Advice after your nerve block for surgery
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Frimley Park Hospital Cardiac Disease Risk Management Programme
Our aim is to help you get well and ease some of your concerns following your heart attack. In this leaflet we hope to answer some of the questions we are commonly asked.
Whenever possible, we try to visit people on the wards, once they are feeling well enough.
WE RECOMMEND YOU CONTACT YOUR GP AS SOON AS POSSIBLE AFTER YOUR DISCHARGE HOME. This is for repeat prescriptions and any further investigations, e.g. blood tests which may be required.
First Reactions
During your stay in hospital you may be thinking about these questions.
Why did I have a heart attack?
It is not always possible to identify the reason why you have had a heart attack but there are certain things that have been identified as increasing the likelihood of having a heart attack. These are known as risk factors and include the following: please tick those risk factors you feel apply to you.
• Smoking (any amount)
• High cholesterol
• High blood pressure (Hypertension)
• Diabetes
• Inactivity (lack of regular exercise)
• Overweight
• Alcohol in excess
• Stress
• Family history (having a history in your family: parents, brothers, sisters, having had a heart attack or angina)
Many of these risk factors are influenced by your lifestyle. If you follow a healthier lifestyle these risks may be reduced. It is possible to be healthier after your heart attack than you were before.
Will I have another heart attack?
No one can say for sure. It is possible to be healthier than before if you look at the possible contributing factors (risk factors) and see what you can do about them. It is often the case that we do not stop and think about our health until something happens, such as having a heart attack. Many people use this event as a fresh start and can live a long and happy life.
What is normal following a heart attack?
There are no rules as to how you should feel after a heart attack. Some people may experience one or more of the symptoms which will be described next, while others feel as if nothing has happened. Some feel like ‘a fraud’ for being in hospital if they do not feel unwell. Feeling well does not mean you have not had a heart attack.
It is not uncommon for you to be more aware of your heartbeat following a heart attack. It can feel as if your heart is going a little faster or missing a beat. Should it make you feel dizzy or unwell, you must inform your nurse or doctor.
A heart attack can sometimes leave you feeling a bit on edge, nervous, depressed and not your usual self. These usually pass as time goes by. The reactions of your body to the heart attack subside and you begin to regain your confidence. However, no two people react in the same way and we are always happy to discuss your concerns with you. Give yourself time to recover; you wouldn’t expect a broken leg to heal in a few days.
Try to relax, even though this may be difficult at first. Remember things will be different in a few weeks when you have recovered a bit more.
Is it normal to feel pain after a heart attack?
Sometimes after a heart attack you may feel a small dull ache on the left side of your chest or shoulder; this may be due to some inflammation. This usually fades after a couple of weeks. You may also get twinges of pain that may be sharp but very short in duration; this may also be due to some inflammation.
If the pain is severe or sharp and of long duration or is something new and persistent, we recommend you report this immediately.
We must stress the importance of reporting any of the above to your nurse or doctor no matter how insignificant you may think it is.
It is common on to experience post PCI discomfort/tenderness in the chest. This is normal and should settle within a few days. Some patients describe a slight stabbing or sharp pain or a general feeling of ‘something there’. This should settle in time.
How long does it take to recover from a heart attack?
For most people, it will take about four to six weeks. Some feel better after only a few days but don’t be tempted to do too much at this stage. The pain may have gone but the healing of your heart muscle has only just begun.
What should I be doing / what should I avoid
While in hospital?
Be guided by your doctors and nurses. While you are attached to monitors and other equipment, your mobility will be limited.
When you are allowed out of bed, start off by sitting on the edge for two minutes before you stand up. If you have been in bed for a while you may feel dizzy if you stand up quickly. You may have been started on medication which can affect your blood pressure, so take your time.
Whilst in bed, do exercises such as rotating your ankles, pushing your feet back and forward, tensing and relaxing your thighs and bottom. When you are allowed, make sure you sit on a chair during the day. Exercise your feet every hour to improve the circulation in your legs.
When you are allowed to walk around the ward do not walk too far to start with. If you are considering leaving the ward area, we recommend you check with the nurse in charge first.
When you go home
The first week should be for resting. If you have stairs to climb, try not to go up and down too frequently for the first few days.
Don’t do heavy housework such as changing the beds, vacuuming, and heavy lifting, shopping or mowing the lawn.
‘Potter’ around the house for a couple of days and then, if you are feeling well, you should begin a walking programme to help your heart recover. Start off slowly, limit your journey to between five and ten minutes and keep to flat areas, no inclines at this stage.
This may not seem long but remember this is the start of your recovery period and you shall build this up over the coming two to four weeks, aiming for 30 minutes a day for at least five times a week.
Remember to wear warm clothing if the weather is cold.
Allow for plenty of rest as your body may require more rest at this time to aid healing and recovery.
Life activities
Driving
When you have had a heart attack you are not allowed to resume driving straight away. If successfully treated by angioplasty, driving may recommence after one week provided:
- No other urgent revascularisation is planned (urgent refers to within 4 weeks from acute event)
- Left ventricular ejection fraction is at least 40% prior to hospital discharge
- There is no other disqualifying condition
If not successfully treated by coronary angioplasty, you may recommence driving after four weeks provided there is no other disqualifying condition.
Please discuss this with your Doctor or cardiac rehabilitation nurse prior to leaving hospital.
You do not need to inform the DVLA unless you hold a PSV or HGV licence, but you should inform your insurance company.
HGV/PSV Drivers
If you are a Heavy Goods Vehicle (HGV) or Public Service Vehicle (PSV) driver, you are required to inform the DVLA of your cardiac condition immediately and will be informed not to drive for a period of at least 6 weeks.
DVLA drivers’ medical enquiries
Telephone: 0300 790 6806
Monday to Friday, 8am to 5:30pm
Saturday, 8am to 1pm
You will also need to be re-assessed by undergoing an Exercise Tolerance Test (ETT) before your licence is re-issued. The initial re-application form can be found on the following webpage;
www.
Complete this form and send to DVLA after you are discharged.
By Post: Drivers Medical Group, DVLA, Swansea, SA99 1DF
*Please note: there may be additional forms to complete which vary according to licence type and/or age group. Please contact the DVLA for further advice.
Flying
The British Cardiovascular Society guidelines on flying are as follow:
An Echocardiogram (ECHO) needs to have been performed to establish the heart’s pump function (EF) prior to flying.
- If you have had a heart attack but you are aged up to 65 years, the blocked artery has been opened, the heart pump is not badly damaged, (EF> 45%) and no further tests or treatment are planned you may fly after 7 days.
- If you have had a heart attack, your heart pump is quite good, (EF> 40%) and you are no symptoms of breathlessness or chest pain and no other test or treatments are planned you may fly after 10 days.
- If you have had a heart attack, and the heart pump is significantly damaged, (EF< 40%) and you have symptoms of breathlessness or you are waiting for further test or treatment defer travel until condition stable.
- If you have had uncomplicated elective PCI and the arteries have been treated with a balloon and a stent you can fly after 3 days.
- If you have had uncomplicated elective Coronary Artery Bypass Graft surgery (CABG) time must be allowed for any air in the chest to be absorbed. You can fly after 10 to 14 days if no complications.
If you have travel arrangements already booked, please discuss these with the Cardiologist or Nurse Specialist.
We recommend that you ensure you have adequate travel insurance if travelling abroad.
If you are travelling abroad within 6 weeks of your cardiac event or have pending treatment/investigations, it may prove challenging to obtain comprehensive insurance.
It is important to update your travel insurance company with any new medical conditions +/or pending treatment.
It is also advisable to contact your airline to discuss your flight if planning to fly within 6 weeks of the cardiac event.
Advice can be found on the British Heart Foundation website. www.
Work
The decision about how soon to return to work will depend on your own medical history and the type of employment you undertake. You are advised to take 4 weeks off work, particularly if you have a heavy manual job. It may be advisable to return to work in a staggered manner. You should discuss this with your doctor or the cardiac nurse before you leave the hospital.
Resuming your sex life
There are no strict rules on this – you and your partner can start to have sex again when you both feel ready. Sex is no different from any other form of exercise – if climbing stairs and walking briskly do not cause chest tightness (angina) or breathlessness, it is possible to resume sexual activity 2 – 3 weeks after discharge, unless you have been advised otherwise.
Sexual health is an important part of an individual’s overall physical and emotional well-being. Erectile dysfunction (ED), also known as impotence, is a very common medical condition affecting sexual health.
ED can have a range of causes that can be both physical and mental (psychological). Physical causes include narrowing of the blood vessels going to the penis – commonly associated with high blood pressure and high cholesterol or diabetes. Psychological causes of ED include anxiety and depression. You can find more information about any of the conditions listed in bold type at www.
There are several treatment options that have proved very successful for ED. If you have problems resuming your sex life, it is important to discuss this with your GP or Cardiac Nurse. Ignoring the problem may only worsen it, and it may cause stress in your relationship with your partner.
Further information and advice can be found on the following websites:
(Sexual Advice Association website with links to downloadable booklets on Sex related subjects.)
Reducing Risk Factors
Smoking
Smoking is a major cause of heart disease. It is essential that you stop smoking. Cutting down is not enough; you must stop.
It may not be easy to give up. You will need the support of family and friends. There is also the support of the NHS Stop Smoking Service. Ask the nurses to refer you whilst you are an inpatient; or you can contact them after you are discharged.
Ongoing support and medication can be provided by the local stop smoking services. To access these services, you can:
GO ONLINE
Visit www.
The website also contains lots of useful tips, advice and tools to help you on your smoke free journey.
CALL US
NHS smoking helpline: 0300 123 1044
DOWNLOAD OUR APP
You can download the NHS Smokefree app by visiting the app store.
Help to quit is also available from your GP.
There is not one particular way to give up smoking. Choose the method that suits you best. Stopping now will greatly reduce the risk of you having further heart problems.
Remember: if you are smoke free for 28 days you are five times more likely to quit for good.
Electronic Cigarettes
These products do not contain tobacco and vaporise the nicotine contained within the device.
No carbon monoxide is produced so they are very much safer than smoking (but further testing is needed before they can be considered safe).
Many smokers are finding these unlicensed products helpful at reducing nicotine cravings and they can be a useful alternative to NRT.
High Blood Pressure
In the presence of coronary heart disease (CHD) and/or you have Diabetes; your blood pressure should be no greater than 130/80 mmHg.
Stress
Stress affects us all in our normal lives. In fact, we need a certain level of stress to motivate us. It can stimulate us to do well. However, being under a constant high level of stress can lead to exhaustion and an inability to cope.
It may be this level of fatigue that has an effect on your physical health. Having angina is a stressful event in itself. The feelings of fear and of not being totally in control of the situation are what you may be feeling now. So now is the time to look at your lifestyle and decide how you can relieve the stress in your life.
Methods of coping with stress:
- Take regular exercise
- Learn to relax using relaxation exercises
- Take up leisure pursuits
- Eat a balanced diet
- Learn to say 'no' and not feel guilty about it
- Try to anticipate situations you find stressful
- When you have identified problem areas in your life, try to do something about them
- Discuss your feelings with someone you can trust
Improving Access to Psychological Therapies (IAPT) services provide evidence-based psychological therapies to people with anxiety disorders and depression.
If you live in England and are aged 18 or over, you can access NHS psychological therapies (IAPT) services. A GP can refer you, or you can refer yourself directly without a referral
IAPT services offer:
- Talking therapies, such as cognitive behavioural therapy (CBT), counselling, other therapies, and guided self-help
- Help for common mental health problems, like anxiety and depression
The problems that IAPT services can treat include:
- depression
- generalized anxiety
- social anxiety
- panic and agoraphobia
- other phobias
- obsessive-compulsive disorder (OCD)
- post-traumatic stress disorder (PTSD)
- irritable bowel syndrome (IBS)
- body dysmorphic disorder
Dietary Advice
It is important to adopt a healthy lifestyle, which includes adopting a healthy diet. This is because certain aspects of diet may play a part in the development and progression of heart disease.
Eating healthily should be fun. There is no such thing as a good or bad food; it is important to look at your diet as a whole, and not become obsessed with foods you think are 'good' for you, or to totally avoid foods that you think are 'bad' for you.
Aim to eat a Mediterranean style diet, including more bread, fruit, vegetables and fish but less meat; and replace butter and cheese with products based on plant oils.
Eating oily fish is not routinely recommended for the sole purpose of preventing another heart attack. There is no evidence that eating oily fish causes any harm and fish may form part of a Mediterranean style diet.
There is no evidence of harm if you choose to take omega-3 fatty acid capsules or eat omega-3 fatty acid supplemented foods.
The advice is not to take supplements containing beta-carotene. It is also recommended not to take antioxidant supplements (vitamin E and/or C) or folic acid to reduce cardiovascular risk.
The main points to follow are:
- Maintain an ideal weight for your height
- Cut down on the total amount of fat you eat. Replace saturated (animal) fat with unsaturated fat/oils (vegetable, fish)
- Eat plenty of foods that are rich in starch and fibre - potatoes, rice, bread, cereals
- Moderate your alcohol intake
- Moderate your salt intake
- Eat a variety of foods
- Eat less meat and more fish
Please find additional dietary information on the BDA Food Fact Sheet at the back of this pack.
Lowering Cholesterol
Try to keep your total cholesterol level (TCL) as low as possible. If you have coronary heart disease, aim for a TCL of less than 4mmol/L with a low-density lipoprotein (LDL) under 1.4mmol/L and a high-density lipoprotein (HDL) above 1mmol/L.
Your GP should monitor this and advise on how often they wish to check your levels. If you have just started to take a statin or a cholesterol lowering drug, or if a dose of this drug has been changed, your GP should check your cholesterol levels within one month of this medication change.
Familial Hypercholesterolaemia (FH)
This is an inherited genetic condition that causes the LDL to be very high. If we suspect that your cholesterol results might indicate this, we will discuss a referral to the FH cascade team at Southampton Hospital for further investigation with you.
Controlling weight
Women should aim for a maximum waist measurement of 32 inches and men a maximum waist measurement of 37 inches.
Drinking within sensible limits
The NHS recommends that you keep alcohol intake of 14 units or less per week
- men should not regularly drink more than 3-4 units of alcohol a day
- women should not regularly drink more than 2 – 3 units of alcohol a day. ‘Regularly’ means drinking every day or most days of the week.
Two alcohol free days are recommended per week.
This may vary with your condition and with medications so check ideal intake levels with your GP.
Controlling diabetes
If you are diabetic, aim for a blood sugar level between 4-7mmol/l before meals. Your blood sugar level should also not be more than 10mmol/l after meals. This may vary depending on your condition so check with your GP or diabetic nurse.
Increasing physical activity
We should all aim to do at least 30 minutes of moderate intensity activity on five or more days a week. The cardiac disease risk management exercise classes are designed to help you recognise and improve your exercise capacity and enable you to achieve this target.
GTN use
It is recommended you receive a GTN spray prior to leaving hospital, although for a few patients this may not be suitable. Please check with the team of doctors looking after you regarding this. If you are suitable to carry one, please ensure you keep it on your person at all times.
Should you experience any of the following when you are at home and you are undertaking an activity, follow the CHEST PAIN INSTRUCTIONS ON THE NEXT PAGE:
- Central chest pain or you may experience a heaviness / dull ache / tightness in your chest area. This may radiate to the following areas – arms, neck / throat, across shoulders, jaw.
- Remember the pain in your chest may be similar to indigestion discomfort. It is therefore recommended you follow the advice below.
CHEST PAIN INSTRUCTIONS
- At the onset of pain, Rest for 1-2 minutes, If pain persists take GTN tablet/spray. Rest
- If unrelieved after 5 minutes take further GTN tablet/spray
- If chest pain continues for a further 5 minutes take another GTN spray
- If you have chest pain despite taking 3 does of GTN
CALL 999 IMMEDIATELY
It is recommended you do not phone your GP first as this delays any emergency treatment you may require. If in doubt, don’t wait - phone 999 for an ambulance
Following your discharge home
The Cardiac Nurse specialist will aim to contact you by phone within 3 working days of your discharge. This will give you the opportunity to discuss your recovery and an appointment will be arranged with you to join the Cardiac Disease Risk Management Programme as recommended by your Cardiology Consultant. This has been shown to accelerate physical and psychological recovery and can significantly reduce the risk of problems in the future.
The Cardiac Disease Risk Management Programme includes the following:
- Lifestyle risk factor management:
- Physical activity and exercise
- Diet
- Smoking cessation
- Psychosocial health
- Cardioprotective therapies
- Medical risk factor management
- Long term management
For further information, please contact the Cardiac Disease Risk Management team at
- Frimley Park on 0300 613 6384
- Wexham Park 03006154684
Office Hours: 8.00am – 4.00pm, Monday to Friday
It is recommended you have your cholesterol checked three months following your heart attack. For this, you will need to liaise with your GP practice and when the result is known, ask for it to be written into your record card.
When can I……..?
Following any illness you must allow for a period of recovery no matter how well you may be feeling. Gradually resuming your activities assists your heart in its recovery. Start off gradually and set weekly goals to increase your activities over a 2-6 week period.
Giving Blood
Unfortunately, if you have had a heart attack or been given a diagnosis of coronary artery disease, you are no longer able to donate blood.
Prescription Prepayment Certificate (PPC)
If you will have to pay for four or more prescription items in three months or more than 14 items in 12 months, you may find it cheaper to buy a PPC.
www.
Telephone 0300 330 1341
Flu Vaccination
The Department of Health recommends that individuals with heart disease receive the flu vaccine. It is free if you have heart disease and you should be vaccinated against flu every winter to make sure you are protected against the latest strains of flu. Contact your GP to organize your vaccination.
Sources of Further Information
Heart Smart
A local support group run by cardiac patients for cardiac patients.
Contact Ian Marshell on 07760 485875.
THROB
Cardiac rehabilitation in the Berkshire area is covered by Heatherwood Hospital in Ascot and Wexham Park Hospital in Slough.
www.
HEARTBEATS
West Berkshire Heart support group. A cardiac support group formed from cardiac patients and partners.
www.
Heartbeat Support Woking
Holds a monthly social evening with guest speakers and runs rehabilitation sessions with its sister group 'Bravehearts' at Woking Leisure Centre
www.
Guildford Cardiac Support Group
A non-exercise heart support group offering social activities and professional healthcare. Tel 01403 893097 or website www.
Patients from the Royal Surrey Hospital
Patients from the Royal Surrey will be referred on to the Royal Surrey Cardiac rehabilitation team after discharge. You will be sent an e-mail confirming referral. If you have any queries regarding your referral or rehab at the Royal Surrey, their team can be contacted on 01483 571122 ext 2931.
Should you have any queries regarding your recovery please do not hesitate to contact us.
Office Hours: 8.00am – 4.00pm, Monday to Friday
Contact Details: Cardiac Disease Risk Management
Direct Telephone – 0300 613 6384
There is an answer phone facility available on this number. Please leave a message if we are unable to take your call. We always reply, although on some occasions this may not be on the same day.
Contact us
If you have any queries relating to this information, please contact the Cardiology service.
About this information
Service:
Cardiology
Reference:
C/012
Approval date:
8 July 2025
Review date:
1 July 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.