From the Heart: A Caregiver's Guide

The worst is over. Your loved one survived a heart attack and is back home. But getting back to normal may take some time. And depending on the severity of the attack, normal may be different than before.

Being a caregiver will require time, patience and looking out for possible post- heart-attack symptoms that signal potentially dangerous physical and psychological changes in your loved one: fatigue, swollen legs, abnormal heart rhythms and palpitations, and signs of anxiety and depression.

If you know what to expect and do, you can help your partner recover more quickly and reduce the risk of a subsequent heart attack.

Be an Informed Advocate

Before being discharged from the hospital, a hospital representative will typically sit down with the patient to review the doctor's instructions. It's important for you to be there because right after a heart attack, people may have a difficult time focusing on or absorbing information, due to medication side effects or anxiety. The representative will explain how to apply dressings (if needed); when and how to take medications and resume activities; and what lifestyle changes the patient should make.

• Use this time to ask questions and express concerns. Ask the hospital representative to repeat any instructions that your loved one appears to be confused by or resistant to.

Be Observant and Ready to Take Action

Once you're home, be watchful for symptoms of medical and psychological disorders that sometimes occur while heart attack patients recuperate.

Some medical disorders are:

• Hypertension ( high blood pressure). Symptoms: headache, dizziness, blurred vision and nausea. There may be no discernible symptoms, so check the patient’s blood pressure regularly.
• Abnormal Heart Rhythm (arrhythmia). Symptoms: palpitations, pounding in the chest, dizziness/light-headedness, fainting, shortness of breath, chest discomfort, weakness, fatigue.
• Pericarditis (inflammation of the pericardium). Symptoms: anxiety, chest pain (may get worse when breathing and go away when standing or sitting), difficulty breathing, dry cough, fast heart rate, fatigue, fever, ill feeling.
• Heart Failure. Symptoms: shortness of breath, persistent wheezing or coughing, swelling in the feet, ankles, legs or abdomen; weight gain, fatigue, loss of appetite, confusion, increased heart rate.
• Sexual Dysfunction.

If you observe any of these symptoms, call the cardiologist. Call 911 if the symptoms appear to be life threatening or related to heart failure.

Psychological/emotional reactions include:

• Depression. Symptoms: frequent crying; difficulty concentrating, remembering details, making decisions; fatigue, decreased energy; feelings of guilt, worthlessness, helplessness, hopelessness, pessimism; insomnia, early-morning wakefulness or excessive sleeping; irritability; restlessness; loss of interest in activities, including sex; overeating or appetite loss; persistent sad, anxious, or empty feelings; thoughts/attempts of suicide.
• Anxiety. Symptoms: apprehension or dread; trouble concentrating; feeling tense, jumpy; anticipating the worst; irritability; restlessness; watching for danger; mind going blank.

Depression, anxiety fear and anger are common responses to having a heart attack. Often patients wonder why it happened, and worry how their life will change, whether they'll ever truly recover and if they may have another heart attack.

If your loved one displays signs of depression or anxiety, arrange a meeting with a therapist and/or support group. Without treatment these emotions could worsen, and they will impede your partner's ability to recover and enjoy life.

Follow the Doctor's Orders

Help your partner recover to the fullest extent possible and as quickly as possible by making sure:

• Medications are taken according to instructions.
• Recommended lifestyle changes are followed (diet, exercise, smoking cessation, stress and/or weight reduction, etc.).
• Enjoyable activities and/or socializing with friends are planned.
• Follow-up visits with healthcare providers and cardiac rehabilitation classes are attended.
Supplement Your Care-giving with a Cardiac Rehabilitation Program Cardiac rehabilitation programs help heart attack patients regain health, strength, vitality and confidence by offering a program that combines education with exercise and support. The educational component includes understanding heart disease, learning specific ways to reduce risk factors, and learning how to manage the disease through lifestyle changes. The exercise component includes supervised, monitored exercises designed specifically for the patient and that gradually rebuild strength and endurance. The support component builds the patient’s confidence through counseling, stress management and vocational guidance, if needed. Build Your Own Support System Being a caregiver is stressful and exhausting and can compromise your physical and psychological health. Take time for yourself—hobbies, social gatherings, and even joining a caregiver support group, so you don’t become a heart attack patient, too. For more information for caregiver of heart attack survivors go to Mended Hearts, a nationwide heart patient support group who's mission is to inspire hope in heart disease patients and their families. Other organizations include the American Heart Association and Heartmates.