Life after heart attack

Obesity can lead to not only heart disease, but also diabetes. Your doctor can help you work out a way for you to take in fewer calories while you burn more. He might also refer you to a dietitian and put you on an exercise program.

Eat a heart-healthy diet. You’ve found the right one if it:

  • Is low in unhealthy fats
  • Contains at least 4 to 5 cups of fruits and vegetables every day
  • Has at least two, 3.5-ounce servings of fish a week
  • Includes at least three 1-ounce servings of fiber-rich whole grains every day
  • Is low in sodium (less than 1,500 milligrams per day)
  • Contains no more than 36 oz. of sugar-sweetened beverages a week
  • Has no processed meats.

There may be other restrictions because of medicines you take. Ask your doctor if there are foods you shouldn’t eat.

Changing your diet is easier if you work with a dietitian. She can help you plan menus and find recipes. She’ll also help you find resources that let you focus on eating healthy foods.

If you aren’t able to work with a dietitian as part of your rehab program, ask your doctor for a referral. You can also find recipes and nutritional aids on the web.

Become more active: One of the most important keys to good heart health is to get up off the couch. Some people are afraid to exercise after a heart attack. But that’s exactly what you need to do to strengthen your heart and lower your chance of having future heart attacks and heart disease.

A cardiac rehab program is a safe way to become more active. If you don’t have a program, be sure to talk with your doctor about what level of exercise is safe for you and how to get more activity into your daily routine. He may have you take a stress test to see what level of exercise is safe to start with.

Also, ask what warning signs you should watch for when you exercise and what you should do about them.

Heart attack, stroke and diabetes ‘can shorten life by 23 years’

“Suffering from heart disease, stroke and type two diabetes could knock 23 years off life,” The Daily Telegraph reports, covering the stark conclusion of a major new UK study. The good news is many chronic diseases, such as stroke, are preventable.

As The Guardian reports, having a history of both heart attack and type 2 diabetes – increasingly common chronic conditions – can shorten life by around a decade.

Researchers looked at more than 130,000 deaths over 50 years. They then estimated the life-shortening effects of different diseases alone and in combination, and found these big three conditions significantly shortened lifespan.

The researchers used a large group and long timespan to make their estimates, giving us confidence in their main conclusions. But they are based on averages.

Each person’s risks and lifespan is individual, and it is never too late to improve your health, even if you do have one or more chronic conditions: you can work towards maintaining a healthy weight, exercising more, eating healthily, not smoking, and not drinking too much alcohol.

Where did the story come from?

The study was carried out by researchers from the Emerging Risk Factors Collaboration co-ordinated by the University of Cambridge.

It was funded by the UK Medical Research Council, the British Heart Foundation, the British Heart Foundation Cambridge Cardiovascular Centre of Excellence, the UK National Institute for Health Research Cambridge Biomedical Research Centre, the European Research Council, and the European Commission Framework Programme 7.

A number of study authors declared potential financial conflicts of interest relating to funding from pharmaceutical companies, health trust funds and not-for-profit research organisations.

The study was published in the peer-reviewed Journal of the American Medical Association (JAMA).

Both The Guardian and The Daily Telegraph reported the main findings accurately, although neither discussed any limitations. Limitations are important to remind the reader no study is perfect or completely accurate.

The first line of The Telegraph’s story told readers the diseases behind the 23-year life loss are largely preventable for “8 out of 10 people”. This figure doesn’t appear to have been taken from the main study publication, so we can’t confirm whether or not this is accurate.

The Telegraph also used the term “heart disease”, but the researchers specifically looked at people who had a heart attack (myocardial infarction). While a heart attack can be a common complication of heart disease, not everyone with heart disease will have one.

Nonetheless, it is well known you can reduce your risk of these conditions by living healthily, so there is something you can do about it.

What kind of research was this?

This analysis of two large cohort studies looked at the impact of diabetes, stroke and heart attack on life expectancy.

The researchers say more and more people are living with one or more conditions that increase their chances of dying early. The conditions of interest were heart attack, stroke and type two diabetes.

The researchers wanted to know the impact on lifespan of having more than one of these three conditions, looking at a large group of people over a significant amount of time.

To do this, they analysed some large and long-term cohort data sets. This is one of the most effective ways of estimating the impact of lifestyle on death across large groups.

The estimates rely on accurate estimates of lifestyle, usually reported in surveys, as well as having a lot of people in the group to boost reliability and generalisablity.

Such analysis produces averages – what happens to most people most of the time. While very useful, individual risk profiles vary from person to person, and can vary a lot around the average.

What did the research involve?

The research team analysed two large cohort studies, both of which had rich sources of lifestyle and medical information, allowing them to estimate the impact of different lifestyles and diseases on life expectancy.

The first and largest cohort was from the Emerging Risk Factors Collaboration. This had 689,300 participants from 91 cohorts, covering around 50 years of survey data from 1960-2007. This collected information on 128,843 deaths up to April 2013. The average age was 53, and most participants were from Europe (69%) or North America (24%).

The second cohort was from the UK Biobank. It was a little smaller, but more relevant to the UK. It had data on 499,808 participants with survey-derived lifestyle information spanning from 2006-10. Data on 7,995 deaths was gathered, the latest from November 2013. The average age was 57, and all from the UK.

Death rates were calculated for those with a history of two or more of the following:

  • diabetes mellitus
  • stroke
  • heart attack

The impact on lifespan of having each of the three conditions at different ages, alone or in combination, was estimated independently in both cohorts and then compared.

What were the basic results?

In men aged 60, a history of any two of the three conditions was associated with a 12-year lower life expectancy. A history of all three of these conditions was associated with 15 years of reduced life expectancy. The estimates were similar for women: 13 years lost for two conditions and 16 years for three.

Life lost was greatest if the history of the conditions was present earlier in life. Estimates in this study started at 40 and ran through until 95.

The highest estimate of life loss was 23 years, the figure picked up by The Telegraph. This related to men aged 40 with a history of diabetes, stroke and heart attack. The loss was only slightly lower in women with the same age and conditions, at 20 years.

Broadly speaking, the impact on risk of death from the three conditions was similar in both cohorts. The researchers found risk of death doubled with one condition, was four times as high with two conditions, and eight times higher with all three. This showed the risk effects were piling on top of each other in an exponential manner, rather than overlapping.

How did the researchers interpret the results?

The authors made three main interpretations. First, because of the addition nature of the results, they concluded that, “Our results emphasise the importance of measures to prevent cardiovascular disease in people who already have diabetes, and, conversely, to avert diabetes in people who already have cardiovascular disease.”

Second, they said the shortening of life as a result of the three conditions studied was “of similar magnitude to those previously noted for exposures of major concern to public health, such as lifelong smoking (10 years of reduced life expectancy) and infection with the human immunodeficiency virus (11 years of reduced life expectancy).”

Finally, they said there were important differences between men and women. “For men, the association between baseline cardiovascular disease (i.e. a history of stroke or MI) and reduced survival was stronger than for women, whereas the association between baseline diabetes and reduced survival was stronger for women.”

Conclusion

This study used two large cohort-derived data sets to estimate the number of years of life lost as the result of a history of heart attack, stroke or diabetes across different ages.

The study’s large size, relevance to the UK and long-term follow-up increases our confidence in its conclusions and their relevance to England and Wales. As with all studies, it has limitations, but these were relatively small and unlikely to affect the main conclusions.

This study shows a history of stroke, type 2 diabetes and heart attack can significantly shorten life expectancy, especially if these conditions are developed earlier in life, at around the age of 40.

But the good news is this is preventable – you can act now to minimise your risk of developing each of these conditions by maintaining a healthy weight, taking more exercise, eating healthily, stopping smoking, and not drinking too much alcohol.

Find out how you can reduce your risk of developing type 2 diabetes or having a heart attack or stroke.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Unhealthy lifestyle can knock 23 years off lifespan

The Daily Telegraph, 7 July 2015

Heart disease plus diabetes can knock more than a decade off your life

The Guardian, 7 July 2015

Links to the science

The Emerging Risk Factors Collaboration.

Association of Cardiometabolic Multimorbidity With Mortality

JAMA. Published online July 7 2015

Recovery


Heart attack

Medicines

There are currently 4 types of medicines widely used to reduce the risk of a heart attack:

  • angiotensin-converting enzyme (ACE) inhibitors
  • anti-platelets
  • beta blockers
  • statins

ACE inhibitors

ACE inhibitors are often used to lower blood pressure, as they block the actions of some of the hormones that help regulate blood pressure.

By stopping these hormones from working, the medicine helps to reduce the amount of water in your blood and also widens your arteries, both of which will reduce your blood pressure.

ACE inhibitors have been known to reduce the supply of blood to the kidneys, which can reduce their efficiency. This means blood and urine tests may be done before you start taking ACE inhibitors to make sure there are no pre-existing problems with your kidneys.

Annual blood and urine tests may be required if you continue to take ACE inhibitors.

The side effects of ACE inhibitors can include:

  • dizziness
  • tiredness or weakness
  • headaches
  • a persistent, dry cough

Most of these should pass within a few days, although some people continue to have a dry cough.

If ACE inhibitors are taken with other types of medicines, including over-the-counter medicines, they can cause unpredictable side effects.

Check with a GP or pharmacist before taking any other medicines if you are taking an ACE inhibitor.

It’s usually recommended that you begin taking ACE inhibitors immediately after having a heart attack and, in most cases, continue taking them indefinitely.

Some people cannot take ACE inhibitors. If this is the case, a related medicine called an angiotensin receptor blocker (ARB) may be prescribed as an alternative.

Antiplatelets

Antiplatelets are medicines that help prevent blood clots. They work by reducing the “stickiness” of platelets, which are tiny particles in the blood that help it to clot.

It’s usually recommended that you take low-dose aspirin, which has blood-thinning properties.

You’re more likely to be given additional antiplatelet medicines, such as clopidogrel, prasugrel or ticagrelor, especially if you have had stent treatment.

These can also be used if you’re allergic to aspirin.

Side effects of antiplateletes can include:

  • diarrhoea
  • bruising or bleeding
  • breathlessness
  • abdominal pain
  • indigestion
  • heartburn

As with ACE inhibitors, treatment with antiplatelets usually begins immediately after a heart attack.

How long you will take an antiplatelet can be between 4 weeks and 12 months and depends on the type of heart attack you have had and the other treatment you have received.

It’s usually recommended that you take low-dose aspirin indefinitely.

If you experience troublesome side effects from aspirin, you should contact a GP for advice.

Do not suddenly stop taking aspirin, as this could increase your risk of another heart attack.

You may occasionally also be prescribed another blood-thinning medicine called warfarin.

This usually only happens if you have remained in an irregular heart rhythm (atrial fibrillation) or sustained severe damage to your heart.

Excessive bleeding is the most serious side effect of warfarin.

Seek immediate medical attention and have an urgent blood test if you experience any of the following side effects:

  • passing blood in your pee or poo
  • passing black poo
  • severe bruising
  • nosebleeds that last longer than 10 minutes
  • blood in your vomit
  • coughing up blood
  • unusual headaches
  • heavy or increased bleeding during your period or any other bleeding from the vagina

You must also seek immediate medical attention if you:

  • are involved in major trauma (an accident)
  • experience a significant blow to the head
  • are unable to stop any bleeding

Beta blockers

Beta blockers are a type of medicine used to protect the heart from further damage after a heart attack.

They help to relax the heart’s muscles so the heart beats slower and blood pressure drops, both of which will reduce the strain on your heart.

It’s usually recommended that you begin treatment with beta blockers as soon as your condition stabilises, and continue taking them indefinitely.

Common side effects of beta blockers include:

  • tiredness
  • cold hands and feet
  • a slow heartbeat
  • diarrhoea
  • feeling sick

Less common side effects include:

  • difficulty sleeping or nightmares
  • inability to obtain or maintain an erection (erectile dysfunction, or impotence)

Beta blockers can also interact with other medicines, causing possible adverse side effects.

Check with a GP or pharmacist before taking any other medicines, including over-the-counter medicine, in combination with beta blockers.

Statins

Statins are a type of medicine used to reduce blood cholesterol.

This helps to prevent further damage to your coronary arteries and should reduce the risk of another heart attack.

Statins block the effects of an enzyme in your liver called HMG-CoA reductase, which is used to make cholesterol.

Statins sometimes have mild side effects, including:

  • constipation
  • diarrhoea
  • headaches
  • abdominal pain

Occasionally, statins can cause muscle pain, weakness and tenderness.

Contact a GP if you experience these symptoms, as your dosage may need to be adjusted.

It’s usually recommended that you take statins indefinitely.

Life After Heart Attack: 3 People Share Their Recovery Journey

Tara Robinson survived three heart attacks in a span of one week at the age of 40. She said that mentally, her mind was a “battlefield” when it came to the lifestyle modifications she needed to make to eat healthier and exercise regularly.

“Before, I did not understand how somebody could not let go of a drug addiction, or any type of addiction,” she says. “But now I do. It is very difficult to change habits.”

Her motto in overcoming these challenges was: “One step at a time.”

Murphy, too, found exercising challenging, but for different reasons.

Before her heart attack, she ran a lot, including half-marathons. After the heart attack, she wasn’t able to resume running at the pace she was used to. Instead, she has had to take up different exercises, such as the elliptical machine or walking the dog.

Disappointed at first, Murphy has embraced these changes and learned to turn them into positives.

“It really has made me take a step back and not always be in such a rush to get out there and run a few miles and then move on to the next thing, but instead to really enjoy and take every day and really be grateful that I did have a day to just take a walk with the dog,” she says.

For Breece, his biggest challenge was absorbing all the information he needed to maintain his new lifestyle, which quickly became overwhelming.

After the initial influx of information, it became important for him to “treat it like a marathon, not a sprint.”

“You don’t go directly straight up a mountain,” he says. “You take zigzags and you get to the top eventually.”

Additionally, the depression and anxiety he experienced as a result of his heart attack were difficult to process. Therapy and meditation have helped him learn to cope.

“It’s been a lot of work personally and emotionally, but it’s life,” he says. “I’m here three years later now.”

RELATED VIDEO: Melissa Murphy Says It’s Important To Eat Better And Make Lean Choices After A Heart Attack

RELATED VIDEO: Tara Robinson On The Importance Of Doing Things One Step at a Time After a Heart Attack

Know the Symptoms of a Heart Attack

Getting treatment as soon as possible for a heart attack greatly increases the chance of survival, so it’s important to know the symptoms. Heart attacks can occur suddenly or symptoms can start slowly and progress over time.

The major symptoms of a heart attack are:

  • Pain or discomfort in the jaw, neck, or back
  • Weakness or light-headedness
  • Chest pain or discomfort (also known as angina)
  • Pain or discomfort in arms or shoulders
  • Shortness of breath

Andrew Freeman, MD, a cardiologist at National Jewish Health in Denver, Colorado, says certain symptoms can be easily overlooked or mistaken for something else.

“The main one I would say is angina, which happens when the heart wants more than it’s getting in terms of nutrients or oxygen,” he says. “In short, any symptom that occurs above the waist that comes on with activity or stress and resolves with rest really needs to be considered as potentially being angina.”

Other symptoms can include:

  • Nausea
  • Vomiting
  • Unusual or unexplained tiredness

Women are more likely to experience a heart attack without chest pressure.

“The presentation is definitely different in women,” says John Osborne, MD, the director of preventive cardiology and imaging at the Dallas Medical Center. “Typical heart attack symptoms in women can be pretty nonspecific. Some women even think they have the flu.”

Robinson says that before her heart attacks her left arm went numb and her neck felt like she had slept poorly, “like I had a crook in my neck. Those were the two main symptoms before I actually had the heart attack itself.”

On the days when she had her heart attacks, she felt those same symptoms in addition to chest pain, upper back pain, nausea, and feeling “hot and clammy.”

Experts say everyone, especially women, should be aware of the many different ways heart attacks can present so they can seek medical attention as soon as possible.

Which Heart Attack Risk Factors Can You Control?

Certain factors make someone more likely to have a heart attack; some of them are modifiable and some are not.

Those that can be changed include high cholesterol, high blood pressure, physical inactivity, obesity and being overweight, tobacco smoking, and diabetes.

Risk factors that are not modifiable include older age, gender (males have a greater risk of heart attack than females), and family history.

The last one, Dr. Osborne says, is particularly important to be aware of. “You may eat right, exercise, not smoke, and do the right things, but if you’ve got a bad family history, be aware that those things certainly may reduce your risk of heart disease but not eliminate it,” he says.

It’s important for people who are at a greater risk of heart attack to be extra vigilant when it comes to noticing signs of a heart attack, and get to a doctor right away if symptoms occur.

Treatment Options for a Heart Attack

There are a number of different treatment options following a heart attack, depending on how much blockage there was in the coronary arteries. Treatments include:

  • Percutaneous coronary intervention (coronary artery stent placement)
  • Clot-dissolving drugs
  • Balloon angioplasty (special tubing with an attached deflated balloon threaded up to the coronary arteries)
  • Surgery
  • A combination of treatments

Certain hospitals offer percutaneous coronary intervention (PCI), a mechanical means of treating heart attack. The procedure involves cardiac catheterization, or the insertion of a catheter tube into the coronary arteries. According to the American Heart Association, approximately 36 percent of hospitals in the U.S. are equipped to perform this procedure.

Of course, long-term treatment for a heart attack involves making lifestyle changes, including a healthy diet, increased physical activity, and changing modifiable risk factors including reducing blood pressure, losing weight, reducing cholesterol, and quitting smoking.

“We most certainly cannot underestimate the value of diet and exercise and changing other modifiable lifestyle factors when it comes to treatment for heart attack,” Dr. Freeman says.

Staying Motivated After a Heart Attack

Adhering to the many lifestyle changes that come after a heart attack can be difficult, but for many heart attack survivors, family and a strong support system helps push them forward.

Murphy explains the importance of “having a great support system and caretakers to let you know that you’re not alone on this journey.” She also found it helpful to talk to other people who have survived heart attacks or strokes or have had some kind of illness for which they needed to rely on their family.

For Robinson, her children provide the biggest motivator to push forward.

“I think about not being here to see my children have children or get married or any success they’re going to have that I wouldn’t be here to share,” she says.

Breece suffered from depression and anxiety after his heart attack and says therapy was extremely beneficial in helping him stay on track with his recovery.

“One of the tricks I use is to personify the anxiety; the therapist taught me how to do this,” he says. “Treat as if it’s your mom and you’re 17 and she’s there to check in on you. You thank her and then get back to what you’re doing so she can go do what she needs to do somewhere else. It’s not an adversarial relationship anymore, it’s more of a familial relationship.”

In this way, he’s learned to “make friends” with the anxiety.

Breece says meditating and periodically getting out of his comfort zone by leaving the city to go solo camping has also helped him stay motivated.

RELATED VIDEO: Exercise And Healthy Eating Help Me Stay Motivated Post Heart Attack

RELATED VIDEO: A Good Support System Is Helpful After A Heart Attack

Heart Disease Deaths by the Numbers

Over the past several decades, heart disease–related deaths in the United States have declined, although more Americans still die from heart disease than any other cause.

According to the American Heart Association, research shows that age-adjusted death rates for heart disease fell from about 520 deaths per 100,000 Americans in 1969 to 169 per 100,000 in 2013.

“The big-picture, 30,000-foot-view, is that we’ve made huge advances in prevention of cardiovascular death,” Osborne says.

This success is due to less smoking among the U.S. population, improved medications, and better control of risk factors such as blood pressure and cholesterol.

Despite this progress, heart disease is still the number one killer of both men and women in the United States.

“Not only is that statistic frightening, but in fact cardiovascular disease kills more people than the next seven leading causes of death combined,” Osborne says. “So we still have a really long way to go.”

What to Do if You Think You Are Experiencing a Heart Attack

A heart attack is a medical emergency. If you think you or a loved one is experiencing a heart attack, call 911 or your local emergency number immediately. Prompt medical attention is necessary. The sooner the person gets to the hospital, the higher his or her chance of survival.

Complications


Heart attack

Arrhythmia

An arrhythmia is an abnormal heartbeat and can include:

  • beating too quickly (supraventricular tachycardia)
  • beating too slowly (bradycardia)
  • beating irregularly (atrial fibrillation)

Arrhythmias can develop after a heart attack as a result of damage to the heart muscles. Damaged muscles disrupt electrical signals that control the heart.

Some arrhythmias, such as tachycardia, are mild and cause symptoms such as:

  • palpitations – the sensation of your heart pounding, fluttering or beating irregularly, felt in your chest or throat
  • chest pain
  • dizziness or lightheadedness
  • tiredness (fatigue)
  • breathlessness

Other arrhythmias can be life threatening, including:

  • complete heart block, where electrical signals are unable to travel from one side of your heart to the other, so your heart cannot pump blood properly
  • ventricular arrhythmia, where the heart begins beating faster before going into a spasm and stops pumping completely; this is known as sudden cardiac arrest

These life-threatening types of arrhythmia can be a major cause of death during the 24 to 48 hours after a heart attack.

However, survival rates have improved significantly since the invention of the portable defibrillator – an external device that delivers an electric shock to the heart and “resets” it to the right rhythm.

Mild arrhythmias can usually be controlled with medicine such as beta-blockers.

More troublesome bradycardias that cause repeated and prolonged symptoms may need to be treated with a pacemaker. This is an electric device surgically implanted in the chest to help regulate the heartbeat.

Find out more about sudden cardiac arrest from the charity Sudden Cardiac Arrest UK.

Here’s a surprising fact: nearly half of people who have a heart attack don’t realize it at the time. These so-called silent heart attacks are only diagnosed after the event, when a recording of the heart’s electrical activity (an electrocardiogram or ECG) or another test reveals evidence of damage to the heart.

One explanation for this phenomenon may be a higher-than-average tolerance for pain. Some people mistake their symptoms as indigestion or muscle pain, while others may feel pain, but in parts of their upper body other than the center of the chest, says Dr. Kenneth Rosenfield, who heads the vascular medicine and intervention section at Harvard-affiliated Massachusetts General Hospital.

Different sensations?

“Many people don’t realize that during a heart attack, the classic symptom of chest pain happens only about half of the time,” he says. People sometimes describe heart attack symptoms as chest discomfort or pressure, while others say they feel an intense, crushing sensation or a deep ache similar to a toothache.

Certain people are less sensitive to pain than others, or they may deny their pain and “tough it out” because they don’t want to appear to be weak. Not everyone has a good sense of their own pain tolerance, however, and a host of other factors (such as your emotional state) can affect pain perception. Of note: people with diabetes may be less sensitive to pain because the disease can deaden nerves (a condition known as diabetic neuropathy), theoretically raising their risk for a silent heart attack.

Where it may hurt

During a heart attack, the location of the pain can also vary quite a bit from person to person, notes Dr. Rosenfield. It may occur in the arm, shoulder, neck, jaw, or elsewhere in the upper half of the body. “I had one patient who had earlobe pain, and another who felt pain in his wrist,” says Dr. Rosenfield. Other nonclassic symptoms people often don’t attribute to a heart attack include nausea, vomiting, and weakness.

During his career, Dr. Rosenfield has seen many thousands of people who’ve had heart attacks. “There’s no question that women are more likely to experience nonclassic heart attack symptoms, but it’s important to remember that men can have those symptoms, too.”

Heart attack symptoms

Although the most common sign of a heart attack in both men and women is the classic one — discomfort in the center of the chest that spreads through the upper body — this symptom doesn’t always occur. Some people experience nonclassic symptoms, and these may be slightly more frequent in women and in older people.

Classic symptoms Nonclassic symptoms
  • Pressure, aching, or tightness in the center of the chest
  • Pain or discomfort that radiates to the upper body, especially shoulders or neck and arms
  • Sweating
  • Shortness of breath
  • Weakness
  • Nausea or vomiting
  • Dizziness
  • Back or jaw pain
  • Unexplained fatigue

I Survived a Heart Attack. Here’s What It Was Like

Imagine a typical, beautiful summer day. The sun is shining, the birds are chirping, and you catch yourself feeling grateful for a life filled with family and friends, creative outlets, and work that you find fulfilling. For me, June 12, 2014 started off as one of those almost too-good-to-be-true days.

I headed to the gym for one of my six workouts a week. I used the treadmill, bicycle, elliptical, and weight machines to whittle away stress, trim body fat, and build muscle. As the sweat dripped from my pores and my heart rate rose, I remember feeling proud that, as a hard-working 55-year-old woman, I could remain physically active.

At the time, I was working as an addictions counselor in an outpatient drug and alcohol rehab, returning home to do my work as a journalist, teaching classes and workshops, and serving as an interfaith minister. By the time my head touched down on the pillow every night, I had clocked 12 to 14 hours of work, which left five to six hours for sleep before waking up to repeat the cycle.

As a semi-vegetarian, I thought I was eating healthfully. And although I was not a caffeine junkie, I would down a chai a few times a week and chug energy drinks occasionally when my bleary eyes couldn’t remain open a moment longer.

But my go-go-and-go-some-more attitude wasn’t solely due to being overworked. In 1998, I became a 40-year-old widow with an 11-year-old son to raise. A decade later, I became an “adult orphan” when my dad died in 2008 and my mom joined him two years later. I tried to remember what my wise father used to say: “You never know what tomorrow brings.” And my equally astute mother would offer what I called her “que sera sera attitude” as she channeled her best Doris Day and told me, “What will be will be.” So, I kept on keepin’ on, but I did not leave room for active grief over the losses I had suffered.

All of this set the stage for what transpired on my way home from the gym on that picturesque June day.

forrest9 / iStock

I was driving on familiar roads when I started experiencing torrential sweats, dizziness, searing heartburn, nausea, and a feeling that someone had gripped my jaw and it became immobile. Call it intuition combined with education, but I knew immediately that I was having a heart attack. Unlike the usual symptoms in men, there was no gripping my left arm, no chest pain, and no loss of consciousness, but I did lose good sense.

Rather than doing what I would have advised anyone else to do (pull over and call 911), I drove home, canceled an appointment with a client, and after a fleeting thought that I should get my sweaty self into the shower, I decided to drive myself to the ER 10 minutes away (a choice I chalk up to oxygen deprivation).

I stumbled through the hospital door and told the woman behind the desk, “I think I’m having a heart attack.”

Within moments, I was whisked via wheelchair and prepped for a stent to be inserted into my heart to prop up a fully occluded artery. I remember thinking, “I can’t miss work. I need that income.” I had been taking care of myself financially since my husband had died 15 years earlier—and yet, even in that moment, I was worrying about everything but my health.

I also remember the nurse preparing me for the possibility of needing to have the stent threaded through the groin rather than wrist (the first is the traditional approach). “You’re going to hate me, but I am only going to shave you on one side,” she said. I asked if she could do a “landing strip” instead, and we both erupted in giggles. (Laughter is definitely the best form of medicine, even when you’re having a heart attack.)

Boonyarit / iStock

Luckily, that wasn’t necessary, and today, I’m grateful that the pin hole in my right wrist is what remains, along with that extra part in my heart that makes me think of myself as the Bionic Woman. My surgeon showed me what my fully occluded artery looked like pre-stent (a broken, bent tree branch) and then post-stent (propped back up so the blood could flow through normally). He cautioned me not to let it happen again.

While recovering, I was reminded by hospital staff, family, and friends that a major lifestyle overhaul was in order. It turned out, my family predisposition (my mother died of congestive heart failure and my sister had had two heart attacks), diet, and sleep-wake imbalance lent themselves to this inevitable outcome. Apparently, working 14 hours a day, sleeping for five, and living off of pre-packed food high in cholesterol and sodium wasn’t serving me well.

My personal support system wagged their collective fingers in my direction as they told me I needed to slow down dramatically and stop taking care of everyone else at my own expense. I realized at that moment that I had an active addiction: I was a Type A+ overachieving workaholic who thought she thrived on activity, but instead, suffered as a result of an almost non-stop urge to keep moving lest her real emotions catch up with her.

The idea of taking the two weeks off work that my doctor suggested in order to push the reset button frankly scared the crap out of me. Healing felt like work. I could barely take a step without getting winded. It was as if my lungs were a collapsed accordion straining to expand. I found myself lying on the couch, staring up at the ceiling fan spinning and wondering if I would ever regain my stamina.

I was fearful, not of death, but of incapacity, such that other people would need to take care of me. I couldn’t imagine such a dramatic role reversal. I had transformed from Wonder Woman to the Bionic Woman, but who would I be if I wasn’t everyone else’s consummate caregiver?

While engaging in some much-needed introspection, I came to realize that I had not allowed myself the freedom to mourn my cumulative losses, to simply be instead of being on and to honor my own heart as I did the hearts of others. My longtime friend Barb, who has known me since we were 14, called me out on my behaviors as only a friend can. “You call yourself a woman of integrity but you have been lying to yourself,” she said. “Every time you say you are going to slow down and you don’t, you lose credibility with yourself.” I had to reluctantly admit that she was spot on.

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In addition to working on my mental wellbeing, I spent several months in medically supervised cardiac rehab. Eventually, I started a new and less stressful job as a journalist writing about wellness, mental health, and addictions. I changed my diet and on-going exercise routines and I started taking naps, which would have felt like a decadent indulgence pre-heart attack.

Five years later, I still work in several capacities: seeing clients in a slower paced therapy practice, and teaching classes, but cutting back hours dramatically.

Every June 12th since, I make sure to celebrate my “cardiaversary” joyfully and spread that joy via the Free Hug flashmobs I began doing in 2014. I walk around the Philadelphia region where I live, offering to embrace anyone who needs it, from folks in homeless shelters to Vietnam vets to people in train stations. They smile, laugh, and sometimes cry when we hug. My goal is to give them something conscious and concrete to do when they feel helpless to make a positive change in the world.

And frankly, I do it for myself as well. It helps me feel more connected to the world around me (and has brought me to Washington, D.C.; New York City; Portland, Oregon; and even Ireland). When I hug my way across the globe, I am not just the giver, but the recipient as well. Because in the years since my heart attack, I have learned the importance of taking care of my own physical and emotional heart—just as I would encourage others to do.

I say that the woman I was died on June 12, 2014 to give birth to the one who is typing these words. She had to, since she was killing me.

And if you want to know the signs of a heart attack to protect yourself, These Are the Heart Attack Warning Signs Hiding in Plain Sight.

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