Controlling your high blood pressure


If your blood pressure is high, you need to lower it and keep it under control. Your blood pressure reading has 2 numbers. One or both of these numbers can be too high.
The top number is called the systolic blood pressure. This reading is too high if it is 140 or higher.
The bottom number is called the diastolic blood pressure. It is too high if it is 90 or higher.
You are more likely to have high blood pressure as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure can lead to stroke, heart attack, heart failure, kidney disease, and early death.
If you have heart or kidney problems, diabetes, or if you had a stroke, your doctor may want your blood pressure to be even lower than people who do not have these conditions.

Medications for Blood Pressure

Many medicines can help you control your blood pressure. Your health care provider will prescribe the best medicine for you. Your health care provider will also monitor your medicines and make changes if you need them.

Diet, Exercise, and Other Lifestyle Changes

In addition to taking medicine, you can do many things to help control your blood pressure.
Limit the amount of sodium (salt) you eat. Aim for less than 1,500 mg per day. Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men.
Eat a heart-healthy diet. Include potassium and fiber, and drink plenty of water. Stay at a healthy body weight. Find a weight-loss program to help you, if you need it.
Exercise regularly -- at least 30 minutes a day of moderate aerobic exercise.
Reduce stress. Try to avoid things that cause you stress. You can also try meditation or yoga.
If you smoke, quit. Find a program that will help you stop.
Your doctor can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian. The dietitian can help you plan a diet that is healthy for you.

Checking Your Blood Pressure

Your doctor may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. It is best to have one with a cuff for your arm and a digital readout. Practice with your health care provider to make sure you are taking your blood pressure correctly.
It is normal for your blood pressure to be different at different times of the day.
It is usually higher when you are at work. It drops slightly when you are at home. It is usually lowest when you are sleeping.
It is normal for your blood pressure to increase suddenly when you wake up. In people with very high blood pressure, this is when they are most at risk for heart attack and stroke.

Follow-up

Your doctor will give you a physical exam and check your blood pressure often. With your doctor, establish a goal for your blood pressure.
If you monitor your blood pressure at home, keep a written record. Bring the results to your clinic visit. Your doctor or nurse may ask you these questions. Having a written record will make them easy to answer:
  • What was your most recent blood pressure reading?
  • What was the blood pressure reading before that one?
  • What is the average systolic (top) number and average diastolic (bottom) number?
  • Has your blood pressure increased recently?

When to Call the Doctor

Call your doctor if your blood pressure goes well above your normal range.
Also call your doctor if you have any of these symptoms:
  • Severe headache
  • Irregular heartbeat or pulse
  • Chest pain
  • Sweating, nausea, or vomiting
  • Shortness of breath
  • Dizziness or lightheadedness
  • Pain or tingling in the neck, jaw, shoulder, or arms
  • Numbness or weakness in your body
  • Fainting
  • Trouble seeing
  • Confusion
  • Difficulty speaking
  • Other side effects that you think might be from your medicine or your blood pressure

Alternate Names

Controlling hypertension

References

Gaziano JM, Ridker PM, Libby P. Primary and secondary prevention of coronary heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Saunders; 2011:chap 49.
Joint National Committee on Detection, Evaluation, and Treatment of Blood Pressure. The seventh report of the joint national committee on detection, evaluation, and treatment of blood pressure. NIH Publication No. 03-5233, May, 2003.
Victor RG. Arterial hypertension. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Saunders; 2011:chap 220.

discharge - Cardiac catheterization






A catheter was inserted into an artery, and then it was carefully guided up to your heart. The catheter was inserted through an artery in your groin or your arm. Once it reached your heart, the catheter was placed into 2 different arteries that deliver blood to your heart. Then contrast dye was injected. The dye allowed your doctor to see any areas in your coronary arteries that were blocked.
If you had a blockage, you may have had angioplasty and a stent placed in your heart during the procedure.

What to Expect at Home

You may feel pain in your groin or arm where the catheter was placed. You may also have some bruising around and below the incision that was made to insert the catheter.

Self-care

In general, people who have angioplasty can walk around within 6 hours after the procedure. Complete recovery takes a week or less. Keep the area where the catheter was inserted dry for 24 - 48 hours. If your arm was used, recovery is usually faster.
If the doctor put the catheter in through your groin:
  • Walking short distances on a flat surface is okay. Limit going up and down stairs to around 2 times a day for the first 2 - 3 days.
  • Do NOT do yard work, drive, squat, lift heavy objects, or play sports for at least 2 days, or for the number of days your doctor tells you to wait.
If the doctor put the catheter in your arm:
  • Do NOT lift anything heavier than 10 pounds (a little more than a gallon of milk).
  • Do NOT do any heavy pushing or pulling.
For a catheter in your groin or arm:
  • Avoid sexual activity for 2 - 5 days. Ask your doctor when it will be okay to start again.
  • You should be able to return to work in 2 - 3 days if strenuous activity is not part of your job.
  • Do NOT take a bath or swim for the first week. You may take showers, but make sure the area where the catheter was inserted does not get wet for the first 24 - 48 hours.
You will need to take care of your incision.
  • Your doctor or nurse will tell you how often to change your dressing.
  • If your incision bleeds, lie down and put pressure on it for 30 minutes.
Many people take aspirin or another medicine -- such as clopidogrel (Plavix), prasugrel (Efient), or ticagrelor (Brilinta) -- after this procedure. These medicines are blood thinners, and they keep your blood from forming clots in your arteries and stent. A blood clot can lead to a heart attack. Take the medicines exactly as your doctor tells you. Do not stop taking them without talking with your doctor first.
You should eat a heart-healthy diet, exercise, and follow a healthy lifestyle. Your doctor can refer you to other health care providers who can help you learn about exercise and healthy foods that will fit into your lifestyle.

When to Call the Doctor

Call your doctor if:
  • There is bleeding at the catheter insertion site that does not stop when you apply pressure.
  • Your arm or leg below where the catheter was inserted changes color, is cool to the touch, or is numb.
  • The small incision for your catheter becomes red or painful, or yellow or green discharge is draining from it.
  • You have chest pain or shortness of breath that does not go away with rest.
  • Your pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 100 to 120 beats a minute).
  • You have dizziness, fainting, or you are very tired.
  • You are coughing up blood or yellow or green mucus
  • You have problems taking any of your heart medicines.
  • You have chills or a fever over 101 °F.

Alternate Names

Catheterization - cardiac - discharge; Heart catheterization - discharge

References

Davidson CJ, Bonow RO. Cardiac catheterization. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 19.
Vandvik PO, Lincoff AM, Gore JM, Gutterman DD, Sonnenberg FA, Alonso-Coello P, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e637S-68S. 

Stroke - discharge



You or your loved one was in the hospital after having a stroke. Stroke happens when blood flow to part of the brain stops. First, you or your loved one received treatment to prevent any further damage to the brain, and to help the heart, lungs, and other important parts of your body.
After you were stable, doctors did testing and treatment to help with recovery from the stroke and prevention of a future stroke. You may have stayed in special units that help people to recover after a stroke.

What to Expect at Home

Because of possible injury to the brain from the stroke, you may notice problems with:
  • Changes in behavior
  • Doing easy tasks
  • Memory
  • Moving one side of the body
  • Muscle spasms
  • Paying attention
  • Sensation or awareness of one part of the body
  • Swallowing
  • Talking or understanding others
  • Thinking
  • Seeing to one side (hemianopia)
You may need help with many daily activities you used to do alone before the stroke.
Depression after stroke is fairly common as you or your loved one learns to live with the changes. It may develop soon after stroke, but symptoms of depression may not be present for up to 2 years after the stroke.
Do not drive your car without your doctor's permission.

Moving Around

Moving around and doing normal tasks may be hard after you or your loved one have a stroke.
Make sure your home is safe. Ask your doctor, therapist, or nurse about making changes in the home to make it easier to do everyday activities.
Learn to make your home safer if your loved one has memory problems from the stroke and could wander away inside the home or away from the home. Find out about what you can do to prevent falls and keep your bathroom safe to use. 
Family and caregivers may need to help with:
  • Exercises to keep your elbows, shoulders, and other joints loose
  • Watching for joint tightening (contractures)
  • Making sure splints are used in the correct way
  • Making sure arms and legs are in a good position when sitting or lying
If you or your loved one is using a wheelchair, follow-up visits to make sure it fits well are important to prevent skin ulcers.
  • Check every day for pressure sores at the heels, ankles, knees, hips, tailbone, and elbows.
  • Change positions in the wheelchair several times per hour during the day to prevent pressure ulcers.
  • If you have problems with spasticity, learn about what makes it worse. You or your caregiver can learn exercise to keep your muscles lose.
  • Learn how to prevent pressure ulcers.

Thinking and Speaking

Tips for making clothing easier to put on and take off are:
  • Do not provide too many choices.
  • Velcro is much easier than buttons and zippers. All buttons and zippers should be in the front of a piece of clothing.
  • Use pullover clothes and slip-on shoes.
People who have had a stroke may have speech or language problems. Tips for talking with your loved one are:
  • Keep distractions and noise down. Move to a quieter room.
  • Give the person plenty of time to answer. After a stroke, it will take them longer to process what has been said.
  • Use simple words and sentences, speaking slowly. Keep your voice lower. Repeat if needed. Use familiar names and places. Tell them when you are going to change the subject. Do not yell or shout.
  • Make eye contact before touching or speaking if possible.
  • Ask questions in a manner that they can be answered with a yes or no. When possible, give clear choices. Use props or visual prompts when possible. Do not give too many options.
When giving someone instructions after a stroke:
  • Break down instructions into small and simple steps.
  • Allow time for them to be understood.
Try using other ways of communicating:
  • You may be able to use pointing or hand gestures or drawings.
  • It may help the person with aphasia and their caregivers to make a book with pictures or words about common topics or people so that they can communicate better.

Bowel Care

Nerves that help your bowels work smoothly can be damaged after a stroke. Have a routine. Once you find a bowel routine that works, stick with it. See also: Daily bowel care program
  • Pick a regular time, such as after a meal or a warm bath, to try to have a bowel movement.
  • Be patient. It may take 15 to 45 minutes to have bowel movements.
  • Try gently rubbing your stomach to help stool move through your colon.
Avoid constipation:
  • Drink more fluids.
  • Stay active or become more active.
  • Eat a diet with lots of fiber.
Ask your doctor about medicines you, or your loved one, are taking that may cause constipation (such as some medicines for depression, pain, bladder control, and muscle spasms).

Medication

Have all of your prescriptions filled before you go home. It is very important that you take your drugs the way your doctor or nurse told you to. Do not take any other drugs, supplements, vitamins, or herbs without asking your doctor about them first.
You may be given one or more of the following drugs. These drugs are meant to control your blood pressure or cholesterol, or keeping your blood from clotting. They may help prevent another stroke:
  • Antiplatelet drugs (aspirin or Clopidogrel) help keep your blood from clotting.
  • Beta blockers or ACE inhibitor medicines may help protect your heart.
  • Diuretics (or water pills), ACE inhibitors, Beta-blockers, and other medications will help control blood pressure.
  • Statins or other drugs that lower your cholesterol.
  • If you have diabetes, control your blood sugar at the level your doctor or nurse recommends.
Do not just stop taking any of these drugs, as well as drugs for your diabetes, high blood pressure, or any other medical problems you may have.
If you are taking a blood thinner, such as warfarin (Coumadin), you may need to have extra blood tests.

Staying Healthy

If you have problems with swallowing, you must learn to follow a special diet that makes eating safer. Ask your doctor what the signs of swallowing problems are. Learn tips to make feeding and swallowing easier and safer. See also: Swallowing problems
Learn more about what you should eat to make your heart and blood vessels healthier.
  • Avoid salty and fatty foods.
  • Stay away from fast food restaurants
Try to limit how much alcohol you drink. Ask your doctor when you may start. Even if you are allowed to drink, limit yourself -- women may have one drink a day and men may have two drinks a day.
Keep up to date with your vaccinations. Get a flu shot every year. Ask your doctor if you need a pneumonia shot.
Do not smoke cigarettes. Ask your doctor for help quitting if you need to. Do not let anybody smoke in your home.
Try to stay away from stressful situations. If you feel stressed all the time or feel very sad and blue, talk with your doctor or nurse.
Many patients who have had a stroke feel sad or depressed at times. Talk to friends or family about this. Ask your doctor about seeing a professional to help you with these feelings.

When to Call the Doctor

Call your doctor if you have:
  • Problems taking drugs for muscle spasms
  • Problems moving your joints (joint contracture)
  • Problems moving around or getting out of your bed or chair
  • Skin sores or redness
  • Pain that is becoming worse
  • Recent falls
  • Choking or coughing when eating
  • Signs of a bladder infection (fever, burning when you urinate, or frequent urination)
Call 911 if the following symptoms develop suddenly or are new:
  • Numbness or weakness of the face, arm, or leg
  • Blurry or decreased vision
  • Not able to speak or understand
  • Dizziness, loss of balance, or falling
  • Severe headache

Alternate Names

Cerebrovascular disease - discharge; CVA - discharge; Cerebral infarction - discharge; Cerebral hemorrhage - discharge; Ischemic stroke - discharge; Stroke - ischemic - discharge; Stroke secondary to atrial fibrillation - discharge; Cardioembolic stroke - discharge; Brain bleeding - discharge; Brain hemorrhage - discharge; Stroke - hemorrhagic - discharge; Hemorrhagic cerebrovascular disease - discharge; Cerebrovascular accident - discharge

References

Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Jan;42(1):227-76. Epub 2010 Oct 21.
Legg L, Drummond A, Leonardi-Bee J, Gladman JR, Corr S, Donkervoort M, et al. Occupational therapy for patients with problems in personal activities of daily living after stroke: systematic review of randomised trials. BMJ. 2007 Nov 3;335(7626):922. Epub 2007 Sep 27. 

Heart bypass surgery - minimally invasive - discharge 2




You had minimally invasive coronary artery bypass surgery on 1 or more of your coronary arteries. Your doctor used an artery from your chest to create a detour, or bypass, around arteries that were blocked and could not bring blood to your heart. A 3- to 5-inch-long incision (cut) was made in the left part of your chest between your ribs. This allowed your doctor to reach your heart.

What to Expect at Home

You may be able to leave the hospital 2 or 3 days after surgery. You may also be able to return to normal activities after 2 or 3 weeks.
After surgery, it is normal to:
  • Feel tired
  • Have some shortness of breath. This may be worse if you also have lung problems. Some patients may use oxygen when they go home.
  • Have pain in the chest area around the wound

Self-care

You may want to have someone stay with you in your home for the first week.
Learn how to check your pulse, and check it every day. Do the breathing exercises you learned in the hospital for the first 1 - 2 weeks.
Weigh yourself every day. Shower every day, washing your incision gently with soap and water. Do NOT swim, soak in a hot tub, or take baths until your incision is completely healed. Follow a heart-healthy diet.
If you are feeling depressed, talk with your family and friends. Ask your doctor about getting help from a counselor.
Continue to take all your medicines for your heart, diabetes, high blood pressure, or any other conditions you have.
  • Do not stop taking any medicine without talking with your doctor or nurse first.
  • Your doctor may recommend antiplatelet drugs (blood thinners) -- such as aspirin, clopidogrel (Plavix), prasugrel (Efient), or ticagrelor (Brilinta) -- to help keep your artery graft open.
  • If you are taking a blood thinner, such as warfarin (Coumadin), you may have extra blood tests to make sure your dose is correct.
Know how to respond to angina symptoms.

Activity

Stay active during your recovery, but be sure to start slowly. Ask your doctor how active you should be.
  • Walking is a good exercise after surgery. Don't be concerned about how fast you are walking. Take it slow.
  • Climbing stairs is okay, but be careful. Balance may be a problem. Rest halfway up the stairs if you need to.
  • Light household chores, such as setting the table, folding clothes, walking, and climbing stairs, should be okay.
  • Slowly increase the amount and intensity of your activities over the first 3 months.
  • Do not exercise outside when it is too cold or too hot.
  • Stop if you feel short of breath, dizzy, or any pain in your chest. You should avoid any activity or exercise that causes pulling or pain across your chest, such as using a rowing machine or weight lifting.
  • Keep your incision area protected from the sun to avoid sunburn.
Be careful how you use your arms and upper body when you move around for the first 2 or 3 weeks after your surgery. Ask your doctor when you may return to work. For the first week after surgery:
  • Do NOT reach backwards
  • Do NOT let anyone pull on your arms for any reason -- for instance, if they are helping you move around or get out of bed.
  • Do NOT lift anything heavier than about 10 pounds (a little more than a gallon of milk).
  • Avoid other activities in which you need to keep your arms above your shoulders for any period of time.
  • Do NOT drive. The twisting involved in turning the steering wheel may pull on your incision.
You may be referred to a cardiac rehabilitation program, where you will receive information and counseling about activity, diet, and exercise.

When to Call the Doctor

Call your doctor if:
  • You have chest pain or shortness of breath does not go away when you rest.
  • Your pulse feels irregular -- it is very slow (fewer than 60 beats a minute) or very fast (over 100 to 120 beats a minute).
  • You have dizziness, fainting, or you are very tired.
  • You have a severe headache that does not go away.
  • You have a cough that does not go away.
  • You are coughing up blood or yellow or green mucus.
  • You have problems taking any of your heart medicines.
  • Your weight goes up by more than 2 pounds in a day for 2 days in a row.
  • Your wound is red or swelling, it has opened, or there is more drainage coming from it.
  • You have chills or a fever over 101 °.

Alternate Names

Minimally invasive direct coronary artery bypass - discharge; MIDCAB - discharge; Robot assisted coronary artery bypass - discharge; RACAB - discharge; Keyhole heart surgery - discharge

References

Aziz O, Rao C, Panesar SS, Jones C, Morris S, Darzi A, et al. Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ. 2007;334:617.
Vandvik PO, Lincoff AM, Gore JM, Gutterman DD, Sonnenberg FA, Alonso-Coello P, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e637S-68S. 
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4;116(23):2762-72. Epub 2007 Nov 12.
Gopaldas RR, Chu D, Bakaeen FG. Coronary insufficiency In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 60.

Being active after your heart attack




You had a heart attack and were in the hospital. You may have had angioplasty and a stent placed in an artery to open a blocked artery in your heart.

What to Expect at Home

While you were in the hospital, you should have learned:
  • How to take your pulse
  • How to recognize your angina symptoms and what to do when they happen.
  • How to care for yourself at home after a heart attack
Your doctor may recommend a cardiac rehabilitation program to you. This program will help you learn what foods to eat and exercises to do to stay healthy. Eating well and exercising will help you start feeling healthy again.

Getting Started with Your Exercise

Before starting to exercise, your doctor may have you do an exercise test and should give you exercise recommendations an exercise plan. This may happen before you leave the hospital or soon afterward. Do not change your exercise plan before talking with your doctor or nurse first.
Take it easy at first:
  • Walking is the best activity when you start exercising.
  • Walk on flat ground for a few weeks at first.
  • You can try bike riding after a few weeks. Walk your bike up any hills, or ride a stationary bike in an easy gear.
  • If it is windy, walk or bike with the breeze behind you.
  • Do not walk outside if it is very cold or very hot. Go to a shopping mall and do your walking inside.
Slowly increase how long you exercise at any 1 time. If you are up to it, repeat the activity 2 or 3 times during the day. You may want to try this very easy exercise schedule (but ask your doctor first):
  • Week 1: about 5 minutes at a time
  • Week 2: about 10 minutes at a time
  • Week 3: about 15 minutes at a time
  • Week 4: about 20 minutes at a time
  • Week 5: about 25 minutes at a time
  • Week 6: about 30 minutes at a time
After 6 weeks, you may be able to start swimming, but stay out of very cold or very hot water. You can also begin playing golf. Start easily with just hitting balls. Add to your golfing slowly, playing just a few holes at a time. Avoid golfing in very hot or cold weather.

Household Activities

You can do some things around the house to stay active, but always ask your doctor or nurse first. Avoid a lot of activity on days that are very hot or cold.
You may be able to cook light meals by the end of your first week. You can wash dishes or set the table if you feel up to it.
By the end of the second week you may start doing very light housework, such as making your bed. Go slowly.
After 4 weeks, you may be able to:
  • Iron -- start with only 5 or 10 minutes at a time
  • Shop, but do not carry heavy bags or walk too far
  • Do short periods of light yard work
By 6 weeks, your doctor may allow you to do more activities, such as heavier housework and exercise, but be careful.
  • Try not to lift or carry anything that is heavy, such as a vacuum cleaner or a pail of water.
  • If any activities cause chest pain, shortness of breath, or any of the symptoms that you had before or during your heart attack, stop doing them right away. Tell your doctor or nurse.

When to Call the Doctor

Call your doctor if you feel:
  • Pain, pressure, tightness, or heaviness in the chest, arm, neck, or jaw
  • Shortness of breath
  • Gas pains or indigestion
  • Numbness in your arms
  • Sweaty, or if you lose color
  • Lightheaded
Also call your doctor if you have angina and it:
  • Becomes stronger
  • Occurs more often
  • Lasts longer
  • Occurs when you are not active
  • If drugs no longer help ease your angina symptoms as well as they did
These changes may mean your heart disease is getting worse.

Alternate Names

Heart attack - activity

References

Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol. 2007 Aug 14;50(7):e1-e157.
Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008 Jan 15;117(2):296-329. Epub 2007 Dec 10.
Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011 Nov 29;58(23):2432-46. Epub 2011 Nov 3.
Antman EM and Morrow DA. ST-Elevation myocardialinfarction: management. In Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald'sHeart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Saunders; 2011:chap 55.
Cannon CP and Braunwald E. Unstable angina and non-ST elevation myocardial infarction. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald'sHeart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Saunders; 2011:chap 56.  

Controlling your high blood pressure




If your blood pressure is high, you need to lower it and keep it under control. Your blood pressure reading has 2 numbers. One or both of these numbers can be too high.
The top number is called the systolic blood pressure. This reading is too high if it is 140 or higher.
The bottom number is called the diastolic blood pressure. It is too high if it is 90 or higher.
You are more likely to have high blood pressure as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure can lead to stroke, heart attack, heart failure, kidney disease, and early death. If you have heart or kidney problems, diabetes, or if you had a stroke, your doctor may want your blood pressure to be even lower than people who do not have these conditions.

Medications for Blood Pressure

Many medicines can help you control your blood pressure. Your health care provider will prescribe the best medicine for you. Your health care provider will also monitor your medicines and make changes if you need them.

Diet, Exercise, and Other Lifestyle Changes

In addition to taking medicine, you can do many things to help control your blood pressure.
Limit the amount of sodium (salt) you eat. Aim for less than 1,500 mg per day. Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men.
Eat a heart-healthy diet. Include potassium and fiber, and drink plenty of water. Stay at a healthy body weight. Find a weight-loss program to help you, if you need it.
Exercise regularly -- at least 30 minutes a day of moderate aerobic exercise.
Reduce stress. Try to avoid things that cause you stress. You can also try meditation or yoga.
If you smoke, quit. Find a program that will help you stop.
Your doctor can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian. The dietitian can help you plan a diet that is healthy for you.

Checking Your Blood Pressure

Your doctor may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. It is best to have one with a cuff for your arm and a digital readout. Practice with your health care provider to make sure you are taking your blood pressure correctly.
It is normal for your blood pressure to be different at different times of the day.
It is usually higher when you are at work. It drops slightly when you are at home. It is usually lowest when you are sleeping.
It is normal for your blood pressure to increase suddenly when you wake up. In people with very high blood pressure, this is when they are most at risk for heart attack and stroke.

Follow-up

Your doctor will give you a physical exam and check your blood pressure often. With your doctor, establish a goal for your blood pressure.
If you monitor your blood pressure at home, keep a written record. Bring the results to your clinic visit. Your doctor or nurse may ask you these questions. Having a written record will make them easy to answer:
  • What was your most recent blood pressure reading?
  • What was the blood pressure reading before that one?
  • What is the average systolic (top) number and average diastolic (bottom) number?
  • Has your blood pressure increased recently?

When to Call the Doctor

Call your doctor if your blood pressure goes well above your normal range.
Also call your doctor if you have any of these symptoms:
  • Severe headache
  • Irregular heartbeat or pulse
  • Chest pain
  • Sweating, nausea, or vomiting
  • Shortness of breath
  • Dizziness or lightheadedness
  • Pain or tingling in the neck, jaw, shoulder, or arms
  • Numbness or weakness in your body
  • Fainting
  • Trouble seeing
  • Confusion
  • Difficulty speaking
  • Other side effects that you think might be from your medicine or your blood pressure

Alternate Names

Controlling hypertension

References

Gaziano JM, Ridker PM, Libby P. Primary and secondary prevention of coronary heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Saunders; 2011:chap 49.
Joint National Committee on Detection, Evaluation, and Treatment of Blood Pressure. The seventh report of the joint national committee on detection, evaluation, and treatment of blood pressure. NIH Publication No. 03-5233, May, 2003.
Victor RG. Arterial hypertension. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Saunders; 2011:chap 220.

Being active when you have heart disease




Getting regular exercise when you have heart disease is important.
Exercise can make your heart muscle stronger. It may also help you be more active without chest pain or other symptoms.
Exercise may help lower your blood pressure and cholesterol. If you have diabetes, it can help you control your blood sugar.
Regular exercise can help you lose weight. You will also feel better.
Exercise will also help keep your bones strong.
Always talk with your doctor before starting an exercise program. You need to make sure the exercise you would like to do is safe for you. This is especially important if:
  • You recently had a heart attack.
  • You have been having chest pain or pressure, or shortness of breath.
  • You have diabetes.
  • You recently had a heart procedure or heart surgery.

Types of Exercise You Can Do

Your doctor will tell you what exercise is best for you. Talk with your doctor before you start a new exercise program. Also talk with your doctor before you do a harder activity.
Aerobic activity uses your heart and lungs for a long period of time. It also helps your heart use oxygen better and improves blood flow. You want to make your heart work a little harder every time, but not too hard.
Start slowly. Choose an aerobic activity such as walking, swimming, light jogging, or biking. Do this at least 3 - 4 times a week.
Always do 5 minutes of stretching or moving around to warm up your muscles and heart before exercising. Always allow time to cool down after you exercise. Do the same activity but at a slower pace.
Take rest periods before you get too tired. If you feel tired or have any heart symptoms, stop. Wear comfortable clothing for the exercise you are doing.
During hot weather, exercise in the morning or evening. Be careful not to wear too many layers of clothes. You can also go to an indoor shopping mall to walk.
When it is cold, cover your nose and mouth when exercising outside. Go to an indoor shopping mall if it is too cold or snowy to exercise outside. Ask your doctor if it is okay for you to exercise when it is below freezing.
Resistance weight training may improve your strength and help your muscles work together better. This can make it easier to do daily activities. These exercises are good for you. But keep in mind they do not help your heart like aerobic exercise does.
Check out your weight-training routine with your doctor first. Go easy, and do not strain too hard. It is better to do lighter sets of exercise when you have heart disease than to work out too hard.
You may need advice from a physical therapist or trainer. Either one can show you how to do exercises the right way. Make sure you breathe steadily and switch between upper and lower body work. Rest often.
You may be eligible for a formal cardiac rehabilitation program. Ask your doctor if you can have a referral.

Pace Yourself and Know Your Limits

If your exercise puts too much strain on your heart, you may have pain and other symptoms, such as:
  • Dizziness or lightheadedness
  • Chest pain
  • Irregular heart beat or pulse
  • Shortness of breath
  • Nausea
It is important that you pay attention to these warning signs. Stop what you are doing. Rest
Know how to treat your heart symptoms if they happen.
Always carry some nitroglycerin pills with you.
If you have symptoms, write down what you were doing and the time of day. Share this with your doctor. If these symptoms are very bad or do not go away when you stop your activity, let your doctor know right away. Your doctor can give you advice at your regular medical appointments about exercise.
Know your resting pulse rate. Also know a safe exercising pulse rate. Try taking your pulse during exercise. This way, you can see if your heart is beating at a safe exercise rate. If it is too high, slow down. Then, take it again after exercise to see if it comes back to normal within about 10 minutes.
You can take your pulse in the wrist area below the base of your thumb. Use your index and third fingers of the opposite hand to locate your pulse and count the number of beats per minute.
Drink plenty of water. Take frequent breaks during exercise or other strenuous activities.

When to Call the Doctor

Call your doctor if you feel:
  • Pain, pressure, tightness, or heaviness in the chest, arm, neck, or jaw
  • Shortness of breath
  • Gas pains or indigestion
  • Numbness in your arms
  • Sweaty, or if you lose color
  • Lightheaded
Changes in your angina may mean your heart disease is getting worse. Call your doctor if your angina:
  • Becomes stronger
  • Occurs more often
  • Lasts longer
  • Occurs when you are not active or when you are resting
  • Does not get better when you take your medicine
Also call your doctor if you cannot exercise as much as you are used to being able to.

Alternate Names

Heart disease - activity

References

Briffa T, Maiorana A, Sheerin N, et al. Physical activity for people with cardiovascular disease: Recommendations of the National Heart Foundation of Australia. The Medical Journal of Australia. 2006; 184 (2): 71-75.
Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4;116(23):2762-72. Epub 2007 Nov 12.
Gaziano JM,Manson, JE, Ridker PM. Primary and secondary prevention of coronary heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007:chap 45.  
Vandvik PO, Lincoff AM, Gore JM, Gutterman DD, Sonnenberg FA, Alonso-Coello P, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e637S-68S.
Gaziano M, Ridker PM, Libby P. Primary and secondary prevention of coronary heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Saunders; 2011:chap 49.
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