While many people who suffer a heart attack are able to experience a full and active life after recovering, it often takes time to get back on your feet. And given the risk of another heart attack — about 1 in 5 of those age 45 and older have a second one within five years of their first — it’s important to prioritize your health and stay proactive about prevention efforts.

Recovery looks different for each person, with treatment dependent upon a variety of factors including the type of heart attack you had, its severity, and your overall health history. In most cases, a combination of lifestyle changes and medication is necessary to manage the risk of another heart attack. Here’s an overview of what to expect.

What is a heart attack?

A heart attack occurs when blood flow to the heart is reduced or blocked as the result of a blockage in a coronary artery. There are two main types of heart attacks, categorized by the extent of the blockage:

• An ST-elevation myocardial infarction, commonly referred to as a “STEMI” heart attack, is caused by a complete blockage.

• A non-ST-elevation myocardial infarction, commonly referred to as an “NSTEMI” heart attack, is caused by a partial blockage.

Causes and risk factors

Coronary artery disease, the most common type of heart disease, is the cause of most heart attacks. In this condition, accumulation of plaque causes the coronary arteries to become hardened or blocked.

Too often, people learn that they have coronary artery disease after having a heart attack. To detect cardiovascular issues at an early stage, consult with your doctor about your risk for heart disease. Your doctor may use a cardiac risk calculator to assess your chances of developing heart disease based on your personal health history.

Remember that your risk can be managed. The purpose of calculating it is to help you take important preventative steps. While some drivers of heart disease like age and genetics aren’t modifiable, you have control over many others, including high blood pressure, high cholesterol, smoking, and physical inactivity.

Symptoms

Presentation of heart attack symptoms can vary significantly from one person to another. In fact, not everyone who has a heart attack develops symptoms. When they do occur, they can range from mild to severe, developing suddenly or over the course of days or weeks. 

If you think you might be having a heart attack, seek medical care right away. Chest pain or pressure is the most common symptom for both men and women, but watch for the following signs as well.

There is some variation between men and women in the presentation of a heart attack. The symptoms marked with an asterisk (*) are more common in women.

• Chest pain, pressure, or tightness

• Fatigue

• Heartburn or indigestion

• Lightheadedness

• Sudden dizziness

• Nausea*

• Shortness of breath*

• Back or jaw pain*

Components of heart attack recovery

The timeline for heart attack recovery ranges from two weeks to three months. Treatment typically includes lifestyle changes, medication, and cardiac rehabilitation. Surgical procedures may be necessary to treat more severe cases.

It’s important to actively participate in your health after a heart attack. Recovery care and prevention should be a collaborative effort between you and your care team. Stay on track with your appointments. The American Heart Association recommends visiting your doctor for a follow-up appointment within six weeks of your heart attack.

Cardiac rehabilitation

Many people find enrolling in a cardiac rehabilitation program to be beneficial for heart attack recovery. These programs offer access to expert healthcare professionals who can support you in making changes to your routine and managing stress. Speak with your doctor about whether cardiac rehabilitation is a good fit for your needs. 

Lifestyle changes

Your doctor may advise you to change health habits after a heart attack. For many people that includes: 

• Avoiding cigarette smoke and limiting your alcohol intake

• Exercising regularly

• Maintaining a healthy weight

• Eating a heart-healthy diet

• Proactively managing stress

Medications prescribed after a heart attack

The primary goal of post-heart attack care is to reduce the risk of another heart attack. A variety of medications may be prescribed to:

• Restore blood flow

• Lower cholesterol

• Improve heart function

• Help the heart muscle heal

• Prevent complications such as arrhythmias, blood clots, and heart failure

These are the most commonly prescribed medication classes.

Anticoagulants

Anticoagulants reduce the blood’s ability to form new clots and prevent existing clots from growing. Commonly prescribed anticoagulants include:

• Warfarin (Coumadin®, Jantoven®), which prevents the liver from processing vitamin K into proteins that help form blood clots.

• Direct oral anticoagulants (DOACs) such as apixaban (Eliquis®), betrixaban (Bevyxxa®), dabigatran (Pradaxa®), edoxaban (Savaysa®), and rivaroxaban (Xarelto®), which directly block the blood’s ability to form clots.

Antiplatelets

Like anticoagulants, antiplatelets prevent blood clots from forming. They accomplish this specifically by preventing blood platelets from sticking together. Commonly prescribed antiplatelets include:

• Aspirin

• Clopidogrel (Plavix®)

• Dipyridamole (Persantine®)

• Prasugrel (Effient®)

• Ticagrelor (Brilinta®)

ACE inhibitors

Frequently used to lower blood pressure, ACE inhibitors block production of a hormone called angiotensin II, which causes blood vessels to narrow, so that more blood can flow through. Commonly prescribed ACE inhibitors include:

• Benazepril (Lotensin®)

• Enalapril (Vasotec®)

• Fosinopril (Monopril®)

• Lisinopril (Prinivil®, Zestril®)

• Ramipril (Altace®)

Angiotensin II receptor blockers

Angiotensin II receptor blockers (ARBs) also protect blood vessels from the hormone angiotensin II to lower blood pressure. Commonly prescribed ARBs include:

• Candesartan (Atacand®)

• Irbesartan (Avapro®)

• Losartan (Cozaar®)

• Telmisartan (Micardis®)

• Valsartan (Diovan®)

Beta blockers

Beta blockers cause the heart to beat more slowly and less forcefully, lowering your blood pressure. They also help improve overall blood flow by opening up your veins and arteries.

Commonly prescribed beta blockers include:

• Atenolol (Tenormin®)

• Bisoprolol (Zebeta®)

• Metoprolol tartrate (Lopressor®)

• Metoprolol succinate (Toprol-XL®)

• Propranolol (Inderal®)

• Sotalol (Betapace®)

Beta blockers typically aren’t recommended for those with asthma, as they can trigger severe asthma attacks.

Never stop taking a beta blocker without first consulting with your doctor. Abruptly stopping the use of these medications can increase the risk of heart attack.

Combined alpha-beta blockers

Alpha-beta blockers combine alpha and beta blockers to decrease constriction of blood vessels and help the heart work less forcefully.

Commonly prescribed alpha-beta blockers include:

• Carvedilol (Coreg®)

• Labetalol (Normodyne®, Trandate®)

Calcium channel blockers

Also used to lower blood pressure, calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and blood vessels. This opens up narrowed blood vessels and eases the heart’s workload.

Commonly prescribed calcium channel blockers include:

• Amlodipine (Norvasc®, Lotrel®)

• Diltiazem (Cardizem CD®, Cardizem SR®, Dilacor XR®, Tiazac®)

• Nifedipine (Adalat CC®, Procardia XL®)

• Verapamil (Calan SR®, Covera HS®, Isoptin SR®, Verelan®)

Statins

The most common cholesterol-lowering medication, statins act on the liver to prevent cholesterol from forming. Commonly prescribed statins include:

• Atorvastatin (Lipitor®)

• Lovastatin (Mevacor®)

• Simvastatin (Zocor®)

• Rosuvastatin (Crestor®)

Non-statin cholesterol-lowering agents

If statins aren’t the best option for you or your cholesterol levels need to decrease further, your doctor may prescribe a non-statin cholesterol medication such as ezetimibe (Zetia®) or alirocumab (Praluent®).

Ezetimibe is a cholesterol absorption inhibitor. It lowers your cholesterol by reducing the small intestine’s absorption of cholesterol.

Alirocumab belongs to a newer class of injectable cholesterol-lowering medications called PCSK9 inhibitors. These medications act on proteins produced by the liver that are linked to high cholesterol levels.

Aldosterone antagonists

Aldosterone antagonists help the body retain potassium and remove excess water and sodium. This helps lower blood pressure by reducing the volume of fluid in your blood vessels.

Commonly prescribed aldosterone antagonists include:

Eplerenone (Inspra®)

Spironolactone (Aldactone®)

If you have been prescribed one of these medications, work with your doctor to monitor your potassium levels. In addition to getting a baseline test before the beginning of treatment or a change in your dosage, attend follow-up appointments to have your potassium tested at regular intervals.

Vasodilators

These medications open up, or dilate, blood vessels, so that blood can flow more easily. This also eases the heart’s workload.

Commonly prescribed vasodilators include:

• Isosorbide dinitrate (Isordil®)

• Isosorbide mononitrate (Imdur®)

• Hydralazine (Apresoline®)

• Nitroglycerin (Nitro Bid®, NitroStat®)

• Minoxidil

Let Alto support your heart attack recovery

At Alto, we make it as simple as possible to follow the treatment plan your doctor recommends. We will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible. And our team of pharmacists is available to chat whenever questions come up about side effects or how to take your medication properly.

Reach out any time through in-app messaging or by phone at 1-800-874-5881.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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