Heart Attack Recovery: Are My Medical Appointments Important?

You experienced a lot over a short span of a few days whilst admitted in the hospital for a heart attack. These include:

• Going through medical procedures, such as an angioplasty, trans-thoracic echocardiography (TTE) and receiving various medication drips
• Being started on and discharged with new long-term medicines
• Speaking with various doctors, nurses, pharmacists and allied health professionals about your condition, new medications, and lifestyle changes

It is not surprising if you went home feeling a little overwhelmed. Now that you have had some time to yourself, you may have some questions and concerns. The risk of another heart attack is highest in the first month. This is why the first few appointments are extremely important.

Your first “appointment” could take the form of a consultation over the phone or a face-to-face appointment. This is to review how you’ve been progressing in your recovery since discharge. This is also an appropriate time to have your questions or concerns addressed!

Do take some time to write down your questions so that you can obtain the explanations you need.

What to expect at your medical appointments along your road to heart attack recovery

1. Blood tests
   They assist clinicians in picking up health threats and side effects in a timely manner. Blood tests will also give them information on how to adjust your treatment better. Some common examples of blood tests include:
   1. Renal function test (RP: Renal Panel)
      The renal function test checks on your kidney function and the levels of some electrolytes/salt levels in your body. This is important because the contrast dye used during your heart procedure, as well as some of your new medications (e.g. ACE/ARBs, diuretics and SGLT2 inhibitors), may affect your kidney function and potassium levels.
   2. Full Blood Count (FBC)
      Antiplatelets, which are critical following your heart attack and coronary stent insertion, may increase your risk of bleeding. A full blood count checks on your blood cell counts, in particular, the haemoglobin and platelet levels.
   3. Lipid monitoring panel
      Bad cholesterol, also known as LDL-C (Low-Density Lipoprotein Cholesterol), is one of the major causes of another heart attack. This test mainly measures blood cholesterol to monitor the effectiveness of your cholesterol medicines.
2. Glycated Haemoglobin Test (HbA1c)
   If you are diabetic or at risk of diabetes, your clinicians may also prescribe an HbA1c to measure your blood sugar control over the past 3 months and determine the effectiveness of your diabetic medications (if any). High blood sugar is one of the major causes of another heart attack.
3. Blood pressure records
   Your home blood pressure readings are often more accurate than measured in the clinic. A review of your home blood pressure records will help your clinicians better adjust (start, stop or change the dose) your blood pressure medications. High blood pressure is one of the major causes of another heart attack.
4. Heart rate records
   Some of your medications (e.g. beta-blockers such as atenolol, bisoprolol, and carvedilol) may slow your heart rate whilst controlling your blood pressure. A review of your heart rate records ensures that your heart rate is at a range suitable for your heart condition.
5. Physical health
   This includes asking if you are still experiencing any physical discomfort or if you are able to perform certain activities (e.g. walking or climbing the stairs)
6. Medications
   Your pharmacist will be checking on how you have been taking your medications, any side effects or discomforts you have experienced from your medications, and clarify any uncertainties you might have.Your medications may be adjusted based on how you have been taking them at home.
7. Mental health
   Your mood and mental health are just as important as your physical health. Do voice your concerns so that you may be referred to the appropriate help you might need.
8. Smoking
   If you smoke, you might receive guidance on smoking cessation.
9. Diet
   You may be offered a referral to a dietitian for more specific guidance on healthy eating habits.

There would always be a chance of a heart attack recurrence unless you manage all your risk factors well. All appointments or check-ins are critical milestones. So please remember to go for your check-up as scheduled and allow your clinicians to check in and assist you on your road towards recovery!

This article is contributed by Mr Samuel Ho Shan Wei, Senior Pharmacist (Outpatient), Khoo Teck Puat Hospital; and Ms Laurane Lim Hui Shien, Pharmacist, SingHealth Polyclinics.