Every year, thousands of people in Malaysia suffer from heart attacks, with over 15,000 admissions for acute coronary syndrome recorded in the 2020-2021 National Cardiovascular Disease annual report. For survivors, the recovery process can be just as challenging as the initial treatment. While medical reports may show that the treatment has been successful, the emotional and psychological impact of a heart attack can linger, making it difficult for patients to return to their normal lives.
Drs. Yew Kuan Leong and Shathiskumar Govindaraju, cardiologists at Bukit Tinggi Medical Centre Klang, emphasize that heart attack recovery extends beyond medical procedures. It involves adopting a healthier lifestyle, adhering to prescribed medications, and engaging in cardiac rehabilitation both during hospitalization and after discharge.
Recovery doesn’t end when the artery reopens
Recovery varies from person to person, with some patients returning to their usual activities within weeks, while others may need longer. Exercise, driving, travel, and work are gradually reintroduced according to the patient’s condition and physical ability. However, even with a clean medical report, some patients may still experience anxiety and fear about living normally again.
Dr Shathiskumar notes that the gap between doing well and feeling well is common, and that a heart attack can be an emotional shock similar to a traumatic event. This can lead to feelings of fear, sadness, irritability, poor sleep, and a constant awareness of one’s own heartbeat, alongside concerns about the possibility of another heart attack.
These feelings do not mean the patient is weak, but they do matter medically, as significant psychological distress has been linked to poorer cardiovascular outcomes. Dr Shathiskumar emphasizes the importance of addressing these emotional and psychological aspects of recovery, saying, “When I see a patient after a heart attack, I don’t just ask, ‘How is your chest?’ I also want to know, ‘How are you sleeping? How are you feeling? Are you afraid?'”
Anxiety can also make ordinary sensations feel alarming, with patients sometimes worrying that chest discomfort, headaches, or numbness in the hand signal another heart attack. While not every sensation is heart-related, patients should not self-diagnose, and new or worsening chest pain, breathlessness, or fainting should always be medically assessed.
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Anxiety of having another heart attack
Fear of another heart attack is very common, especially soon after discharge. Some caution is healthy, as it keeps patients on their medication and follow-ups. However, when fear stops protecting the patient and starts running their life, it can become a problem. Dr Shathiskumar notes that the key distinction is whether fear is helping the patient protect their heart or preventing them from living their life.
Persistent anxiety can affect sleep, physical activity, medication adherence, and other healthy habits. Warning signs that fear is taking over can include constantly checking one’s pulse, repeatedly seeking reassurance, avoiding exercise, travel, or social activities, or becoming afraid of being alone. Family members can help by not dismissing the fear and offering reassurance based on the patient’s medical assessment.
For patients who are medically cleared but still afraid, Dr Yew‘s advice is simple: “Do not be afraid, but do be patient and take things one step at a time.” Cardiac rehabilitation can play an important role in this process, helping patients improve risk factors, understand their condition, and gradually rebuild confidence in what their body can do. Dr Shathiskumar describes it as one of the most important, yet sometimes underused, parts of recovery.
A common misconception is that angioplasty means the heart disease has been fixed. However, Dr Yew notes that angioplasty only treats the blockage and does not mean coronary artery disease has disappeared. Healthy living, medication, and regular follow-up remain important in slowing its progression and reducing future risk. Treatment today also goes beyond reopening the artery, with protecting heart muscle from permanent damage being another priority.
For selected patients, this may include therapies to support the injured heart muscle. Dr Yew has witnessed a shift over the past decade, with heart disease now being seen in younger patients and in an increasing proportion of women.
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