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    Learning About Your Health

    Heart Attack: Myocardial Infarction (MI) - Your Guide to Recovery

    Welcome to California Pacific Medical Center.

    Note: Please review this information about your health condition. We want you to be involved in the decisions affecting your care. If you have family members, caregivers, or friends caring for you, please have them read this information.

    Each person has a unique health condition. If you have any questions, please ask the doctors, nurses, and therapists caring for you.

    What is a Heart Attack (Myocardial Infarction)?

    A heart attack is also known as a "myocardial infarction" (MI). A heart attack occurs when there is a blockage of blood flow in one or more of the coronary blood vessels (arteries) that supply blood to your heart muscle (See Figure 1).
    Figure 1. Anterior (front) and posterior (back) views of the heart showing Left Main Coronary Artery, Right Coronary Artery, Left Circumflex Artery and Left Anterior Descending Artery.
    Figure 1
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    How Does a Heart Attack Occur?

    A heart attack can occur when coronary arteries become blocked due to coronary artery disease (CAD). This blockage is due to a build-up of fat-like deposits (plaque) on the artery walls. This process is called atherosclerosis. As plaque builds up, the artery narrows and blood flow is reduced (See Figure 2).

    Many heart attacks are caused by "unstable" plaques. An unstable plaque is a fatty deposit that triggers an inflammatory response in the body. This inflammatory process causes plaque deposits to weaken and rupture.

    When plaque ruptures, a blood clot can form partially or completely blocking the artery. The area of the heart muscle supplied by the artery no longer receives enough blood and oxygen. The heart muscle becomes damaged resulting in a heart attack.
    Figure 2. Cross sections of artery showing plaque, vessel wall and vessel lumen.
    Figure 2
    After a heart attack, scar tissue forms in the damaged muscle. The remaining heart muscle works harder to pump blood through the body. Collateral circulation or new blood vessels may grow around the damaged muscle to carry blood to the heart.

    Medication and coronary interventional procedures such as angioplasty, atherectomy, and stent placement may be necessary to restore blood flow, optimize the function of your heart, and limit the size of the heart attack.

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    Knowing the Risk Factors for a Heart Attack

    • High blood pressure (blood pressure greater than 130/85)
    • High blood cholesterol
    • Low HDL cholesterol (too little "good cholesterol")
    • Cigarette smoking
    • A lifestyle that does not include physical activity
    • Overweight
    • Diabetes
    • Stress
    • Excessive alcohol intake
    • Having parents with heart disease
    • Other Trends Under Investigation:
      • Increased C-reactive protein levels
      • Increased Homocysteine levels
      • Increased Lipoprotein levels – Lp(a)

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    Recognizing Danger Signals

    If You Have Chest Pain, Call 911

    Immediate emergency care improves your chances of survival and of avoiding damage to your heart.

    Note: Heart attack symptoms in women, the elderly, and people with diabetes tend to be less obvious.

    • Chest pain or epigastric pain/pressure/discomfort at rest or with exercise.
    • Pain radiating in neck, jaw, shoulders, back, or one or both arms.
    • Increasing episodes of chest pain.
    • Unexplained indigestion or epigastric pain.
    • Shortness of breath.
    • Intense sweating.
    • Nausea and vomiting.

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    For Women: Signs & Symptoms of Heart Attack

    • Pain or pressure in the middle of your chest.
    • Pain or pressure that radiates to your neck, shoulders or arms.
    • Sweating.
    • Shortness of breath.
    • Nausea and vomiting.
    • Abdominal pain.
    • Lightheadedness.
    • Feeling faint or fainting.
    • Fatigue.

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    Tests to Evaluate Your Heart

    Your doctor will order the following tests to see if you are having a heart attack:

    • Cardiac Enzymes (CPK, Troponin): A blood test to determine if the heart muscle has been damaged.
    • Electrocardiogram (EKG or ECG): A test that measures and records the electrical activity of your heart. When your heart muscle is damaged, electrical irregularities in the rate or rhythm of the heart may develop.
    • Chest x-ray: A chest x-ray can show abnormal heart size and signs of heart failure (poor pumping by the heart).
    You may also receive the following tests to further evaluate your condition:
    • Echocardiogram: A non-invasive test to evaluate the structure and motion of heart function, heart valves, and blood flow through the heart. Echocardiogram uses ultrasound (high-frequency sound waves) to create an image of your heart on a television screen (monitor). This test identifies whether an area of your heart has been damaged by a heart attack.
    • Cardiac Catheterization & Coronary Angiogram: Cardiac catheterization is an invasive, non-surgical procedure. A coronary angiogram is a specialized x-ray procedure that is done as part of a cardiac catheterization. A cardiac catheterization and a coronary angiogram are done to study the structure of the arteries that bring blood to the heart muscle and to evaluate the function of the main pumping chamber of the heart. During a cardiac catheterization, the cardiologist inserts a small hollow tube (catheter) into an artery or vein and then advances it into the heart. The cardiologist injects contrast (x-ray dye) through the catheter to outline the arteries to show any blockages or narrowings that may exist within them.
    • Myocardial Perfusion Imaging (MPI) “Stress Testing” (Persantine Thallium): These tests help identify blood flow problems to your heart. Small amounts of a radioactive material are injected into your bloodstream through your IV. Special cameras can detect the radioactive material as it flows through your heart.

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    Understanding Your Medications

    Your doctor will order medications to:

    • Reduce blood clotting
    • Control your pain
    • Stabilize your heart rhythm, if necessary
    • Lower your blood pressure
    • Prevent further damage to your heart
    Your medications may include:
    • Blood-thinning medications (anticoagulants and antiplatelets): Blood-thinning medications prevent blood clots from forming in the blood. Aspirin, Coumadin (Warfarin), Heparin, Integrilin (Eptifibatide), Lovenox (Enoxaparin), Plavix (Clopidogrel), and ReoPro (Abciximab) are used to make the blood less sticky and less likely to clot. When taking these medications report any unusual bleeding to your doctor.
    • Nitrates: These medications, used to treat chest pain, open narrowed blood vessels and improve blood flow to the heart. Examples include: Imdur (Isosorbide Mononitrate), Isordil (Isosorbide Dinitrate), Nitro-Bid (Nitroglycerin oral) Nitroglycerin IV, and Transderm-Nitro (Nitroglycerin topical).
    • Pain Relievers: Morphine is often given intravenously to relieve chest pain.
    • Thrombolytics: These medications, often called clot-busters, dissolve a blood clot that is blocking the blood flow in a coronary artery.
    • Beta-Blockers: These medications reduce the workload of your heart. A beta-blocker is usually started at a low dose and gradually increased over time. Common beta-blockers are Coreg (Carvedilol), Inderal (Propranolol), Lopressor or Toprol-XL (Metoprolol), and Tenormin (Atenolol).
    • ACE Inhibitors: These medications help your heart pump effectively by relaxing the blood vessels. Some common ACE Inhibitors are Altace (Ramipril), Capoten (Captopril), Lotensin (Benazepril), and Zestril or Prinivil (Lisinopril).
    • Calcium Channel Blockers: These medications relax the muscle of the blood vessels and may slow your heart rate. Common calcium channel blockers are Calan or Isoptin (Verapamil), Cardene (Nicardipine), Cardizem (Diltiazem), and Norvasc (Amlodipine).
    • Cholesterol-lowering drugs: A variety of medications such as statins, niacins, and fibrates can help lower your cholesterol. Examples of statins include: Lipitor (Atorvastatin), Zocor (Simvastatin), Mevacor (Lovastatin),and Pravachol (Pravastatin). Examples of niacins: Nicotinex (OTC), Slo-Niacin (OTC) (Nictonic Acid,Vitamin B3). An example of a fibrate: Lopid (Gemfibrozil).
    Note: Make sure to tell your doctor about any non-prescription drugs you may be taking, such as cold remedies, sleep aids, or herbal medications.

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    Percutaneous Coronary Intervention (PCI) and Other Procedures

    PCI is a treatment procedure that enlarges narrowed coronary arteries without performing surgery. Your cardiologist will determine the most appropriate treatment for your condition during this procedure. Treatment will vary from patient to patient. PCI may include one or more of the following treatment strategies:

    • Balloon catheter angioplasty: A small balloon is placed in the narrowed area of the artery and inflated with liquid. This pushes the plaque (blockage) to the sides of the artery where it remains. This technique restores the opening of the artery. The cardiologist removes the balloon at the end of the procedure.
    • Stent: The cardiologist places a small, hollow metal (mesh) tube called a “stent” in the artery to keep it open following a balloon angioplasty (See Figure 3). This technique prevents constriction or closing of the artery during and after the procedure.
    Figure 3. Cross section of coronary artery with stent showing catheter, vessel wall, plaque, stent, balloon.
    Figure 3
    • Rotational Atherectomy: Calcium build-up is removed from the blood vessel using a specialized instrument. You may experience some discomfort such as chest pain, pressure or tightness in your chest during the procedure. Please let the staff know if you are feeling any discomfort during the procedure. Medications may be given to ease the discomfort.
    • Brachytherapy: This technique delivers radiation treatment to prevent scar tissue from growing back in the area of a previously implanted stent. If this treatment is recommended, a doctor who specializes in radiation therapy will speak with you and will answer any questions you may have about brachytherapy.
    • Coronary Bypass Surgery: In rare cases, emergency coronary bypass surgery may be performed at the time of a heart attack. Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery.

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    Planning Your Activity

    Your doctor may suggest a cardiac rehabilitation program for you. Cardiac rehabilitation services are designed to help you to recover faster and to return to a full and productive life.

    • Phase I Cardiac Rehab – Begins in the hospital with physical therapy, occupational therapy, and a nutritional consult.
    • Phase II Cardiac Rehab – An outpatient program comprised of an exercise program, education, and counseling.
    • Phase III Cardiac Rehab – A continuation of the above and support for heart-healthy lifestyle changes.
    For more information on cardiac rehabilitation classes at California Pacific, call (415) 600-3361.

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    Live a Heart-Healthy Lifestyle

    Obtain Regular Medical Checkups
    Conditions such as high cholesterol, high blood pressure, and diabetes, may be present without any symptoms in the early stages.

    Stop Smoking
    Smoking is harmful to the health of your heart. Smoking increases your heart rate and blood pressure, contributes to atherosclerosis (build-up of plaque in your blood vessels), and decreases oxygen to your heart. Cigarette smoking is a major risk factor for another heart attack.

    Smoking is an addiction. Nicotine releases a chemical to your brain which gives you a feeling of pleasure. Your doctors and nurses realize that smoking is not an easy habit to quit, and we want to support you.

    Here are some tips:

    • Make the decision to quit smoking while you are in the hospital. Inform your doctor and nurse.
    • Ask your doctor to prescribe a treatment plan to help you stop smoking. Your doctor may order medications to help with nicotine withdrawal and smoking cessation. These include nicotine replacement therapy (patch or gum), a smoking avoidance medication, or an antidepressant medication. Ask your doctor if these medications are appropriate for you during your hospitalization and after you go home.
    • Inform your doctor or nurse when you are experiencing symptoms of nicotine withdrawal such as anxiety, cravings, irritability, restlessness, depression, and insomnia.
    • Call 1-800-NO-BUTTS for more information about smoking cessation.

    Exercise Regularly
    Exercise helps improve heart muscle function following a heart attack. It also helps you maintain a healthy weight and control risk factors such as diabetes, high cholesterol, and high blood pressure. You are encouraged to exercise regularly. Regular exercise can reduce your symptoms.

    Follow These Guidelines:

    • Rest after meals. Wait at least 1 hour after you eat to walk or do any strenuous activities.
    • Space your activities to avoid getting too tired.
    • Exercise (walk or cycle) at a calm, easy pace.
    • Pace yourself so you can easily hold a conversation while you exercise.
    • Exercise when you are rested.
    NOTE: If you become short of breath, dizzy, develop pain or chest tightness – stop and rest. If symptoms persist - Call 911.

    Maintain a Healthy Weight
    Being more than 10 percent overweight increases your risk of heart disease.

    Measure your waist circumference: Your waist circumference (waist-line measurement) serves as an important value in determining if you are overweight. The recommended waist circumference for men and women is as follows:

    • Women: Less than 35 inches
    • Men: Less than 40 inches

    Eat a Heart-Healthy Diet
    Read labels on packages, jars, and cans of food:

    • Salt is sodium chloride. Canned foods, frozen dinners, pickled vegetables, and processed foods often contain lots of sodium chloride.
    • Most luncheon meats (cured meats) such as ham, smoked turkey, salami, and bologna are high in sodium chloride and other sodium-containing preservatives.
    Low cholesterol, low sodium:
    • Most doctors recommend that you do not have more than 2-3 grams (2,000- 3,000 mg) of sodium chloride each day.
    • If you have high blood pressure or diabetes check with your doctor for special diet instructions.
    Limit high-cholesterol foods:
    • Limit high-cholesterol foods such as egg yolks, whole milk, cheese, organ & fatty meats, and processed foods.
    • Recommended cholesterol (lipid) lab values for people with heart disease:
      • Total cholesterol should be less than 200.
      • LDL (low-density lipoprotein) cholesterol, sometimes called “bad cholesterol” should be less than 100.
      • HDL (high-density lipoprotein) cholesterol, “good cholesterol”, should be greater than 40.
      • Triglycerides (fat carried by cholesterol) should be less than 150.
    Avoid/reduce saturated fats:

    Avoid butter, coconut, palm, and partially hydrogenated oils, and fatty meats which are high in saturated fats. Choose canola, olive, safflower, sunflower or peanut oils in small amounts.

    Minimize intake of trans fats:

    Trans fats are found in processed foods with hydrogenated or partially hydrogenated oil (boxed crackers, cookies, & cakes).

    Eat more fiber and carbohydrates:

    Eat at least 5 serving per day of a variety of vegetables & fruits. Other good food choices include: pasta (plain), grains, dried beans, potatoes, and brown rice.

    Add folic acid & B vitamins to your diet:

    Adequate folic acid intake in your diet may reduce the amount of homocysteine in your blood. Homocysteine is an amino acid that builds and maintains tissues. Too much homocysteine may promote atherosclerosis. Folic acid can be found in green, leafy vegetables, citrus fruits, legumes, peanuts and cereal grains.

    Consume alcohol in moderation:

    Consult your doctor to evaluate the benefits and risks of alcohol consumption for you.


    Manage Stress

    • Practice relaxing by resting, meditating, or taking slow deep breaths.
    • Rethink “workaholic” habits and reduce stress in your daily activities.
    • Fear, anger, guilt or depression can occur after a heart attack or any major stressful event.
    • Socializing with friends, listening to music, and adopting a wellness lifestyle are helpful ways to cope with daily stress.
    • Use your spiritual beliefs to help you relax.
    • Discuss any concerns or fears that you may have with someone you trust. Seek professional support and counseling if needed.

    Sexual Activity
    For most people, it is safe to resume sexual activity 2 weeks after a heart attack. Many people worry that having sex after a heart attack will be too strenuous on their heart. Research indicates that this concern is usually unfounded. Check with your doctor on when it is safe to resume sexual activity.

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    Getting Support from the Medical Team

    • Doctors and nurses are available to listen to your concerns and feelings, as well as case managers, social workers, and chaplains.
    • Case managers are available to assist you with getting ready to go home. Your doctor may decide that you need more time in the hospital for treatment or rehabilitation before going home. A "Post Acute Unit" is a licensed, Skilled Nursing Facility that provides short-term care for people who do not need to be in the hospital.
    • Social workers are available to help with matters related to finance and your home situation. They provide counseling and supportive services in relation to adjustment to illness.
    • Financial counselors are available to answer questions or concerns about your health insurance.
    • Chaplains are available at all times. Please let your doctor or nurse know if you would like us to arrange for a visit.

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    More Ways to Learn

    1. Watch the Patient Video Education Channel in your hospital room: Anyone can use the video channel by following these instructions:
      • Tune to channel 60 on the television set, and follow the on-screen directions.
      • Pacific Campus dial ext. 78888, California Campus dial ext. 21000, & Davies Campus dial ext. 33600. Order videotape for viewing according to category or title by listening to information given over the telephone.Please watch videotape # 49 "How to Beat Cigarettes."
    2. Ask about Our Cardiac Rehabilitation Program at California Pacific Medical Center: This is a comprehensive program for cardiac patients and their families. A multidisciplinary team of health care professionals provide supervision in a supportive environment, motivating participants to achieve a healthy lifestyle. The program includes monitored exercise three times per week, group education, and risk factor counseling for optimal health and fitness. For more information call (415) 600-3361.
    3. Visit Our Community Health Resource Center: The Community Health Resource Center is located at 2100 Webster Street, San Francisco, (415) 923-3155. Services include smoking cessation classes, and written information on a wide variety of health topics.
    4. Browse These Internet Sites:
    5. Interactive Tools
      • Measure your readiness to quit smoking.
      • Determine how smoking affects your chance of having a heart attack in the next 10 years.
    Note: This handout is also available in Chinese, Russian, and Spanish.


    Produced by the Center for Patient and Community Education in association with the staff and physicians at California Pacific Medical Center. Date: 6/03.

    Illustrations: Christine Gralapp, M.A., CMI

    Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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