My Heart My Life 3rd Edition : simplebooklet.com

Contents My heart 2 3 4 5 10 11 14 1 How your heart works Coronary arteries Coronary heart disease What is a heart attack Cardiac arrest and CPR What is angina What causes coronary heart disease In hospital 17 19 Common medical tests 23 Common medical procedures 27 Medicines 35 Cardiac rehabilitation 38 Managing your emotions 40 Leaving hospital My recovery 46 47 47 48 48 49 53 55 57 59 62 66 70 45 Set goals and priorities for your health See your doctor regularly Care for your wounds Take your medicines Attend your cardiac rehabilitation Getting back to normal Eat healthy foods What about fat What about salt How to make healthier meals How to choose healthy food and drinks Healthy eating and drinking ideas Be physically active heartfoundation org au Helpline 13 11 12

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76 Be a healthy weight 80 Quit smoking 83 Manage diabetes 85 Manage high blood pressure 89 Manage cholesterol 91 Alcohol 94 Manage your emotional and social life Services and support 101 102 Important phone numbers 104 Money insurance and other support 106 Cardiac rehabilitation service providers 107 Heart Foundation Walking 108 Your help can save more lives Take action 111 112 My coronary arteries 113 My recovery 114 Which risk factors can I change to improve my health 115 My risk factor readings 116 Nutrition action plan 120 Physical activity action plan 122 Healthy weight action plan 124 Smoking action plan 126 Diabetes action plan 128 Blood pressure action plan 130 Cholesterol and triglycerides action plan 132 Alcohol action plan 134 Psychological and social health action plan 137 Will you recognise your heart attack 139 CPR My heart my life Heart Foundation

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Foreword Recovering after a heart attack or heart surgery can be a daunting experience for you and your family The Heart Foundation has developed My heart my life to help you understand and better manage your heart health My heart my life is a wonderful resource that will help make your journey to recovery as easy as possible for you and your family It provides practical advice and important information such as how your heart works what to expect while in hospital steps you can take to keep your heart healthy and the support services that are available to you and your family With this booklet you will be able to manage your heart health by taking simple steps to change your lifestyle including changes to your food physical activity and getting back to work Adj Prof John G Kelly AM Chief Executive Officer National National Heart Foundation of Australia The information in this booklet supports the advice and guidance from your cardiologist general practitioner and other health professionals who have been supporting you in your recovery If you have any questions please call the Heart Foundation s Helpline on 13 11 12 or visit www heartfoundation org au aftermyheartattack for more information and support I wish you all the very best with your recovery and for continued good health for many years to come heartfoundation org au Helpline 13 11 12 i

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We re here to help The Heart Foundation leads the fight against heart disease Our mission is to prevent heart disease and improve the heart health and quality of life of all Australians through our work in prevention support and research For close to 60 years we have been dedicated to saving lives by making a difference to the heart health of all Australians Community donations help us to fund vital research develop guidelines for health professionals support patient care and help Australians to live healthier lifestyles There is much more to do and we are determined to save as many lives as we can Our work has helped to reduce the number of deaths from cardiovascular disease But the disease remains one of Australia s most devastating health problems It claims a life almost every 12 minutes 29 of all deaths in 2015 One in six Australians or an estimated 4 2 million people reported a long term cardiovascular disease condition in 2015 Get free information and support from the Heart Foundation Helpline 13 11 12 Our three health aims are Prevention to reduce the prevalence and impact of risk factors for heart disease Support and Care to improve the health outcomes for Australians with heart disease HFN0922_JUN17 Research to fund the highest impact research in heart disease heartfoundation org au Helpline 13 11 12 iii

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This booklet will help you and your family or carer understand more about your heart condition and what you will need to do when you leave hospital It gives you information about what has happened to your heart first steps for recovering how to make lifestyle changes to reduce your risk of more heart problems You can play an active part in planning your recovery and improving your long term health by building a strong relationship with your health professionals asking questions having your say working with your doctor to develop a plan for your recovery that is right for you You can find more information about everything in this booklet on our website www heartfoundation org au aftermyheartattack There s also information to support your family and carers iv My heart my life Heart Foundation

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This booklet belongs to My telephone number My cardiac rehabilitation program My doctor My doctor s telephone number Emergency number Triple Zero 000 Get free personalised information and support from the Heart Foundation Helpline Translating and interpreting service also available Call 13 11 12 or email health heartfoundation org au This booklet is based on M y heart my life originally developed by the Heart Foundation s WA office with contributions from local healthcare providers M anaging my heart health developed by the Heart Foundation s NSW office

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How your heart works Your heart is a muscle that pumps blood to all parts of your body The blood gives your body the oxygen and nourishment it needs to work properly The heart has two sides left and right separated by a muscular wall There is an upper and lower chamber on each side connected by valves that direct the flow of blood The smaller upper chambers are known as the atria and the larger lower chambers are the ventricles The pumping of the heart is controlled by special fibres that conduct electrical signals to the various chambers The right side of the heart pumps the blood to the lungs where it receives oxygen Blood enters the left side of the heart from the lungs and the heart pumps the oxygen rich blood around the body Your heart Aorta oxygenated blood Superior vena cava deoxygenated blood Pulmonary arteries Pulmonary veins Left atrium Right atrium Pulmonary valve Aortic valve Tricuspid valve Mitral valve Right ventricle Left ventricle Inferior vena cava deoxygenated blood 2 My heart my life Heart Foundation

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Coronary heart disease Coronary heart disease affects many people It s a chronic condition that means it is long term Coronary heart disease happens when fatty material builds up in your arteries This makes them narrower The fatty material is called plaque Plaque builds up slowly and this process is called atherosclerosis It can start when you are young and be well advanced by middle age Stable plaque is generally not harmful but if it narrows the arteries too much it can cause angina see page 11 Unstable plaque has more fat a thin cap and is inflamed It does not have to be associated with severe narrowing of the artery Unstable plaque can develop a crack on the surface exposing the contents of the plaque to the blood Blood cells try to seal the gap in the surface with a blood clot The blood clot partially or completely blocks the artery If a blood clot forms in a narrow artery and blocks the blood supply to part of your heart it can cause a heart attack While atherosclerosis develops slowly over decades the major consequences can appear to be sudden Some people may not know they have coronary heart disease until they have a heart attack 4 My heart my life Heart Foundation

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What is a heart attack You might hear health professionals use other names for a heart attack It s sometimes called myocardial infarction or MI acute myocardial infarction or AMI coronary occlusion or coronary thrombosis A heart attack happens when there is a sudden complete blockage of an artery that supplies blood to an area of your heart The usual cause of a heart attack is coronary heart disease where plaque has built up in your arteries see page 4 Some people may not know they have coronary heart disease until they have a heart attack This process begins early in life and continues over many years A heart attack usually begins when an area of plaque cracks leading to a blood clot forming This clot can stop the blood reaching your heart causing areas of the heart muscle to die Without early medical treatment the damage to your heart can be permanent and could cause death Learn the warning signs of a heart attack so you recognise them see the action plan at the back of this book A heart attack is an emergency call Triple Zero 000 immediately Heart attack Plaque builds up The fibrous cap of the plaque ruptures A blood clot forms blocking the artery heartfoundation org au Helpline 13 11 12 5

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The warning signs of a heart attack The most common warning signs of a heart attack are outlined here You may have just one of these symptoms or a combination of them Symptoms can come on suddenly or develop over minutes and get progressively worse If you have had one heart attack you are at higher risk of having another heart attack But the symptoms may be different Y ou may feel pain pressure heaviness tightness In one or more of your chest neck jaw arm s back shoulder s 6 Chest Arm s Back Jaw Neck Shoulder s My heart my life Heart Foundation

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If you experience the warning signs of heart attack 1 STOP what you are doing and rest 2 TALK if someone is with you tell them how you are feeling ALL Triple Zero 000 and ask for an 3 C ambulance Acting quickly can reduce the damage to your heart muscle and increase your chance of survival Chew 300mg aspirin unless you have an allergy to aspirin or your doctor has told you not to take it Be prepared Learn the warning signs and keep your action plan in a handy place so you can refer to it if and when you need it See page 137 for details A heart attack is an emergency Call Triple Zero 000 immediately With a heart attack every minute counts Too many people die because they take too long to call Triple Zero 000 for an ambulance Getting to hospital quickly can reduce the damage to your heart muscle and increase your chance of survival Treatment you will receive in hospital will help reduce this damage 8 My heart my life Heart Foundation

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Call Triple Zero 000 to get an ambulance fast be treated as soon as possible get advice on what to do while the ambulance comes Ambulances have special lifesaving equipment to begin to treat a heart attack on the spot You can get immediate medical help The ambulance is the safest and fastest way to get you to hospital Driving yourself or being driven can be dangerous for both you and other people on the road Even if you are unsure it is always better to call Triple Zero 000 for an ambulance and be told it s not a heart attack than to wait until it is too late heartfoundation org au Helpline 13 11 12 9

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Cardiac arrest and CPR A cardiac arrest may be caused by a heart attack A cardiac arrest occurs when your heart suddenly stops beating A person in cardiac arrest will be unresponsive not breathing normally and not moving They need an immediate response You should begin cardiopulmonary resuscitation CPR straight away and continue until an ambulance arrives If an automated external defibrillator AED is available turn on the AED s power You ll hear voice prompts and may see prompts on a screen follow these instructions AEDs are user friendly devices that untrained bystanders can use to save a life Remember DRSABCD Before starting CPR remember DRSABCD D check for danger R check for responsiveness S send for help A open airway B check breathing C start CPR D attach defibrillator Knowing CPR can help save a life maybe the life of someone close to you Everyone should learn this lifesaving skill Contact our Heart Foundation Helpline on 13 11 12 for information on CPR courses in Australia See the CPR chart at the back of this book 10 My heart my life Heart Foundation

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What is angina Angina is temporary pain or discomfort that happens when your heart can t get enough blood and oxygen If angina symptoms continue for more than 10 minutes are severe or get worse call Triple Zero 000 Angina is a symptom of coronary heart disease It is important that you visit your doctor and get appropriate treatment What causes angina In most cases angina is caused by plaque narrowing your coronary arteries Blood flow is reduced and less blood and oxygen gets to your heart Angina does not happen all the time The reduced blood supply can still keep up with your heart s needs most of the time Angina usually happens during exertion severe emotional stress or after a heavy meal That s because the heart is demanding more blood oxygen than the narrowed coronary arteries can deliver Angina is not the same as a heart attack as there is generally no permanent muscle damage The pain usually fades away with rest If angina comes on at rest when it has always been associated with activity in the past this is a sign that the problem is progressing and you should seek medical attention What are the symptoms of angina Angina causes pain or discomfort that usually feels tight gripping or squeezing It can vary from mild to severe You may feel angina in the centre of your chest It may spread to your back neck jaw shoulder s arm s or hand s Or you may feel it in other areas of heartfoundation org au Helpline 13 11 12 11

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your body You may not even have pain but instead get an unpleasant sensation or discomfort in your chest or feel short of breath Angina can affect people in different ways People can experience different symptoms at different times You may get it early in the morning only or you may get it when you are resting or even sleeping Some people get it in cold weather after a heavy meal or after physical activity Managing angina symptoms If you need angina medicine your doctor will prescribe a nitrate spray or tablet Angina symptoms usually stop in a couple of minutes if you rest and take your angina medicine If they don t stop in 10 minutes you should call Triple Zero 000 because you may be having a heart attack See the checklist What to do if you have angina for the steps when you get symptoms If you know when you might get angina you can use your nitrate medicine before those times However talk with your doctor about this first It can be difficult to tell the difference between angina and heart attack warning signs because the symptoms can feel similar Talk to your doctor if your angina becomes more severe happens more often lasts longer doesn t respond as well to medicine happens with less exertion happens at night or when you are resting 12 My heart my life Heart Foundation

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C hecklist What to do if you have angina 1 As soon as you feel angina symptoms immediately stop and rest If your angina comes on predictably with a particular activity for example walking up a steep flight of stairs it is reasonable to take your medicine beforehand as a preventative measure 2 If rest alone does not relieve the symptoms take a dose of your angina medicine Sit or lie down before using your spray or tablet because it can make you feel dizzy Use the smallest dose you normally take e g a full a half or even a quarter of a tablet S pray one spray under the tongue will relieve angina quickly in most people Tablets place a tablet under your tongue do not swallow it When your angina symptoms stop spit out what is left of the tablet 3 Wait 5 minutes If the angina is not relieved take another dose of your angina medicine 4 Wait another 5 minutes 5 Talk if someone is with you tell them how you are feeling or call a relative or friend 6 Call Triple Zero 000 if the angina is not completely relieved within the 10 minutes you have waited or is severe or gets worse quickly Ask for an ambulance Don t hang up Wait for advice from the operator heartfoundation org au Helpline 13 11 12 13

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What causes coronary heart disease Heart attacks and angina are both outcomes of coronary heart disease There is no single cause for coronary heart disease but there are risk factors that increase your chance of getting it The more risk factors you have the more likely you are to have a heart attack Risk factors that you can t change include getting older being male having a family history of coronary heart disease being a post menopausal woman The risk factors that you can change include unhealthy eating see pages 53 68 being physically inactive see pages 70 74 being overweight or obese see pages 76 79 smoking either being a smoker or inhaling other people s smoke passive smoking see pages 80 82 diabetes see pages 83 84 high blood pressure see pages 85 88 high cholesterol see pages 89 90 not having quality social support see pages 94 99 14 My heart my life Heart Foundation

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A lot can happen in hospital and you may feel shocked confused emotional or even angry It can be hard to remember everything you are told Ask your health professionals to explain things you re not sure about Checklist Questions to ask your health professionals while you re in hospital Can you explain what has happened to me How long do I have to stay in hospital How long will it take me to recover What tests will I need to have Will I have any procedures or surgery What medicines will I have to take Are there any risks associated with my treatment What can I do to help improve my recovery How can I access a cardiac rehabilitation program 18 My heart my life Heart Foundation

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Common medical tests Some of the common tests are explained below You may have already had these tests in the emergency department or on your way to hospital Tests involving physical activity are generally done after you have been discharged from hospital Blood tests When your heart muscle has been damaged as in a heart attack your body releases substances in your blood Blood tests can measure the levels of these substances and show if and how much of your heart muscle has been damaged The most common test after a heart attack checks levels of troponin in your blood Your doctor may order medical tests to help find out what your heart condition is and the best way to treat it Ask your doctor if you re not sure about any tests Blood tests are also done to measure the level of other substances in your blood such as blood fats e g cholesterol and triglycerides and minerals Your blood sample is taken from a vein in your arm A laboratory then tests it and sends the results to your doctor who will explain the results to you Electrocardiogram ECG An ECG reads your heart s electrical impulses Small sticky dots and wire leads are put on your chest arms and legs The leads are attached to an ECG machine which records the electrical impulses and prints them out on paper Your doctor may use an ECG to diagnose a heart attack or abnormal heart rhythms called arrhythmias Electrocardiogram ECG heartfoundation org au Helpline 13 11 12 19

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Exercise stress test A stress test sometimes called a treadmill or an exercise test is a type of ECG that is done while you are exercising It helps your doctor to find out how well your heart works when you are physically active This will usually be done after you leave hospital Echocardiogram ultrasound Exercise stress test An echocardiogram is a common test It gives a picture of your heart using ultrasound It uses a probe either on your chest or sometimes can be done down your oesophagus throat It helps your doctor check if there are any problems with your heart s valves and chambers and see how strongly your heart pumps blood An echocardiogram performed before and after exercise is also used to detect areas of the heart where the blood supply through the coronary arteries to the heart muscle is reduced Nuclear cardiac stress test This test is sometimes called an exercise thallium scan a dual isotope treadmill or an exercise nuclear scan A tiny dose of a radioactive substance called a tracer is injected into your bloodstream It goes to your heart and releases energy Special cameras take a picture of this energy from outside your body Your doctor uses this picture to see how much blood flows to your heart muscle and how well your heart pumps blood when you are resting and doing physical activity This test also helps your doctor to see if your heart muscle is damaged 20 My heart my life Heart Foundation

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Coronary angiogram A coronary angiogram may be done during or after a heart attack or angina It s sometimes called cardiac catheterisation A catheter a small tube is put into an artery in your groin arm or wrist under local anaesthetic The catheter is moved up inside the artery until it reaches your heart You will not feel this A special dye is injected into your coronary arteries and an X ray is taken It will make you feel hot and flushed for a few seconds The X ray shows your doctor where and how much your coronary arteries are narrowed It also shows how well your heart is pumping Coronary angiogram Coronary angiograms help your doctor decide the best treatment for you Sometimes it is best to go straight on to coronary angioplasty see page 23 while you are in the laboratory having a coronary angiogram and the tubes are in place The cardiologist will discuss this option with you before the procedure and it is your choice whether to proceed Visit heartfoundation org au aftermyheartattack for more information heartfoundation org au Helpline 13 11 12 21

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Magnetic resonance imaging MRI An MRI uses very strong magnets and radio waves to create detailed images of your heart on a computer It can take still or moving pictures of your heart It does not involve radiation and the main thing you will notice is a drumming noise while the scanning is being done Sometimes a special dye is used to make parts of the heart and coronary arteries easier to see This test shows your doctor the structure of your heart and how well it is working so they can decide the best treatment for you Coronary computed tomography angiogram CCTA This is a type of computed tomography CT scan that can help diagnose coronary artery disease It gives a three dimensional image of the heart chambers and coronary arteries supplying blood to the heart A CCTA is a non invasive test for people who may be experiencing unusual cardiac symptoms Calcium scoring Your doctor might also arrange a scan that provides a coronary artery calcium score This is a measurement of the amount of calcium in the walls of the arteries that supply the heart muscle using a computed tomography CT scan of the heart It shows the amount of hardening of the artery wall atherosclerosis 22 My heart my life Heart Foundation

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Common medical procedures Some common procedures and treatments are explained below Coronary angioplasty and stent implantation This is a procedure to open a narrowing in your artery It improves blood flow to your heart The cardiologist inserts a small deflated balloon through a main artery in your groin or wrist and moves it to the heart s artery using an X ray machine to see what they are doing Once your doctor knows what your heart condition is he or she will then decide what treatments or procedures to recommend Ask your doctor if you re not sure about a procedure The balloon is inflated inside the narrowed part of your artery After that the cardiologist may use a stent to keep the artery open A stent is a tiny expandable tube The balloon is deflated and taken out and the stent stays in place to help stop the narrowing recurring Stent implantation 2009 2012 National Heart Foundation of Australia No further reproduction allowed heartfoundation org au Helpline 13 11 12 23

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Thrombolytic therapy Thrombolytic therapy is a treatment in which you are given medicines through a drip to dissolve a blood clot that is narrowing or blocking a coronary artery This improves blood flow to your heart muscle and around your body Coronary artery bypass graft surgery CABG Coronary artery bypass graft surgery is also called bypass surgery or CABG often referred to as cabbage In bypass surgery a blood vessel is taken from your chest leg or arm and then attached grafted to your coronary artery This lets blood detour bypass around a narrowing or blockage in this artery During this operation your surgeon will generally cut down the midline of your chest through your breastbone to reach your heart Bypass surgery improves blood flow to your heart muscle and reduces angina Bypass surgery 24 My heart my life Heart Foundation

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Artificial pacemaker ICD The heart has a natural pacemaker to make it beat normally If that s not working reliably an artificial pacemaker can be inserted to do the same job An artificial pacemaker is a small device that is put under the skin of your chest below your collar bone One or two wires connect the pacemaker to the chambers of your heart A pacemaker makes small electrical currents that stimulate your heart muscle and help it pump regularly Modern pacemakers are very reliable and sophisticated A pacemaker s battery can last up to 10 years Your doctor will check the battery every year and replace it when needed Artificial pacemaker You may be given an implantable cardiac defibrillator ICD This small device is put into your chest and connected to your heart by one or more wire leads It monitors your heart rhythm and corrects it if it beats too fast or stops beating Defibrillation Defibrillation helps to restore a normal heart rhythm when your heart stops beating during cardiac arrest It may also be used to treat other heart rhythm problems e g if your heart beats too fast Paddles or pads are put on your chest A regulated electrical current is applied to your heart to make it start beating regularly again If it is done urgently as a lifesaving measure time is of the essence and you will feel a thumping sensation in the chest In less urgent situations you will be given a mild anaesthetic heartfoundation org au Helpline 13 11 12 Defibrillation 25

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Heart valve surgery Some valve problems can be treated using catheter techniques similar to a coronary angioplasty described above However often surgery is required Heart valve surgery fixes a damaged or faulty heart valve and helps your heart to pump blood properly Your surgeon usually cuts down the midline of your chest through your breastbone to reach your heart The faulty heart valve will then be repaired or replaced There is emerging use of keyhole or robotic surgery for this procedure Visit heartfoundation org au aftermyheartattack for more information 26 My heart my life Heart Foundation

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Medicines There are many medicines that treat heart attack angina high blood pressure high cholesterol and other heart conditions Your cardiologist along with your doctor will decide the best medicines for you to take at home to help you manage your heart condition When you leave hospital you will only have enough medicine for a short time It is important that you keep taking these medicines and see your doctor for more prescriptions Why are medicines important Medicines can help Get to know your medicines and why they re important Take your medicines exactly as advised by your doctor or pharmacist Carry a list of your medicines doses and instructions for taking them reduce your risk of a future heart attack angina heart failure and stroke manage your symptoms improve your quality of life keep you out of hospital you live longer You may be given different medicines to do different things You will need to take most of your medicines long term See pages 31 34 for more information about particular types of medicines heartfoundation org au Helpline 13 11 12 27

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Get to know your medicines It s important to know what medicine you re taking what it does and how it might affect you Your doctor or pharmacist can give you this information Name The drug name and brand name are different and some medicines have more than one brand name Ask your doctor or pharmacist if there are cheaper brands available How to take the medicine Follow your doctor and pharmacist s advice about when and how to take your medicines e g at a particular time of the day or with food Possible side effects Talk with your doctor about these and what to do if you have side effects Check if any of your medicines might affect you before driving operating machinery or doing jobs where you need to be alert Do not stop your medicine if you feel you have a side effect without first talking to a doctor Often symptoms are coincidental and due to another cause What to do if you miss a dose Check what the information sheet says or ask your doctor or pharmacist How to store your medicines e g away from direct sunlight Other ways to find out about your medicines Medicines often come with an information sheet called consumer medicines information CMI If they don t ask the pharmacist or doctor for it and read all about your medicines Call the Medicines Line on 1300 633 424 or visit nps org au The internet is a handy source of information about medicines But it is not as reliable as what your doctor or pharmacist can tell you 28 My heart my life Heart Foundation

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Home Medicines Review A pharmacist can visit you at home to check your medicines and how you are taking them Talk to your doctor to arrange a Home Medicines Review Over the counter medicines Many people take over the counter medicines available from a pharmacy or supermarket These can affect your prescription medicines Talk to your cardiologist doctor or pharmacist about which over the counter medicines are safe for you to take Checklist taking your medicines Take your medicines exactly as your doctor advises Get into a routine Don t stop taking medicines or change doses unless your doctor tells you to Talk with your doctor or pharmacist about possible side effects Don t run out of your medicines keep enough of a supply at home Carry a list of your medicines doses and instructions for taking them Check with your doctor or pharmacist before taking over the counter or complementary medicines e g cold and flu medicine vitamins or herbs Don t take medicine that s past its use by or best before date See your doctor regularly to check that your medicines are working properly heartfoundation org au Helpline 13 11 12 29

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Checklist questions to ask your doctor Take your medicine list with you to your medical appointments so your doctor can answer any questions What s the name of the medicine Is it the brand name or the drug name Why am I taking this What is it supposed to do How and when do I take my medicine For how long How will I know my medicine is working What are the risks of taking this medicine Will I have side effects If so what should I do How often should I visit my doctor or other health professional Do I need to avoid any foods dietary supplements other prescription or overthe counter medicines while I m taking this medicine

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Common medicines The medicines you take depend on your heart condition and symptoms For a heart attack or angina it s normal to take different kinds of medicine Below is a list of medicines commonly used to stop blood clots manage high blood pressure manage high cholesterol manage and stop angina Anti clotting blood thinning medicines Aspirin You may have to take a small dose of aspirin every day It can stop blood clots from forming in a narrow artery and reduce the risk of heart attack and stroke If you can t take aspirin you might take another anticlotting medicine Antiplatelet medicines Antiplatelet medicines include clopidogrel prasugrel and ticagrelor They can be used with or instead of aspirin They help to stop blood clots forming in your blood vessels You usually need antiplatelet medicines if you ve had coronary angioplasty and stent implantation or have had recurring heart attacks or angina If you take an antiplatelet medicine unless you are suffering severe bleeding you must not stop taking it unless your cardiologist or doctor tells you to This is even more important if you have had a stent implanted heartfoundation org au Helpline 13 11 12 31

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Anticoagulant medicines Warfarin Warfarin helps to prevent blood clots forming and treats existing clots If you are taking warfarin you need to have regular blood tests to check you re taking the right dose and that it s working properly Other medicines including some foods alcohol herbs and vitamins can change how warfarin works Speak to your doctor nurse or pharmacist about what foods can interact with warfarin Tell your doctor or pharmacist about any other medicines you take or plan to start taking and read the instructions carefully Novel anticoagulant therapies Some other anticoagulant medicines called NOACs novel anticoagulant therapies include dabigatran apixaban and rivaroxaban These do not require blood testing Blood pressure medicines Angiotensin converting enzyme ACE inhibitors ACE inhibitors widen dilate your blood vessels and reduce strain on your heart They are used to lower blood pressure make your heart work better and improve your chance of surviving after a heart attack Angiotensin II receptor blockers ARB ARBs are sometimes used instead of ACE inhibitors if you get side effects such as a persistent cough from taking ACE inhibitors ARBs work like ACE inhibitors they widen your blood vessels and reduce strain on your heart 32 My heart my life Heart Foundation

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Beta blockers Beta blockers can make your heart beat more slowly and lower your blood pressure and risk of a heart attack You may sometimes be given a beta blocker for arrhythmias abnormal heart rhythms or angina Cholesterol medicines Statins Statins reduce your risk of heart attack and stroke by helping to lower your cholesterol They also sometimes lower your triglycerides see pages 89 90 for more about cholesterol and triglycerides Statins help to stabilise plaque in arteries They are often given to people after they have had a heart event e g heart attack stroke or angina even if the person s cholesterol is in the normal range Statins are recommended for almost everyone with coronary heart disease You will usually be given a statin when you are in hospital You will need to keep taking it when you go home Your doctor may change the dose or type of statin you are taking to make sure it is working properly and not causing side effects heartfoundation org au Helpline 13 11 12 33

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Anti anginal medicines Nitrates Nitrate medicines increase blood flow to your heart by widening blood vessels They prevent or treat angina See What to do if you have angina on page 13 for more information There are two types of nitrate medicines Short acting nitrate medicines relieve angina symptoms within a few minutes These medicines are a spray or tablet that goes under your tongue They are absorbed through the lining of your mouth into your bloodstream The most common short acting nitrate medicine is glyceryl trinitrate sometimes called GTN Long acting nitrate medicines prevent angina symptoms They do not relieve an angina episode within a few minutes These are usually tablets that you swallow whole you do not put them under your tongue like short acting nitrate medicines Nitrate medicines may also come as patches and you gradually absorb the medicine through your skin Men should not take erectile dysfunction drugs with nitrate medicines This can have serious consequences or even cause death Other medicines Your cardiologist or doctor may prescribe you other drugs These may be for a range of conditions such as high blood pressure or irregular heartbeats 34 My heart my life Heart Foundation

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Cardiac rehabilitation What is cardiac rehabilitation Cardiac rehabilitation is a program where health professionals support you and your carers with your heart disease It s a valuable part of your recovery and recommended for all eligible patients It can support you to understand coronary heart disease and how it s treated manage your risk factors get back to your usual activities e g work driving having sex cope with fear stress depression and anxiety understand medicines tests and procedures know heart attack warning signs and what to do in an emergency It s really important to complete cardiac rehabilitation Cardiac rehabilitation gives you and your carers professional support in your recovery Ask your nurse or doctor to refer you to a program or call our Heart Foundation Helpline on 13 11 12 to find one have a healthy lifestyle You still need to visit your doctor regularly while you re doing cardiac rehabilitation heartfoundation org au Helpline 13 11 12 35

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Why attend cardiac rehabilitation Cardiac rehabilitation will help you recover make you feel better sooner and help prevent further heart problems Some of the benefits include getting back to your usual activities more quickly increasing your social independence and confidence reducing depression and anxiety increasing your ability to be physically active making you less likely to start smoking again if you smoked before helping you meet other people in a similar situation Ask if you can bring your partner or carer along It can help them understand what you have gone through and what you need to do to get better How is cardiac rehabilitation run Cardiac rehabilitation usually runs for six to 10 weeks It often starts in hospital and continues when you go home Programs can be run in different ways and places for example over the telephone on the internet face to face in a group in hospitals community centres and clinics in your home 36 My heart my life Heart Foundation

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A heart attack can affect you emotionally as well as physically It s normal to have lots of different feelings after a heart event Talk with family friends or professionals about how you re feeling Managing your emotions Some people worry about whether they will ever get back to normal You may have many different feelings after a heart attack or heart surgery You may feel sad worried shocked stressed angry lonely or guilty These feelings can be common and usually don t last long Talking to others may help you to feel better You could talk to your doctor nurse cardiac rehabilitation team family or friends What can I do to manage my emotions Think about how you have handled other stresses in your life Remember what got you through the hard times and what didn t Get support from friends and family and learn as much about heart disease and its management as you can Do the things you enjoyed doing before your heart attack Try and be physically active Join a cardiac rehabilitation program to get support and learn more about your heart disease and what you can do about it You will be with other people who have had a heart attack or heart surgery Speak with your doctor about how you are feeling They will be able to provide the help you need For more information on depression see page 94 38 My heart my life Heart Foundation

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Personal accounts Unless you ve had a heart attack and survived you really honestly don t know how painful the experience is And I don t mean just the physical pain it s the emotional pain I was a mess because everyone was saying Oh at 45 you re very young to have a heart attack let alone two So I got to the stage where for a long time I didn t even get out of bed I never went outside my front door because I was frightened what if I have another heart attack Kathleen 52 I was working pretty hard I knew I was stressed I knew the depression was there I was eating poorly I had a silent heart attack there was no pain no symptoms I had artery blockages just near the heart and I had three stents inserted over a two year period Richard 64 Printed with permission from beyondblue heartfoundation org au Helpline 13 11 12 39

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Your doctor will only let you leave hospital when you re well enough to continue recovering at home Talk to your health professionals about what you will need to take home and what to expect Leaving hospital When can I go home Your doctor will let you go home when you feel better your symptoms have gone your condition is being well managed This usually happens within two to seven days after your treatment or operation But it can be longer and it s different for everyone It depends on how serious your heart condition is what treatment you need to have and what your tests results are Leaving hospital can be hard Many people feel a little anxious and depressed about leaving hospital care But your doctor will only let you leave hospital if you are well enough to continue your recovery at home Have you got questions Speak with a health professional Call 13 11 12 40 My heart my life Heart Foundation

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Checklist before leaving hospital Make sure that you have information on your diagnosis enough medicines and information on how to take them talked with a pharmacist if you have any questions about your medicines a written plan for what to do if you have more symptoms see the Warning signs action plan on page 137 follow up appointments with specialists your general practitioner GP or other health professionals instructions on how to look after your wound s if you have had any procedures or surgery information about lifestyle changes you need to make to reduce your risk of more heart problems a referral to a cardiac rehabilitation program heartfoundation org au Helpline 13 11 12 41

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What happens when I get home For the first few weeks it may be good to have someone close by to support and help you If you live alone someone may need to stay with you during this time depending on how serious your health condition is If you don t have family or friends who can be with you you can get help from a home care agency If you need extra community services such as Meals on Wheels ask your doctor or cardiac rehabilitation team for information You will need lots of rest but try to get back into a normal routine as soon as possible including get up at a normal time have a bath or shower if possible get dressed for the day don t stay in your sleeping clothes during the day rest at mid morning mid afternoon and after any physical activity You should be able to do light work around the house go to places such as a theatre restaurant or church visit friends travel in a car but not drive a car until your doctor has given you approval to do so for more information on driving see page 50 climb stairs slowly You may feel weak at first but this isn t necessarily serious It is normal because you didn t use your muscles much when in hospital heartfoundation org au Helpline 13 11 12 43

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Caring for someone after a heart attack Caring for someone you love after their heart event can be daunting But we re behind you from the first days in hospital and for as long as you need us Information at your fingertips Explore heartfoundation org au aftermyheartattack to learn more about your loved one s condition and how you can help them return to an active and healthy life Personalised support is just a phone call away Qualified health professionals are available to speak with you or your loved one with no appointment necessary Call us on 13 11 12 Sign up to receive regular emails at heartfoundation org au aftermyheartattack and we ll provide you with information and guidance to help you help your loved one return to an active and healthy lifestyle 44 My heart my life Heart Foundation HFN0922_JUN17 Let us help you along the way

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Checklist Take charge of your recovery Set recovery goals and priorities for working on your emotional and physical health See your doctor regularly Take your medicines as directed Start and complete your cardiac rehabilitation Set goals and priorities for your health Work with health professionals to set goals and priorities for making lifestyle changes such as quitting smoking losing weight or eating healthier foods Remember you may be more successful if you focus on one goal at a time your doctor cardiologist or cardiac rehabilitation team member can help you set priorities don t give up Discuss these health goals with your health professionals if you smoke aim to quit if you have high cholesterol and or high blood pressure aim to lower them to the targets set with your doctor if you have diabetes work with your doctor to manage it if you are overweight aim to reach a healthy weight and maintain it 46 My heart my life Heart Foundation

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eat healthy foods be more physically active and try to reduce the amount of time spent sitting manage your emotional health This section provides more information on improving your health See your doctor regularly See your doctor as soon as you can after leaving hospital You will manage your health better with regular check ups Take your medicines list discharge information or any test results These tell your doctor about your medicines and doses Your doctor may already have this information from the hospital Care for your wounds If you had surgery or a procedure you need to look after your wounds so they heal well Follow the doctor s or hospital instructions See your doctor if you notice any unusual pain or tenderness in your chest or signs of infection e g increased soreness oozing bleeding a bad smell or a high temperature To help your wounds heal eat a balanced healthy diet quit smoking avoid straining activities as this could damage the wound or cause other problems follow advice about managing pain and exercising from your doctor physiotherapist or cardiac rehabilitation team heartfoundation org au Helpline 13 11 12 47

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Take your medicines Talk with your doctor about medicines Don t be afraid to ask questions You need to understand the benefits how and when to take your medication and what the side effects might be Take your medicines exactly as directed Try not to miss a dose Don t stop taking them just because you feel better See pages 27 34 for more information about medicines Call the Medicines Line on 1300 633 424 for consumer advice on medicines Attend your cardiac rehabilitation Cardiac rehabilitation will help you to get back on track Ask your doctor nurse about a referral to a cardiac rehabilitation program It includes important information social support and a physical activity program It will also help you to make lifestyle changes and reduce your risk of more heart problems See pages 35 37 for more information about cardiac rehabilitation 48 My heart my life Heart Foundation

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Getting back to normal You should be able to return to your normal activities a few weeks after your heart attack or surgery Talk to your doctor or cardiac rehabilitation team about when you can start different activities again and how to pace your recovery Talk to your doctor or cardiac rehabilitation team about when you can get back to normal activities For more advice about starting physical activity see pages 71 72 Going back to work Returning to work is a very important part of your recovery The earlier you plan for it the better your chances of getting back sooner Decide with your doctor cardiac rehabilitation team and other health professionals when to go back to your job They will tell you how to prepare for returning and the type of activities that will best help your recovery You can usually go back to work a few weeks after you go home from hospital But this depends on how fast you recover and how physically active your job is Your workplace may have a Rehabilitation and Return to Work Coordinator who can help If you do physically demanding work you may need to build up your strength first Think about asking your workplace for lighter duties or shorter work hours or days Whatever your job make sure you are physically and emotionally ready to go back Give yourself time to settle into your work routine again heartfoundation org au Helpline 13 11 12 49

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Travelling Most patients can travel straightaway by train tram or bus or as a passenger in a car If you are traveling on public transport make sure you have a seat so you don t get too tired If you have had heart surgery discuss using public transport with your doctor Long trips may make you feel tired so try to have regular breaks If you have had bypass surgery placing a cushion pillow or rolled up towel between your chest and the seat belt may help to reduce pressure on the wound while it heals Check with your doctor if you can travel by plane You may also need to get medical clearance Ask the airline about any air travel requirements if you re unsure Travel insurance coverage can be affected by your heart condition The insurance company may require a medical assessment and there may be extra costs or exclusions on your cover Talk with your doctor before buying travel insurance Driving Driving a motor vehicle is a complex task and driver health and fitness to drive is important A heart attack and heart surgery can affect short term driving capacity as well as long term licensing status Always talk with your doctor before you start driving again The following are suggested minimum times to wait before you begin driving a private car again coronary artery bypass graft CABG surgery at least four weeks heart attack myocardial infarction at least two weeks coronary angioplasty and stent insertion at least two days 50 My heart my life Heart Foundation

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Your car insurance might not cover you if you start driving sooner than the recommended waiting time Check with your insurance company By law you must report a permanent or long term illness that might affect your driving To check if you should report your condition contact the Transport Authority in your state or territory They may also set some conditions you must meet to make sure you can drive safely If you drive a commercial vehicle e g a truck or forklift there are longer waiting times There are also different conditions you need to meet Some medicines can affect your ability to drive Ask your doctor about the side effects of your medicines This is very important if you drive a commercial vehicle If you feel insecure or your family is worried about you driving don t drive alone only drive routes you know avoid peak hour traffic Intimacy and having sex Most people can have sex again soon after a heart attack or other heart problems The exertion during sexual activity can be similar to mild to moderate physical activity such as brisk walking or climbing up two flights of stairs As a general guide if you can do physical activity at this level without getting chest pain or short of breath you are probably fit enough to resume sexual activity If you have had heart surgery wait until your breastbone has healed about six to eight weeks after the operation Do not put any pressure or stress on your chest Some positions may be more comfortable than others heartfoundation org au Helpline 13 11 12 51

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Stop having sex if you experience the warning signs of a heart attack If you are short of breath have chest pain or even discomfort in your chest during or after sex you should consult your doctor Try not to have sex after eating a large meal drinking alcohol or when you are very tired You may notice changes in your sexual interest or ability This is common and is usually short term Reasons can include tiredness depression anxiety concerns about physical ability and the effect of your medicines Take things slowly It can take time for a sexual relationship to get back to normal It s important to remember that intimacy is not just the act of sexual intercourse It is about feeling connected and close to someone and feeling loved for who you are Kissing cuddling kind words hand holding and togetherness are all important ways to be close to each other This will increase your feelings of intimacy Talk with your partner or doctor about your feelings and any concerns you may have about having sex If you think your medicines are affecting your sexual desire or ability talk to your doctor Do not stop taking your medicines without checking with your doctor Nitrate medicines can interact with erectile dysfunction medications see page 34 for more information 52 My heart my life Heart Foundation

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Eat healthy foods Healthy eating and drinking is an important part of looking after your health Eating healthy foods will help you recover make you feel better and reduce your risk of more heart problems Healthy eating is easier than you think You can usually find all the foods you need at your local supermarket You just need to know what foods to buy to make healthier meals Our recommended goals Eat vegetables fruit wholegrains nuts and seeds every day C hoose lean meats and poultry including fish and seafood C hoose reduced fat dairy such as unflavoured milk yoghurt and cheese C hoose healthier fats including nuts seeds avocados olives and their oils for cooking Healthy eating and drinking will help you recover and avoid more heart problems Some simple changes can make a big difference Talk to your doctor or dietitian about the diet that is best for you Use the action plan on page 116 to make some changes U se herbs and spices to flavour foods instead of salt Make water the drink of choice For healthier recipes see heartfoundation org au recipes heartfoundation org au Helpline 13 11 12 53

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Healthy eating Eat plenty of vegetables aim for five serves every day and fruit aim for two serves every day Choose wholegrain types of breads cereal pasta rice and noodles Eat a variety of nuts and seeds Select lean meat meat trimmed of fat and poultry without skin Have two to three serves 150 g of fish and seafood every week fresh frozen or canned Include legumes in at least two meals a week e g lentils split peas dried or canned beans like four bean mix or baked beans Eat up to 6 eggs a week Choose reduced fat milk yoghurt and cheese Use healthier fats and oils for cooking spread and dressings Some suitable choices include canola sunflower soybean olive sesame and peanut oils Make water your drink of choice Talk to your doctor or dietitian about the diet that is best for you 54 My heart my life Heart Foundation

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What about fat If you have coronary heart disease you need to be careful about the foods you eat It s important to change the types of fat you eat Eating too much unhealthy saturated and trans fats can increase cholesterol Choosing foods with healthier fats can help you lower your cholesterol and avoid more heart problems Saturated fats Saturated fats raise cholesterol To keep your cholesterol level low it s important to eat fewer foods that are high in saturated fats Trans fats Trans fats raise your low density lipoprotein LDL bad cholesterol and lower your high density lipoprotein HDL good cholesterol Trans fats are in commercially baked products pies pastries cakes and biscuits It s best to avoid these foods Trans fats are also found naturally in small amounts in dairy products beef veal lamb and mutton Polyunsaturated fats Polyunsaturated fats help to lower high cholesterol Some oils margarine spreads nuts seeds and fish contain polyunsaturated fats heartfoundation org au Helpline 13 11 12 55

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Monounsaturated fats Monounsaturated fats also help to lower cholesterol There are monounsaturated fats in some oils margarine spreads avocado nuts and seeds Omega 3 fatty acids Omega 3 fatty acids can improve your outcomes after a heart attack and can help manage your triglycerides a type of fat in your blood Many fish and some types of seafood are good sources of Omega 3 All Australians should aim to include 2 3 serves of fish or seafood per week as part of a healthy diet Reduce unhealthy fats and replace them with healthier fats Choose lean cuts of meat or trim all the fat you can see before cooking Remove skin from chicken before cooking Eat fish instead of meat 2 3 times a week and choose legume or bean based meals twice a week Consume nuts and seeds daily Choose reduced fat unflavoured milk cheese and yoghurt Choose healthy fats with nuts seeds avocados olives and their oils for cooking Minimise consumption of processed meats eg sausages and salami bought cakes biscuits and pastries and take away foods like hamburgers pizza and hot chips 56 My heart my life Heart Foundation

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What about salt Salt is hidden in lots of food The amount of salt you eat should be less than 4 g per day That s less than a teaspoon Salt holds fluid in your body If you eat too much salt the extra water stored in your body raises your blood pressure Salt is made up of sodium and chloride It s the sodium that can be bad for your health and it is listed on food packages Some salty foods include commercially baked products like biscuits pastries cakes and breads processed meat such as ham bacon sausages hot dogs tinned meat corned meat and pies take away foods such as hamburgers pizza hot chips noodles potato chips many Asian foods pasta and fried chicken packaged foods such as tinned and instant soup fish in brine and instant noodles condiments and sauces like packet seasoning stock cubes soy sauce and tomato sauce snack foods like salted nuts olives and dips heartfoundation org au Helpline 13 11 12 57

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Reduce your salt intake Make fresh foods the main part of your diet include a wide variety of fruit and vegetables wholegrains lean meat poultry and fish reduced fat dairy plain unsalted nuts and seeds and legumes Use lemon juice garlic herbs and spices to add flavour whilst cooking rather than adding salt whilst cooking Remove the salt shaker from the table to avoid adding salt as a habit Use the salt and sodium converter on the Heart Foundation website to understand the salt content of your food 58 My heart my life Heart Foundation

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How to make healthier meals There are two easy ways to change your favourite recipes to reduce the energy kilojoules or saturated fat content You can try healthier cooking methods and reduce replace or remove the less healthy ingredients Healthier cooking methods Method Deep fry Try these healthier ingredients or cooking methods Roast in the oven on a lined tray or grill tray Lightly steam or microwave food before roasting Brush food with canola sunflower soybean or olive oil to make it crisp Cook crumbed fish chicken and oven fries in the oven instead of deep frying them Shallow fry Saut Stir fry food using a spray of canola sunflower soybean olive or peanut oil so you use less oil Use a non stick frying pan so you use less oil Roast Choose lean cuts of meat or trim all visible fat Put meat on a rack in a baking dish with 1 to 2 cm water Add herbs to the water for extra flavour Brush meat with a marinade to stop it drying out Try covering it with a lid or aluminium foil for part of the cooking time Roast meat on a spit or rotisserie and let the fat drip away Brush or spray vegetables with canola sunflower soybean olive or peanut oil and bake them in a separate pan from meat Casserole Stew Trim fat off meat before cooking Add legumes for extra fibre and flavour e g kidney beans chickpeas soybeans or lentils After cooking chill the food so the fat becomes solid on the surface Skim the fat off before reheating and thickening heartfoundation org au Helpline 13 11 12 59

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Healthier ingredients Ingredient Try these healthier alternatives Milk Yoghurt Cream Use reduced fat varieties Plain yoghurt is best as many flavoured products are high in sugar Use ricotta cheese whipped with a little icing sugar fruit or reduced fat milk instead of cream Sour cream Replace sour cream with one of these options cottage cheese blended with reduced fat milk add a little lemon juice or vinegar to make it more sour acidic if you like reduced fat natural yoghurt evaporated reduced fat milk mixed with lemon juice Cheese Use smaller amounts of reduced fat cheese instead of full fat cheese Use a little grated parmesan cheese instead of grated cheddar it gives more flavour and you don t need to use as much Mix grated reduced fat cheese with oats breadcrumbs or wheatgerm to make toppings for casseroles gratins and baked dishes Butter Instead of butter use spreads like avocado nut butters or tahini Oil Use a variety of oils for cooking Suitable cooking oils include canola sunflower soybean olive and peanut oil Dressing Use salad dressings made from canola sunflower soybean and olive oil Make your own salad dressing Use ingredients such as reduced fat yoghurt tomato paste balsamic or other vinegars lemon juice ricotta cheese mustard or fruit pulp 60 My heart my life Heart Foundation

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Ingredient Try these healthier alternatives Meat Poultry Choose lean meats and poultry Remove all visible fat from meat and skin from poultry before cooking Marinate or add flavour with ingredients such as wine vinegars Sear meat quickly to keep in juices Cake Biscuit ingredients Cook with spreads made from canola sunflower or olive oil instead of butter Cook with canola sunflower or olive oil The minimum fat required for biscuits is about 2 tablespoons per cup of flour this will keep biscuits crisp Make plain sponges yeast cakes breads muffins and scones because they generally use less fat Use wholegrain or wholemeal flour to add some extra fibre Pastry Use filo pastry Brush every three to four layers with canola sunflower soybean or olive oil egg white or reduced fat yoghurt Use pastry made with canola sunflower or olive oil Coconut cream Coconut milk Add a little coconut essence to evaporated reduced fat milk Soak desiccated coconut in warm reduced fat milk for 30 minutes Strain the mixture discard the coconut and use the milk Occasionally use a reduced fat coconut milk heartfoundation org au Helpline 13 11 12 61

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How to choose healthy foods and drinks Small changes can make a big difference Think about what changes you can make to the foods you eat and the way you prepare and cook them to make them healthier One small change Less healthy choices Go for a healthier snack 1 cinnamon doughnut 70 g 1 packet potato crisps 50 g 2 chocolate coated cream filled biscuits 1 chocolate bar with biscuit and caramel 50 g 1 glass dry white wine 100 mL Choose light reduced alcohol drinks Change what you put on your veggies 1 can full strength beer 375 mL 1 large corn cob with 2 tsp butter cup green beans 60 g with 1 tsp butter Kilojoule kJ content 1102 1080 776 1020 295 572 1012 177 1 medium baked potato 769 with 1 tbsp sour cream 62 Healthier choices Kilojoule kJ content 377 1 medium banana 150 g 1 medium apple 374 150 g 2 plain sweet 316 biscuits Small handful of 516 raw almonds 20 g 1 glass reduced alcohol white wine 100 mL 1 can light beer 375 mL 1 large corn cob steamed cup green beans steamed 60 g 1 medium baked potato with 1 tbsp low fat natural yoghurt My heart my life 173 390 764 53 542 Heart Foundation

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One small change Go for leaner meats Less healthy choices Kilojoule kJ content 1 medium T bone steak 2263 fat untrimmed Regular beef mince 1185 100 g Roasted chicken breast 781 with skin 100 g 1 meat pie 175 g 1650 Hungarian salami 30 g 535 Use a different cooking method Switch to low fat dairy Swap sugary drinks 1 fish fillet battered and 1649 fried 150 g Chicken parmigiana 3648 French fries 90 g 1217 Cappuccino with full 552 cream milk 1 cup Extra creamy vanilla ice 956 cream 100 g Regular fat berry 802 yoghurt 200 g 2 breakfast wheat 934 biscuits 30 g 2 3 cup full fat milk 1 glass cola soft drink 437 250 mL 1 glass orange juice 250 mL 305 Healthier choices 1 medium T bone steak fat removed Extra lean beef mince 100 g Roasted chicken breast without skin 100 g Ham and salad sandwich Lean leg ham 30 g 1 fish fillet grilled 150 g Kilojoule kJ content 1388 849 637 876 140 792 Stir fried chicken breast without skin 100 g Potato wedges oven baked 90 g Cappuccino with skim milk 1 cup Low fat vanilla ice cream 100 g Low fat natural yoghurt 200 g 671 2 breakfast wheat biscuits 30 g 2 3 cup skim milk 1 glass unflavoured mineral water 250 mL 1 glass water 698 706 291 638 482 0 0 Note All figures are approximate values Source material FoodWorks 8 Professional nutrient analysis software Available at www xyris com au Accessed December 2016 heartfoundation org au Helpline 13 11 12 63

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choose healthier food and drinks are energy kilojoules sodium salt fibre saturated fat and trans fat note that not all foods will list how much trans fat they contain Nutrition Information Servings per package 10 Serving size 20mL Per 20mL Per 100mL Energy 320kJ 1600kJ Protein 0 6g 3 1g Fat total 7 2g 36 0g saturated fat 2 0g 10 0g Carbohydrate total 2 4g 12 0g sugars 2 0g 10 0g Sodium 220mg 1 100mg Use food labels to make choices It is important to look at thehealthier overall food instead of Nutritionainformation panels andnutrient ingredients lists choosing food based on just one can ingredient help you choose healthier food The list on the label can alsoand helpdrinks you see the food high in energy kilojoules Theiffour mainisnutrients to look for to help you choose healthier food and drinks are The main Ingredients are listed in order by weight ingredient weight will be listed first and the energy by kilojoules ingredients that weigh less at the end If the first sodium salt in the ingredients list are high in fat few ingredients and or sugar then the food drink is probably high in fibre energy kilojoules saturated fat and trans fat not all foods will list Heart Foundation My heart my life how much trans fat they contain 46 MHML2015 NAT_InsidePages 20151128 indd 46 Compare these nutrients in different brands for similar foods The quantity per 100 g or 100 28 11 2015 mL column will help you choose foods with lower kilojoules saturated fat or sodium or with more fibre Read the per serving value for how much of the nutrient is in each serve 3 44 PM Foods labelled lite light low fat or low sugar may not be lower in kilojoules than other foods The best way to tell is to read the nutrition information panel and ingredients list 64 My heart my life Heart Foundation

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Checklist using food labels for healthier choices Look at the food as a whole rather than deciding based on just one nutrient Ingredients are listed in order by weight If the first few ingredients are fats and or sugars then the food is probably high in energy kilojoules Use the per 100 g or 100 mL column to compare products and choose the options that contain less kilojoules saturated fat sodium or the foods with more fibre Keep in mind the amount you eat may be more or less than 100 g or 100 mL Use the per serving column to check how much of the nutrient you might be eating Avoid foods with partially hydrogenated vegetable oils or vegetable fats listed in the ingredients list these ingredients have trans fats and trans fat is not always listed on the nutrition information panel heartfoundation org au Helpline 13 11 12 65

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Healthy eating and drinking ideas Make healthier lower energy kilojoule meals and snacks with these ideas Breakfast ideas Make wholegrain or wholemeal toast with a small serve of baked beans tomatoes creamed corn mushrooms or cottage cheese Or spread thinly with jam honey or peanut butter Use spreads made from canola sunflower or olive oil Have wholegrain cereal such as rolled oats wheat biscuits or bran cereals Choose untoasted types and use reduced fat milk or yoghurt Add some fruit fresh stewed or canned Choose fruit canned in natural or unsweetened juice Poach boil or scramble eggs made with reduced fat milk Serve with tomatoes spinach mushrooms and salmon Serve on wholegrain or wholemeal bread Lunch ideas Have a sandwich made with wholemeal or wholegrain bread Fill with lots of salad vegetables and a small serving of lean meat skinless chicken canned fish hommus or a reduced fat cheese Make an interesting salad with plenty of different coloured vegetables Include lean meats skinless poultry fish or legumes like four bean mix Try adding fresh fruit or plain unsalted nuts and seeds You could add wholemeal pasta brown rice couscous or noodles Use dressings based on olive or canola oil 66 My heart my life Heart Foundation

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Try a vegetable or legume based soup Serve with crusty wholemeal bread For a creamy soup use evaporated skim milk instead of cream or full fat milk Check labels on tinned or instant soups they may contain a lot of salt Dinner ideas Make a stir fry with lots of vegetables and some lean meat skinless chicken or fish Use canola sunflower soybean olive sesame or peanut oil Flavour with garlic onion chilli or ginger and add some legumes or plain unsalted nuts Serve with brown rice Grill or roast a lean cut of meat skinless poultry or fish and flavour with herbs spices or garlic Serve with vegetables or salad and a grain based food such as wholemeal pasta brown rice couscous or polenta Make burritos tacos or tortilla wraps using lean meat skinless chicken or red kidney beans Add plenty of vegetables to the mixture and use reduced fat natural yoghurt instead of sour cream Try a vegetable frittata or quiche Use reduced fat milk and spreads made from canola sunflower or olive oil in the quiche Serve with a garden salad heartfoundation org au Helpline 13 11 12 67

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Dessert ideas Serve fresh fruit salad or stewed poached or canned fruit with reduced fat yoghurt Choose fruit canned in natural or unsweetened juice Make a fruit pie or strudel with filo pastry Serve with reduced fat yoghurt Snack ideas Snack on fruit fresh stewed or canned Choose fruit canned in natural or unsweetened juice Choose reduced fat unflavoured yoghurt Crunch on a small handful of plain unsalted nuts and seeds Snack on wholegrain or wholemeal crisp bread with sliced tomato and pepper Drink ideas Plain water is the best drink for you because it has no energy kilojoules It s also cheap and quenches your thirst Other suitable choices to include in moderation are plain mineral water soda water reduced fat milk herbal tea tea coffee 68 My heart my life Heart Foundation

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Healthy eating doesn t have to be boring Recovering from a heart event doesn t mean saying goodbye to delicious food Explore our free collection of healthy recipes to find your new favourites and some tricks to improve your old ones With lots of recipes for breakfast lunch dinner and snacks you re sure to find something you love heartfoundation org au Helpline 13 11 12 HFN0922_JUN17 Visit heartfoundation org au recipes to browse our collection of delicious and healthier recipes you can make today 69

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Being more active every day will help you recover and lower your risk of more problems Talk with your doctor or health professional about how to safely build up your activity Use the action plan on page 120 to set goals for getting more active Be physically active You should be able to return to your usual activities a few weeks after your heart attack or other heart problem Talk to your doctor or cardiac rehabilitation team about when you can start different activities again and how to pace your program Do regular activity Regular moderate intensity physical activity is good for you especially if you have coronary heart disease It will help you recover better from a heart attack or other heart problems reduce your risk of more heart problems improve your long term health feel more confident happy and relaxed have more energy manage your weight more easily improve your cholesterol lower your blood pressure have stronger bones and lower your risk of osteoporosis manage your blood glucose levels if you have diabetes You won t get these benefits all at once or all of the same benefits But doing regular physical activity and reducing the amount of sitting time will improve your health even if you have coronary heart disease 70 My heart my life Heart Foundation

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Our recommended activity goals Aim to build up to doing at least 30 minutes of moderate intensity physical activity on most if not all days of the week You can do this in three lots of 10 minutes each if it s easier For example you could do 10 minutes each of walking gardening and light housework Keep walking Walking is a good type of physical activity for people with coronary heart disease because it is gentle on your body as it is a low impact activity you can go at your own pace you can walk and talk with other people which can help with motivation and confidence it doesn t cost anything Start slowly Do some easy walking around your house and garden or on your street Start by walking on flat ground each day Have a destination in mind such as the local shop or the end of the block Walk at a pace you find comfortable a good guide is a pace at which you can still have a conversation Build up gradually over a few weeks walk longer distances and then uphill Think about joining your local Heart Foundation Walking group This will help you to keep fit and make new friends For more information see page 107 heartfoundation org au Helpline 13 11 12 71

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Guidelines for walking after you leave hospital Goals Minimum time minutes Times per day 1 2 3 4 5 10 10 15 15 20 20 25 2 2 2 1 2 5 25 30 1 2 6 30 1 2 Pace Stroll Comfortable Comfortable Comfortable Stride out Comfortable Stride out Comfortable Stride out Build up your walking gradually over time Start at stage 1 Walk up to 10 minutes twice a day Do this at least two days in a row If you find this tiring stay at Stage 1 until you feel stronger You may need to stay at Stage 1 for a few weeks Talk to your doctor or health professional if you aren t sure whether you are doing too much or too little walking Only move to the next stage when you meet your walking target without discomfort As you advance it may take longer to move to each new stage You may take more time to get used to how much more walking you need to do If you don t feel well enough to walk one day let your body get some rest Miss walking that day or at least drop back one or two stages Take the stairs If there are stairs where you live you can climb them slowly as soon as you come home from hospital 72 My heart my life Heart Foundation

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As a general rule if you can walk normally at your usual pace you can also climb two flights of stairs at your usual pace Gradually increase how many stairs you can climb and how fast you climb them Find your local walking group Call 13 11 12 Do sport and other recreational activities Do the sort of activities you like to do regularly Start with walking and everyday tasks like light gardening and housework Aim to limit the amount of time you sit each day Gradually add other activities such as cycling and swimming that need more effort You may be able to start cycling swimming tennis golf and bowls again after six weeks as your fitness and confidence increases Ask your doctor or cardiac rehabilitation team about specific sports The strain of lifting heavy weights and some other activities can raise your blood pressure so don t do these in the short term You may later include resistance weight training with light weights in your activity program But talk with your doctor or cardiac rehabilitation team before you start this sort of training How much activity is safe How you feel is your best guide to doing physical activity at a safe level It is normal to worry about what you should and shouldn t do Slowly build up your activity level based on what your doctor or health professionals tell you You may feel more comfortable exercising with a friend or family member for increased motivation as well as confidence or safety concerns Increase your physical activity slowly Your doctor will advise you about this when you leave hospital Also use the walking guidelines on page 72 heartfoundation org au Helpline 13 11 12 73

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Checklist Stay safe during physical activity Start the activity gradually and at a low level of intensity You should be able to talk without getting short of breath If you want to do more intense physical activity build up slowly over a number of weeks As you start to feel better and fitter while being active increase the intensity so you start to puff a little during the activity Talk with your doctor if you want to do more intensive activity or competitive sports Don t do physical activity if you feel unwell tired or sore take a day off to recover Don t do physical activity straight after meals or alcohol Drink lots of water before during and after the activity you will lose water through sweating Share the activity with a friend you may feel more confident and motivated and enjoy it more too Carry your mobile telephone with you while walking so you can call for help if you feel unwell If you need to take angina medicine keep it with you 74 My heart my life Heart Foundation

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Being a healthy weight is important to avoid more heart problems Talk to your doctor about whether you need to lose weight If you do need to lose weight plan to do it the healthy way Change your eating habits do more physical activity and sit less Use the action plan on page 122 to set goals for keeping to a healthy weight Be a healthy weight It s important to be a healthy body weight because it lowers your risk of more heart problems It reduces your risk of developing diabetes see pages 83 84 and helps lower your blood pressure and cholesterol If you carry extra weight around your middle being apple shaped it s a bigger health risk than if you are just overweight It s very important for you to lose weight if this is the case Our recommended goals The Heart Foundation recommends you aim for a waist measurement of less than 94 cm for males 80 cm for females Body mass index or BMI is used to determine whether you are in a healthy weight range for your height We recommend for a healthy weight for your BMI to be between 18 5 and 25 kg m2 BMI is a useful measurement for most people over 18 years old But it is only an estimate and it doesn t take into account gender age ethnicity and body composition We recommend you also check your waist measurement and other risk factors To calculate your BMI measure your body weight in kilograms and divide it by the square of your height in metres For example if you weighed 75 kg and were 1 7 m tall your BMI would be BMI 75 kg 1 7 m x 1 7 m 75 kg 2 89 m 25 95 kg m Visit www heartfoundation org au BMI to calculate your BMI online 76 My heart my life Heart Foundation

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Lose weight healthily To lose weight you need to use up more energy kilojoules than you take in You can do this by reducing your kilojoule intake by having lower kilojoule foods and drinks increasing your kilojoule use by doing more physical activity and sitting less Losing weight the healthy way is not quick Many weight loss books and crash diets often suggest unhealthy ways to lose weight and won t help you keep weight off in the long term It comes down to the type and amount of food and drinks and the type and amount of physical activity you do Don t think about it as going on a diet which is a short term thing but as a choice to be healthy for life People tend to put weight on over time sometimes several years Losing it will not happen overnight You should not lose it too quickly or ignore what a health professional tells you If you are making lifestyle changes then generally the weight loss will follow As an easy first step to losing weight you can change the types and amount of foods and drinks you consume increase your physical activity levels every little bit helps reduce the amount of time you spend sitting stand up more often and move around your home workplace or when you are out and about Doing only one of these is usually not enough heartfoundation org au Helpline 13 11 12 77

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Checklist lose weight the healthy way Lower your energy kilojoules intake by making fresh foods the main part of your diet Include a wide variety of fruit and vegetables wholegrains lean meat poultry and fish reduced fat dairy plain unsalted nuts and legumes watching your portion sizes Use more energy by doing more physical activity and sitting less often Ask your doctor if you need to do more than 30 minutes of physical activity on most days of the week to lose weight Do a weight loss plan If you and your doctor agree that you need to lose weight plan how to do it together This will help you decide on the lifestyle changes you will make It will also help you to be realistic about what you can achieve Make a list of things to help you lose weight Include ways of having better eating habits doing more physical activity and sitting less often like follow a healthy diet go for a 30 minute walk on most days of the week watch less TV or spend less time in front of a computer each day 78 My heart my life Heart Foundation

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Weight loss plan steps Step 1 Set realistic weight loss or lifestyle goals Step 2 Identify what you eat and drink your level of physical activity and amount of sitting time Step 3 Make changes to what you eat and drink Step 4 Do more physical activity and sit less often Be as active as you can in as many ways as possible Do this on most if not all days of the week Step 5 Keep going with your weight loss plan Make weight loss last Once you have a healthy body weight keep it there by balancing the kilojoules you get from your food and drinks with how much you use by doing physical activity See pages 53 74 for more information on keeping a healthy body weight by healthy eating and doing physical activity Get walking tips at walking heartfoundation org au heartfoundation org au Helpline 13 11 12 79

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If you smoke you must quit It s never too late to make a difference to your health Get help from your doctor or health professional or call the Quitline 13 78 48 Avoid secondhand smoke Use the action plan on page 124 to set goals for quitting or avoiding smoke Quit smoking Quitting smoking is an important way to lower your risk of more heart problems It s never too late to quit Even if you already have smoking related health problems like heart disease quitting helps From the moment you quit your risk of heart attack begins to drop And you will feel the benefits almost immediately Know the risks of smoking Smoking reduces the amount of oxygen in your blood and damages and weakens artery walls Smoking can increase your risk of stroke by three times your risk of peripheral arterial disease e g clogging of the arteries in your legs by more than five times the chance of an artery wall becoming weak and possibly rupturing by six to seven times Cigarette smoke has thousands of chemicals including these dangerous ones nicotine an addictive drug that affects your brain and muscle activity and increases your blood pressure making your heart work harder carbon monoxide a poisonous gas that replaces oxygen in your blood making your heart beat faster than usual tar a sticky substance that coats your lungs like soot in a chimney making it hard for you to breathe and that contains a variety of chemicals that cause cancer 80 My heart my life Heart Foundation

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What about second hand smoke Try not to be around other people who smoke Being exposed to second hand smoke passive smoking on a regular basis increases your risk of coronary heart disease by about 30 What about e cigarettes The Heart Foundation does not support using e cigarettes It s better to stop smoking altogether You can learn to quit Quitting smoking can be hard at first But the benefits of quitting outweigh any temporary difficulties or symptoms you may feel Plan to quit Set a date for quitting While in hospital is a good time to start Begin to change your habits Learn how to handle stress and urges to smoke Think about who and what can help you through the tough times Don t give up Many people slip up after they quit and start smoking again Don t see this as a failure Instead think about what made you smoke again How can you deal with this situation next time What worked and what didn t work Learn from this and try quitting again You become better at quitting each time you try heartfoundation org au Helpline 13 11 12 81

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Things to help you quit Talk with your doctor and other health professionals about quitting smoking They can tell you what options are available to help you to quit and can check your progress Talk to your doctor about using nicotine replacement products e g nicotine gums patches or lozenges or bupropion or varenicline tablets These products can double your chances of quitting successfully Ask your family and friends for support and encouragement Read about how to quit and do quit smoking courses Call the Quitline on 13 78 48 for information and advice about quitting smoking Make sure your home and car are smoke free 82 My heart my life Heart Foundation

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Manage diabetes Diabetes is a condition that affects the way body cells take up and use glucose from the blood If you have high blood glucose levels you may have diabetes This increases your risk of cardiovascular disease for example heart attack angina or stroke There are two main types of diabetes type 1 and type 2 People with cardiovascular disease often have type 2 diabetes This makes up 90 of diabetes cases Diabetes is on the rise The best way to manage diabetes is to be physically active eat a healthy diet and achieve and maintain a healthy weight Talk to your doctor about screening for diabetes Having diabetes puts you at a higher risk of heart attack or stroke Ask your doctor about screening for diabetes If you have diabetes work with your doctor to manage it Use the action plan on page 126 to set goals Our recommended diabetes goals Manage your diabetes long term Ask your doctor to check your blood glucose levels with a regular HbA1c glycosylated haemoglobin blood test This shows your average blood glucose levels over the past 10 to 12 weeks Generally aim for an HbA1c level of less than or equal to 7 These goals can vary for different people Find out from your doctor or accredited diabetes educator what your blood glucose and HbA1c goals should be Keep a record of your blood glucose levels This will help you and your doctor to best manage your diabetes together heartfoundation org au Helpline 13 11 12 83

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How to manage diabetes Work with your doctor to make a plan for managing diabetes Your doctor will advise lifestyle changes like being physically active eating healthy foods and staying at a healthy weight You should also stop smoking see pages 80 82 manage your blood pressure see pages 85 88 manage your cholesterol see pages 89 90 regularly see your doctor for diabetes reviews If you have type 2 diabetes you may need to take medicines to help you to maintain normal blood glucose levels Your doctor may also refer you to an accredited diabetes educator or clinic For more information visit the Diabetes Australia website at www diabetesaustralia com au 84

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Manage high blood pressure What is blood pressure Blood pressure is the pressure of your blood on the walls of your arteries as your heart pumps it around your body As your heart pumps your blood pressure rises and falls in a regular wave pattern It peaks when your heart pumps and falls when your heart relaxes The pressure in your arteries when your heart beats is called systolic pressure The pressure between beats is called diastolic pressure A blood pressure reading is usually shown as the systolic pressure over the diastolic pressure as in 130 80 Having high blood pressure over a long time can cause heart problems Have regular blood pressure checks Work with your doctor to manage your high blood pressure Use the action plan on page 128 to set goals Having normal blood pressure matters Over time high blood pressure can overload your heart and blood vessels and speed up the artery clogging process This can cause a heart attack heart failure or stroke It can also affect other vital organs like your kidneys and brain Your blood pressure can vary It can be affected by things like your breathing body position emotional state physical activity sleep medicines and stimulants like alcohol or coffee Blood pressure is usually lowest when you are sleeping and highest when you are excited upset or physically active Temporary rises are normal and your blood pressure should return to its usual level when you are resting Because these changes can make it hard for your doctor to get a true reading of your blood pressure he or she may need to measure your blood pressure several times over several visits heartfoundation org au Helpline 13 11 12 85

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Our recommended blood pressure goals Aim to have a target blood pressure of less than 130 80 Talk with your doctor about what your blood pressure should be Why does blood pressure stay too high The exact cause of high blood pressure is often not clear Your family history eating habits alcohol intake weight and level of physical activity affect your blood pressure In some people medicines including the oral contraceptive pill contraceptive depot injections steroids cortisone like medicines and arthritis medicines can also raise blood pressure The medical term for constantly high blood pressure is hypertension Have regular blood pressure checks Often you won t have any symptoms to warn you that you have high blood pressure so have your doctor check it regularly to stop it causing any serious health problems If you have coronary heart disease blood pressure lowering medicine is a common way to reach a good blood pressure level Your doctor also needs to check if all your medicines are working properly and change them if necessary Did you know High blood pressure can be a sign that your kidneys are not working properly Ask your doctor for a kidney health check 86 My heart my life Heart Foundation

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Why check your blood pressure at home Your blood pressure may be different at home to what it is in the hospital or at the doctor s Home measurements can give more information and help your doctor decide about treatment Your doctor may show you how to measure your blood pressure yourself and ask you to bring the results to your next appointments They may ask you to wear a special monitor that records your blood pressure over 24 hours How to manage my high blood pressure Even if you take a blood pressure lowering medicine you still need to change your lifestyle for better blood pressure and health Ways to lower your blood pressure include losing weight if you re overweight being more physically active limiting your alcohol intake quitting smoking eating healthy foods and reducing your salt sodium intake see page 57 heartfoundation org au Helpline 13 11 12 87

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To help to decrease your salt intake make fresh foods the main part of your diet include a wide variety of fruit and vegetables lean meat poultry and fish reduced fat dairy plain unsalted nuts and legumes avoid high salt foods such as potato crisps chips salted nuts commercial sauces e g tomato soy and fish processed meat and most take away foods use food labels to choose low or reduced salt options of your favourite foods flavour meals with herbs and spices rather than salt aim for foods with less than 400 mg of sodium per 100 g Foods with less than 120 mg of sodium per 100 g are considered low in salt Still got questions Ask about your diet on 13 11 12 88 My heart my life Heart Foundation

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Manage cholesterol What is cholesterol Cholesterol is a fatty substance that is carried around the body in the blood The body produces most cholesterol naturally and it is found in some foods Lipoproteins carry cholesterol in the blood The two main types that carry cholesterol to and from cells are called low low density proteins LDL C and high density lipoproteins HDL C The lower the density of the lipoproteins the more fats it contains High density lipoprotein HDL cholesterol is called the good cholesterol because it helps to keep cholesterol from building up in the arteries Low density lipoprotein LDL cholesterol is called the bad cholesterol because it is the main source of cholesterol build up and blockage in the arteries Statin medication work to reduce this LDL C Too much cholesterol in the blood over time can cause a heart attack or stroke Work with your doctor to manage high cholesterol Use the action plan on page 130 to set goals Total cholesterol is a reading of the good and bad cholesterol Triglycerides are another form of fat in the blood that can also raise the risk of heart disease High triglycerides are often associated with low HDL cholesterol increasing risk even though total cholesterol levels in the blood appear normal When there is too much LDL cholesterol in the blood it builds up in the walls of the arteries plaque Over time this build up causes hardening of the arteries This can cause chest pain and or a heart attack What causes too much cholesterol Eating a lot foods high in saturated and trans fat raises your cholesterol Reducing saturated and trans fats and replacing them with healthy fats can help lower your cholesterol The main sources of saturated fat include deep fried take away foods and bought pies biscuits buns and pastries heartfoundation org au Helpline 13 11 12 89

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fatty meats full fat dairy products and butter coconut and palm oils Foods high in trans fat include bought pies biscuits buns and pastries and deep fried take away foods Eating healthy foods can help to manage your cholesterol See pages 55 56 for more information about replacing saturated and trans fats with healthier fats and page 54 for our healthy eating checklist Our recommended cholesterol goals It is generally better if you have lower LDL cholesterol and triglycerides and higher HDL cholesterol This is especially true if you have coronary heart disease or are at risk of getting cardiovascular disease If you have coronary heart disease we generally recommend LDL cholesterol less than 1 8 mmol L HDL cholesterol greater than 1 0 mmol L fasting triglycerides less than 2 0 mmol L Talk with your doctor about what your cholesterol and triglycerides should be Keep your cholesterol low 1 Take cholesterol lowering medicines as your doctor directs Statins are recommended for almost everyone with heart disease even if your cholesterol is not elevated See page 33 for more information about statins 2 Heathy eating especially eating less saturated and trans fats and replacing them with healthier fats See pages 53 68 for more information about healthy eating 3 Be physically active See pages 70 74 for more information 90 My heart my life Heart Foundation

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Alcohol Drinking too much alcohol increases your risk of high blood pressure It also increases your risk of coronary heart disease stroke and many other problems We recommend that healthy men and women drink no more than two standard alcoholic drinks a day If you have high blood pressure chronic heart failure cardiovascular disease coronary heart disease liver disease or diabetes or are obese you may need to drink less than the above recommended limits Alcohol causes high triglycerides and low HDL cholesterol Talk with your doctor to find out what is right for you If you don t already drink alcohol or drink less than these limits don t drink more Tips to lower your alcohol intake Alternate your alcoholic drinks with low kilojoule drinks such as tap water or plain mineral water Dilute your alcoholic drinks with plain mineral water or soda water when you can Use only half measures of spirits Choose a low alcohol or light beer Choose a low alcohol wine When you are thirsty drink cold water instead of alcohol Keep a jug of water on the table with your meals heartfoundation org au Helpline 13 11 12 91

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What s a standard drink Examples of a standard drink are a can of mid strength beer a small glass of wine or a nip of spirits Tables of standard drink measures Use the following charts to check how many standard drinks you have a day or in a week The number beneath each container gives the number of standard drinks RTD ready to drink Reproduced with permission National Health and Medical Research Council Examples of a standard drink Note options in the table vary depending on the amount mL and alcoholic strength 92 My heart my life Heart Foundation

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Depression and a lack of social support can slow your recovery They can also increase your risk of more problems Monitor how you re feeling and talk to your doctor if you think you might have depression Use the action plan on page 134 to set goals for looking after your emotional health Manage your emotional and social life After a heart attack or other heart problem it is normal to feel sad angry anxious guilty lonely confused or stressed You may have one or more of these feelings They may last a few hours days or a couple of weeks We recommend that you talk with your doctor if they last longer than two weeks Some emotional and social factors like depression being socially isolated or not having social support can affect your recovery and future health It s important for you to take care of your emotional and mental health as well as your physical health What is depression Depression is more than just feeling sad or having a low mood it s a serious illness If you have depression you can find it hard to do everyday things You may not want to be with friends or family or enjoy working or playing sport Depression also affects your relationships and overall sense of wellbeing You might get depression for different reasons This may be to do with your heart problem family or work problems or feeling overwhelmed by having to change your lifestyle It can also be caused by a chemical imbalance in your brain Some medicines may cause depression as a side effect Know the signs of depression Ask for help when you need it Your doctor can tell you different ways of treating it 94 My heart my life Heart Foundation

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Depression and coronary heart disease Depression and coronary heart disease often go together Evidence shows depression can be a risk factor for coronary heart disease Depression can also slow your recovery and increase your risk of more heart problems Managing depression will help you recover better It can reduce your risk of more heart problems and help you stay healthy Depression can be treated Checklist How to tell if you re depressed You may be depressed if for more than two weeks you have felt sad down or miserable most of the time or you ve lost pleasure in usual activities and you ve also experienced some of these signs and symptoms not going out not speaking with or seeing close family members and friends using alcohol sedatives or other drugs not doing things you once enjoyed not being able to concentrate feeling overwhelmed guilty or irritable feeling disappointed miserable or sad feeling frustrated unhappy or indecisive having headaches and muscle pain not sleeping properly or sleeping too much loss or change of appetite heartfoundation org au Helpline 13 11 12 95

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Depression is just like any other illness there are treatments for it Medical treatments include anti depressant medicines to relieve the physical symptoms If you have mild depression and heart disease cardiac rehabilitation programs and regular physical activity can help You may also benefit from psychological therapies and if necessary medication Checklist Managing depression If you think you have depression or you have been diagnosed with it there are different ways to manage it These things may also help to lower your risk of coronary heart disease Talk with your doctor and health professionals about your concerns and what treatments you can get Ask for and accept help support and encouragement from family and friends Spend time with people to feel less isolated by joining support groups doing social activities or visiting or calling family and friends Be active this will improve both your physical and mental health Eat different types of healthy foods Achieve and maintain a healthy weight Get enough sleep Take time to relax and reduce your stress levels Have regular check ups and take your medicines as directed 96 My heart my life Heart Foundation

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Social isolation and lack of social support What is social isolation and lack of social support Social isolation can occur when you live alone or if you feel lonely isolated for other reasons Social support is when you have friends and family who listen to you and understand how you feel They give you emotional support and you share activities with them like dinners drinks sports picnics and other outings Social isolation social support and coronary heart disease People who live alone or are lonely may have a higher risk of coronary heart disease than people who have support from family and friends Why being connected and having social support is important You will get well faster and more easily when other people like your family friends health professionals and support groups help you Your cardiac rehabilitation program is an important way to give you support and comfort You get the advice and care of health professionals while sharing experiences with others who have similar heart problems See page 35 for more information about cardiac rehabilitation Joining groups such as walking groups and clubs where you can get support and meet new people can also be an important part of your recovery Websites such as www heartfoundation org au aftermyheartattack can also offer support heartfoundation org au Helpline 13 11 12 97

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Strategies that may help your relationships re are Coming to terms with a long term health condition such as a heart attack or heart surgery and all that goes with that can put a strain on you your family and your friends It can be difficult to talk with people about your condition even if they are close to you Be open about how you feel and let your family and friends know what they can do to help se nefit ary The way you feel about yourself will probably change and coping with any physical and emotional changes can affect how you feel and interact with others It is very likely that some of the roles you played in a relationship will change Recognising this and accepting this can be a way to move forward If you have a partner think about things from their perspective as well Your heart attack or heart surgery has affected them too so try to be understanding about what they are going through Don t rush or expect things to be the same straight away Adjustments take time for everyone beyondblue beyondblue is an independent not for profit organisation working to increase awareness and understanding of depression and anxiety in Australia and to reduce the associated stigma Some of the information in this section was reproduced with permission from beyondblue For more information on depression and anxiety available treatments and where to get help visit www beyondblue org au or call 1300 22 46 36 98 My heart my life Heart Foundation

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A letter from one person with coronary heart disease to another You will often hear the phrase coping with coronary heart disease but coping seems to mean getting by You and your carer will need to do more than get by to deal with the situation that has entered your lives in so many instances without warning Thinking heart condition will help you to own the condition for now it is very much a part of your life From now on start thinking managing By doing so you are saying you are in control you are managing your heart condition However before you learn to manage you need to know what it is you are managing It is now that you and your carer learn how similar the path that you both need to travel is You may have one or more of a range of emotions Anger sadness or anxiety are the most common emotions You may feel them from the moment you are first diagnosed as having a heart condition through to post operative recovery Anger may come from a sense of intrusion of the inconvenience to not only your lifestyle but also to plans for your future You may also feel angry at yourself for getting into this situation Anger fades with time but if it lasts you may want to talk to your doctor Sadness or feeling down is probably the most common emotion Perhaps your main question is Why me If you can t answer this question you might ignore or even deny the issue Again if this emotion doesn t ease with time talk with your doctor heartfoundation org au Anxiety nearly always relates to the future What about my work What about my family Anxiety affects everyone at some time but it is very strong when you are concerned about your health A heart condition casts a darker shadow than most for underlying all of the above is fear As well as questions about family friends and work other questions may tumble through your mind How much pain can I stand How far can I push myself physically What is the danger of doing too much or too little How much can I expect of others and of myself Can I cope and how much of my burden do I share And always sitting in a deep recess of your mind are the questions Will it happen again What if it happens again The level of your emotion depends on you and your circumstances but take some comfort in knowing that these emotions usually fade with time Any patient or carer who reads this may have experienced all or some of these emotions Rest assured they are quite common You are not alone These are the many emotions you may come across before you set about managing your heart condition Printed with kind permission Gerry Atkinson board member Heart Foundation WA Helpline 13 11 12 99

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My coronary arteries Left main coronary artery Right coronary artery Left circumflex artery Left anterior descending branch This image may be used by your health care professional to explain your diagnosis Checklist Have you been prescribed the following medicines statin ACE inhibitor aspirin Are you taking your medicines as directed Does your doctor suggest taking these medicines indefinitely or for a limited time Have you experienced any new symptoms since you started your medication that could be a side effect Have you discussed any side effects or other concerns with your doctor 112 My heart my life Heart Foundation

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Which risk factors can I change to improve my health Tick your risk factors and write down the changes you will make Smoking How I will make a change Sitting less often How I will make a change eing physically inactive How I B will make a change Being overweight How I will make a change Having high cholesterol How I will make a change Having diabetes How I will make a change Having high blood pressure How I will make a change Unhealthy eating How I will make a change B eing depressed socially isolated and having a lack of social support How I will make a change D rinking more than the recommended amount of alcoholic drinks each day How I will make a change 114 My heart my life Heart Foundation

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My risk factor readings Aim for LDL cholesterol 1 8 mmol L HDL cholesterol 1 0 mmol L Triglycerides 2 0 mmol L Total cholesterol 4 0 mmol L Date Date Date Date However focus more on LDL cholesterol rather than total cholesterol Blood pressure 130 80 mmHg Your doctor may want it lower Fasting blood sugar Generally 5 5 mmol L HbA1c This will be 7 measured if you have diabetes Weight Waist measurement 94 cm males 80 cm females BMI 18 5 24 9 kg m2 Please note that these targets are a general guide Work with your doctor to set your personal goals heartfoundation org au Helpline 13 11 12 115

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Nutrition action plan Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet Eat two serves of fruit everyday Eat plenty of vegetables aim for five serves every day Choose wholegrain breads cereal pasta rice and noodles Select lean meat meat trimmed of fat and poultry without skin Have two to three serves 150 g serve of fish and seafood every week Include legumes in two meals a week Choose from dried peas e g split peas dried beans e g haricot beans kidney beans canned beans e g baked beans three bean mix or lentils Eat up to six eggs every week Choose reduced fat milk yoghurt or cheese Use a variety of oils for cooking some healthier choices include canola sunflower soybean olive sesame and peanut oils Instead of butter use spreads and margarines made from canola sunflower or olive oil Continued over 116 My heart my life Heart Foundation

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Nutrition action plan continued Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet Use salad dressings made from oils such as canola sunflower soybean olive sesame and peanut oils Snack on plain unsalted nuts and fresh fruit aim to eat two serves of fruit and one handful of nuts every day Avoid processed meats including sausages and deli meats such as salami Avoid take away foods such as pastries pies pizza hot chips fried fish hamburgers and creamy pasta dishes Avoid salty fatty and sugary snack foods such as crisps cakes pastries biscuits lollies and chocolate Drink water plain mineral water or soda water Avoid soft drinks fruit juices and fruit juice drinks Limit how much alcohol you drink Ask your doctor for a referral to an accredited practising dietitian 118 My heart my life Heart Foundation

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Physical activity action plan Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet Getting started Talk with your doctor or health professional about how to increase your physical activity levels Start slowly and gradually build up your activity Do everyday tasks like light gardening and housework Walk around your house and garden or out on your street Gradually increase your physical activity to 30 minutes on most if not all days of the week See page 72 as a guide As your fitness increases try activities such as cycling swimming tennis or golf Ways to be more active every day Spend less time sitting down e g watching TV or at the computer Be more physically active at home e g vacuum do some gardening mow the lawn Try walking cycling or taking public transport Take the stairs instead of the lift Buy a pedometer and keep a record of your steps Get support by joining a local walking group See page 107 or call 13 11 12 120 My heart my life Heart Foundation

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Healthy weight action plan Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet For everyone Do at least 30 minutes of moderateintensity physical activity on most if not all days of the week Choose a wide variety of fruit and vegetables lean meat poultry and fish reduced fat unflavoured dairy and plain unsalted nuts and legumes Sit less If you need to lose weight Choose a wide variety of fruit and vegetables lean meat poultry and fish reduced fat unflavoured dairy and plain unsalted nuts and legumes Avoid discretionary junk foods and drinks like cakes biscuits take away and fried foods and sugar sweetened drinks Choose smaller portion sizes Drink plain tap water plain mineral water or soda water Avoid soft drinks fruit juices and fruit juice drinks Limit how much alcohol you drink Ask your doctor for a referral to an accredited practising dietitian 122 My heart my life Heart Foundation

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Smoking action plan Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet If you haven t quit smoking yet Work out the benefits of quitting Discuss quitting options including nicotine replacement therapy Talk with your health professional or call the Quitline on 13 78 48 Set a date to quit Make sure your home and car are smoke free If you have already quit Avoid areas where you might be exposed to second hand smoke Call the Quitline on 13 78 48 if you are having problems with not smoking Remind yourself of two benefits of quitting Make sure your home and car are smoke free If you are a non smoker Avoid areas where you might be exposed to second hand smoke Make sure your home and car are smoke free 124 My heart my life Heart Foundation

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Diabetes action plan Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet Take your diabetes medicines as prescribed Achieve and maintain a healthy weight Be physically active Enjoy healthy eating refer to the action plan on page 116 Include a wide variety of fruit and vegetables wholegrains lean meat poultry and fish reduced fat unflavoured dairy plain unsalted nuts and legumes Avoid discretionary junk foods and drinks like cakes biscuits take away and fried foods and sugar sweetened drinks Choose smaller portion sizes Choose healthier fats and oils for cooking spreads and dressings Some suitable choices include canola sunflower soybean olive sesame and peanut oils Avoid using butter other dairy blends lard copha or cooking fats Find out more about diabetes Ask your doctor about a referral to a diabetes educator services 126 My heart my life Heart Foundation

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Blood pressure action plan Tick the relevant column after each review Already doing this Actions Ready to do now Not ready yet Talk with your doctor about your blood pressure Take blood pressure medicines as prescribed See your doctor regularly to have your blood pressure checked Be physically active Minimise salt intake Make fresh foods the main part of your diet include a wide variety of fruit and vegetables wholegrains lean meat poultry and fish reduced fat unflavoured dairy and plain unsalted nuts and legumes Avoid high salt foods such as potato crisps chips salted nuts commercial sauces e g tomato soy fish processed meat and most take away foods U se herbs and spices instead of salt in cooking and at the table C hoose low salt or salt reduced foods where available Healthy men and women limit alcoholic drinks to two standard drinks per day If you have high blood pressure or are taking blood pressure medicine limit alcoholic drinks to two standard drinks per day men or one standard drink per day women Achieve and maintain a healthy weight 128 My heart my life Heart Foundation

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Cholesterol and triglycerides action plan Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet Talk with your doctor about your cholesterol and triglycerides Take your cholesterol lowering medicines e g statins as prescribed Choose a wide variety of fruit and vegetables wholegrains lean meat poultry and fish reduced fat unflavoured dairy and plain unsalted nuts and legumes Choose healthier fats and oils for cooking spreads and dressings Some suitable choices include canola sunflower soybean olive sesame and peanut oils Avoid using butter other dairy blends lard copha or cooking fats Be physically active Ask your doctor for a referral to an accredited practising dietitian Find out more information about cholesterol and triglycerides Limit how much alcohol you drink 130 My heart my life Heart Foundation

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Alcohol action plan Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet Alternate your alcoholic drinks with low kilojoule drinks such as water plain mineral water or soda water Where possible dilute your alcoholic drink with plain mineral water or soda water Use only half measures of spirits Choose a low alcohol or light beer When you are thirsty drink cold water instead of alcohol Keep a jug of water on the table when dining in or out Establish one or two alcohol free days per week When stressed take a walk or exercise instead of drinking Healthy men and women limit alcoholic drinks to two standard drinks per day If you have high blood pressure or are taking blood pressure medicine limit alcoholic drinks to no more than two standard drinks per day men or one standard drink per day women 132 My heart my life Heart Foundation

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Psychological and social health action plan Tick the relevant column after each review Actions Already doing this Ready to do now Not ready yet Take your medicines as prescribed Regularly monitor yourself for depression using the self assessment checklist on page 95 and take action as recommended Talk with your partner family friends about how you feel Talk with your health professional about how you feel Attend a cardiac rehabilitation program Join a local heart support group Join a social group Join a walking group Be physically active every day Ask your doctor for a referral to a registered clinical psychologist Find out more about depression and social isolation Limit how much alcohol you drink 134 My heart my life Heart Foundation

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Will you recognise your heart attack Do you feel any pain pressure heaviness tightness In one or more of your chest neck jaw arm s back shoulder s You may also feel nauseous a cold sweat dizzy short of breath Yes If you take angina medicine Take a dose of your medicine Wait 5 minutes Still have symptoms Take another dose of your medicine Wait 5 minutes Symptoms won t go away Are your symptoms severe or getting worse or Have your symptoms lasted 10 minutes Yes and chew 300mg aspirin unless you have Triple Zero an allergy to aspirin or your doctor has told you not to take it If calling Triple Zero 000 does not work on your mobile phone try 112 2017 National Heart Foundation of Australia ABN 98 008 419 761 CON 076 v3 HFN0785 JUN17 Ask for an ambulance Don t hang up Wait for the operator s instructions

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CPR Cardiopulmonary resuscitation D R S A B C D D anger Check for danger R esponse Check for response If no response S end for help Call Triple Zero 000 and ask for an ambulance If calling Triple Zero 000 does not work on your mobile phone try 112 A irway Check the airway is open and clear B reathing C heck for breathing If not breathing or not breathing normally C PR S tart CPR ive 30 chest compressions 2 breaths G Continue CPR until responsiveness or normal breathing return D efibrillation Attach a defibrillator AED if available and follow its voice prompts Automated External Defibrillator This information is to help you remember the important steps of CPR and is not a substitute for training in CPR

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Important phone numbers Emergency phone number Dial Triple Zero 000 for an ambulance at any time for 24 hour service if you have heart attack warning signs Health information and services Heart Foundation Helpline 13 11 12 A telephone service for heart health information heartfoundation org au health heartfoundation org au Information about medicines NPS Medicines Line 1300 63 34 24 nps org au Australia MedicAlert Foundation 1800 88 22 22 A service for people with heart conditions particularly people who are prescribed ongoing medicines Medical ID bracelets and wristbands provide critical information in case of emergency www medicalert com au Free fax 1800 64 32 59 Quitting smoking Quitline 13 78 48 quitnow gov au Health information beyondblue 1300 22 46 36 beyondblue org au Diabetes Australia 1300 13 65 88 diabetesaustralia com au 102 My heart my life Heart Foundation

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Kidney Health Australia 1800 45 43 63 kidney org au Stroke Foundation 1800 78 76 53 strokefoundation com au Commonwealth Respite and Carelink Centre 1800 05 22 22 dss gov au Find an accredited practising dietitian daa asn au Find an exercise physiologist essa org au Find a physiotherapist physiotherapy asn au Financial issues Money Smart moneysmart gov au life events andyou life events dealing with illness Centrelink humanservices gov au customer services centrelink Concession and health care cards humanservices gov au customer subjects concessionand health care cards Commonwealth Home Support Programme 1800 200 422 www agedcareguide com au information home care commonwealth home support programme heartfoundation org au Helpline 13 11 12 103

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Money insurance and other support Money matters For some people a heart attack or heart surgery can lead to money worries Costs can add up especially if you can t work for a while or you are a pensioner When you re already coping with recovery this can add more stress There s help available and places you can go for advice Checklist Find out what financial help you can get Find out from your employer how much paid sick leave you are entitled to Check your insurance and superannuation policies to see if they could cover some bills or replace some income e g health insurance for medical costs not covered by Medicare or income protection insurance Contact Centrelink to find out if you qualify for a concession or health care card or for benefits like Sickness Allowance or the Disability Support Pension Talk with your doctor or pharmacist about ways to save money on medicines without compromising your health e g using generic brands and making sure you are receiving all available subsidies If transport to appointments is difficult ask your hospital about transport services You can also check if you qualify for Mobility Allowance Don t be afraid to seek emergency financial help from local charities for things like food transport chemist vouchers and help with bills and budgeting 104 My heart my life Heart Foundation

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Insurance If you have had a heart attack it can affect your health income protection and life insurance A heart attack is classed as a pre existing condition That may affect premiums and require special conditions or exclusions Some companies might ask you to do a medical assessment Contact your insurance company to find out if your policy is affected Talk with your doctor before buying health insurance Insurance companies often ask for detailed medical information Shop around to get the best value insurance You can still get cover with a pre existing condition but there could be a waiting period before you can claim You should also think about ambulance cover Your private health insurance may cover you for ambulance but only for emergencies so it s important to check If you live in Queensland or Tasmania ambulance cover is automatically provided Other support Some people need support to get back to independent living You may be eligible for help with nursing and allied health care in the home meals and social activities There are also support services that can help with things like cleaning showering shopping transport and home maintenance Talk with your doctor social worker and local council about what help you are eligible for heartfoundation org au Helpline 13 11 12 105

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Heart Foundation Walking Heart Foundation Walking is a network of free community based walking groups Groups are led by volunteer organisers These groups are a great way to be active have fun and meet new people There s probably a group in your area By walking for at least 30 minutes a day you get many health benefits including maintaining a healthy weight increasing your fitness and strength improving your self esteem and mental health We are helping Australians lead active healthy lives by encouraging them to join or start Heart Foundation Walking groups in their area Heart Foundation Walking members receive special offers regular newsletters incentives and prizes to help keep them motivated To find out about your nearest Heart Foundation Walking group or how you can start a new group call the Heart Foundation Helpline on 13 11 12 or visit www walking heartfoundation org au heartfoundation org au Helpline 13 11 12 107

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Your help can save more lives The Heart Foundation is here to save lives keep families together and help you enjoy your best possible health following your heart attack or surgery For close to 60 years the generous support of everyday Australians has produced advances that have saved the lives and improved the heart health of hundreds of thousands of people The Heart Foundation Research Program s ongoing investment in research in heart disease has led to major advances in preventing heart attacks and improving the diagnosis treatment and management of people living with heart conditions These achievements include the national emergency Triple Zero 000 number intensive care ambulances coronary care units in hospitals cardiac rehabilitation technology like the pacemaker improved medicines for high cholesterol and high blood pressure Information developed by the Heart Foundation informs the treatment you receive in hospital your cardiac rehabilitation and the ongoing management of your heart condition To help you manage your heart health we have put our most trusted information in this booklet Our Helpline health professionals are also ready to talk to you about your heart health questions or concerns We can do this because of the financial support of everyday Australians like you We want you to make a great recovery and enjoy 108 My heart my life Heart Foundation

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your best possible heart health When you are ready we would also like you to consider how you might help others You can become a regular supporter by volunteering with us or consider making a lasting contribution by donating or leaving a gift in your will In fact two out of every three research projects we fund are because of wonderful Australians who have left a gift to the Heart Foundation in their will To find out about how you can help to save more lives please call us on 13 11 12 or visit www heartfoundation org au to find out more I had two heart attacks at the age of 53 The Heart Foundation has been wonderful to me with information when I ve needed it I am grateful for the work of the Heart Foundation and the research it has supported After ensuring that our children are looked after my husband and I have included a bequest to the Heart Foundation in our wills We think this is a special way of saying thanks for the past 33 years of my life To find out how to support us call 13 11 12 Val 86 heartfoundation org au Helpline 13 11 12 109

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For heart health information 13 11 12 heartfoundation org au 2017 National Heart Foundation of Australia ABN 98 008 419 761 First published 2012 Reprinted with corrections 2013 2014 Reprinted 2015 Second edition 2015 ISBN 978 1 74345 128 1 Terms of use This material has been developed for general information and educational purposes only It does not constitute medical advice Please consult your healthcare provider if you have or suspect you have a health problem The health information provided has been developed by the Heart Foundation and is based on independent research and the available scientific evidence at the time of writing The information is obtained and developed from a variety of sources including but not limited to collaborations with third parties and information provided by third parties under licence It is not an endorsement of any organisation product or service While care has been taken in preparing the content of this material the National Heart Foundation of Australia its employees and related parties cannot accept any liability including for any loss or damage resulting from the reliance on the content or for its accuracy currency and completeness This material may be found in third parties programs or materials including but not limited to show bags or advertising kits This does not imply an endorsement or recommendation by the National Heart Foundation of Australia for such third parties organisations products or services including their materials or information Any use of National Heart Foundation of Australia materials or information by another person or organisation is at the user s own risk The entire contents of this material are subject to copyright protection CON 141 v5 0617 Don t give up Talk to your doctor about reducing your modifiable risk factors Continue your cardiac rehabilitation Take your medicines as prescribed by your doctor Be informed Set priorities Visit your doctor regularly Take charge of your recovery Key points to remember about managing your heart health