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INFORMATION FOR PATIENTS HAVING AN ANGIOPLASTY.pdf

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					INFORMATION
FOR PATIENTS
  HAVING AN
ANGIOPLASTY
Section A – Your Angioplasty

Introduction                                           6

What is a heart attack?                                6

What is angina?                                        7

What is an angiogram?                                  8

What is an angioplasty?                                8

What is a coronary stent?                              8

Diagram of angioplasty and stent                       9

On admission                                           10

What happens when you go to the catheter laboratory?   10 – 11

The first week at home                                 12

Wound care                                             12

Medication                                             13 -15




                                   2
Section B – Your rehabilitation

Relaxation and the heart          16 - 17

Physical activity and the heart   18

Walking                           20

Home exercise regime              21

Household tasks                   22

Active hobbies and lifting        22

Driving                           22

Returning to work                 22

Sexual relationship               23

Air travel                        23




                              3
Section C – Maintaining a healthy heart disease

Risk factors associated with the development of coronary heart disease


Risk factors we can change                                    24

Smoking                                                       24

Lack of exercise                                              25

Poor diet                                                     25

Being overweight                                              25

Alcohol                                                       26

Stress                                                        27

Risk factors we can control                                   28

High blood pressure                                           28

High levels of fats (cholesterol) in the blood                29

Diabetes                                                      30

Risk factors we cannot control                                31

Family history                                                31

Gender                                                        31

Socio – economical and geographical                           31




                                   4
Dietary advice                                                32

Healthy diet – healthy heart                                  32 - 39

Cardiac rehabilitation programmes                             40

Wythenshawe hospital programme                                41

Stress management group                                       42

Community rehabilitation course                               43

Support groups                                                44

Contact numbers and useful addresses                          45



If after reading this booklet you need to ask any questions
please telephone:- either 0161-291-2679 or 0161-291-2177




                                  5
Section A – Your angioplasty

Introduction
The aim of this booklet is to help you to understand your condition. It also explains the
investigations that may be done during your illness.

Coronary heart disease (angina and heart attacks - sometimes called acute coronary syndrome)
is caused by a build up of fatty material called atheroma in the coronary arteries. These
deposits of atheroma can cause angina or a heart attack. You may have experienced one or both
of these, or you may not have had any symptoms at all.

It is important to remember that most patients who have an angioplasty make an excellent
recovery and go on to lead a normal healthy life.

What is a heart attack?

Your heart is a muscular pump, responsible for pumping blood rich in oxygen to all parts of the
body. Like any other muscle it needs its own supply of energy. It receives this via blood
vessels called coronary arteries. There are two main ones, the right and left. The left divides
into two arteries, which with the right artery, form a network around the heart. A heart attack,
or myocardial infarction (MI), happens when one of these arteries becomes blocked by a blood
clot lodging in a narrowed section of the artery, causing the muscle to be starved of oxygen.




Picture/Heart

                                                6
What is angina or acute coronary syndrome?

Angina or acute coronary syndrome is a pain or tight discomfort commonly felt in the chest, or
in some cases in the arms, jaw, shoulder or upper back. It occurs when the coronary arteries
have narrowed and the blood and oxygen to the heart muscle is reduced. Exercise or emotional
stress usually brings on the pain of angina, but it can come on at rest or even wake you from
your sleep. Using a glyceryl trinitrate (GTN) spray or tablets will usually takes this pain away.


Guidance on what to do if you get chest pain
If chest pain occurs when you are being more physically active:
    • STOP what you are doing and sit down.
    • Take your GTN spray or tablet and wait for 5-10 minutes.
    • If the pain continues or becomes worse, take another spray of GTN and wait for a
        further 5-10 minutes.
    • If there is no improvement after a third attempt of using GTN, call for an
        ambulance by dialing 999.

If you get chest pain while you are at rest, take your GTN spray as above. You need to tell
your GP, as this needs urgent investigation and treatment.

If you find doing something such as walking upstairs causes chest pain, then try taking your
GTN spray before going up the stairs. GTN may cause some people to get a headache. If it
does, take a regular painkiller such as paracetamol.
Remember to always carry your GTN spray with you.
It is important that you are able to tell the difference between the various types of chest
pain, for example angina, indigestion or muscle pain.


Investigations and Possible Treatments
The first investigation you will have is called an angiogram. You may then need to have an
angioplasty or coronary artery bypass surgery depending on the result of the angiogram. These
are called ‘revascularisation procedures’. Revascularisation means giving the blood supply back
to the heart muscle.

There are risks with all of these procedures as there are with many hospital treatments. Your
doctor or nurse will explain these to you before your procedure.




                                                7
What is an Angiogram?

•   An angiogram is a test that takes x-ray pictures of your coronary arteries. It gives vital
    information about the blood pressure inside your heart, and how well the pumping chambers
    and valves are working. Most importantly, it can also show where any narrowings in the
    coronary arteries are and how severe they are.

•   The test is done in an x-ray room and takes between twenty minutes and an hour. The test
    can be done as a day case which means you can go home the same day. If you go on to
    have an angioplasty you will need to stay in hospital overnight.

What is an Angioplasty?
•   An angioplasty is a method used for treating coronary artery disease. It is also known as a
    P.C.I (Percutaneous Coronary Intervention). In the cardiac catheter laboratory a tube is
    inserted into an artery, either in the leg arm, and guided using an x-ray machine to the
    narrowed or blocked artery. A small ‘sausage - shaped’ balloon on the end of the tube is
    then inflated . This squashes the fatty plaques into the wall of the artery which widens it.
    More often than not during the angioplasty the doctor will use a ‘stent’ to support the artery
    wall (see picture on page 9).

What is a Coronary Stent?
•   A coronary stent is a small tube of stainless steel mesh about the size of a spring in a
    ballpoint pen. It is put into the artery where it is narrowed, to act as a form of internal
    scaffolding or support.

•   In the four weeks following insertion of the stent, a thin film of cells (like a skin) grows
    over the stent. Until the skin has grown over the metal there is a risk of the blood sticking to
    the stent. Tablets called aspirin and clopidogrel reduce the chances of this. The stent
    remains in the artery permanently; the body does not reject it (see pictures on page 9 ).

•   Some stents are coated with drugs and these are called drug-eluting stents.




                                                  8
Coronary Angioplasty with Stenting




                               9
On Admission

•   When you arrive at the hospital for an angioplasty a bed will be made available for you as
    quickly as possible. Unfortunately you may be asked to wait in the day room until your bed
    is ready.

•   If you have not been to a pre-admission clinic then a doctor or nurse will discuss your care
    with you and take a medical history.

•   We need to ensure that you are fit for the procedure and for this reason we need to take a
    small sample of blood.

•   The procedure will be explained to you prior to you signing a consent form, it is important
    that you understand what is going to happen so please ask questions if you need further
    clarification. A copy of your consent will be given to you.

•   Your usual medication may be altered, on the day of the procedure you will be advised
    which tablets to take prior to the angioplasty and at what time.

You can note the information here:-
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….
…………………………………………………………………………………………………….

•   During the procedure you may require intravenous medication or fluids and for this reason a
    small flexible tube called a cannula will be inserted into a small arm vein.

•   For a short time prior to the procedure we ask that you have nothing to eat of drink. This is
    for safety reason so it is important that you comply. If you are diabetic please make sure
    that you are clear about any adjustment to your insulin dosage or tablets.

•   If you require transport home after the procedure please tell your nurse as soon as possible
    and this can be arranged for you.

What happens when you go to the cardiac catheter laboratory
(for either an angiogram or angioplasty)

•   You will be met by a nurse who will take you in for the angiogram or angioplasty. The
    doctors and nurses will be wearing theatre gowns and gloves. This is to keep the test as
    clean and sterile as possible. You will then be transferred on to an x-ray table. This is very
    narrow and firm and can be moved up and down. You will then be attached to a heart
    monitor.

•   The top of your leg or arm will be cleaned and then covered with sterile towels. The doctor
    will give you a local anaesthetic in your arm or leg at the start of the test. This does not take
    the feeling of touch away but does take the pain away.

•   A catheter, which is a long narrow plastic tube, is put into an artery usually at the top of the
    leg or sometimes in the arm (mainly the wrist). Remember that you will not feel the tube.
    The doctor uses the x-ray pictures to guide the tube through the arteries to the heart. When
                                                 10
    the tube is in place a dye is injected through it. X-ray pictures are then taken. This gives a
    picture of the artery and shows parts that may be blocked. The picture is shown on a
    television screen, that you can watch if you wish.

•   When the dye is injected it can cause a hot flushing sensation, which lasts a few seconds.
    Occasionally people can get chest pain during the test. You will be given a pain killer if this
    happens. The x-ray equipment will at times be very close to you and it may be necessary
    for you to rest your arms above your head and turn your head from side to side.

• If you are going on to have an angioplasty, another catheter (tube) with a small inflatable
    balloon at its tip is passed into the artery. The doctor then uses x-ray pictures to direct the
    tube to the blocked coronary artery.

• The balloon is then gently inflated so that it squashes the fatty tissue responsible for the
    narrowing. As a result this widens the artery (see the illustration on page 9).

• The tube contains a “stent” which is a short tube of stainless-steel mesh. As the balloon is
    inflated, the stent expands so that it holds open the narrowed blood vessel. The balloon is
    then let down and removed, leaving the stent in place.

• If you have had an angiogam the introducer sheath (the device through which the catheter
    was passed into your artery) is removed straight away. If you have had an angioplasty the
    introducer sheath may remain in place for a few hours, this is so that the anticoagulant drugs
    (blood thinning drugs) used during the procedure can wear off.

• Whilst the introducer sheath is still in place you will have to lie flat, (if it is in the groin).
    When the introducer sheath is removed the doctor or nurse will need to press on the site for
    about 20 minutes or until there is no bleeding. Sometimes “collagen plugs” are used to
    close the hole in the artery so that the sheath can be removed immediately after the
    angioplasty.

• A nurse will check your blood pressure and heart rate regularly for four to eight hours. The
    nurse will also check the place where the catheter was inserted (the “puncture site”), and the
    pulses in your feet or arm.

• On the day you go home you will have an ECG (electrocardiograph) and a blood test. The
    doctor or nurse will see you before you are discharged. You will have to wait for the result
    of the blood test and for your tablets to be checked by the pharmacist before you leave the
    ward.

It is important that someone comes to collect you from the hospital and you do no make
your own way home.




                                                  11
Discharge home following an angioplasty
The following advice is to help you return to your normal and active life as quickly as possible.

The first week at home

•   Your GP will take over your care when you leave hospital. A letter detailing your hospital
    stay, recovery and tablets will be sent to your GP the day after you leave hospital.

    Contact your GP if you feel unwell or if you have any worries regarding your recovery.

•    You may feel better immediately but it may take a number of weeks to feel completely
     “back to normal”. It is important to take everything at your own pace. Remember everyone
     is different. You can discuss any concerns with your cardiac rehabilitation team
    (contact numbers on page 45).

•   It is best to avoid any demanding activities like heavy lifting for at least a week.

•   You should be able to return to work approximately a week after your angioplasty. It may
    take some people longer than this, but do not worry as everyone is different.


•   Approximately 8 weeks after your angioplasty you will see a specialist nurse or doctor for a
    check-up at Wythenshawe Hospital or your own local Hospital.


Wound care

•   Bleeding or sudden swelling
    Apply direct pressure over the wound site for 15 minutes using a clean cloth. After this
    time slowly release the pressure. If the wound continues to bleed reapply pressure and seek
    medical help at your nearest Accident and Emergency.

•   Infection
    If the wound becomes red, painful or oozes fluid then it may be infected. Please make an
    immediate appointment with your GP.

•   Circulation
    If the limb (arm/leg) via which you had the procedure becomes cold, or you lose sensation
    in it please seek medical help at your nearest Accident and Emergency.

•   Removal of Dressing
    The clear film dressing may be removed 24-48 hours after the procedure. This is best done
    by soaking it off in the bath or shower.

•   Sutures
    Suture removal if required is via your GP around 7 to 10 days

•   There are contact numbers for all wards at the back of the booklet. (on page 45)

                                                 12
Medication
All patients will need to take some medication (tablets) following an angioplasty.
The aim of medical treatment is to reduce the risk of you going on to have a heart attack and
also to treat the symptoms of angina (chest pain). It is important to understand why you are
taking your tablets. Some of these medications will need to be taken for a short period of time
whereas others will probably need to be continued for the rest of your life.

Approach your GP or pharmacist to discuss whether you qualify for free prescriptions. If not it
may be cheaper to buy a prepaid prescription for 3 or 12 months.

•   As well as taking the medication mentioned above, you may also be taking other tablets. It is
    important to remember which tablets you have been prescribed. It may be helpful to write down
    this information and keep it with you.

•   You should always read the patient information leaflet with your tablets; this contains important
    information about your medication. If you have any questions, or are not sure about anything, ask
    your pharmacist or health professional.

•   Do not stop taking any of your medications unless advised to by your doctor, or specialist nurse.

Listed below are the medications commonly taken following an angioplasty.


Antiplatelets (Apirin, Clopidogrel)
Antiplatelet drugs help prevent blood clots by stopping platelet cells in the blood from sticking
to each other or the stent. This reduces the chance of a heart attack. The antiplatelet drugs are
Aspirin and Clopidogrel.

Following an angioplasty, if you have had a stent inserted, you will usually need to take these
two antiplatelet drugs (unless you are allergic to one of them). The usual dose of Aspirin is 75
– 150mg (in some cases 300mg) once daily and you will need to continue to take Aspirin for the
rest of your life.
The usual dose of Clopidogrel is 75mg once daily which you usually take for one year. In some
cases you may have to take it for longer.

Patients taking antiplatelets sometime complain of a feeling of indigestion or heartburn. This
can be overcome by either taking the tablets after food, or you can be prescribed a coated
tablet or another drug to reduce the amount of acid produced by the stomach.

Statins (Simvastatin, Pravastatin, Atorvastatin)
Statins are a group of drugs that reduce the amount of cholesterol produced by the body. They
have also been shown to reduce the risk of having a heart attack. They slow down the
narrowing of your arteries and reduce the build up of fatty plaques.

You should have your cholesterol checked three months after starting a statin, then yearly. The
aim is to lower your cholesterol to below 4 mmol/litre. In some cases this may need to be
lower than 4mmol/litre. Your health professional or GP will discuss this with you.
Whilst you are taking statins you are advised to report any unexplained muscle pain, tenderness
or weakness to your doctor.

                                               13
ACE Inhibitors (Ramipril, Lisinopril, Perindopril)
ACE inhibitors work in a complex way by stopping certain enzymes within the body working.
They are used to help the heart pump blood around the body if you suffer from heart failure and
are also used to treat high blood pressure and angina.

Using an ACE inhibitor can prevent your heart from weakening and has been shown to lower
the risk of a heart attack, whether or not you suffer from high blood pressure or heart failure.

A possible side effect can be a dry tickling cough. If you get this, you should continue taking
the tablets if possible. However if the cough becomes troublesome then your doctor may reduce
the dose or stop the tablets and prescribe another tablet.

Beta-blockers (Atenolol, Bisoprolol)
Beta-blockers work by slowing the heart rate and decreasing the force of contraction of the
heart. As a result they reduce the amount of work done by the heart. They are commonly used
to treat high blood pressure and angina. Beta-blockers have been shown to reduce the risk of
patients going on to suffer a heart attack.

Beta-blockers are sometimes not suitable if you suffer from any of the following as they may
make your symptoms worse:

                       •   asthma, or other breathing difficulties such as chronic bronchitis
                       •   a slow heart rate, or
                       •   low blood pressure.


Nitrates Isosorbide mononitrate (Imdur), Glyceryl trinitrate (GTN)
Nitrates have a vasodilating effect; this means they widen the arteries that supply blood to the heart.
As a result, the heart has to do less work and also more oxygen-rich blood reaches the heart. Nitrates
are commonly used to treat the symptoms of angina (chest pain).

Sublingual GTN tablets or spray used under the tongue provide rapid relief from angina pain and
should be used without delay at the onset of pain.

Calcium channel blockers (Diltiazem, Amlodipine)
Calcium channel blockers work in two ways. Firstly, they widen the arteries that supply blood to the
heart. Secondly, they relax the muscle of the heart. As a result they stop the heart muscle from
contracting (tightening) too much, which helps to prevent angina.




                                                14
Nicorandil (Ikorel)

Nicorandil is used to treat angina. It works by widening the blood vessels that supply the heart
muscle to increase its blood supply. It also reduces the amount of work the heart has to do.

Omacor

Omacor is a highly purified and concentrated fish-oil capsule. When given once a day it can help
protect you from having heart disease. Sometimes this may cause a fish odour on your breath.

Medication list

You can list all your heart tablets below

Tablets                                 Dose    Per Day          What are they for




                                               15
Relaxation and the heart

Relaxation techniques can be learnt by anyone and with practice you should be able to relax
almost anywhere. Spend a short time each day practising the following technique and your
physical and mental wellbeing should improve.

Relaxation benefits the heart as it can help to lower your blood pressure, heart rate and possibly
your cholesterol.

Five minute relaxation

•   Try to find a quiet room and ensure you are warm.

•   You could try this with your partner, friends or family.

•   Wear loose clothing and remove any spectacles.

•   You may relax either lying down or sitting in a chair.

•   Make sure your head, thighs and back are well supported (use a cushion in the small of the
    back if it helps).

•   Your feet should be flat on the floor if in a chair and your hands resting on the arms of the
    chair or on your lap.

•   Close your eyes. If you are uncomfortable with your eyes closed, keep your eyes focused on
    one point ahead of you throughout the session.


Begin by breathing out. Then breathe in easily, just as much as you need. Now breathe out
slowly, with a slight sigh, like a balloon slowly deflating. Do this once more, slowly breathing
in…breathe out sigh…as you breathe out feel the tension begin to drain away. Then go back to
your ordinary breathing, even, quiet and steady.

Now direct your thoughts to each part of your body in turn, to the muscles and joints.
Think first about your left foot. Your toes are still. Your foot feels heavy on the floor. Let
your foot and toes start to feel completely relaxed.

Now think about your right foot…toes…ankles…they are resting heavily on the floor. Let your
feet, your toes and ankles start to relax.

Now think about your legs. Let your legs feel completely relaxed and heavy on the chair or
floor. Your thighs and your knees roll outwards when they relax, so let them go.

Think now about your back. Let the tension drain away from your back. Follow your breathing,
and each time you breathe out, relax your back and spine a little more.

Let your abdominal muscles become soft and loose. There’s no need to hold your stomach in
tight, it rises and falls as you breathe quietly – feel that your stomach is completely relaxed.



                                                16
Without tension in your chest. Let your breathing be slow and easy, and each time you breathe
out, let go a little more.
Think now about the fingers of your left hand – they are curved, limp and quite still. Now the
fingers of your right hand relaxed, soft and still. Let this feeling of relaxation spread – up your
arms…feel the heaviness in your arms – up to your shoulders. Let your shoulders relax, let
them drop easily…and then let them drop even further than you thought they could.

Think about your neck. Feel the tension melt away from your neck and shoulders. Each time
you breathe out, relax your neck a little more.

Now before we move on, just check to see if all these parts of your body are still relaxed
your feet, legs, back, tummy, hands, arms, neck and shoulders. Keep your breathing gentle and
easy. Every time you breath out relax a little more and let all the tensions ease away from your
body. No tensions just enjoy this feeling of relaxation.

Now think about your face. Let the expression come off your face. Smooth out your brow and
let your forehead feel wide and relaxed. Let your eyebrows drop gently. There’s no tension
round your eyes - your eyes are still. Let your jaw relax with your teeth slightly apart.

Feel the relief of letting go.

Now think about your tongue and throat. Let your tongue drop down to the bottom of your
mouth and relax completely. Relax your tongue and throat and your lips…Lips lightly together,
no pressure between them.

Let all the muscles in your face unwind and let go,- there is no tension in your face – just
let it relax more and more

Now, instead of thinking about yourself in parts, feel the all-over sensation of letting go, think
of quiet and of rest. Check to see if you are still relaxed. Clear your mind of thoughts by
concentrating on this relaxed sensation as this time is for relaxing not thinking. Stay like this
for a few moments and listen to your breathing…in…and out… Let your body become looser,
heavier each time you breath out.

Now continue for a little longer, and enjoy this time for relaxation.

Coming back - slowly wiggle your hands a little and your feet. When you are ready, open your
eyes and sit quiet for a while, Stretch, if you want to, or yawn and slowly start to move again.

If you have any questions about the above, or would like details of where to obtain Relaxation
tapes, or compact discs please contact the Cardiac Rehabilitation Secretary on 0161-291-2177.




                                                 17
Physical activity after your angioplasty

The convenience of modern life is making us increasingly inactive and this is proving hazardous to
our health. For example, inactive people have twice the risk of developing coronary heart disease
compared with active people. Inactivity increases the risk of coronary heart disease as much as
smoking does.

Physical activity is very good news for your heart:-
• it halves the risk of developing coronary heart disease.
• it reduces the risk of having a stroke.
• it lowers blood pressure.
• it reduces the chance of developing diabetes and helps control diabetes.
• it helps you to lose weight.
• it relieves stress.
• makes you feel more energetic.

The type of exercise that helps your heart the most is called “aerobic activity”. Aerobic activity is
any repetitive, rhythmic exercise involving large muscle groups such as the legs, shoulders and
arms. Examples of aerobic activity include walking, cycling, swimming and dancing. This type of
activity increases the body’s demand for oxygen and adds to the workload of the heart and lungs,
making the heart and circulation more efficient, and helping to develop your stamina.

Other activities are good for improving flexibility and mobility. Keeping your body supple and
flexible will help you keep a full range of movement and stay independent as you get older. Try
anything that involves gentle reaching, bending and stretching of muscle groups – for example,
gardening, housework such as hoovering, golf, bowls, yoga, dance and pilates.

Strengthen your muscles and bones with strength-type activities. These will help give you good
balance, good posture and bone strength. Example of strength-type activities include climbing
stairs, digging the garden carrying shopping or young children, weight training and walking uphill.

You should aim for 30 minutes a day of moderate activity, such as brisk walking. It is better to
take regular exercise, rather than isolated sessions. With any activity it is important to begin
slowly and to build up gradually.


Normal response to exercise:

* Faster and stronger heart beat (pulse rate)                 * Slight sweating

* Slight breathlessness                                       * Slight muscle ache approximately
                                                                36 hours after exercising




                                                 18
Perceived Exertion Scale
The following scale (0-10) should be used to help gauge how much effort is experienced during an
activity. This scale will be explained in more detail when you attend the cardiac rehabilitation
programme. The correct guidelines are given below:



No      Intensity of effort experienced                                               Weeks
                                                                                      post event
0       Nothing at all
0.3                                                                                   Up to
0.5     Extremely weak                              Just noticeable                   1 weeks
1       Very weak                                   No problem                        1-3
1.5                                                                                   on scale
2          Weak                                     Light/very easy to continue
2.5
                                                                                      After
3       Moderate                                    Comfortable to continue           1 weeks
4                                                                                     3-5
5       Strong                                      Beginning to feel puffed          on scale
                                                    Heavy/feeling a bit puffed

                                                                                      Never
6                                                   Feeling puffed                    6-10
                                                                                      on scale
7      Very Strong                                  Tired/You have to push yourself
                                                    to continue
8                                                   Very tiring
9                                                   Out of breath/shattered
10     Extremely strong                             As hard as most people have
                                                    experienced



Never continue to exercise or carry on with activity if you feel any of the following symptoms:

* Chest Pain                                * Palpitations

* Dizziness                                 * Muscle Cramps

* Nausea                                    * Extreme fatigue

* Excessive shortness of breath




                                               19
Walking

Regular walking is recommended as the main exercise to improve fitness after your angioplasty
and to maintain fitness in the future.


Start by walking at a normal pace on the flat. You should be able to walk and talk at the same
time. Feeling slightly breathless on returning home is normal (as you are exercising your heart
and lungs), but you should not feel exhausted. If you do too much one day, rest the following
day and then continue at a lower level the next day.


Gradually progress by:

•      increasing the distance of your walk ,
•      increasing the speed of your walk - aim for a brisk walk,
•      try going up and down a hill during your walk.



If possible walk uphill on the way out and downhill on the way home. Go for your walk in the
morning or at your best time of day. Do not leave it until the evening when you are likely to be
tired and no sooner than one hour following a meal. In cold or windy weather, wear a hat, scarf
and gloves, as the heart has to work much harder in these conditions.




                                               20
Home Exercises
The following exercise can be carried out if you are unable to go for your daily walk due to bad
weather:

1. Standing on the spot               2. Step-ups
   Lift alternate heels.                 Stand 10 inches (25cm) away from the stairs,
   Continuing for 1 minute.              step up with one leg for half the time and then change to
                                         Lead with other leg. Continue for 1minute.




3. Walk on the spot                   4. Sitting to standing
   Walk at a comfortable speed.          Sit on 18 " (40cm) firm chair
   Continuing for 1 minute               with arms out in front. Stand up and sit down.
                                         10 times.




Aim to begin with the time or number of repetitions suggested above.
When you are able to cope comfortably with the above exercises, you may slowly increasing
the time or number of repetitions, i.e. 30 seconds to 40 seconds, 10 repetitions to 12 repetitions
and so on. Give yourself time for your breathing to return to normal between each exercise.




                                                21
Section B – Your rehabilitation

Household tasks

•   Housework and gardening can be resumed when you feel ready.
•   Do not attempt heavy lifting in the first week.


Active hobbies and lifting

After an angioplasty you may return to active hobbies. It may be a good time to take up a new
active hobby or sport. Remember to always start gently and gradually build up. If one activity
causes discomfort, it should be stopped and you should try another.

It is best to avoid sports and activities in the following instances (as it is for anyone).

    •   Extremes of temperature

    •   For two hours after eating a large meal

    •   During illness or infection, including the common cold.

It is recommended that you attend a cardiac rehabilitation programme to improve your
fitness and to obtain further advice prior to taking up sports and activities (see page 40-43).

If you or your relatives have worries about you starting or commencing physical exercise or you
wish to know more about the cardiac rehabilitation service please telephone 0161 291 2177
and ask to speak to a member of the cardiac rehabilitation team.


Driving
Following an angioplasty you should not drive a car or motorbike for one week if you have an
ordinary driving licence. All other driving licence holders need to check with a doctor or
member of the cardiac rehabilitation team. You need to inform your car insurance company,
but you do not need to inform the Driver and Vehicle Licensing Agency (DVLA).



Returning to work

After leaving hospital it is advisable to stay off work for a least a week. However every patient
is different and some people will need longer than others.




                                                  22
Sexual Relationships

If you have been having sexual intercourse without problems then carry on. The exercise is
good for you and can be resumed when you feel ready. Be guided by how you are coping with
other physical activities. Sex uses about the same energy as walking briskly for 20 minutes on
the flat.

Make sure you and your partner talk to each other about your feelings. Make time for each
other. You don’t have to have full sex. Cuddling doesn’t tire you out. Some of the tablets that
people take for their heart disease can cause problems for a very small number of people. Men
may get problems with their erections. Women may lose their desire to make love. Talk to your
doctor or nurse about it don’t be shy. A simple change of tablet may be all you need.


Air Travel

You should wait 10 days before travelling by air but it is advisable to check with your
consultant prior to leaving hospital or your GP if you intend taking a holiday abroad.
Having a stent will not set off the metal detectors at the airport.




                                               23
Section C – Maintaining a healthy heart
Risk factors associated with the development of coronary heart disease
In Britain today we continue to have one of the highest rates of heart disease known in the
western world. Although no single reason has been shown to cause coronary heart disease,
research has demonstrated that certain factors in a person’s lifestyle can increase the risk of
getting coronary heart disease. These factors contribute to narrowing of the arteries
surrounding the heart which leads to coronary heart disease.

These factors are called risk factors and generally fall into three categories; those which the
individual can change, those they can control and those they cannot control.

It is important to remember that some people may have many risk factors and others may have
none.

Risk factors we can change
1. Smoking

Major studies show that smoking is the most significant preventable risk factor. People who smoke
cigarettes have twice as great a risk of developing coronary heart disease as those who do not.

Smoking affects the heart in many ways:

•      It increases the heart rate - nicotine releases
       certain hormones which increase resting heart rate
       and therefore the amount of oxygen required by the
       heart muscle.

•      It Raises blood pressure.

•      Carbon monoxide combines more readily with
       the cells that carry oxygen than the oxygen itself,
       therefore starving the heart and other parts of the
       body of oxygen.

•      It increases the ability of the blood to clot,
       therefore increasing blood clot formation.

Even if you have tried to give up before, it is worth another try. Stopping smoking dramatically
reduces your risk of a heart attack and stroke. Did you know that former smokers live longer
than continuing smokers no matter what age they stop smoking. Whatever age you are, it is
never to late to stop; your chances of a heart attack or stroke reduce with everyday you
continue not to smoke.

If you require further help or advice on nicotine replacement therapy we can refer you to the
Smoking Cessation Nurse (0161-291 5030) who can offer you support in stopping smoking.

The Nicotine replacement therapy I have chosen is …………………………………...
…………………………………………………………………………………………………………….


                                                 24
2. Lack of exercise

Before coming into hospital for an angioplasty you may have been limited as to the amount of
activity you could do. Following your angioplasty you should now find that you are able to do
a great deal more. It is important to take some form of exercise as a non-active lifestyle can be
considered another risk factor.

The cardiac rehabilitation team will advise you regarding appropriate exercise.
Physical activity and the heart is discussed on page 18.

3. Poor diet

Eating should be a pleasure. A healthy diet does not mean eating
things you do not like, and there is no such thing as bad or good foods.
The key to a healthy diet is to have a balanced diet so you get all the
nutrients you need.

Would you like to see the dietician Yes/ No

Dietary advice is discussed in detail (see page 32 - 39).

4. Being overweight

Losing weight has many health benefits as well as making you
feel more energetic and increasing your confidence. Being
overweight can make you more at risk of developing conditions
such as high blood pressure, diabetes, osteoarthritis
and coronary heart disease.

Ask the nurses in hospital to weigh you to see how much weight
you need to lose.

To lose weight you need to use up more energy (calories or joules)
than your body takes in from food and drink.

You can do this in three ways:

•   By eating and drinking fewer calories

•   Using more calories by getting more active

•   A combination of both the above.

Most people find that doing both achieves the best results.

For further advice you can speak to the Cardiac Rehabilitation Team and Dietitian.

My weight:………………………….. Height:…………………BMI:…………………….
                                     BMI = Body Mass Index (height in
                                     relation to weight)
My waist circumference:……………………………………


                                                 25
5.       Alcohol

Alcohol in moderation is fine, most people enjoy a drink. However alcohol is a drug and
increased levels may result in high blood pressure. All alcoholic drinks contain calories, which
is another reason why too much alcohol is not a good idea when trying to lose weight. It is
important to stick to sensible limits.

A small amount of alcohol might help to prevent heart disease. It doesn’t have to be red wine.

Current advice is that men who drink no more than 3 to 4 units a day and women who drink no
more than 2 to 3 units a day, do not face a significant health risk. The weekly amount is 21
units for a man and 14 units for a woman.

1 unit         =      ½ pint of normal strength beer
                      1 glass of table wine
                      1 standard single measure of spirits




My alcohol consumption in one week is:…………………………………………………..




½ pint of normal      1 standard single             1 glass of table wine
strength beer         measure of spirits




                                               26
6. Stress

Stress is an unavoidable part of modern life.
In the hustle and bustle of the modern world,
it is important to take time out every so often.
Long-term stress can lead to symptoms such
as irritability, loss of appetite, feeling sick,
depression, high blood pressure, constipation and
skin conditions, e.g. eczema and psoriasis.
So, although you may not be able to change
the stress in your life, you can try to change the
way you react to it.

If you feel you need help in managing stress speak
to your doctor or the Cardiac Rehabilitation Team
for advice and information about stress management techniques.


Taking time out to relax is very important (see pages 16 - 17).


The following are some techniques for coping with stress:-

•   Be reasonable with yourself

•   Avoid perfectionism

•   Don’t panic

•   Know your own stress symptoms

•   Talk problems through either with your partner or a friend.

•   Learn from those who know how

•   Take regular exercise each day

•   Eat sensibly

•   Find a hobby you enjoy

•   As far as you can, make your surroundings peaceful

•   Spoil yourself occasionally

•   Don’t take your worries to bed with you

•   Learn to forgive yourself




                                               27
Risk factors we can control

1. High blood pressure (hypertension)

Blood pressure (BP) is the ‘pressure’ that the heart and arteries
apply in order to pump blood around the body.

Blood pressure becomes high if the walls of the larger
arteries lose their natural elasticity and become rigid,
and the smaller arteries or vessels constrict (become narrower).

As we get older, we often need a ‘higher pressure’
to force the blood through vessels that have ‘stiffened’ with age.
So, what might be a high reading for a young person can be
perfectly normal for someone older. Your doctor or nurse
will tell you the correct reading for you.

You have probably heard the Doctor or Nurse say something like,
“the BP is 140 over 80”.
Blood pressure (BP) is measured in millimeters of mercury. This is
usually written down as mmHg. The first number (140) is the
pressure that your heart is pumping at. The second number (80)
is the pressure between heartbeats when the heart is resting.

High blood pressure is often unrecognised as there are no
obvious symptoms. This is why it is particularly
dangerous. If left untreated, it can cause damage to many
parts of the body including blood vessels, the heart,
the kidneys and the eyes. It is a major risk factor for
hardening of the arteries, heart attack, stroke,
heart failure, kidney failure and sight loss.

High blood pressure can be easily diagnosed
(by your GP, nurse or doctor on the ward)
and treated. You can help yourself by:

•   not smoking

•   controlling weight

•   reducing alcohol consumption

•   reducing salt consumption

•   avoiding stressful situations

•   using stress management techniques

    My Blood Pressure is:……………………….



                                                28
2. High levels of fats in blood (cholesterol)

Cholesterol is a word you may well have heard, but never understood. Cholesterol is the best
known of a group of fat-like substances in the body called lipids. The liver makes cholesterol
from the saturated fats in food. A certain amount of cholesterol is essential to life and it is
present in every cell in the body and also in blood. When people have an excess of fats in their
blood, the body is unable to break these down and therefore they may be deposited in the artery
wall. These affected areas are known as atherosclerotic plaques. Over time these get bigger
and can spread into the centre of the artery, making the artery smaller. This may cause the
symptoms of angina or more seriously lead to a heart attack.




   •   Cholesterol is made up of different parts.
       LDL cholesterol is the bad part. (LDL stands for low density lipoprotein). This is the
       main ingredient in the fatty deposits clogging up your arteries.


   •   High density lipid (HDL) cholesterol is the good part .

   •    HDL lowers the amount of LDL cholesterol in your blood.

   •    If you have a high cholesterol or a high LDL and Low HDL cholesterol you are more
        at risk of a heart attack.

A high level of cholesterol may be inherited (a condition called familial
hyperlipidaemia or hypercholesterlaemia) or it may be affected by diet and lifestyle.
If you are known to have a heart problem, you should try to lower
your cholesterol. You can cut down on saturated fats
in your diet, have moderate alcohol
intake and take regular exercise.

For many people these natural ways are not enough on their own. In these cases
research has shown that the need for tablets is essential (see page 13).


My cholesterol result was………………………….. Date Taken:………………..

I need to get my cholesterol rechecked in 3 months time on……………………….at the GP Surgery.




                                               29
2. Diabetes


Diabetes occurs when the glucose level in the blood is too high.
Glucose is a sugar that the body makes mainly from the starches and sugars (carbohydrates) in
our food. The blood carries glucose to all the cells in our body, where it is used to produce
energy. But the cells cannot just take the glucose out of the blood on their own. To do this,
they need a chemical called insulin. Insulin is made in the pancreas – a large gland that lies
behind the stomach. Insulin is also carried in the blood. As the insulin lets the cells take
glucose out of the blood, the amount of glucose left in the blood goes down.

There are two types of diabetes:-

   •   Type 1 – Diabetics who do not produce any insulin

   •   Type 2 – Diabetics who do not produce enough insulin, or their cells lose the ability to
       use the insulin.

In Diabetes, the cells become starved of glucose because they cannot take it in from the blood.
At the same time, because the glucose cannot get into the cells, the level of glucose in the blood
goes up.

Diabetes seems to act in several ways to damage the heart:-

   •   High glucose levels in the blood affect the walls of the arteries, making them more
       likely to develop atheroma (plaque).

   •   Diabetes increases the damage done by the major coronary heart disease risk factors of
       smoking, high blood pressure and high blood cholesterol.

   •   People with diabetes are more likely to have high blood pressure

   •   Diabetes can affect the heart muscle itself, making it a less efficient pump

   •   Diabetes can affect the nerves to the heart, so that symptoms are not felt in the usual
       way. This leads to delay and difficulties.

If you have this condition we will give you more information and you will be referred to
the Diabetic Nurse (0161-291-2888).

Do you need to see the Diabetic Nurse        Yes/No please circle.




                                               30
Risk factors we cannot always control

1. Family history

Coronary heart disease runs in families. Other factors include
inherited high cholesterol levels, diabetes and hypertension,
as well as a high fat intake in the diet. It is important that
family members are aware of their own risk factors and
take steps to prevent heart disease.

2. Gender

Men are much more likely to develop coronary heart disease
at a younger age than women. Women appear to be protected
by their hormones until the menopause, after which their
risk of heart disease increases.

3. Socio – economical and geographical

Manchester has the highest incidence of coronary heart disease
in England and Wales. The lower the social group, the higher
the prevalence of heart disease. This is generally associated
with a poorer diet, increased smoking levels and poorer
education.




                                               31
Dietary Advice


Q. Does it really make any difference what I choose to eat?

A. Yes it does. Research has shown that by making changes to your diet you can reduce your
risk of recurrent heart problems.

Q. I feel that I have done all I can to eat healthily but I still had a heart attack.

A. Unfortunately this is true of many people, but your efforts were not wasted. If you had not
chosen a healthy diet, you may have had a heart attack at an earlier age or it may have been
much more serious. By continuing to choose a healthy diet, you will reduce your risk of further
heart attacks. Can you make any changes to reduce other risk factors?

Q. What are the most important changes I should make to my diet?

A. That will depend on what you are eating right now. For many people, the most important
change will be to start eating oily fish more often. Research has shown that the omega-3 fats
found in oily fish protect your heart. Anyone who has had an angioplasty or open heart surgery
should include one portion of oily fish per week. If you have had a heart attack, it is advisable to
increase this to 2-3 large portions of oily fish per week, unless you have been prescribed
Omacor.

Also, many people would benefit from reducing the total amount of fats, oils and foods
containing these. As you read through the next few questions think about what you eat and
whether you could make any helpful changes to your eating pattern.

Q. Are all fats the same?

A. No. All fats and oils contain a mixture of saturated fat and unsaturated fat in different
proportions. Some foods contain mostly saturated fat and very little unsaturated fat, either
mono-unsaturated or poly-unsaturated.

Q. Is it important to reduce my intake of saturated fat?

A. Yes. Too much saturated fat causes the level of cholesterol in your blood to increase.

Q. Which foods contain a lot of saturated fat?

A. Saturated fat is mainly found in
• butter, lard, suet, ghee, coconut oil, palm oil, and any products made using these for
    example pastry, pies, cakes, biscuits
• fat on meat, processed meats such as sausages, beef burgers, salami, corned beef
• full-fat dairy products such as full-cream milk, cream, cheese, full-fat yoghurt
• manufactured foods such as chocolate, mayonnaise, cream substitutes




                                                  32
Q. What is cholesterol?

A. Cholesterol is an important fatty substance, which is found in every cell of the body. It is
mainly made in the body by your liver. It is carried around the blood in different forms. The two
main forms are HDL cholesterol and LDL cholesterol. HDL is sometimes known as “good
cholesterol” because it carries the cholesterol away from your arteries back to your liver. LDL
is sometimes referred to as “bad cholesterol” because it carries the cholesterol to your arteries
where it can contribute to the build up of fatty deposits on your artery walls known as atheroma.

Q. What are trans-fats and hydrogenated fats?

A. These fats are formed during processing when the fats are subjected to high temperatures and
are mainly found in deep fried foods, shop-bought cakes, biscuits, confectionery, pastries,
crisps. It is important to try to eat as little trans-fat and hydrogenated fat as possible, because
they cause your blood cholesterol to increase.

Q. What fats or oils should I use?

A. Try not to use too much of any fat or oil, particularly if you are watching your weight. Try
“light” varieties of spreads as they contain fewer calories. Choose fats and oils labelled high in
poly-unsaturated fats or preferably mono-unsaturated fats.

Mono-unsaturated fat.
Main dietary sources: olive oil, rapeseed oil, spreading fats made from these oils, some nuts
such as hazelnuts, peanuts and seeds.

Poly-unsaturated fat.
Main dietary sources: vegetable oils such as soya, sunflower, safflower, corn oil, spreading fats
made from these oils, nuts, seeds.

Q. Is exercise important?

A. Yes. Exercise helps to increase the levels of “good cholesterol” in your blood. It also
increases your fitness, helps to control your weight and makes you feel more energetic.

Q. How do I know if I am overweight?

A. Have a look at the following chart and check whether your weight falls into the
recommended range. If you need to lose a lot of weight, it may be better to choose a more
realistic target. Even losing 10% of your body weight will significantly reduce your risk of heart
disease e.g. this would mean that if you are
    • 100kg (15st 10lbs) reducing your weight to 90kg (14st 2lbs)
    • 70kg (11st) reducing your weight to 63kg (9st 13lbs)
Once you have reached this target, you can always set a new lower target if you wish.

Also check your waist measurements as some people will fall within the recommended weight
range but would benefit from reducing their waist measurement.




                                                33
HEIGHT          Recommended            HEIGHT                        Recommended
In ft and ins   Weight Range           in metres                     Weight Range
without shoes   stones & pounds        without shoes                 kg

4ft 10ins       6.12 - 8.8             1.47m                         43.2 - 54.0

4ft 11ins       7.1 - 8.12             1.50m                         45.0 - 56.2

5ft 0ins        7.4 - 9.2              1.52m                         46.2 - 57.8

5ft 1ins        7.8 - 9.06             1.55m                         48.0 - 60.0

5ft 2ins        7.11 - 9.11            1.57m                         49.4 - 61.6

5ft 3ins        8.1 - 10.1             1.60m                         51.2 - 64.0

5ft 4ins        8.5 - 10.6             1.63m                         53.2 - 66.4

5ft 5ins        8.8 - 10.10            1.65m                         54.4 - 68.0

5ft 6ins        8.12 - 11.1            1.68m                         56.4 - 70.6

5ft 7ins        9.2 - 11.6             1.70m                         57.8 - 72.2

5ft 8ins        9.6 - 11.10            1.73m                         59.8 - 74.8

5ft 9ins        9.9 - 12.1             1.75m                         61.2 - 76.6

5ft 10ins       9.13 - 12.6            1.78m                         63.4 - 79.2

5ft 11ins       10.3 - 12.11           1.80m                         64.8 - 81.0

6ft 0ins        10.7 - 13.2            1.83m                         67.0 - 83.8

6ft 1ins        10.12 - 13.7           1.85m                         68.4 - 85.6

6ft 2ins        11.2 - 13.13           1.88m                         70.6 - 88.4




Q. Does your waist affect your health?

                 A. Yes. You can’t choose your shape but if you are carrying extra weight around
                your waist, it is a greater strain on your heart. If you are “apple shaped” rather
                than “pear shaped”, make an effort to lose some of those extra inches.

                       If your waist measures more than
                                     80cm (32 inches) for women
                                     94 cm (37 inches) for men

                      your risk of heart disease is increased. The larger the
                      measurement, the greater the adverse effect on your health. Recent
evidence suggests that if you are from an Asian background you should aim for a weight in the
lower half of the recommended range and a slightly lower waist measurement.



                                                 34
Healthy heart qui z
1. Which of the following are classed as oily fish?

herring        tuna           haddock        mackerel       battered cod

salmon         pilchards      kippers        plaice         mussels

prawns         sardines       halibut        trout          sild


2. How much oily fish is recommended for people to eat if they have had a heart attack?

a. 110g (4oz) portion once a month
b. 110g (4oz) portion once a week
c. 110g (4oz) portion 2-3 times a week


3. What does oily fish contain which is beneficial for your heart?
a heart attack?

a. iodine
b. omega-3 fats
c. iron


4. If someone is overweight, what is the minimum amount of weight they need to lose
before they begin to see some benefit to their health?

a. 5-10%
b. 10-15%
c. 15-20%


5. How much fruit and vegetables should we eat in a day?
a. 1-2 portions
b. 3-4 portions
c. 5 portions


6. What counts as a portion of fruit?

a. 1 apple or small banana
b. 1 plum or kiwi fruit
c. 1 strawberry
Answers.
1. Those fish underlined in the list below are classed as oily fish.
*Tuna when tinned has very little omega-3 fat but fresh tuna steak is rich in omega-3. All
the other examples of oily fish are equally rich in omega-3 fats whether fresh, frozen or
tinned.
herring        fresh tuna*     haddock         mackerel       battered cod

salmon         pilchards       kippers         plaice         mussels

prawns         sardines        halibut         trout          sild

2. answer c
Research suggests that if someone has had a heart attack, they should aim to take 500-
1000mg omega-3 fats per day. This can be achieved either by taking 2-3 large portions of
oily fish per week, or by taking omacor or other fish oil capsules. Fish oil capsules can
be purchased in some supermarkets, chemists or health food stores. For more
information request a copy of the leaflet omega – 3 fats – see page 39.
For those who have not had a heart attack, one portion of oily fish per week will provide
sufficient omega – 3 fats.

3. answer b.
Oily fish contains iodine, omega-3 fats and iron. All are important for your general health
but it is the omega-3 fats found in oily fish that is particularly beneficial in reducing your
risk of further heart disease.

4. answer a.
Even losing 5-10% of your body weight can lower your risk factors and result in an
improvement in your health. It is much better to lose weight slowly and consistently than
to go on a crash diet. Studies have shown that it is also easier to maintain the loss if you
lose it slowly too.

5. answer c.
Government agencies all recommend that you aim to include 5 portions of fruit and
vegetables a day because of the health benefits this brings. Studies of people who have
had heart attacks have shown that those who have a Mediterranean type diet have a much
lower risk of further heart attacks. It isn’t clear which particular aspect of the
Mediterranean diet is most beneficial. This type of diet includes more fruit and
vegetables, more fresh food rather than processed foods, more fish and less saturated fat.

6. answer a.
Any of the following would count as 1 portion of fruit
    • 1 average sized piece of fruit e.g. 1 apple, pear or orange or
    • 2 smaller sized fruits e.g. 2 kiwi, 2 plums 2 clementines or
    • 1 cup strawberries, raspberries, cherries




                                              36
Making changes – helpful hints

1. Now that you have read this booklet, what changes do you think you need to make to
your diet? Jot them down
.........................................................................................................................................
.........................................................................................................................................
.........................................................................................................................................
2. It is never easy to make changes. You may feel you have too many other changes to
make right now and want to concentrate on stopping smoking or becoming more active
first.
You must be convinced that making the change is worthwhile. Think of the benefits and
jot them down. When you are ready to tackle changing your eating habits, get the list out
again and remind yourself of what you have written.
.........................................................................................................................................
.........................................................................................................................................
Also try to jot down all the disadvantages or difficulties of making these changes
.........................................................................................................................................
.........................................................................................................................................
Can you do anything to help overcome these difficulties?
.........................................................................................................................................
.........................................................................................................................................

3. Try to jot down what you plan to eat for your main meals before you go shopping so
that you buy all the foods you need. If you have suitable foods in the fridge/freezer you
are much more likely to keep to your new eating pattern.

4. Prepare an extra portion of suitable meals and freeze to use at times when you are in a
hurry or when the rest of the family want to get a meal from the chip shop.

5. If you live alone, it can be hard to make the effort to prepare regular meals. Remember
you are as important as anyone else. You will find it easier to eat healthily if you plan and
cook regular meals. This makes it easier to avoid snacking too.

5. Try to get as much variety as possible so that you enjoy your meals. Borrow the recipe
books from the cardiac rehabilitation gym (Wythenshawe Hospital) for more ideas of
suitable meals.


Occasional treats
Eating should be a pleasure. No food is healthy or unhealthy, rather it is the combination
of foods we eat and the balance that is important. There is no harm in enjoying the
occasional treat or family occasion. Try to choose wisely from day to day and do not let
treats creep back into your eating pattern too often.
Remember that the only way your body obtains all the nutrients it needs to keep you
healthy is from the foods you choose to eat.

If you have a poor appetite or have been losing weight unintentionally, ask one of the
cardiac rehabilitation team or your doctor to refer you to a dietitian




                                                                                    37
What should I eat?
Changing the proportions of food we eat can lead to a healthier diet.

Use the plate model below as a guide for your main meals




                          Lean meat, poultry, fish, eggs, pulses,
                          nuts or low fat cheese




                            Vegetables,            Potatoes, bread, rolls, rice, pasta,
                            salad or fruit         pitta bread, chappatis, or other
                                                   starchy food




Section 1 – Lean meat, poultry, fish, eggs, pulses, nuts or low fat cheese

•   Even lean meat contains some saturated fat therefore limit the size of portion to
    approximately 110g (4oz) raw weight or 55g (2oz) cooked weight.
•   Trim all visible fat from meat. Remove skin from poultry. Avoid adding extra fat or
    lard. Use a little rapeseed oil or olive oil when cooking stir-fries or curries.
•   Include oily fish once a week. If you have had a heart attack, try to increase this to 2-
    3 times per week. Often it is easier to include this as a sandwich or baked potato
    filling or toast topping so other members of the family can choose something else.
•   Skim fat from gravies. Choose tomato-based sauces rather than cheesy or cream
    sauces. Add onions, garlic, herbs, spices, tomato puree, vinegar to give flavour.
•   Vegetarian options – base meals on pulses, tofu, soya meats, nuts and seeds.
•   Choose fat-reduced cheese and limit quantity to 110g (4oz) per week. Spread this out
    over 3 meals. Avoid eating cheese as a snack unless it is very low-fat such as cottage
    cheese.

Section 2 – Starchy foods such as potatoes, bread, rice, pasta, chappatis

•   Many people think these foods are fattening. This is not true unless you fry them or
    add extra fat. Avoid frying potatoes or rice. Spread margarine thinly on bread.
•   Serve plain boiled or baked potatoes. Use a little low-fat milk in mashed potatoes.
•   Use potato as a topping instead of pastry. Once you reach your target weight, add
    variety by making your own pastry, crumbles, stuffing’s or roast vegetables
    occasionally using an olive oil based margarine or rapeseed oil or olive oil.
•   Serve pitta bread, wraps or hot fresh rolls for a change.




                                                 38
Section 3 – Vegetables, salad and/or fruit

•   Many people eat too little fruit and vegetables – try to serve an extra portion of
    vegetables at your main meal. Take fruit or salad along with snack meals.
•   Serve extra vegetables instead of yorkshire pudding, dumplings, batter, stuffings.

Summary

Include 1 portion of oily fish per week.
Limit foods containing a lot of saturated, hydrogenated or trans-fats. Choose rapeseed oil,
olive oil or sunflower oil and margarines made from these oils. Use sparingly.
Check your weight and waist measurement. If higher than recommended, set a realistic
target and check weekly to see if you are making progress.

If you have had a heart attach in the past
Increase to 2-3 large portions of oily fish per week.
Research suggests it is also beneficial to follow a “Mediterranean” style of eating. You
can do this by following the advice above as well as choosing more fresh foods rather
than processed foods and including plenty of fruit and vegetables.

Additional dietary information
•   Ask one of the cardiac rehabilitation team to refer you to the dietitian if you want to
    discuss your diet in more detail.
•   Attend the information programme once you are discharged from hospital. The
    dietitian will give one of the talks.

Information leaflets are available from the dietetic department on the following topics
    1. Eating to protect your heart (includes suggestions of meals)
    2. Limiting your saturated fat
    3. Omega-3 fats
    4. Fruit and vegetables
    5. Weight control
    6. Do we need salt – useful for those who have high blood pressure
    7. Fat content of cheeses
    8. Guide to food labelling (British Heart Foundation leaflet)

If you want any of these leaflets, phone 0161-291 2294 and leave a message for the
cardiac rehabilitation dietitian with a contact name, telephone number or your address.

The British Heart Foundation produces various dietary information booklets and videos.
Many are available in the hospital or you can contact them directly. (See address at back
of this booklet) There are a small number of videos and recipe books kept in the gym at
Wythenshawe Hospital where the cardiac rehabilitation exercises are held. Speak to a
member of staff if you wish to borrow any of these.

If you have access to the Internet, the following web addresses have useful dietary
information:                           www.bhf.org.uk
www.heartuk.org.uk                     www.foodstandards.gov.uk
www.bda.uk.com                         www.nutrition.org.uk

                                             39
Cardiac rehabilitation

Cardiac rehabilitation is a service delivered by a multidisciplinary team of health
professionals. This team will support you and your family with the aim of helping you
return to the best possible health.

Aims to:

•   Improve your quality of life.

•   Increase your confidence to exercise regularly and improve your physical fitness.

•   Provide you with information on your heart condition.

•   Your partner or friend can attend the course with you.

Cardiac Rehabilitation Programmes

During your stay on the ward, a member of the cardiac rehabilitation team will give you
information about the nearest programme.
In South Manchester there are two programmes available.
                              • Wythenshawe Hospital Programme.
                              • Community based Cardiac Rehabilitation Course at
                                 Burnage Health Care Centre.

The main elements included in any cardiac rehabilitation programme are:


•   Initial assessment        .     an assessment to discuss any concerns

                              .     tell you about the programme

•   Exercise classes          • usually in a group setting

                              •     last for 6 to 12 weeks

                              •     exercises are supervised and
                                    adapted for you

•   Education sessions        Topics include:

                              •     healthy eating

                              •     medication

                              •     how to modify the risk factors of heart disease

                              •     relaxation

                              •     stress management
                                                 40
1.      Wythenshawe Hospital Programme:
        Venue:-
        Physiotherapy Department
        Wythenshawe Hospital
        Southmoor Road
        Wythenshawe
        M23 9LT
        Cardiac rehabilitation secretary on 0161-291-2177

When can you join this Programme?

You can start the Programme about 2 weeks after the angioplasty.

What does it involve?

The Programme is divided into two parts:

•    Exercise One hour session twice a week for 8 weeks, supervised and adapted for the
     individual.

•    Education 45 minute session once a week for 8 weeks run by the Cardiac
     Rehabilitation team.

Topics include:-

•    How the heart works.

•    Risk factors in heart disease.

•    Benefits and effects of physical activity.

•    Healthy eating.

•    Relaxation.

•    Being Active.




                                              41
Wythenshawe Hospital Stress Management Group
Aims to:

•   Enable you to recognise the signs of stress and develop ways to cope.

•   Teach you how to reduce and overcome stressful situations, through breathing
    techniques and relaxation.

•   Give you an opportunity to talk about your worries, anxieties and help improve, self
    confidence, morale and concentration.

How do you join?

During your time on the ward you may discuss joining the programme with a member of
the cardiac rehabilitation team. Alternatively the patients who return to the outpatient
programme at Wythenshawe Hospital will be asked if they would like to attend.

What does it involve?

The group consists of approximately 8 patients who have experienced a heart condition.
It takes place in the occupational therapy department once a week for four consecutive
weeks.
Partners are also encouraged to attend.

Topics include:

•   Effects of stress on mind and body

•   How life events can influence stress levels

•   Ways to cope

•   Time management

•   Personality – how this is linked to coronary artery disease




                                             42
2. Burnage Cardiac Rehabilitation Course
Venue:           Burnage Health Care Centre
                 Burnage Lane
                 Burnage
                 Manchester
                 M19 1EW

Contact:         Cardiac Rehabilitation Tutor 0161-946-9425


How do you join the course?

If you live in Withington, Chorlton, Heaton Mersey, Didsbury, Burnage or Fallowfield,
the hospital Cardiac Rehabilitation Team will send your referral to the
South Manchester community based course tutors.

When would you start the course?

You will start the course approximately 2 weeks after your Angioplasty. You will
receive a letter and further details in the post inviting you to attend 2 weeks after your
procedure.
Spouses/partners are invited to participate in the course with you.

What does it involve?

The course is 9 weeks long. Each session is held on a Wednesday morning for 2½ hours.

Each session comprises three components:

•   Physical Activity

•   Relaxation

•   Health Information

Topics include:

•   How the heart works
•   Smoking and alcohol
•   Benefits of physical activity
•   Stress awareness/management
•   Healthy eating
•   Emotional side to heart disease




                                              43
Support groups
Ticker Club
Tel 0161-291- 2873
Wythenshawe Hospital

This registered charity was formed in 1987 by former open-heart surgery patients. It
provides non-medical support to patients, their families and friends. It also raises funds to
support the hospital’s Heart and Lung Division.
Patient Support Volunteers who visit the cardiac ward daily and distribute leaflets.
Members meet on the second Thursday of each month and there is a bi-monthly
Newsletter.

Heart Help Group
Withington Therapy Centre
Tel: 0161- 434- 2149
439 Wilmslow Road
Manchester
M20 4AN

This self help group offers up to date information, support, regular exercise and social
events. Exercise classes on Tuesday mornings. A drop-in centre is also available.

Trafford Strong Heart Group
Tel: 0161- 973- 1542

The group meet every week for supervised exercises, games and friendly discussion.
Held on:
Tuesday 10.00 am Altrincham Leisure Centre.
Wednesday 10.00 am George Carnall Leisure Centre.
Wednesday 10.00 am Trafford Community Centre.
Partners and relatives welcome.

Stockport Heart Club
Tel: 0161- 432- 5709
St Peter's Parish Centre
Green Lane
Hazel Grove

Meet on the second Thursday of every month, 7.30 to 9.30pm. Various speakers and
different topics covered each meeting.

Salford Healthy Heart Group
Tel: 0161- 787- 0278/0276

The Group meets every Wednesday or Every Friday 9.30am to 10.30am at Clarendon
Recreation Centre, Liverpool Street, Salford.




                                             44
Useful Contact numbers
Cardiac Rehabilitation Secretary                           0161-291-2177

Cardiac Liaison Nurse                                      0161-291-2679

Cardiac Rehabilitation Sisters                             0161-291-2679

Cardiology Specialist Nurses (post procedure)              0161-291-5301

Dietitian                                                  0161-291-2701

Occupational Therapy                                       0161-291-2110

Pharmacist                                                 0161-291-2288

Physiotherapist                                            0161-291-2177

Pre-operative/Waiting List (pre procedure)                 0161-291-2882

Ward telephone numbers (24hr)

ACCU                                                       0161-291-6077

RCCU                                                       0161-291-2202

Ward F5                                                    0161-291-5302

Day Case Monday – Friday

Ward F2                                                    0161-291-5398


Useful addresses
British Heart Foundation                                   Heart Information Line
14 Fitzhardinge Street                                     08450-70-80-70 (At local rate number)
London                                                     A BHF helpline service for the public
WIH 6DH                                                    and health professional, providing
Tel: 020 7935 0185                                         information on a wide range of issues
Website: www.bhf.org.uk                                    relating to heart conditions

The BHF produces a range of booklets and videos. The booklets are free of charge and
can be ordered through the website, or call the BHF orderline on 01604-640-016

The address is www.bhf.org.uk or telephone 0161 464 0016

Driver and Vehicle Licensing Agency (DVLA)
Drivers' Medical Branch
Swansea
SA99 1DF
Tel: 0870 600 0301
Tel: 0870 241 1879 for HGV enquiries
Website: www.dvla.gov.uk
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46
NOTES




        47
                          Leaflet code:EB/0434/06
                            Issue date: Feb 2006
                           Review date: Feb 2008
  ©2004 South Manchester University Hospital NHS Trust. All rights reserved.

This booklet has been written by the Cardiac Multidisciplinary Team



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