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Jack Nicholson looked at Keanu Reeves and summed up one of the most serious concerns of many a person who has suffered a heart attack: How long before I can have sex again, doc?
Nicholson and Reeves were playing parts in the comedy "Something's Gotta Give," but for tens of thousands of people each year, the question of life --- sex, driving, work, sports --- after a heart attack is filled with dramatic, urgent overtones.
"After a heart attack, the doctors are thinking about all the medical issues, but the patients are thinking, 'When can I return to a normal life?' " said Dr. Laurence Sperling, director of preventive cardiology at Emory University.
The answer Reeves gave Nicholson --- as soon as you can climb a flight of stairs --- was actually correct. But the two never got into many other things a heart attack survivor should do; Nicholson was out strolling on the beach with Diane Keaton within a few days and having drinks with another woman soon after that.
No one told him about the need for a lifestyle change or the need for cardiac rehabilation, two crucial elements of getting one's health back after a heart attack.
"I feel very strongly about a person beginning cardiac rehabiliation," said Sperling. "It not only helps medically, but it gives support and gives a person a chance to speak to others who have had a heart attack."
Life does go on after a heart attack --- in about 50 percent of cases --- and it goes on much faster today than it did even 10 years ago.
Most patients return to normal levels of activity within six weeks after a heart attack, about half the recuperation time of 25 years ago. Patients no longer stay in the hospital for seven to 10 days, which was standard for years. Now patients often are home by day three. Many are back at work, so long as their job is sedentary, within a month, compared with three months in years past.
Doctors credit new classes of drugs --- the statins, beta-blockers and ace inhibitors --- and higher-tech procedures like angioplasty for the faster recovery times.
But none of the recovery happens without good rehabilitation and a change in lifestyle, doctors said. Also, a swifter, safer return to normal activities often depends upon the effectiveness and immediacy of the treatment a patient receives after a heart attack, doctors believe.
Dee Anderson, 54, was especially fortunate. She suffered a heart attack on a Tuesday in October. She was back to work the next Monday.
Anderson had experienced mild chest pain, lack of energy and an odd pain in her elbows before her heart attack. She made an appointment with a cardiologist, and doctors were able to essentially stop her heart attack while it was in progress. They found a 90 percent blockage in her heart and immediately performed angioplasty, a procedure in which a tiny catheter is inserted into the plugged artery to unclog it.
"My primary symptom was fatigue," Anderson said. "Then shortness of breath, a little angina [chest pains]. What really told me is that it developed into what I called a 'sick ache.' Then when I realized it was in my elbows, I knew I was in trouble."
Anderson's knowledge of heart attack symptoms may have saved her life, but knowing risk factors can also be lifesaving, doctors said. Risk factors include a family history of heart disease, smoking, high levels of triglycerides and low-density cholesterol, low levels of high-density cholesterol, obesity and diabetes. And sticking with her rehab program has been essential.
While doctors are encouraged by new treatments and drugs that thwart heart disease, most predict an increase in coming years because of the obesity epidemic and soaring rates of diabetes. They also worry that powerful drugs called statins that lower high levels of bad cholesterol, and other treatment like angioplasty and stents to open blocked arteries, are giving some patients the impression that a drug or surgery can compensate for an unhealthy lifestyle.
"There's this whole group of people who think the drugs will solve their lifestyle issues," said Dr. Jay Groves, director of the Kim Dayani Health Promotion Center at Vanderbilt University. "They will be on the fast track to return to the emergency room. If they don't change their lifestyle, it [heart disease] will continue."
Lifestyle changes are important not only to avoid a future heart attack but also to return to work, exercise, driving and sexual activity. Rehabilitation helps patients focus on the lifestyle changes, but fewer than 30 percent of patients stick with it, studies show. The low rates of compliance trouble doctors.
Women are less likely than men to continue with cardiac rehab, and that worries Dr. Gina Lundberg director of the Women's Heart Center at St. Joseph's Hospital.
"Far fewer women go to cardiac rehab than men," she said. "We don't know if this is referral bias, or if women aren't as likely to go to a gym, but it's something we're very concerned about."
Most rehabilitation programs begin when a patient is out of the danger zone, Sperling said, at about four to six weeks. The arteries of the heart are inflamed in the days immediately after a heart attack, and they must be given time to become less inflamed. In days past, that might have taken 12 weeks, but with newer drugs, doctors are able to minimize the inflammation after four to six weeks. When the person's arteries are stabilized, it's time for rehabilitation to begin, Sperling said.
The rehab begins with very closely monitored and limited workouts under nurse supervision. The patient wears a heart monitor. Gradually, as the patient improves, he or she will work up to moderate exertion. Doctors and therapists also work closely with patients on lifestyle, reviewing changes that need to be made in diet, exercise and lowering stress levels.
While heart attack patients face shorter recovery times than in years past, doctors do not want patients to rely on technology and drugs alone to move beyond a heart attack.
"The downside of all this is that people are not taking heart disease as seriously as they need to," said Groves. "There is no cure for heart disease. Once you've got it, it's there. It continues to march on, and how quickly it accelerates depends on how a patient manages the disease."
Copyright 2004 The Atlanta Journal-Constitution
