Navigating Life After a Heart Attack (Webinar)

Good morning or good afternoon to everyone joining us today. Thank you for taking time out of your busy day to join today's webinar, hosted through Movn Health. Today we're going to talk about navigating life after a heart attack — essential tips not only for patients, but for their families, loved ones, and caregivers: the support system you'll have in place.

I'll introduce myself. My name is Kassi Valade. I'm a clinical exercise physiologist with a master's degree in exercise physiology, and I've been working in cardiac and pulmonary rehab for close to 20 years. I started with Movn Health a little over a year ago and have been loving it. Coronary heart disease, also called coronary artery disease, has long been a leading cause of death in the United States, followed by stroke, high blood pressure, heart failure, and diseases of the arteries.

There are several types of cardiac events. You may have gone into the hospital with symptoms and been treated for a heart attack — you might also see it called an MI, or myocardial infarction, on your discharge report. You might have had an intervention or procedure, such as a stent, angioplasty, or coronary artery bypass grafting, or you may have been diagnosed with heart failure.

So you've had one of these events. Now what do you do? They give you a report and a discharge summary and send you on your way. The first 48 hours are really key in recovery, and we understand it can be very overwhelming. We don't plan for these events, and there's a lot of information and a lot of unfamiliar terms on that discharge report. It takes time to make changes. A few things to be mindful of in those first 48 hours and that first week:

Medication pickup and adherence. Many of you may not have taken medications before — maybe just a multivitamin or an ibuprofen for a headache — and now suddenly you have five or six different medications to take. When am I supposed to take them? How often? Do I have a pharmacy where I can make sure my refills are ready so I'm not missing any? Do I have a routine to keep track of them? It's really important to share this with the spouse or loved one who will be taking care of you, so they can help you create that routine.

Adequate food in the house. Especially for bypass patients, or anyone who has had their chest opened, it might be hard to move around, and just getting out of the hospital you're going to be tired and overwhelmed. Make sure your house is prepped: do you have food and quick snacks? You might not be able to move your arms very much, or you might be too tired to prep or cook, so having meals or snacks planned out, or asking for help with grocery shopping, can make a big difference.

Feeling safe at home. Are you able to take care of yourself? Putting a shirt over your head might not be doable, so getting out button-up shirts can help. If you're worried about falling in the bathroom, prepare for that so you feel safe. Many of you might be on diuretics now, which means you'll need to get up and go to the bathroom more frequently than in the past. Look around your house and make sure you don't have clutter, boards, or lifted carpet corners in your way, especially in hallways — and that's a good practice for everyone, not just after a cardiac event.

Compliance with follow-up visits. You're going to have a lot of doctor's appointments to make sure you're healing and not becoming symptomatic. Look through your discharge report, see which specialists you need to see, and put the appointments on your calendar. Also plan for rides — some of you may not be able to drive right now, so make sure a loved one can help, or look into programs like medical transport vans or taxi services that can pick you up, take you to your appointment, and bring you home. It's really important to adhere to those follow-up visits.

What are your red flags? After leaving the hospital, some of you may be scared of having another cardiac event. We want you to be mindful of certain symptoms — we're not saying it's going to happen, but it's good to be cautious and ready. Anginal symptoms are your body's way of saying something is wrong. You may have heard the term angina. It's whatever brought you into the hospital — for example, chest pain or chest pressure that traveled up to your shoulders or jaw and wouldn't stop, or suddenly getting very short of breath, weak, and fatigued. Those symptoms were your body's way of saying you had a blockage or that your heart was being injured. After your cardiac procedure, if something happens again, your body may mimic those symptoms — we call this an anginal equivalent. If you experience that chest pain, chest pressure, or numbness or tingling going up your left side, that's the red flag to call your doctor. A lot of people don't want to call, but it's peace of mind to know either that there's nothing to be concerned about, or that you should go to the hospital or see your doctor.

Medication side effects. These medications may all be new for you, and some have side effects, such as dry mouth, fatigue, dizziness, sweating, dry cough, or muscle cramping — some people experience that with cholesterol medications. After your medications get into your system, notice how you're feeling. If you have a dry cough or muscle cramping, talk to your doctor. There are many different medications and dosages, which is why it's key to keep up with follow-up appointments — they can adjust your medications going forward. You can also talk to your care manager or the team in your cardiac rehab program; they can tell you whether it's a symptom of your medication and help you follow up with your doctor.

The emotional and psychological impact is huge. Most of you have probably felt some stress or anxiety with this, and even without a cardiac event, life can be stressful. Stress is a modifiable risk factor. Take a look at the signs your body is under stress: your body might feel fatigued or get headaches; your mind might worry or think negatively; you might feel irritable or depressed, lose your appetite, or reach for a couple of drinks or a cigarette. What are your signs of stress, and can you recognize them? Stress is unavoidable — it's around us all the time — but try to identify your stressors. What stresses you out might not stress your spouse, kids, or family. Know what's bothering you, know how your body reacts, and then learn your strategies to cope. There are so many ways to cope, and it's key to find something that works for you — just like with exercise, one person likes to walk, another likes to ride a bike, another likes to stretch or do strength training. Whether it's journaling, listening to music, or doing yoga, find what helps you feel better.

It's not only important for the person who had the cardiac event to understand their diagnosis and recovery — it affects their loved ones too. Your loved ones are concerned and stressed because they don't want it to happen to you again. Everyone deals with the stress differently, and it's key to talk about it and educate. That's why we have this webinar. When you're going through your rehab program — inpatient, outpatient, or virtual — bring your family or loved ones with you so they can understand, grow with you, and make changes too.

Your long-term care and lifestyle changes are a new way of life. Having a stent or bypass isn't going to miraculously make you healthy overnight; we want to ensure you can maintain good heart health. We talk a lot about exercise to make the heart healthier and stronger, but the risk factors that put you at risk for heart disease are also important to look at and adjust. There are two types: modifiable and non-modifiable. The non-modifiable ones — like genetics, age, and sex — we can't change. But the modifiable ones are where to focus: activity, diabetes, cholesterol, blood pressure, and more. Take note of which ones apply to you, and start to educate yourself on how to control them. If you've just been diagnosed with diabetes or started a cholesterol medication but don't fully understand what those mean, start learning about them.

Your next steps and goals — for anyone with cardiovascular disease or just trying to get healthier: Log or track as needed. Many of you may have been told to log your blood pressure, weight, and any symptoms, so that at your follow-up visits your team can see how you're managing. You can use apps or a journal — whatever works for you. Manage your exercise and risk factors: go through your modifiable risk factors and decide what you can work on and change, then start an exercise routine. It might just be increasing your activities of daily living — getting out and walking more — and gradually building up to more intentional, regimented exercise. Get a support system in place: family, friends, loved ones, and your care team. And set goals using the SMART framework — specific, measurable, attainable, relevant, and time-bound. We tend to look at the long term — where will I be in six months or a year? — but we don't always think about the steps to get there, and that's how people fall off the bandwagon. By setting smaller, specific, and measurable goals, it's easier to stay motivated and reach that longer-term goal.

There's a difference between physical activity and exercise, and your doctor and family want you to increase both. Physical activity is like your activities of daily living — getting up and moving more. I like to call them "exercise snacks": what can I do throughout the day to get my activity up? Just like we eat throughout the day to keep our energy up, try to get up and move every 45 minutes to an hour to keep your body feeling good. Exercise is more intentional or planned — going for a half-hour walk and purposely getting your heart rate up for 20 to 30 minutes to help your heart and body.

Some safety considerations for anyone: warm up and cool down before and after exercise. It's like starting your car's engine in the wintertime — you warm it up before taking it out on the road. Your body, heart, and cardiovascular system are that engine: warm it up, do your exercise, then cool down and let it get back to resting. Always listen to your body; it'll tell you when something's wrong and when to slow down or take a break. Keep following your medication regimen — are you taking them as prescribed and not missing doses? A support system helps you stay motivated. And hydration, hydration, hydration — water is the fuel you need to move throughout the day. Healthy eating can be hard. You leave the hospital and the doctor tells you to eat heart-healthy and watch your sodium, which can be overwhelming if you've eaten a certain way your whole life or rely on takeout. Make small changes — you won't change your diet overnight, but maybe one or two changes a week: increasing vegetables and fruits, changing the types of bread you eat, or swapping burgers for chicken. The Mediterranean diet has a lot of evidence supporting that it reduces the risk of cardiovascular disease, blood pressure, and cholesterol, and the DASH diet focuses on reducing sodium, which helps with blood pressure control.

Why is cardiac rehab so important? I call it the diamond in the rough — not many people know about it, but those who take part realize how helpful it is, not only for feeling better and improving cardiovascular function, but for that lifestyle change. It's been around a long time and really does help reduce rehospitalizations and mortality, and — the biggest thing — it improves your physical function and quality of life. It helps you understand your body and the changes you can make, and it helps you stay motivated.

You have a few options when choosing a program. Consider location and travel: in-person, you have to commute two to three times a week; with a remote program like ours, you can do it wherever you are. Consider flexibility: in-person has a set schedule, while remote can be accessed any time. Consider cost, support, technology, and equipment: in-person equipment is provided at the facility, while with our program we send you a smartphone and monitoring devices, all through the internet, so you can do it at home. Consider personalization: in-person is structured, while remote is highly personalized — we work with whatever you have going on in your life so it fits your schedule and you can maintain it. And consider monitoring: in person, they monitor you at the facility; in a remote setting, we're always watching too, which a lot of patients enjoy. A few other things to think about: we really do promote the virtual program, but it's not right for everyone. Consider safety — can you exercise safely at home, or do you need closer monitoring? Consider cost and copays — inpatient versus outpatient versus remote, and whether it's covered by your insurance. Consider accessibility — how far away is the outpatient facility? Driving 45 minutes each way two to three times a week could take three to four hours out of your day. And consider the program's reputation and staff experience — is it accredited, and does it have qualified staff like exercise physiologists, nurses, and doctors who can help you?

Movn is a fully remote cardiac rehab program. We set you up with the devices, and you meet with your care manager — an exercise physiologist or nurse. We really promote exercise, because that's why you're in the program — you want to get stronger — but we also address those modifiable risk factors. You'll get education and help with nutrition and stress management, and if you're a smoker trying to quit, we'll be your cheerleader the entire way. We help you get into a routine of tracking and logging, adhering to your medications, and understanding your weight fluctuations and blood pressure. It's a holistic approach — we're really trying to help the whole body going forward.

A few final takeaways. There are many types of cardiac events, and they are a leading cause of health-related issues and death in the U.S. Immediate aftercare is a primary concern: look carefully at your discharge report and summary, understand where your follow-up appointments are and how you'll get there, and understand your medications and their possible symptoms and side effects. The psychological and emotional impact is huge — you should not be ashamed or upset that it's bothering you, but know that you have support and there are many ways to manage and cope. No matter what rehab program you choose, or if you're already in one, talk to the person helping you so you can understand your diagnosis. Doctors don't always have a lot of time to talk, and when people go online they often end up down a rabbit hole that makes them more stressed. So ask and communicate: what can I do to manage this, and what steps do I need to take to learn about my diagnosis and manage stress day in and day out?

Long-term care requires SMART goals. This won't fix you overnight — it's a journey that takes time, and you have to be patient with your recovery. Some people feel good after a month, some after six months, some after a year, and that's okay. What little steps can you take toward the bigger goal? Exercise safely: some people are scared to put stress on their heart for fear of another event, so understand your parameters and guidelines for how hard you can push yourself, and set daily goals so you can be active and know you're putting good stress on your body. Learn healthy eating habits one step at a time — you don't need to overhaul your eating overnight, because that's not maintainable. What can you do to decrease your sodium and eat more well-rounded meals? Think of the rainbow — fruits, vegetables, and whole foods — when you cook or plan your week. Manage those risk factors: going back to the modifiable ones, what are mine? Do I have high blood pressure or high cholesterol? Am I a stressed-out person? Learn about them and what you can do to improve them. For example, if you have high blood pressure — average blood pressure is about 130 over 80 — take your medications, watch your stress, and reduce your sodium. And find a program that's right for you. Of course we promote our virtual cardiac rehab program, but it doesn't fit everyone. Consider whether you need an in-person setting two to three times a week — exercising in front of someone, on an EKG monitor — or whether a virtual setting would be better, where wherever you are, we can work with you, set up calls around your work schedule and vacations, and help you fit it into your day-to-day routine.

Thank you so much for joining today and for taking the time to listen. My name is Kassi, and I'm one of the care managers here. Please feel free to reach out with any questions or concerns. Thank you for attending with Movn Health, and I hope you have a wonderful day.

‍