One of the aspects of life after a heart attack that doesn’t seem to get much “air-time” or consideration, is the effect it can have on one’s mental health.
This seems very strange to me, as it has long been understood that stress, loneliness, anxiety & depression are significant risk factors for developing heart disease in the first place.
Once released from hospital after an intervention post heart-attack (I refer to the UK as this is the only experience I have to go on) one is advised to:
Take more exercise (but not over-exert oneself)
Eat less fat & cholesterol (terrible advice)
Quit smoking (if applicable)
Don’t expose yourself to extremes of temperature
Reduce stress (although if the stress comes from an intrinsic part of your pre heart attack life, such as your job, your relationship or money worries, then that is easier said than done).
For many, this advice leads them on a path of life adjustment and improved health practices.
From witnessing some in my post-op cohort, they commonly aim to increase their step-count to aim for 10,000 steps a day, lose the 2/3/4 stone they have been carrying around for a while, and clean-up their poor eating practices (although in that particular endeavour the advice sometimes leads them down a less healthy path than the one they were one and becomes a little counter-productive).
The big elephant-in-the-room that seems to go completely un-noticed, however, is the thing common to all heart-attack survivors?
What do all heart-attack survivors have in common?
They all have the knowledge that they nearly died from cardio-vascular disease, and there is a very strong likelihood that they will experience another event.
Heat disease isn’t something that occurs overnight.
Everybody that experiences heart disease has had an internal environment that has been progressively compromised over a long period of time to result in an MI or stroke.
Some of that may be genetic, some may be environmental and some may be their poor lifestyle practices, but all survivors will then be left with the puzzle of looking at their lives before and wondering which elements created their heart disease and which are, therefore, priorities to redress in the hope that this may delay (or prevent) the next, potentially terminal, heart “event”.
This leads to challenges of life adjustment even if the elements that need to be changed are obvious.
For example.... if a 65 year old male that lives alone and has a poor social life, has always smoked 60 cigarettes a day and is 6 stone overweight & consumes 6 litres of coke daily, leaves hospital after receiving a PCI (stent)...then there are a number of very obvious changes that can be made to improve his chances of another event.
The fact that he has gone through years of this type of physical self-abuse, and has such obvious risk-factors means that losing weight, cessation of smoking and removing sugar will have a massive impact on his condition. This won’t be easy, especially as the habits that he has developed may have been ingrained over many years.
How much harder then for the survivor that doesn’t smoke, has a vibrant social-life and lives with a loving partner, isn’t overweight, eats well, exercises regularly and is relatively young?
Not only are there lifestyle/environmental changes that must be made for these people, but they probably also need to take more extreme measures to mitigate future heart-health issues.
For example....if a genetic pre-disposition for clotting, or a genetically high LP(a) level is present in a survivor, that person knows that they can’t afford even what most would consider a generally “healthy” lifestyle.
The lifestyle interventions in the previous example would not be enough, and they wouldn’t even be aware of what in their lifestyle (if anything) could have been done to prevent their heart-disease from developing.
They may need to adopt a very strict dietary regime (such as a ketogenic diet), give-up a job they love (if the accompanying stress might have been a factor in their disease) and have many subsequent potential lifestyle changes as a result of this (such as down-sizing their home and other financial sacrifices).
All of this...and no real understanding of whether it will make any difference, because the answer they are given to the reasonable question “what was it that caused my heart-attack?” Is generally “It must be genetic because we don’t know! You don’t have any risk factors”.
1 in 5 heart-attack survivors will have another within 5 years of the first one.
Imagine how that affects mental health. The thought that you nearly died, you were saved this time, but you are likely to have the experience repeated again and the medical professionals treating you have no idea what caused it, & have no interest in going through an exploratory process to find out either.
The protocol in the UK in these instances is to prescribe the highest dose of statins available (80mg Atorvastatin for me) even though there is no evidence that they prevent heart-attacks and they actually increase all-cause mortality, as well as potentially delivering a slew of horrible side-effects including erectile dysfunction, Alzheimer’s, dementia, muscle pain, joint-pain, diabetes.
This can leave the survivor with a constant sense of anxiety & a sense of impending doom.
“Was that a twinge in my chest?” ......Indigestion.
“My left arm feels like it is tingling!”......I slept on it.
“I feel my heat beating faster for no reason!”.....I have just eaten a big meal.
Now if this doesn’t make you anxious and depressed nothing will. And all this extra anxiety is just contributing to the risk, as I mentioned at the start of this article.
The reality is, amongst stress management strategies such as meditation, gratitude practice, yoga, saunas, etc one must start to adopt a practice of changing the difficult lifestyle factors every day as much as one can.
If you have a stoic, dedicated, single-minded personality then living an essentially abstentious life may come easier to you, but for most it is more a case of working towards progress more slowly, and if you aren’t used to this it can be difficult & dis-heartening.
The best strategy I can think of is to take this approach:
Be kind to yourself.
Start the activities that will lead to improvement step by step every day.
Create good habits to make adhering to the new activities easier.
Break activities down into small steps and work towards improvement every day.
If one day you can’t achieve what you hoped for then just aim a little lower and try again.
Never give-up.....just make the steps smaller if necessary.
Don’t be tough on yourself! Just try to improve a little every day.
The compound effect of this strategy will leave you feeling less stressed about the end goals you set for your new lifestyle.
You will feel less worried about the possibility of another heart event, & will feel generally happier and more in control of the progress you are making.
Avoiding the worry and stress post heart-attack is as much part of the recovery as anything else you can do, so try not to fall into the trap of falling into a downward spiral of negative thoughts, or setting yourself up to fail with big lifestyle changes.
I have created the world’s most simple flowchart to help you keep on track with the changes you need to make in my Life Improvement Daily Formula here.
Smile, enjoy your friends and family & revel in the thought that you have been given another chance at life.