• Can I ever recover from the trauma of this near-death experience?
• Will I ever stop being afraid?
• Will my life ever get back to normal?
• Will I ever feel like a healthy person again?
• Will I live for another year?
• What are my chances of having another heart attack?
• Can I ever overcome my heart disease?
• Will I ever find someone who understands how I feel?

Women heart attack survivors founded the Coalition, and we know exactly how you feel. Our goal is to help you help yourself. The more knowledge and insight we share with each other, the more we will all lead healthier and productive lives. The one thing we do know firsthand is that you can recover and live a health life.

Some of your recovery obviously depends upon the quality of and how quickly you received medical care, your age, whether you have another medical condition (such as diabetes, obesity, or depression) other than heart disease, the competence of your doctors, and if you can afford health insurance and prescription medicines.

But we also know that your chances of recovery improve dramatically if you follow your health professionals' treatment instructions AND are willing to assume responsibility for your own health and recovery. This means you need to keep up your end of the recovery bargain and make necessary changes in your life:

• Getting regular exercise
• Stopping smoking
• Controlling diabetes, depression, or obesity
• Taking medicines as prescribed
• Keeping all healthcare appointments
• Reducing your anger and stress.

In other words, you have to put yourself, your health, and your heart's recovery first above all else. It must become your number one priority. (Do you find this difficult? Many of us have spent our whole lives taking care of and nurturing others· and putting others' needs ahead of our own. This must stop!)

It's also easy to feel overwhelmed, confused, and defeated even before you begin. There are simply too many changes you are expected to make. Too many doctors and healthcare professionals telling you what to do. Too many friends hovering over you. Too many family members monitoring what you eat. Too many medicines to take.

Many women report that it takes several years to recover fully from a heart attack -- physically, psychologically, and emotionally. Go slowly - making small changes in your diet and exercise over two or three months is a good way to feel in control and stay positive. Eventually, with your efforts and good medical care, you will re-gain your self-confidence and live life to the fullest. Remember, you are not your disease - you are a woman living with heart disease who also has a life to lead.

Your Reactions

Each woman's heart attack is different. But our reactions to them are similar. Here are some thoughts and feelings you might experience·

Denial and Minimization.
It didn't happen. It couldn't have happened. It wasn't that serious. Only minimal damage. I'll be back in no time.

Anger and Resentment.
Why me? What did I ever do to deserve this? How come all those fat women don't have heart attacks? Why are my doctors such jerks?

Guilt.
I should have stopped smoking years ago. I never should have let myself get so overweight. All those cheeseburgers and fries - I should have controlled my eating.

Depression.
My healthy years are over. I should prepare myself for an early death. It's God's will. What's the point? Everyone's telling me what to do.

Anxiety and Worry.
What was that pain I just felt? What does it mean? Who will raise my children or take care of my husband if I die? I dreamed about my heart attack again last night. I can't bear to drive by that hospital. I just can't go out and face the world.

Acceptance.
I've got heart disease. I can learn to overcome it. I need to make changes in the foods I eat. Getting healthy is my responsibility. I need new healthy friends. I need to get regular exercise. How did I end up like this? I can beat this. I need help.

Steps to Recovery

Go Slowly. Your body needs three months or more and lots of rest to recover from the trauma of a heart attack. Equally important, you will need time - two years or more - to recuperate emotionally and psychologically from the shock of your brush with death. Your moods may go up and down, you may burst into tears, you may snap at family members. It's all part of trying to cope with the traumatic ordeal that you have just been through. And don't let anyone rush your emotional recovery - you will work it through at your own pace.

During the first few weeks after your heart attack, keep visitors to a minimum. If friends want to visit, ask your family members to tell them beforehand they can only stay for 10 minutes or, preferably, ask them to postpone their visit for several weeks. You'll be amazed how tiring visitors can be! If they ask what they can do to help you, suggest they drop off a low-fat meal or some fresh fruit.

Talk with your doctor about when you can resume your normal activities. He or she will give you a schedule of what you can do at so many weeks or months, such as, returning to work, gardening, driving, walking, and lifting. Be sure to ask the doctor about specific activities that are unique to you, your living situation, or your job. When you resume your normal activities, do so gradually. Listen to your body and slow down if you are getting tired easily. Call your doctor if experience any disturbing heart symptoms that worry you.

Resuming sex is often a big concern - for both you and your partner. Again, discuss this, your questions and fears with your doctor. Usually, after a month or so after your heart attack, you will probably be able to safely resume sexual activity. Go slowly, and gradually build up to your former level of sexual activity - there are no timetables or rules. Do what is comfortable for you, your partner, and your heart. If you experience rapid heartbeat, angina, prolonged breathing problems, or are very tired after sex, call your doctor.

Cardiac Rehabilitation. Your doctor may recommend that you attend a cardiac rehab program during which healthcare professionals and physical therapists will work with you to develop healthy eating habits and start you on a graduated program of exercise. These programs also offer guidance about reducing your risk factors for another heart attack, such as smoking, high blood pressure, and high cholesterol.

Sometimes these programs are geared for older men, so ask if any provisions are made for women your age. If you are working, scheduling may be a problem since many rehab programs are held during the morning. Also, check and see if your health insurance company will pay for cardiac rehab. (Most companies cover rehab after a heart attack or angioplasty).

Communicate with Your Doctor. You will have a check-up six weeks after your heart attack and probably be given an exercise treadmill test to evaluate how you are doing. Your doctor will also review your medicines with you, so be sure to discuss any side effects or problems you might be having. Depending on your progress, your doctor will schedule periodic check-ups with you that are vitally important to you recovery - don't miss them! You may also need to have your cholesterol and blood pressure checked every few months.

Before your doctor visits, make a list of any unusual symptoms, side effects to medicines, or question you have. Make a copy and leave the list with your doctor so s/he can read it at leisure. During your visit, be frank with your doctor about any unhealthy behaviors - such as failing to take your medicines, regularly eating fast foods, smoking, or drinking too much alcohol - so, together, you can figure out ways to curb your behavior. Also, report any new information you learn about your family's history of heart disease, stroke, obesity, depression, and diabetes.

Depression is common among women with heart disease - and even more so among women who have had heart attacks. In many cases, the depression will lift several weeks after a heart attack but if it persists, tell your doctor. Symptoms of depression to watch for are: always feeling sad, often teary, have no energy, restless and irritable, can't sleep or eat, lose interest in activities you once enjoyed, or have thoughts of death. Your doctor can treat depression with medicines or refer you to a therapist for counseling.

Follow Your Doctor's Treatment Instructions. Take the daily aspirin, vitamins, and prescription medicines as your doctor prescribes. If you want to change or stop, discuss it with your doctor first. And, if you disagree with your doctor about some course of treatment, ask him/her to explain the reasons for the treatment.

You are perfectly entitled to seek another opinion from a second doctor or, if, you are really dissatisfied, you can find another doctor. Women often have difficulty finding a doctor they feel comfortable with and who will listen to them. If you are unhappy with your medical care, shop around. Don't ever settle for second best!

Cholesterol. Elevated blood levels of lipids, such as cholesterol and triglycerides, are associated with angina and heart attacks. Having a low HDL cholesterol, which is the "good" or protective cholesterol, is a risk factor for another heart attack. Getting you lipid levels to goal is one very clear way to decrease this likelihood. Make sure your doctor has obtained an accurate fasting lipid blood test and discussed the results with you. All women who have had a heart attack need to make sure that their lipid levels are at goal, either through dietary changes or prescription medicines.

Stop Smoking. No ifs, ands, or butts. Non-negotiable. You cannot recover if you continue to smoke. Call your local chapter of the American Lung Association or the American Cancer Society to locate a smoking cessation class near you, or ask your doctor for help. There are also new medicines available to help you stop smoking, as well as nicotine patches and gum. Find a friend to stop smoking with you - you'll need the encouragement and support!!

Start Moving. Your heart is a muscle and it needs physical activity so it can pump blood and oxygen throughout your body. The phrase "use it or lose it" is never truer - if you don't get exercise, you will lose your heart muscle. (Check with your doctor about when you can start walking again after your heart attack and for how long. Also, ask if you need to take any precautions when you exercise).

When you are well enough to begin a regular physical activity program, start small with a five-minute daily walk. Then increase to a 10-minute daily walk the following week. You can also go swimming, or sign up for water aerobics or low-impact aerobics classes at your local Y or health club. The important thing is to find some form of physical activity that you enjoy; otherwise you won't stick with it. Also, find a friend to exercise with - you'll keep each other motivated and supported. You can also enroll in a cardiac rehab program.

Your ultimate goal is to get 30 minutes or more of physical activity most every day. And you don't need to do intense aerobic workouts; moderate physical exercise, such as brisk walking, dancing, gardening, and house cleaning, will do.

Eat Healthy. Easier said than done! Changing our eating habits -- which we learned as children -- is terribly difficult and best achieved by making changes gradually over time, such as· drinking skim milk and tea, eating more salads, fresh vegetables and fruit -- and skipping the pizza, cake and cookies, and greasy fast foods.

Sometimes it's easy to get confused, overwhelmed, and frustrated about these food changes - you may get so upset that you are afraid to eat, or you burst into tears at mealtimes. Start reading low-fat cookbooks and magazines, such as Cooking Light, Prevention, Weight Watchers, and Vegetarian Times, for good low-fat recipes. Eventually, you'll feel more comfortable around food and you'll start to make small but important changes in your eating habits. Pretty soon you may actually prefer the taste of low fat foods!

Educate Yourself. Understand what happened to you and your heart. Read articles and books that describe heart attacks, how they occur, and how they are treated. Check out WomenHeart's Bookstore through which you can order from our selected list of books on women and heart disease. Become an expert on and an advocate for your heart. If you have questions, write them down and ask your doctor during your next visit, or discuss them in our chat rooms.

Find a Support Network. Research studies show that women who have close family relationships and good friendships make better recoveries from heart attacks, as the healing impact of love and friendship soothes both the heart and spirit. Having someone to talk to about what you are going through - your fears, sadness, anger, and vulnerability - is vitally important to your recovery. Your spouse or lover can listen to your concerns but may eventually feel burnt out and overwhelmed by your emotional needs. Some women talk with a therapist if they get too overwhelmed, depressed, or anxious. The important thing is to have someone to confide in: a "place to put your stuff." WomenHeart now offers local Support Networks.

Re-Connect Spiritually. Being part of a spiritual community - church, mosque, or synagogue - can help your recovery. If you practice your faith regularly, your blood pressure and stress levels tend to be lower, you feel more peaceful, and are likely to take better care of yourself. You also can receive strength and comfort from your ties to a community of worshippers, and a sense of connection, purpose, and meaning in your life. Your recovery is a good opportunity to develop and explore your faith, and to connect with the roots and healing traditions of your faith.

Clean House and Set Priorities. Recovering from a heart attack affects every woman differently. Many women look back on it as a life-altering experience that gave them a special gift: the opportunity to examine their life's priorities, make choices about with whom and how they spend their time, and find new meaning or direction for their life.

However, you probably won't have this perspective until three or four years after your heart attack. Then you will feel more secure about your health and can look back on the changes you have made. Well-meaning friends may ask you soon after your heart attack if you have had a spiritual awakening or will be making dramatic life changes - taking a trip around the world or retreating to a Buddhist monastery. They don't understand that you are too traumatized to do much of anything, and that it will take several years for you to recover and sort out the rest of your life. Tell them to back off!

This also means that, eventually and over time, you may let go of old friends who are not taking you where you want to go - who may still smoke or won't exercise. You may even question your marriage or intimate relationship, especially if you have been unhappy for a long time or if you spouse/lover doesn't support your healthy behavior changes. (Remember that your changes can be very threatening. Go together and talk with a marriage and family therapist (check out the American Association for Marriage and Family Therapy and click "Find a Therapist") if things get too difficult.)

Dealing with Family and Friends. Sometimes your heart attack can cause more emotional trauma for your family and friends than for you. You know you have survived and are getting well, but they are often still shocked by what has happened to you and helpless that you came close to death - they almost lost you.

For your friends, your heart attack forces them to confront their own mortality - especially if you and they are under 60 - and they often overreact: either hovering over you or avoiding you. Understand that they are simply trying to cope with their own fears and panic. For your own mental health, however, keep the hovering people at a distance until they get grip on their emotions. Otherwise, they will "kill you with kindness" and expect you to meet their own emotional needs. This can be exhausting!

Family members often fear that you will suffer another heart attack and die. They should be encouraged to express their emotions, read books and articles about heart attacks, and even speak with your doctor if need be. They may also want to take a CPR class at their local fire and rescue department or Red Cross chapter.

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