor possible that the patient may have, including smoking cessation, control of their diabetes if they have diabetes, control of their cholesterol if they have high cholesterol, and control of their blood pressure, staying on a heart healthy diet and starting an exercise program. These are all extremely important things. So, the first thing is to come early and have the heart attack stopped as quickly as possible. The next important thing is to make important changes to decrease the chance of you having a second heart attack.

Melanie:  Thank you so much for great information. You’re listening to UVA Health Systems Radio. For more information, you can go to uvahealth.com. That’s uvahealth.com. This is Melanie Cole. Thanks so much for listening.