Long-Term Treatment following Heart Attack
The goals of long-term treatment are to facilitate healing within the heart, to make it easier for the heart to function effectively, and to decrease the risk for future heart attacks. Medications may include aspirin and beta-blockers, and ACE inhibitors.
Patients who have had a heart attack should not smoke. Smoking cessation substantially reduces the risk for heart attack. Within one year of quitting, heart attack risk decreases by about 50%; and within 5 to 10 years of quitting, the risk is about the same as for anyone who is the same age and has never smoked.
Support groups, behavior modification, relaxation techniques, hypnosis, acupuncture, and drug therapy (e.g., bupropion [Zyban®]) may be helpful while quitting. A recent study suggests that a combination of bupropion and a nicotine patch may also be helpful.
In 2009, the U.S. Food and Drug Administration (FDA) issued a black box warning for the smoking cessation drugs bupropion (Zyban®) and varenicline (Chatix®). According to the FDA, these medications carry an increased risk for mental health side effects, such as depression, behavioral changes (e.g., hostility, irritability), and suicidal thoughts. Patients who use these drugs to stop smoking should be closely monitored while taking them and after the medication is discontinued.
Cholesterol reduction therapy has been proven to decrease the risk for future heart attacks and strokes and to decrease the need for coronary angioplasty or bypass surgery. The primary goal of treatment is to reduce the level of "bad" (LDL) cholesterol to less than 100 mg/dL.
Medications called statins often are used to lower cholesterol. They include atorvastatin (Lipitor®), cerivastatin (Baycol®), fluvastatin (Lescol®), lovastatin (Mevacor®), pravastatin (Pravachol®), and simvastatin (Zocor®). These medications effectively lower LDL cholesterol levels and usually are well tolerated. Rare side effects include liver inflammation and muscle pain and inflammation. Patients taking these medications also must follow a low-cholesterol diet.
People who are physically active and exercise regularly have a lower risk for coronary heart disease than those who have inactive, sedentary lifestyles. Regular exercise can improve levels of "good" (HDL) cholesterol, can help control diabetes, can lead to modest reductions in blood pressure, and can reduce the risk for future heart attacks.
Heart attack patients must consult a physician for help devising an exercise program before beginning to exercise. Cardiac rehabilitation programs are available at many hospitals and community centers.
Resuming Sexual Relations after Heart Attack
Many heart attack patients are concerned about resuming sexual relations. Some patients worry they are not healthy enough and that sexual activity will put too much strain on the heart or cause another heart attack. Partners of heart attack patients often worry about these issues even more so than the patient. As a result of these concerns, many couples are reluctant to resume sexual activity.
Most patients are safely able to resume sexual relations at some point after a heart attack. The strain on the heart during sexual intercourse is about the same as from walking up two flights of stairs. However, specific recommendations for resuming sexual relations depend on a number of factors, including the severity of the heart attack and the degree of residual heart function. The decision to resume sexual relations should be discussed with a physician.
Some men and women become depressed after a heart attack, which can interfere with sexual drive and performance. In addition, men who are taking beta-blockers may experience erectile dysfunction. Abrupt discontinuation of these medications is dangerous and discontinuation should be discussed with a physician.
