University Teaching Trust
Cardiovascular Rehabilitation
- your health in your hands
Cardiovascular rehabilitation has been shown to be as beneficial to both
patients’ symptom control and survival as many of the drug therapies used.
In Salford we are blessed with a department that provides a superb standard
of care and is recognised nationally. I would recommend all suitable patients
to take up this service
Paul Bishop, GP Salford
Cardiovascular
Rehabilitation Team
0161 206 0033
© G15111001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Unique Identifier: MED 49 (15). Review date: January 2018.
The aim of cardiac
rehabilitation is to help you to
recover and resume as full a life as
quickly as possible after a cardiac
event; such as a heart attack, stent
or coronary artery bypass surgery.
The process aims to restore your
confidence and benefit both
you and your family. It will help
promote your health and keep you
well. Programmes feature three
key areas- exercise, psychological
support and information on
lifestyle and treatment. They are
tailored to suit individual lifestyle
and ability.
Evidence shows that cardiac
rehabilitation is as important as
many of the high-tech cardiac
procedures and specialised
medications in improving longterm survival. For this reason I
strongly encourage participation
in a cardiac rehabilitation
programme irrespective of
age or infirmity.
Dr Alan Fitchet
Consultant Cardiologist
Salford Royal NHS Foundation Trust
© G15111001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Unique Identifier: MED 49 (15). Review date: January 2018.
Content
Why have I been given this
4
booklet?
What is cardiovascular
4
rehabilitation?
Your stay in hospital
4
Your journey through 5
cardiovascular rehabilitation
What to do if you get chest
6
discomfort / pain in the future?
How can the cardiovascular
8
rehabilitaion team support you
Feelings and emotions
9
The heart
12
What is cardiovascular heart 13
disease (CVD)?
What is angina?
13
What is a heart attack?
14
ECG16
Other tests and investigations 17
for your heart condition
Exercise Tolerance Test
18
Coronary angiogram
19
Echocardiogram21
Myocardial perfusion scan
22
Dobutamine stress
22
echocardiogram (DSE)
Percutaneous coronary
23
intervention
Coronary artery bypass grafts
25
Common physical effects after
26
bypass surgery
Other heart conditions
28
Causes of cardiovascular 33
heart disease
How to make a lifestyle change?
34
High cholesterol (fat levels)
35
High blood pressure 41
(hypertension)
Stress and tension
43
Factors which cannot be changed 50
Discharge from hospital after a
52
cardiac event
Activity guidance
52
Walking advice
55
General activities
56
Exercise with the cardiovascular
57
rehabilitation team
Aerobic activity
58
Sex60
Driving61
Returning to work
64
Returning to hobbies
65
Holidays66
Medications for cardiovascular
68
disease
Missed doses of medication
68
Re-ordering your medicines
69
Unplanned hospital admission
70
Getting the most from your
71
treatment
Self management section
91
Appointment and tests
92
Further information and support 93
3
© G15111001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Unique Identifier: MED 49 (15). Review date: January 2018.
Why have I been given
this booklet?
It has been given to you because
you have recently been an
inpatient or been seen in clinic
with your heart condition.
Or you have recently had a
circulation test on your legs and
been diagnosed with reduced
circulation known as peripheral
arterial disease (PAD). This
booklet aims to provide you with
information about cardiovascular
disease and help you to
understand your condition. It
should also help to reduce any
fears or anxieties you may have.
Please read the booklet at your
leisure and ask the cardiovascular
rehabilitation team if you do not
understand anything or would
like more information.
What is Cardiovascular
Rehabilitation?
It is suitable for people of
all ages and abilities. It aims
to return you to a full and
active life after a diagnosis
of angina or heart failure,
after a cardiac event such as
a heart attack or following
treatment such as percutaneous
coronary intervention (PCI)
(stent), coronary artery bypass
graft surgery (CABG), heart
valve surgery, the insertion of
an implantable cardioverter
defibrillator (ICD) or a diagnosis
of PAD.
Your stay in hospital
The length of your stay in
hospital will depend on your
particular condition and health.
If you feel unwell, have pain
or discomfort in the chest, or
feel short of breath then let the
nurse looking after you know.
Cardiovascular rehabilitation is
a programme for people with
If there is anything you wish to
heart problems and peripheral
know or do not understand then
arterial disease (PAD), their
ask a nurse or doctor.
partners, families and carers,
which aims to support your
recovery, help you to understand
your condition and make
lifestyle changes.
4
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Your journey through cardiovascular rehabilitation
If you are an inpatient at
Salford Royal the cardiovascular
rehabilitation team will aim to
see you before you go home. If
you have had a cardiac event or
have been referred to the service
by a health professional you will
be contacted by telephone. This
will happen once you are home
from hospital or after a referral
is received by the service.
Cardiovascular Rehabilitation
Service telephone number is:
0161 206 0033
We are available
Monday to Friday
between
8am and 4pm
8am
4pm
for non-urgent advice
Please leave a message on the
answerphone and we will aim
to return your call within one
working day
Please do not leave urgent
messages on the answerphone
This will be to:
l Assess your needs
l Discuss your progress and
ongoing treatment
l Answer any questions related
to your condition - heart or PAD
l Give you advice, information
When to call 999 for an
and support
ambulance
l Give you an opportunity
l You have sudden difficulty in
to discuss any problems or
breathing
worries you may have
l You experience chest discomfort
l Inform you of the services
available to aid your recovery. / pain which is not relieved
by 1 or 2 tablets or sprays of
l Adapt the service to meet
Glyceryl Trinitrate (GTN) taken
your particular needs.
every 5 minutes and which is
If we are unable to contact you by
still present at 10 minutes
phone, we will send you a letter
l You have palpitations which
requesting that you contact us at
last for more than 10 minutes
your earliest convenience.
and make you feel unwell
If you do not wish to be
l You blackout.
contacted by the team then
please let us know.
5
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What to do if you get
chest discomfort / pain
in the future?
If you have had a heart attack
or have angina then you will
be introduced to GTN (Glyceryl
Trinitrate) spray or tablets.
This is a short acting nitrate. It
is used to dilate (widen) the
coronary arteries so that the
blood supply to the heart muscle
is improved and the discomfort
is relieved.
All people with coronary heart
disease (heart attack or angina)
should have a supply of GTN.
If you get chest discomfort/
pain do the following:
l Sit down if possible and relax
l Put 1 or 2 tablets or 1 or 2
sprays under your tongue.
After 5 minutes, if the
discomfort / pain still continues
l Spit out the first tablet
l Put 1 or 2 tablets or 1 or 2
sprays under your tongue.
If you cannot tolerate GTN and
have chest discomfort then rest
for 10 minutes.
If the discomfort / pain is
still present 10 minutes
after starting
Telephone 999
DO NOT ring your GP as they
cannot get to you as quickly
as an ambulance can
You should contact your GP if:
l You regularly have any
pressure or squeezing pain in
your chest, which may spread
to your neck or arms, which
does not last for 10 minutes
or more. If it lasts for 10
minutes or more you should
call ambulance
l You have swollen ankles
(especially in the morning)
l You get palpitations (slow
or fast heart beat), which
does not last for 10 minutes
or more. If it lasts for 10
minutes or more you should
call an ambulance if you feel
unwell
l You are unusually tired or feel
faint or dizzy
l You are more short of breath
than normal.
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The Cardiovascular Rehabilitation Team consists of:
Specialist Nurses
Dietitian
Counsellor
Occupational Therapist
Cardiovascular Rehabilitation Practitioner
Assistant Practitioners
Physiotherapists
Exercise Specialists
Administration Assistants
My Cardiovascular Rehabilitation Specialist is:
Name
Role
Contact Number
7
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How can the Cardiovascular Rehabilitation Team
support you?
After you have been diagnosed
with a heart condition or PAD
you may be interested to know
that the team offers a wide
range of options to aid your
recovery. This will help you
to live with your condition
and provide you and your
family with the support and
information you need.
The options are suitable for all
ages and abilities and aim to
provide you with opportunities
to meet your specific needs.
l Individual sessions with the
dietetic team for support with
healthy eating
l Support with lifestyle changes
l Relaxation sessions
l Telephone support
lCounselling
l Stress Management
programme (Healthy Minds
Group) and individual sessions
with the occupational therapist
l Detailed written information
is available in booklets and on
Options include:
our website to support your
recovery www.srft.nhs.uk
lExercise and health education
in the hospital and community The cardivascular rehabilitation
l Home exercise booklet and
pedometers to help monitor
and increase physical activity
levels - these are available
once you are attending an
exercise class
team can also provide advice
tailored to your needs about
exercise and activity.
For example advice can be
provided about returning to:
l Playing bowls
lWalking
l Playing golf
l Cycling
l Weight management
l Running
l
Swimming
programme - a programme
of healthy eating advice for
l Dancing.
your heart (cardiovascular
Once you are ready the team can
protective diet), calorie
refer you to the Salford Active
control, motivation and
Lifestyles, which will support
support techniques, “weigh
you to maintain your physical
ins” and home based exercises activity.
8
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These are community exercise
sessions available across Salford,
run by Salford Community
Leisure.
Feelings and emotions
After you have been told that
you have heart disease or PAD
you may feel that you have lost
your confidence. You may also
feel that you do not know what
the future holds. This is normal
and should improve over time.
It is important to recognise
when you are feeling tired and
to rest.
This is especially important
in the 4 to 6 weeks after the
cardiac event when your heart
is recovering. Any tiredness
will usually reduce and should
improve as you get stronger and
more confident.
Try not to compare yourself
to others. Focus on one issue
at a time. These feelings and
emotions should all improve
You may also feel:
in a few weeks but can persist
l Low in mood
for up to 6 to 12 months. Life
can feel more difficult if you
l Tearful
become tired or stressed and
l Irritable
have other major life events to
l Tense
cope with. Feelings of anxiety
l Lacking in energy
and depression are known to be
l Anxious
a possible problem experienced
l Frustrated about your progress. by people with cardiovascular
disease.
All of this is normal and is
If you feel you need to talk
happening because you are
to someone please speak to a
going through a major life
member of the cardiovascular
changing event.
rehabilitation team or one of
It is normal to feel tired after
the nurses on the ward if you
a cardiac event such as a heart
are in hospital. Counselling and
attack or heart surgery, or if you stress management services are
have a long term condition such available if you feel that you
as PAD or heart failure.
need them.
9
© G15111001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Unique Identifier: MED 49 (15). Review date: January 2018.
Advice for partners,
family, friends and
carers
The role of the GP and
Practice Nurse in your
care
l It is normal for people to
exhibit feelings of depression,
tiredness and/or irritability if
they have heart problems or
PAD
You will receive as a minimum
an annual review of your
condition, medications and
lifestyle risk factors for
cardiovascular disease at your GP
practice.
l Good communication can
relieve tension and often
improve relationships
l Try to be sensitive and
understanding
l Don’t be over protective
l Allow time alone. Constant
supervision can be very
irritating and may cause
unnecessary arguments and
stress
l Try to discuss problems with
partners, families, friends or
health professionals such as
your nurse or doctor
l Counselling is available for
you and/or your partner if you
need it. Please discuss this
service with a member of the
cardiovascular rehabilitation
team or ward staff.
This will help support you in
reducing the risk of future
cardiac events, stroke,
complications with your heart
condition and PAD.
The annual review will include
the following:
l A review of your symptoms
l Smoking status
l Level of exercise
l Dietary review
l Medication review
l Physical examination
l Blood pressure
lWeight
lHeight
l BMI (body mass index)
l Urine sample for diabetes
l Cholesterol test
l Kidney function test.
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l Liver function test if on
cholesterol lowering
medication
l Thyroid function test may be
required
l Arranging further tests or
investigations if needed.
Although you will attend for an
annual check it may be necessary
for you to have some risk factors
or blood levels screened on a
more frequent basis. Your GP or
practice nurse will inform you of
this and will continue to support
you with any on-going medical
needs.
If you are not automatically
called for your annual
review, please speak to
your GP practice
My Consultant is:
Name
Hospital
Contact Number
11
© G15111001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Unique Identifier: MED 49 (15). Review date: January 2018.
The Heart
What does the heart do?
The heart is the muscle which
pumps blood and oxygen to all
parts of the body and carries
waste products, such as carbon
dioxide, to the lungs so that the
body can get rid of them.
The heart is about the size of
your clenched fist. It is split into
four chambers: two atria and
two ventricles.
Within the heart there are
four valves. These are at the
entrance and exit of the two
ventricles and ensure blood can
only flow in one direction.
Diagram of the front
of the heart
During the day the heart beats
on average 100,000 times, but
changes its speed according to
what you are doing.
For example if you are walking it
beats faster than when you are
sitting down.
The heart muscle receives its
own blood supply from the
coronary arteries. These are
found on the surface of the
heart muscle.
The heart has three main
coronary arteries and a network
of smaller ones.
Diagram of the back
of the heart
Heart muscle
Right coronary
artery
Left anterior descending
coronary artery
Atria
Valves
Circumflex coronary artery
Ventricles
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What is Cardiovascular
Disease (CVD)?
What is angina?
The narrowing process is called
atherosclerosis.
lFeelings of discomfort,
tightness, heaviness, ache or
pain in the chest, which can
also feel like indigestion.
Over the years one or more
of the coronary arteries may
Cardiovascular disease can take
become narrowed with fatty
many years to develop. It is
deposits. This means that not
caused by a gradual build up of
fatty deposits in the lining of the enough blood carrying oxygen
can travel along the arteries to
artery walls.
the heart muscle.
The fatty deposits, or plaques,
Symptoms:
are called atheroma.
CVD consists of four main
conditions:
lAngina
This feeling may also occur in the:
lHeart attack (also known as
myocardial infarction, MI for
short)
lShoulders, back, neck, throat,
jaw or arms.
lAngina and a heart attack
are also known as coronary or
ischaemic heart disease
lShortness of breath
Other symptoms may include:
lFatigue.
lPeripheral arterial disease
(PAD) affecting the legs.
Diagram showing narrowing of the arteries
Blood clot
Fatty deposits
Fatty deposit
visible
Artery becoming narrowed
angina may occur
Heart attack
13
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The feelings in the chest are
the heart saying that it is not
getting enough oxygen. These
symptoms are usually relieved by
rest and GTN (Glyceryl Trinitrate)
tablets or spray under the
tongue.
This medication relaxes the
coronary arteries and helps
the blood to flow to the heart
muscle more efficiently. It is
possible to have angina and
never have a heart attack.
Angina usually happens in the
following situations:
lOn exertion
lIn cold windy weather
lIf a person is stressed and/or
emotional
lFollowing a large mealparticularly if you are
physically active afterwards.
This is because the stomach
needs an increased blood
supply to aid digestion, which
places an increased demand
on the heart.
It is worth noting that angina
can sometimes occur at rest,
with less activity or can wake
you at night.
If this happens or the angina is
happening more often then tell
your doctor or nurse, as this is a
sign that you may be developing
a condition called unstable
angina.
This is angina which is
unpredictable and not well
controlled with medication and
may need further investigation.
What is a heart attack?
A heart attack occurs if a
narrowed coronary artery
becomes completely blocked by
a blood clot or a blockage due
to atheroma.
In many cases this will cause
damage to the heart muscle and
result in scarring of the heart
muscle.
The amount of damage and
scarring is different for everyone.
Symptoms:
Pain or discomfort in one or
more of the following areas:
lChest
lBack
lShoulders / arms
lNeck / throat / jaw.
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The pain / discomfort may be
dull, feel like a heavy weight
or pressure and can feel like
indigestion.
Fatty deposit
(atheroma)
Diagram of a
Blocked Artery
Any of the following symptoms
may also occur:
l Breathlessness
l Sweating
l Feeling cold and clammy
l Nausea and/or vomiting
l Palpitations
l Dizziness.
Many people with peripheral
arterial disease (PAD) do not
have any symptoms. However,
you may feel painful aching in
your calf muscles triggered by
physical activity such as walking,
especially on hills, slight inclines
or climbing stairs. This is known
as intermittent claudication.
The pain usually develops in the
calves, but sometimes the hip,
buttock or thigh muscles can be
affected. The pain can range
from mild to severe.
The pain will usually go away
when you rest your legs. Other
symptoms of PAD may include:
lHair loss on legs and feet
lNumbness or weakness in the
legs
lBrittle, slow-growing toenails
What is Periphearal
Artery Disease (PAD)?
PAD is a common condition
in which a build-up of fatty
deposits in the arteries restricts
blood supply to the leg muscles.
It is also known as peripheral
vascular disease (PVD).
l Ulcers (open sores) on your feet
and legs, which do not heal
lChanging skin colour on the
legs, turning pale or bluish
lShiny skin
lLoss of muscle mass in the legs
lImpotence in men (erectile
dysfunction) may also be a
sign of PAD.
15
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How is CVD diagnosed
(angina / heart attack
PAD)?
lBy the doctor, specialist nurse
or podiatrist taking a history
of the symptoms you describe
l Blood tests for heart disease
The main blood test which
is used to see if your heart
is damaged (heart attack)
measures the level of
Troponin. Troponin is a
substance (protein) not
normally found in the blood.
However, Troponin leaks into
the blood when the heart is
damaged.
BNP (B-type natriuretic
peptide) is a hormone
produced by the heart muscle.
The level of BNP is measured
and an echocardiogram is
performed to help diagnose
heart failure.
l Electrocardiogram (ECG) for
heart disease
An ECG records the rhythm
and electrical activity of the
heart.
How is an ECG carried out?
Small sticky patches called
electrodes are placed on the
arms, legs and chest. They
are connected to a machine
which records the electrical
signals / conduction of the
heart.
An ECG can show:
lWhether the heart rhythm
is normal or abnormal
lIf a person has had a heart
attack recently or in the
past
lIf the heart is working
under strain
The ECG is a simple and useful
test. It does not always show
if you have heart disease and
does not show how you may
be feeling.
16
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The ankle brachial
pressure index (ABPI)
for PAD
Other tests and
investigations for your
heart
The ankle brachial pressure
index (ABPI) test is used to
diagnose PAD, assess blood flow
to the legs and help to assess
how well you are responding to
treatment.
You may also undergo one or
more of the following tests:
While you rest on your back,
your GP or a specialist podiatrist
will measure the blood pressure
in the upper arm and the ankle.
lMyocardial perfusion scan
These measurements are taken
with a Doppler probe, which
uses sound waves to look at the
flow of blood in the arteries.
If circulation is healthy, the
blood pressure in both parts of
the body should be exactly or
almost the same and the result
of the ABPI would be one (1.0).
lExercise treadmill test (ETT)
lCoronary angiogram
lEchocardiogram
lDobutamine stress
echocardiogram (DSE)
lCardiac MR scan.
All tests and investigations carry
a small risk.
These risks will be discussed with
you on an individual basis. The
risk level will depend on your
specific condition and other
illnesses you may have.
However, if you have PAD, the
blood pressure in the ankle will
be lower than the arm due to
a reduction in blood supply to
your leg. This calculation is done
by dividing leg pressure by arm
pressure (e.g. 0.7).
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Exercise Tolerance Test (ETT)
This can also be called an
exercise electrocardiogram or
exercise stress test.
An exercise test is an ECG that
is recorded whilst you are
exercising under supervision on
a treadmill.
The test helps to:
l Assess whether you have any
heart rhythm disturbances on
exercise. This can be useful
if you have had blackouts or
collapses when you have been
physically active
You may be advised to stop
taking beta-blockers for one or
two days before the test so that
your heart rate will rise naturally
during the test.
l Can give information about
how severe your condition is
Every three minutes the speed
and slope of the treadmill will
l Assess how well your heart is
increase so that your blood
working if you have recently
pressure and heart rate increase.
had heart surgery, angioplasty Your blood pressure will be
/ stent or a heart attack
recorded before, during and
after the test.
l Find out if you are fit to
drive if you have a LGV (large The test will be stopped:
goods vehicle) licence or drive
l When the person carrying
public transport
out the test has enough
l Decide the level of exercise
information or
you should do as part of your
l If it makes you very tired, sick,
cardiovascular rehabilitation
dizzy, very short of breath, or
programme.
have chest pain or
l If you feel you can’t carry on
with the test.
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Coronary angiogram (cardiac catheterisation)
This test helps to identify
whether you may need a
coronary stent or coronary
artery bypass surgery. It may
also suggest that no treatment
is needed or that some
medications are required to
manage your heart condition.
Under local anaesthetic, a fine
tube called a catheter is passed
into an artery either in the groin
or the wrist.
X-ray screening is used to direct
the catheter through the blood
vessels and into the heart. You
will not be able to feel the tube
moving around in your chest.
Routes Used
for Coronary
Angiogram
Route 1
A special dye is injected via the
catheter, so that pictures of the
heart and coronary arteries can
be taken.
The test takes between 20
minutes and an hour and is
usually carried out as a day case.
A coronary angiogram provides
information about:
l The number, location and
severity of any narrowings
or blockages in the coronary
arteries. This will indicate
how good or bad the blood
supply to the heart muscle is
l How well the heart pumps
l How well the heart valves
work.
When the test is finished the
tube is taken out. If the tube
was in the groin then a nurse or
doctor may press on your groin,
a pressure pad may be applied
or an angioseal may be used to
stop the bleeding. This is a soft
plug, which dissolves over 90
days.
If the tube was inserted via your
arm then a tight dressing will be
applied for a few hours.
Route 2
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Is there any risk?
Your doctor will not recommend
that you have a coronary
angiogram unless the benefits
outweigh the small risk involved
with the procedure. The doctor
will be able to tell you what
your specific risk is.
The risk level will depend on
your general health and heart
condition.
The risks may include:
l Heart rhythm disturbance
l Trauma to the heart
l A drop in blood pressure
l Allergic reaction to the dye
l Bleeding
l Heart attack
l Stroke
A coronary angiogram is a
relatively safe test and serious
complications are very rare
and occur in approximately
1 in 1000 procedures (British
Cardiovascular Society).
However, you are more likely to
experience the following during
the test:
l A hot, flushing sensation
when the dye is put down the
catheter
l A small amount of bleeding
when the catheter is removed
l A bruise in the groin or arm
l Occasional palpitations during
the test
l You may also feel tired after
the test.
l Small risk to life
l Damage to the kidneys which
is usually temporary.
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Echocardiogram (echo)
An echocardiogram is a safe and
simple test, which may take up
to an hour to complete.
The echocardiogram can provide
information about:
l How well the heart pumps
l The structure of the heart and
its valves
It is a useful test if you:
l Have recently had a heart
attack
l If you have or might have
heart failure
l Have disease of the heart
valves
l Have congenital heart disease
(defects you were born with).
The test will take place in a
dimly lit room and you will be
asked to remove the top part of
your clothing. Ultrasound gel is
placed on the chest to help make
good contact between the skin
and recorder and provide clearer
images.
A small recorder is used to look
at the structure of the heart
by passing ultrasound waves
through the chest to the heart.
This then provides a picture of
the heart on a screen.
Another type of echo
which may be used is
called Transoesophageal
echocardiography (TOE).
Detailed pictures of the heart
are taken from the gullet
(oesophagus) which is behind
the heart.
During this test a small recorder
on the end of a flexible tube is
swallowed. A local anaesthetic
is sprayed onto the back of
the throat and you may have
a light sedative first, to help
you to relax. The test is used if
the doctors need to look more
closely at the heart and how it is
working.
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Myoview (Myocardial
Perfusion Scan) or MPS
Dobutamine Stress
Echocardiogram (DSE)
A myoview can show:
A stress echocardiogram is an
ultrasound scan of your heart.
l How well your heart pumps
It is done whilst the heart is
l The flow of blood to the
made to pump harder and beat
heart muscle.
more quickly using a drug called
This test is particularly useful if
Dobutamine (and sometimes
you are unable to exercise.
Atropine). The test is used to
The test is done in two parts, one help find out if you have:
with the heart at rest and one
l Coronary heart disease
with the heart beating faster.
l To help assess your heart to
A small amount of radioactive
substance (isotope) is injected
into the blood for both tests. A
drug which stimulates the heart
to beat faster and harder is
given for the non-resting scan.
A “camera” positioned close
to the chest, picks up the
radioactivity as it passes through
the heart.
The doctor will be able to decide
from this test whether you need
further treatment.
Are there any risks?
A myoview scan does mean that
you are exposed to radiation.
Your individual risk will be
discussed with you prior to the
test.
see if you have angina or have
had a heart attack
l Heart failure
l Cardiomyopathy.
Cardiac Magnetic
Resonance Imaging
(MRI) scans
MRI is a way of getting detailed
pictures of your heart. It can:
l Show how well the heart is
pumping
l Look at the blood supply to
the heart
l Estimate the amount of
damage to your heart after a
heart attack.
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Treating CVD
The first line of treatment
for cardiovascular disease is
reviewing and making changes
to your lifestyle in order to
reduce your risks in the future.
This includes looking at your
cholesterol levels, how physically
active you are and whether you
smoke.
Secondly, medications such as
aspirin, blood pressure lowering
medications and cholesterol
medication (statins) may be
started to protect your heart and
lower your lifestyle risk factors.
See medications section page 66
for further information.
If any procedure or treatment
for your condition is
recommended, then a doctor,
specialist nurse or podiatrist
will discuss the risks and
benefits with you.
These will vary
depending on
your general
health and
heart
condition
or PAD.
Percutaneous Coronary
Intervention (PCI)
This treatment is known as
either:
l Angioplasty / Stent, (PCI) if
carried out for angina or
some types of heart attack
l Primary PCI if the procedure
is carried out immediately
following the diagnosis of a
heart attack, which is clearly
seen on an ECG.
Balloon
Stent
Diagram showing a stent being
inserted into a coronary artery
using a balloon
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What is PCI?
PCI is a treatment used to
open blocked and/or narrowed
arteries so that the blood flow
to the heart muscle is improved.
The artery is opened using a
catheter (a fine, flexible hollow
tube) with a small inflatable
balloon and a stent (a short
stainless steel mesh structure)
near the tip of the tube. Under
a local anaesthetic, this is passed
into an artery in your groin or
arm. X-ray screening is used to
guide the tube to the blockage
and/or narrowing in the
coronary artery.
Staff within the department
wear lead aprons when x-ray
equipment is being used to
protect them against the daily
exposure to radiation. This
is not needed for patients as
radiation exposure during the
procedure is very small.
When the catheter reaches the
blocked and/or narrowed section
the balloon is gently inflated,
opening up the artery so that
the blood can flow through.
The balloon is deflated and
the catheter and balloon are
removed leaving the stent in
place.
How does the heart
benefit from a PCI?
PCI helps return blood supply to
the heart muscle. This helps the
heart to recover more quickly
from a heart attack and improve
the symptoms of angina.
In angina this helps to reduce
or prevent symptoms such as
chest discomfort or shortness
of breath. In a heart attack this
should also reduce the amount
of muscle damage and scar
tissue.
Do I have to take
any medication after
treatment?
Most people will be started on
medication to help prevent any
clotting around the stent. This
type of medication is usually
given for 12 months after the
stent has been put in.
It is very important that you
keep taking the medication
until you are told to stop either
by your hospital doctor, GP or
nurse.
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Thrombolysis
This is a treatment used very
occasionally for heart attacks.
Clot dissolving drugs are used to
reduce the amount of damage
and scar tissue. It is given in
hospital, but is not suitable for
everyone.
Common drug name:
Tenecteplase (TNK)
The common side effects of this
drug are bleeding and bruising.
How is a CABG carried
out?
A bypass is usually carried out
as “open heart” surgery.
This means that there is a wound
afterwards along the breast bone
and during most operations the
job of the heart and lungs is
done by a bypass machine.
One or more of the following
blood vessels may be used
to provide the bypass to the
narrowed blood vessel:
Coronary Artery Bypass
Grafts (CABG)
l Chest (internal mammary
artery)
This procedure is often referred
to as a “cabbage”.
l Arm (radial artery).
A CABG is surgery carried out to
treat coronary heart disease. It
is used for patients who:
l Leg (long saphenous vein)
Coronary
artery bypass
graft surgery
l Have regular angina attacks
in spite of taking anti-angina
medication or
Bypass
l Have severe blockages and/
or narrowing in the coronary
arteries, but few symptoms
Blockage
l Are not suitable for a PCI.
Muscle
damage
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Common physical effects after bypass surgery
Aches and pains
Chest wound
It is common to have some aches
and pains in your back, neck,
shoulders or front of your chest.
The discomfort is often worse
in the morning after waking. It
may also be worse after moving
your arms and shoulders. This
should improve over time. You
will be prescribed painkillers to
help with this.
It is common to get some
swelling around the top of your
chest wound. This will gradually
reduce over time. If the internal
mammary artery has been used,
then it is also common to feel a
stabbing or ache in the left side
of the chest. The area may also
feel numb or tingle. This can
last for 6 months or more.
If you have had a graft taken
from the chest it is common
to get stabbing pain in the
chest when moving. The chest
may also feel numb, tingly or
uncomfortable.
Aches and pains are a normal
part of recovery and will
disappear over time.
“Clicking” of the breastbone
It is common to feel the two
edges of the breastbone rubbing
together for the first few weeks.
However, if this persists, or
you feel frequent “grating”
or “clicking” when moving or
coughing then you should report
it to your doctor or nurse.
Leg wound
It is common to get some
tingling and numbness around
your leg wound, but this is likely
to improve over time. The leg
may also swell, whilst the other
veins take over the role of the
removed vein. Support stockings
may be advised by your
consultant and these should be
worn as prescribed.
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Surgery for PAD
Taste disturbances
Many people experience a
metallic taste in their mouths
and can find food tasteless or
bland. Your appetite may also
be reduced. Try to eat a small
amount at each meal or have
snacks. This should improve
over time. If your appetite
remains poor then a referral to
the cardiovascular rehabilitation
dietitian can be made for advice.
Visual disturbances
Some people experience blurred
vision or spots before their
eyes. Some people may also
experience visual hallucinations.
It is best to wait three months
before having your eyes checked
as these symptoms often settle
down.
Concentration
People can find it difficult
to concentrate on tasks such
as reading. They may forget
things such as their phone
number. This should improve
over time. Concentration can
be affected for 6 to 12 months.
Support can be provided by the
cardiovascular rehabilitation
team.
There are two main types of
surgical treatment for PAD.
1. Angioplasty
where a blocked or narrowed
section of artery is widened
by inflating a tiny balloon
inside the vessel.
2. Bypass graft
where blood vessels are taken
from another part of your
body and used to bypass
the blockage in an artery.
Synthetic (man-made) grafts
can also be used.
Angioplasty vs bypass
surgery
There are pros and cons to both
types of surgery. An angioplasty
is less invasive (it does not involve
making major incisions in your
body). It is usually performed
under a local anaesthetic as a
day procedure. This means you
will be able to go home the same
day you have the operation.
You also feel less pain after an
angioplasty. The improvement
in symptoms varies from person
to person and may only last for
around 6-12 months.
continued page 28
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Bypass surgery, which is usually
only used when angioplasty is
not suitable or has failed, has
a longer recovery time (around
two to three weeks). However,
the improvement in symptoms
usually lasts for longer than a
year.
Other heart conditions
Heart failure
This is a condition where the
heart muscle is weakened and
becomes less efficient.
This means that it is not able to
pump enough blood around the
body to meet all of the body’s
needs. This usually happens
because the heart muscle has
been damaged.
These include:
n Family history / inherited
conditions
n Viral / bacterial infection
nDrugs
nAlcohol
n After pregnancy.
Possible symptoms of heart
failure:
l Breathlessness - which may
happen on exertion, at rest or
on lying flat
lCoughing
l Weight gain together with
ankle and leg swelling
l Tiredness, weakness
l Reduced ability to be
physically active
l Feeling bloated
Common causes of heart failure:
lConstipation
l Coronary Heart Disease (CHD)
- heart attack
l Loss of appetite.
l High Blood Pressure
Diagnosis and management of
heart failure:
l Irregular Heart Beat
l Damaged Heart Valves
l Find the cause and treat if
possible
l Cardiomyopathy (see page 27):
l Improve symptom control
There are many causes of
l Reduce stress and anxiety
cardiomyopathy.
l Reduce risk factors.
continued page 29
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How to improve your symptoms
and quality of life:
l Take your prescribed
medication
l Have a healthy, active lifestyle
l Reduce your risk factors - give
up smoking, only drink alcohol
in moderation, lose weight
if necessary, as excess weight
can put a strain on the heart
l Learn ways to cope with
anxiety and depression
l Become an expert patient be aware of and tell your GP/
nurse about your heart failure
symptoms especially if they
get worse
l Weigh yourself at the same
time each day, ideally first
thing in the morning after
going to the toilet. If you
notice an increase of 2kg (4lb)
in 48 hours seek advice from
your heart failure nurse or
doctor
l Follow the recommendation
of your nurse or doctor if
they have advised a fluid
restriction for you
l Reduce your dietary intake of
sodium (salt)
l Know when to ask for help.
Cardiomyopathy
This is a disease of the heart
muscle, which affects the size
and shape of the heart. It can
also affect the electrical activity
system of the heart.
It can run in families (inherited)
and can affect one or more
members of a family.
There are 3 main types of
cardiomyopathy:
l Ischaemic cardiomyopathy
due to CVD
l Hypertrophic cardiomyopathy
(HCM)
l Dilated cardiomyopathy
(DCM)
Other rarer cardiomyopathies:
l Arrhythmogenic right
ventricular cardiomyopathy
(ARVC)
l Takotsubo cardiomyopathy
(TCM).
Heart valve disease
There are four valves in the
heart making sure the blood
only flows in one direction.
The two main pumping
chambers of the heart (left and
right ventricles) both have two
valves-one at the entrance and
one at the exit of each chamber.
continued page 30
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The causes of valve disease are:
The treatments are:
l Being born with abnormal
valves (congenital heart
disease)
l Medication
l Rheumatic fever
l Ageing of the heart
l Cardiomyoapthy
l Coronary heart disease
l Previous infection with
endocarditis.
If heart valve disease is not
treated, the heart can become
enlarged or heart failure can
develop. This can lead to
symptoms of:
l Surgery - valve repair
or replacement with a
mechanical or tissue valve
l Valvuloplasty - balloon
treatment for stenosis
(stiffening) usually of the
mitral valve.
For further information about
heart valves, please ask a
member of the Cardiovascular
Rehabilitation Team for the
British Heart Foundation (BHF’s)
booklet; ”Heart Valve Disease”.
lTiredness
lBreathlessness
lPalpitations
l Swollen ankles and legs.
In more severe cases people may
feel dizzy or faint.
Many people with heart valve
disease lead a normal life
with little or no treatment.
Treatment may be required
depending on which valve or
valves are affected and the
severity of the disease. Your
symptoms and general health
will also be taken into account.
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Implantable cardioverter
defibrillator (ICD)
An ICD is a device similar to a
pacemaker, which is used to
treat life-threatening heart
rhythms. It consists of a pulse
generator: a small metal box,
which contains an electronic
circuit powered by a battery.
This is attached to one, two or
three fine, flexible wires which
go through a vein and into the
heart.
At the end of the wires are
electrodes, which are attached
to the heart muscle.
ICDs are used for people who
have life-threatening irregular
heart rhythms. These include:
The ICD can:
l Pace the heart - provide
treatment if the heart is
going too fast and increase
the heart rate if the heart is
going too slowly
l Pace the heart if VT or VF is
detected and try to return the
heart to a normal rhythm
l Provide an electrical shock
(defibrillation) if VT or VF is
detected and pacing does
not work. This should stop
the VF/VT and allow the
usual heart rhythm to resume
normally.
l Those who have had
ventricular tachycardia (VT)
and are at risk of having VT
again
As with any procedure there is
a small risk with having an ICD
inserted, but your cardiologist
will discuss the risks and benefits
with you before the procedure.
l Those who have had a cardiac
arrest due to VT or ventricular
fibrillation (VF)
For further information
please ask the cardiovascular
rehabilitation team.
l Those who may be at risk of
VT or VF due to their heart
condition.
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Cardiac resynchronisation
therapy
This is sometimes used as a
treatment for people with heart
failure, but is not suitable for
everyone who has this condition.
When the two pumping
chambers of the heart (the
ventricles) are contracting
slightly out of time with each
other a biventricular pacemaker
is inserted. This is known
as cardiac resynchronisation
therapy.
The pacemaker has up to three
leads and helps the ventricles to
contract more in time with each.
This makes the heart pump more
efficiently and therefore
may help to improve the
symptoms of heart failure.
A pacemaker wire is added if
the person is at risk of the heart
beating too slowly.
As with any procedure there
is a small risk with having a
pacemaker inserted, but your
cardiologist will discuss the risks
and benefits with you before the
procedure
For further information
please ask the cardiovascular
rehabilitation team.
Leads
ICD
It does not cure heart
failure.
A defibrillator wire is
added if the person
is also at risk of a life
threatening heart
rhythm such as VT
or VF.
A picture of an ICD
An ICD - goes on
the left side of the
chest just under
the collar bone
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© G15111001W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Unique Identifier: MED 49 (15). Review date: January 2018.
Causes of cardiovascular
heart disease
It is not yet fully understood why
cardiovascular disease develops
but there are several factors
which research has shown can
increase the risk.
Lifestyle risk factors which
can be managed with lifestyle
change:
a)High cholesterol (fat levels in
the blood)
b)Unhealthy eating
c) Being overweight
d)Lack of physical activity
e)High blood pressure
(hypertension)
f)Smoking
g)Stress and tension
h)High alcohol intake.
i) Use of illegal drugs such as
cocaine and cannabis
Risk factors which cannot be
changed:
k) Increasing age
l)Gender
m) Family history of CVD
n) Ethnic group.
Some people develop
cardiovascular disease, but do
not have any of the risk factors
above.
Advice for partners,
family, friends and
carers about risk factors
You can support people to
change their lifestyle by avoiding
“nagging” about smoking or
other lifestyle risk factors. This
can make it harder for people to
be in control of making decisions
about their own health.
j)Diabetes.
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How to make a lifestyle change?
When thinking about or wanting
to make a change to our lifestyle
we need to go through a change
process. This process is known as
the cycle of change and follows
the pattern below.
Change needs to be planned
and needs to be a consciously
thought about. For example,
trying to lose weight is difficult
if you still have a cupboard full
of crisps.
Change happens in stages:
Contemplation - thinking about
the change - sitting on the fence
- Should I change? Should I stay
the same? What are the risks and
benefits of change?
Preparation for the change getting information, setting goals,
planning how to make the change.
Action - carrying out the change carrying out the actions / plan.
Maintenance of the change sticking to the plan, letting the
change become a habit.
Actio
n
De
cis
ion
on
lati
Maintenance
p
tem
Con
Pre-contemplation Relapse - this can happen at
any stage in the cycle and may
happen more than once. Don’t
see it as a failure. Look at it as an
opportunity to prepare and plan
Relapse
for the change again.
Pre contemplation - not aware
of the need to change or in
denial about the need to change.
Risk factors which can be
changed
Thinking about and changing
lifestyle risk factors will help to
reduce the risk of your heart
condition worsening. It will also
improve your quality of life.
Lifestyle changes and medication
are both important in helping
to reduce risk factors. Help and
support is available from the
cardiovascular rehabilitation team,
your doctor and your nurse.
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High cholesterol
(blood fat levels)
Cholesterol is a fatty substance
found in the blood, which plays
an essential role in the body.
As a minimum, cholesterol levels
will be checked annually at your
CVD review at your GP Practice.
Cholesterol levels will be
checked regularly until they are
controlled. This is to ensure that
l HDL (high density lipoprotein) the cholesterol medication is
working effectively.
Good, protective cholesterol
Total cholesterol includes two
major components:
l LDL (low density lipoprotein)
Bad, harmful cholesterol.
Too much cholesterol in
the blood raises the risk of
cardiovascular disease. This
is a particular risk if the bad
cholesterol (LDL) level is high
and the good cholesterol (HDL)
level is low.
Levels of cholesterol may be
raised due to the food you eat
or may be hereditary (in the
family)
The aim of starting cholesterol
lowering medication is to reduce
the bad cholesterol level by
greater than 40%.
If this level is not reached then
your doctor or nurse will review
your cholesterol lowering
medication and lifestyle. If
your medication is changed
then cholesterol levels may
be checked more often. Your
doctor or nurse will advise you.
A combination of healthy
eating, cholesterol-lowering
medication and physical activity
can help lower bad cholesterol
levels and raise good cholesterol
levels.
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Unhealthy eating
Healthy eating can help to
protect your heart in the future,
help you to maintain a healthy
weight and reduce your risk of:
l Diabetes
l High blood pressure
l High cholesterol.
‘Getting the balance right’Eat Well Plate
All foods can be included in a
healthy diet. You just need to
make sure you get the right
balance. The eat well plate
below shows how to balance the
different food groups to make
up a healthy diet.
The eatwell plate
Use the eatwell plate to help you get the balance right. It shows how
much of what you eat should come from each food group.
Bread, rice,
potatoes, pasta
Fruit and
vegetables
and other starchy foods
© Crown copyright 2011
Milk and
dairy foods
Meat, fish,
eggs, beans
and other non-dairy
sources of protein
Foods and drinks
high in fat and/or sugar
Department of Health in association with the Welsh Government, the Scottish Government and the Food Standards Agency in Northern Ireland
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Six main dietary messages:
1. Eat less saturated fats by
reducing:
l Full fat dairy products such
as butter, lard, ghee
l Processed meats such as
sausages, burgers
l Pies, pastries, cakes and
biscuits
l Foods containing coconut
oil or palm oil.
2. Swap to monounsaturated
fats:
l Olive oil / rapeseed oil and
their spreads - use in small
amounts.
3. Eat more oily fish
(omega-3 fats)
Omega-3 fats (EPA
(eicosapentaenoic acid)
and DHA (docosahexaenoic
acid) help the heart to beat
more regularly and reduce
the stickiness of the blood,
making it less likely to clot.
Aim for 1 serving of oily fish and
1 serving of white fish per week.
l A serving is 4-6ozs (100-150g)
of fresh, frozen or tinned oily
fish.
Rich sources of omega-3 fats:
Mackerel, kippers, pilchards,
tuna (fresh), trout, salmon,
sardines and herring.
l Smoked fish is high in salt so
limit to once per week
l Eat no more than 4 portions
of oily fish per week due to
the mercury / toxin level in
the sea water
l Tinned tuna fish is a low
source of omega-3 as the
omega-3 is removed during
the canning process.
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4. Eat more fruit and vegetables
5. Eat less salt
Too much salt could contribute
to high blood pressure and
put a strain on the kidneys.
Aim for less than 6g per day
(teaspoonful).
75% of our daily salt intake is
from processed foods.
To reduce your salt intake:
Fruit, vegetables and salad
are low in fat, high in fibre
and contain antioxidants
(Vitamins A, C and E). All of
these help to protect your
heart.
Aim to eat 5 or more
portions of a variety of fruit,
vegetables and/ or salad daily
1 portion = l Avoid adding salt at the
table
l 1 apple
l 1 orange
l A handful of grapes or strawberries
l 2 small fruit e.g. plum or satsuma or 1 tbsp raisins
l 150ml fruit juice
n Processed meats like
bacon
l 2-3 tbsp carrots or sweet corn or peas
n Snacks like crisps, salted
nuts and crackers.
l 2 broccoli florets
l 16 medium okra
l ½ large tin of tomatoes
l ½ large onion
l 3 heaped tbsp of beans including baked beans.
l Limit salty foods e.g. by
reducing:
n Tinned and packet foods
like soups, ready meals
and cook-in sauces
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6. Cholesterol lowering foods:
Being overweight
Weight loss can be achieved in
3 ways:
1. Eat and drink less calories
(energy)
2. Become more active and use
up more calories (energy)
3. Ideally a bit of both - eat less
and do more!
Adopting a cardioprotective
style of eating may also help
to lower your cholesterol.
You can do this by increasing:
l Wholegrains / oats / beans
and pulses
l Nuts (unsalted) e.g
almonds, walnuts, peanuts
and cashew nuts
l Soya foods e.g milk and
cheese
l Stanol and sterol fortified
foods e.g yogurts and
spreads
l Avoid frying foods. Grill,
steam and oven-bake
instead.
For further advice about how
to implement the changes and
for further support ask for a
referral to the cardiovascular
rehabilitation dietitian.
Do you need to lose weight?
An increased waist measurement
(fat around the middle) increases
the risk of cardiovascular disease
and diabetes.
You are at an increased risk if
your waist measurement is more
than:
37”/ 94cm for men
32”/ 80cm for women
For people of South Asian origin,
you are at increased risk if your
waist measurement is more
than:
35” (90cm) for men
32” (80cm) for women
continued page 40
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For further support with weight
management please ask any
member of the cardiovascular
rehabilitation team to refer you
to the dietitian or cardiovascular
rehabilitation weight
management programme.
As you get stronger and fitter,
you can do more with less effort.
This can help you to return to
work or to your normal daily
activities as quickly as possible.
If you have been advised by your
doctor or nurse to restrict your
fluid intake then please keep
within the recommended level.
housework or walking the
dog to attending a supervised
exercise session or playing golf.
You should aim to achieve a
total of 150 minutes (2½ hours)
Unless you have been advised to of moderate intensity physical
follow a fluid restriction by your activity over the week. This can
doctor or nurse, aim for 6-8 cups/ be done in separate bouts of 10
glasses of fluid daily to maintain minutes or more throughout the
week.
hydration. Some fluids, such as
caffeine based drinks like coffee The term ’physical activity’
can dehydrate you.
can range from doing the
Remember to enjoy your food,
and eat a healthy, well-balanced
diet.
Lack of physical activity
Regular physical activity helps to
reduce the risks associated with
CVD and also has other health
benefits. It can help to:
l Lower blood pressure
l Improve cholesterol levels
l Control your weight
l Prevent or control diabetes
l Reduce the risk of stroke
l Improve stress levels
l Lower the risk of osteoporosis.
After any cardiac event, surgery
or diagnosis of PAD, it is normal
to feel uncertain about how
much physical activity you
should be doing. Remember
that everyone is unique and will
progress at a different rate.
For cardiac patients it is
important that you do not start
any unsupervised exercise other
than walking at this point, as
your heart needs time to recover.
It is important to gradually
increase your activity levels as
outlined in the ‘Activity Guidance’
section, found on page 50.
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High blood pressure
(hypertension)
High blood pressure is
when your blood pressure is
consistently higher than the
recommended level. Blood
pressure is the pressure of the
blood in the arteries.
Over years high blood pressure
can cause the heart to become
abnormally large and so to
pump less effectively.
High blood pressure can be
caused by:
l Too much salt in and/or on
food
l Being overweight
lSmoking
l Not doing enough physical
activity
If you have CVD and are under
80 years of age, your target
blood pressure should be
140/90mmHg or below. If you
are over 80 years old, your
target blood pressure should be
150/90mmHg or below.
If you have kidney disease
and or diabetes as well as
cardiovascular disease your
doctor will advise that your
blood pressure should be
130/80mmHg or below.
Please discuss any concerns
about your blood pressure with
a member of the cardiovascular
rehabilitation team.
l Excess alcohol / binge drinking
l Family history
l Illnesses such as kidney disease.
If you have high blood pressure
this may need to be checked
regularly - your doctor will
advise you.
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How can I reduce my blood
pressure?
l Take regular physical activity
l Try to lose excess weight
l Stop smoking
l Reduce the amount of salt in
your diet
l Reduce alcohol intake
l Find time to relax.
Smoking
What does smoking do to the
heart and circulation?
l Makes the heart beat faster
l Makes blood stickier and
more likely to clot
l Raises blood pressure
l Deprives the heart and leg
muscles of oxygen
l Damages the lining of the
arteries throughout the body
and makes the build-up of
fatty deposits more likely.
It is strongly advised that you try
to stop smoking immediately.
You may need some help to do
this as smoking is addictive and
a habit.
The cardiovascular rehabilitation
team can refer you to the Stop
Smoking Advisers; please ask if
you wish to be referred for help
or support. Appointments can
be held on the ward, at home
or in clinics.
Your GP, practice nurse,
pharmacist and the
cardiovascular rehabilitation
team can support you to stop
smoking. Please discuss giving
up smoking with any of them.
If you live or work in Salford and
would like help to quit or reduce
smoking, call the Stop Smoking
Service on:
0800 952 1000
Secondhand smoke:
People who do not smoke but
inhale second-hand (passive)
smoke on a regular basis
increase their risk of smokingrelated diseases.
You should consider making
your home smoke free by
politely asking others if they will
smoke outside rather than in the
house.
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Stress and tension
What is Stress?
Stress is natural and a normal
part of life. Some stress is
positive. It keeps us motivated
and gives us more energy. It
helps people perform better and
can help you respond quickly in
dangerous situations.
We tend to refer to the term
‘stress’ to describe a feeling that
things have got too much or
when we feel overloaded. This
is the negative side to stress.
Many things in daily life can
contribute to our stress levels
increasing. These include:
lWork problems
lRelationship and family
difficulties
lMoney worries
lIll health.
Our stress response is a natural
response to physical threats and
is known as “fight or flight”.
When we feel threatened, our
bodies respond by triggering
the “fight or flight” response.
We release adrenaline and other
hormones to enable us to run
away or fight to help us survive.
The adrenaline causes our blood
pressure and heart rate to
increase, we breathe quicker and
fats and sugars are released into
our bodies. This makes muscles
tense up ready for our body to
move into action.
Everybody experiences life
events differently and has
different techniques and abilities
to cope with stress.
The stress response can be
triggered by worrying thoughts
as well as physical stress. Over
a period of time this can take
its toll on our bodies. It can
give us unwanted physical and
psychological symptoms and
affect the way we behave.
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Symptoms of stress
Physical
Psychological
Behavioural
Headaches
Worrying
Crying
Dizziness
Focussing on negative thoughts
Verbal aggression
Aching muscles
Nervousness
Physical aggression
Chest pain / palpitations
Fear
Avoiding activities
Nausea
Guilt
Forgetting things
Diarrhoea
Panic attacks
Neglecting yourself
Dry mouth
Feeling down
Over / under eating
Tiredness / exhaustion
Feeling irritable
Smoking or drinking more alcohol
Stress and your heart
Research about stress and the
heart does not show a direct
link. It is known that stress
has an effect on heart disease
lifestyle risk factors. For
example smoking more, eating
unhealthily.
The risk factors which stress can
have an impact on are:
l High blood pressure
l High cholesterol
l Increased weight
l The use of negative coping
strategies such as smoking,
being less active and drinking
alcohol.
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Coping with stress
Stratgeies for Coping Suggestions and Ideas
Time
management
l Write things down
l Use a calendar or diary
l Prioritise your activities
l Delegate more
l Look at your space around you and how you do things.
Setting goals
l Think about creating balance in your life between work, leisure and self-care
l Pace yourself, set small goals and build up any activities gradually
l Goals should be SMART (specific, measurable, achievable, relevant and timely).
Example of a goal that is not SMART - “I want to be thin”.
Example of a SMART goal - “I want to lose a pound per week for the next 6 weeks by
following my healthy eating plan and attending the cardiac rehabilitation classes”.
Remove/reduce l Look at the way you and others communicate
l Change your mode of transport
the source of
l Explore working hours / work options
stress
l Learn to say ‘no’.
Communication l Good communication is essential in reducing relationship stresses
l Talking to others who listen can help
and
l Learning to be assertive and communicate our feelings in an open and honest manner
Assertiveness
reduces stress
l Say “no.” You have needs and rights too.
l Be aware of how much sleep you need, don’t compare yourself to averages
Sleep well
l Create a regular routine before bed
l Avoid caffeine (coffee, tea, chocolate and energy drinks) in the late afternoon/evening
l Write down any worries and keep a notepad and pen by your bed
l Avoid watching TV or playing computer games in bed
lTry relaxation before bed.
l Our thoughts are very powerful and can change how we feel. They can also trigger
Think about
the flight or fight response
your thoughts
l If you are worrying try to pinpoint exactly what you are worrying about
l Try writing your thoughts down
l Is it a problem you can solve? If ‘yes’ look at problem solving strategies. If ‘no’ is it
something you need to distract yourself from, something you need time to accept or
something you need to let go of?
l Cognitive Behavioural techniques can help; speak to a member of our team about them.
Relaxation
l Relaxation is the opposite of feeling stressed
l You can use breathing techniques, relaxation techniques, Tai Chi, Pilates and many
more techniques to learn to relax
l Relaxation isn’t easy at first if you are used to being on the go, but with time and
practise you will feel calmer and more in control
l We have relaxation CD’s available- speak to a team member.
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Some other useful suggestions
l Try to change the way you
react to stress. Think of the
problem from another point
of view
l Discuss your fears and worries
with family, friends, people
you trust - don’t bottle things
up
l Eat a healthy, well-balanced
diet and have regular meals
l Take some regular physical
activity within your limitations
l Take time out for you. Do
something that makes you
feel happy and relaxed
l Cut down on tea, coffee and
other sources of caffeine
l Remember that feelings,
good or bad, always pass and
they don’t last forever
l Imagine a close friend/family
member was talking to you
about the things you are
currently stressed about what would you say to them?
l If you are feeling stressed
in a specific situation take a
few minutes out. Go to the
bathroom, take a few relaxed
breaths and then return
feeling calmer
l Be kind to yourself, we are
often our own worst critic
l Mindfulness is a very simple
idea. Mindfulness means
paying attention on purpose,
trying to stay in the present
moment, without judging or
being critical to yourself.
It is a practical way to
notice your thoughts, body
sensations and feelings, sights,
sounds and smells - anything
you might not normally notice.
An example of mindfulness
might be:
n An adult gets up one
morning, opens the
curtains and thinks “what
a grey day and I need to
do my shopping, it will be
miserable doing it in the
rain”
n A child gets up one
morning, looks out the
window at the rain and
thinks “I am listening
to the sound the rain is
making on the window”.
continued page 47
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Mindfulness can simply be
noticing what we don’t normally
see or hear because our heads
are too busy thinking about
what has been done, or needs to
be done.
You will be given the
opportunity to learn more
about stress management at the
rehabilitation classes.
Being mindful helps to train
your attention. It is perfectly
normal for your mind to wander
about a lot but every time we
practise being mindful, we
are exercising the mind and
becoming “mentally fitter”.
lCounsellor
Options available to support you
with stress include:
l Occupational Therapist
l Healthy Minds Group
l Relaxation CD / tape.
We can take more control over
what we choose to put our
minds on. If this is a new skill
we will need to practise. It may
take time to learn, but we get
better at the things we practise.
Even if we can’t solve some
problems, we can help ourselves
by focussing on something else,
even for a short time. It can
reduce the times your mind
“runs away with itself” and will
help to reduce stress levels.
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Alcohol
Drinking excessive amounts of
alcohol can cause high blood
pressure and lead to you being
overweight, which increases the
risk of developing CVD.
It can also make it harder to
maintain a healthy lifestyle.
For example when you have a
drink you may be more likely to
smoke.
The alcohol content of drinks
is measured in ‘units’. One
unit is equivalent to around
10mls or 8g of pure alcohol
(ethanol). The number of units
in any drink is related to the
strength of the alcohol content
(the concentration) and to the
volume of the drink.
There is no safe level of alcohol
consumption. Men and women
are advised NOT to regularly
drink more than 14 units of
alcohol per week. Spread your
drinking over 3 days or more.
DO NOT save up your 14 units of
alcohol for one day.
Have regular drink free days.
For more information please ask
a member of the cardiovascular
rehabilitation team.
How to work out the number of
alcohol units you are drinking:
Strength of
the alcohol
(ABV %)
Volume
of alcohol
(ml)
1000
No. of
units
e.g. average strength beer that has a 5%
alcohol content, one pint (568ml):
5(%) x 568 (mls) ÷ 1000 = 2.8 units
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Illegal drugs:
Cocaine
Using illegal drugs can cause
health problems - however,
cocaine in particular can cause
problems for your heart.
Cocaine is a stimulant that
makes you feel wide awake.
It also increases your blood
pressure and makes your heart
beat faster.
Cocaine releases chemicals which
can tighten and narrow the
coronary arteries reducing the
amount of blood and oxygen to
the heart muscle. This can cause
a heart attack.
We would like you to tell us
about recent use of illegal
drugs. Please also tell us about
medications bought over the
counter / online and herbal
remedies, as these can affect
which medications can be given
to you safely.
Cannabis
If you regularly smoke cannabis
with tobacco you are likely to
become addicted to nicotine.
This can lead to the development
of cardiovascular disease.
Diabetes (raised blood
glucose)
If you are diabetic you are more
likely to develop CVD. This is
because you are more prone to
high blood pressure and high
cholesterol.
Your glucose levels should be
checked regularly. High glucose
levels affect the artery walls
encouraging fatty deposits to
develop.
Glucose levels are checked on
admission to the hospital so that
the doctors can find out if you
do have diabetes or are at risk of
developing it.
Anything you tell us about drug
use is confidential.
For more information ask for
the ‘Cocaine and the Heart’
Leaflet from a member of the
cardiovascular rehabilitation
team.
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Factors which cannot be changed
Age
Family history
The chances of developing CVD
increase with age. Risk levels
increase year-on-year from 45
years onwards.
If a male relative (father/brother)
develops CVD under the age of
55 or a female relative (mother/
sister) develops CVD under the
age of 65 then blood relatives
e.g brothers, sisters and children
should be screened for CVD.
Gender
Cardiovascular disease happens
to men and women.
Women are more at risk after
the menopause.
If you are taking HRT (Hormone
Replacement Therapy), please
discuss the preparation you take
with your doctor or nurse as you
may need to change or stop HRT.
A routine screen can be done by
your own GP or Practice Nurse.
This includes measurement of:
lCholesterol
l Physical activity
l Blood pressure
l Smoking history
lWeight
l Blood glucose levels.
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Ethnic group
In the United Kingdom the risk
of cardiovascular heart disease
is high in the South Asian
Community.
l Be physically active
The risk of high blood pressure,
a risk factor for cardiovascular
disease, is greater in people with
an African Caribbean origin. The
risk of diabetes, a risk factor for
cardiovascular disease, is high in
people with an African Caribbean
or South Asian background.
l Reduce and manage your
levels of stress
The key messages to help reduce
lifestyle risk factors:
l Don’t smoke any form of
tobacco
l Keep your cholesterol under
control
l Keep your blood pressure
under control
l Maintain a healthy weight
l Eat a healthy well balanced
diet
l Take time out for relaxation
l If you drink alcohol then
stay within the safe,
recommended levels
l If you have diabetes then
aim for good control of your
blood sugar levels
l Do not use cocaine or other
illegal drugs
l Take your medication as
prescribed
l Attend your annual CVD check
with your practice nurse / GP.
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Discharge from hospital
after a cardiac event
A relative or friend should
collect you from the ward.
You can get a “Fit” note (sick
note) from the nursing staff.
You will get written information
and be given a supply of tablets
for the first few days at home.
Your GP will be informed by
letter about your stay in hospital
and your treatment.
Your GP will then prescribe
your medication after discharge
and will provide a sick note if
needed. Sick notes are now
known as “Fit” notes.
Activity guidance after
a heart attack or heart
surgery
If you were reasonably mobile
and independent before your
cardiac event, aim for the levels
outlined on the next page.
If you have any problems
walking or with activities of
daily living, you should gradually
progress towards the level of
activity you had previously. Use
the following as a guide only.
You should then seek advice
from a member of the
cardiovascular rehabilitation
team as to how you can progress
further.
Remember that everyone is
different and will progress at a
different rate. Try not to feel
guilty about leaving household
tasks for a while and sharing the
workload with others.
The recommended walking
times on the next page are a
rough guide only. If you are
finding it difficult to walk for
the advised time, take things
more slowly and do not increase
the time until the effort
becomes easy.
If you are finding it easy to
walk for the advised time,
you may progress through the
stages more quickly. It is very
important that you work within
your own limits and think about
any signs and symptoms that you
have.
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Week
1
Week
2
l Take your time and enjoy
being at home
l Walk up and down stairs
as necessary
l If tired, have a short sleep
during the day
l Try to increase the number
of activities you do (e.g.
- washing up or dusting)
without getting too tired
l Try to stick to your normal
daily routine of dressing,
meals etc
l Try to go up and down
stairs as little as possible
for the first few days
l Encourage visitors not to
stay too long at this stage
l Take a warm bath or
shower, without having
the water too hot or too
cold
l If comfortable, increase
your walking by 1-2
minutes at a time, aiming
for 10 minutes. Try to
do this twice a day at a
leisurely pace
l Once again, do not
increase your walking time
until it feels easy.
l Take a 5 minute walk each
day once you feel able.
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Week
3
l If comfortable, increase
your walking time by
1-2 minutes, aiming to
walk for 15 minutes once
or twice daily. Aim for a
leisurely to moderate pace
l Increase light household
chores as you feel able.
Heavier tasks such as
vacuuming or changing
the beds should be
avoided for at least 6-8
weeks
l You may want to go to
the supermarket with
someone. Do not carry
any heavy shopping bags
- only carry light bags such
as the bread
l You may feel like doing
some light gardening, such
as planting or weeding.
Heavy digging, sawing or
mowing the lawn should
be avoided for at least
8-12 weeks.
Week
4
l Continue to increase your
walking as comfortable,
aiming for 20 minutes
once or twice daily
l Return to general
household activities,
taking frequent breaks
l Remember to pace
yourself - clean one room
at a time!
l During any form of
physical activity, it is very
important to stop if you
experience any of the
following:
n Chest tightness or pain
n Excessive shortness of
breath (unable to hold
a conversation)
nNausea
nDizziness
nPalpitations
n Feeling cold and
clammy
n Feeling generally
unwell.
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Walking advice
Walk daily if possible - physical
are taking and help you to
activity needs to be regular to be increase your activity levels.
effective!
Please speak to a member of the
cardiovascular rehabilitation
Some people like to walk
team for advice.
with someone in the early
If there is a hill, try to warm up
stages. This can increase your
on the flat before you attempt to
confidence and make the walk
slowly climb it. You may find it
more enjoyable.
easier to drive somewhere flat to
It is important not to start your
walk initially. See driving advice
walk too quickly. A gradual
(page 59) for advice about when
increase in pace will improve
you are able to drive.
the blood flow to the heart and
Avoid steep hills for about 8
working muscles. Warm up by
weeks as walking uphill makes
walking slowly for the first 5-10
minutes, then increase your pace your heart work harder.
as comfortable. Your breathing
should be comfortable and you
should always be able to hold a
conversation whilst walking. As
you approach home, slow the
pace down for the last 5 minutes
or so, allowing your blood
pressure and heart rate to return
to normal in a controlled way.
Try to avoid walking into a cold
wind as it can take your breath
away and your heart will have
to work harder. You can place a
fine scarf over your face in order
to warm the air as you breathe.
Remember to increase your walk
by only 1-2 minutes at a time and
plan your route so that you can
take rests if necessary. If on a bus
route, you could walk to the local
stop and catch the bus home.
In summer, walk early in
the morning or later in the
afternoon when it is cooler.
In winter, walk later in the
morning or early in the afternoon
when it tends to be warmer.
Do not walk straight after a
meal, as this can bring on the
symptoms of angina. Your body
A pedometer could help you to needs about an hour to digest
increase the number of steps you your food.
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General activities
l With any activity, start slowly
and build up gradually. Only
progress from a light task to a
moderate task, when the light
one has become easy
l When you go back to work
try a gradual return to your
normal hours if possible.
Remember to schedule your
walk or exercise into your
daily routine
l Give yourself plenty of time to
complete your jobs and don’t l Remember that everyone’s
try to do everything at once
condition and abilities are
different. This is general
l Keep your physical activity
guidance only and any
regular - avoid overdoing
specific questions can be
things when you feel good,
answered by a member of the
which can lead to excessive
cardiovascular rehabilitation
fatigue for the following day
team.
or so
l Don’t worry if you feel tired
some days. This is a normal
part of your recovery. Reduce
the amount of activity you do
on these days and then return
to normal the day after
l If you are going to have a
late night, take a rest in the
afternoon
l If you feel that your
symptoms have changed or
you have developed new ones
such as increased chest pain,
breathlessness or swollen
ankles, do not try to increase
your activity levels and
contact your GP as soon as
possible
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Exercise with the cardiovascular rehabilitation team
Supervised exercise on a
cardiovascular rehabilitation
programme is available for
people of all ages and abilities.
Providing your condition is
stable, it usually starts:
2-4 weeks after angioplasty /
stenting;
4 weeks after a heart attack;
6 weeks after bypass, valve
surgery or other open heart
surgery.
Once - heart failure or angina is
stable and you have been seen
in clinic.
After your first check up if you
have had an ICD or Biventricular
pacemaker inserted.
The cardiovascular rehabilitation
team will carry out an individual
assessment to ensure a safe and
effective plan of exercise within
the rehabilitation class and at
home.
Remember not to commence any
unsupervised exercise other than
walking before this point. Your
heart will then have time to
recover as you steadily increase
your activity levels.
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Aerobic activity
The main type of activity
recommended for a healthy
heart is ‘aerobic’. Aerobic
activities use the large muscles
of the body such as in the legs,
arms and back in a rhythmic and
repetitive way.
Examples of aerobic activity are
walking, cycling, gardening and
dancing. This type of activity
makes you breathe harder and
your heart beat faster. It will
help to improve your levels of
fitness and stamina, so that you
can return to your normal daily
activities as soon as possible.
Swimming and aqua aerobics
are very good for improving
health and fitness. However,
swimming and aqua aerobics
are strenuous activities for the
heart. What you are able to
do will be advised according
to your health and particular
heart condition. Therefore it
is important before starting or
returning to swimming and aqua
aerobics that you get advice and
support from the cardiovascular
rehabilitation team.
For aerobic activity to be both
safe and effective, the aim is to
work at a level which makes you
feel comfortably ‘puffed’, but
still able to hold a conversation.
Along with increasing your
confidence, the main focus
for you on the cardiovascular
rehabilitation programme will
be to introduce and establish
you in a regular pattern of
aerobic activity.
Remember, activity is for life.
To have any benefit it needs to
be performed regularly.
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Borg’s rating of perceived exertion scale
Whilst taking part in the
exercise on the cardiovascular
rehabilitation programme, you
will be introduced to Borg’s
Rating of Perceived Exertion
(RPE) scale.
This scale helps you to rate how
you are coping with the exercise;
this allows us to prescribe your
exercise at an appropriate level.
On the programme, the aim
is for you to fully understand
the RPE scale and to use it
effectively. You should then be
able to put it in to use when
undertaking every day activities
and unsupervised exercise in the
future’.
In some more specialised classes
a scale of 0 to 10 will be used
but this will be explained to you
on an individual basis.
Remember, activity is for
life. To have any benefit
it needs to be performed
regularly.
Borg RPE scale@Gunnar Borg,
1970,1984,1985,1988
6 No exertion at all
7
8
Extremely light
9 Very light
10
11 Light
12
13 Somewhat hard
14
15 Hard
16
17 Very hard
18
19 Extremely hard
20 Maximum exertion
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Sex
Physical contact is important
throughout life. Hugs, holding
hands or a kiss show you care and
can greatly assist in recovery after
a cardiac event. Physical contact
can help to raise the self-esteem
and confidence of both partners.
Resuming sexual activity
will vary for everyone. It is
recommended to wait 4 to 6
weeks after a cardiac event or
surgery. This is around the same
time that you are becoming
more physically active in daily
life. For PAD patients it is
whenever you feel ready.
Key points:
l The pleasure that comes from
having sex can greatly assist
in recovery
l Try to choose a time when you
are comfortable and relaxed,
not after a large meal, after
alcohol or when you are tired
l The risk of a heart attack or
angina attack during sex is low.
If you experience angina
symptoms during sex then
take your GTN medication. It
may help to take it prior to
sexual activity if chest pain has
previously occurred during sex.
If you have an ICD in place then
do not worry about it firing if an
irregular heartbeat is detected.
If it does fire your partner will
not also receive a shock.
If your sex drive is lower than
usual it may return over time,
as your fitness and health
improves. A low sex drive is
often caused by emotional
worry. The medicines you are
taking may also be a problem.
Speak to your nurse or doctor.
l Make sure the room is a
comfortable temperature
l Ask your partner to take the
more active role
l Having sex is equal to the
energy needed to walk up
two flights of stairs, doing
household chores, gardening
or DIY
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Erectile dysfunction (ED) Driving
A problem in getting or
maintaining an erection is
known as impotence or erectile
dysfunction. It is a common
difficulty: one-in-ten men have
ED at some point in their lives.
This is often one of the first signs
of cardiovascular disease.
The DVLA provides guidance for
heart patients about when you
can return to driving your car. It
gives details of the process you
must follow if you have a type
2 licence for driving. A type 2
licence allows you to drive a bus
or heavy goods vehicle.
Key points:
Taxi drivers are governed by
l ED is due to a problem with
their local authority but type 2
the blood and nerve supply to licence rules are often applied.
the penis
l Anxiety, especially if you have
been unwell, and fear of failure
can affect your performance
l ED can be caused by certain
medications - speak to your
doctor or nurse
l Viagra and other drugs like
Viagra - such as Spedra - are
not recommended if you are
taking any form of nitrate
whether GTN spray, or nitrate
tablets or Nicorandil.
Lack of sexual function can
happen to both men and
women. If you have any sexual
or relationship problems please
do not hesitate to speak to
any of the cardiovascular
rehabilitation team, your doctor
or your nurse. They can arrange
a referral to one of the specialist
support services in Salford.
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Car drivers
ICD
In most cases you cannot drive
your car for four weeks after a
heart attack or Coronary Artery
Bypass Graft (CABG).
If you have had an Implantable
Cardioverter Defibrillator (ICD)
inserted then you can drive a car
or motor cycle:
l6 months after the first
device is inserted. If you
were initially unwell with the
abnormal heart rhythm
l1 month after the device is
inserted if you were well with
the abnormal rhythm
l1 month after the device is
inserted if the device was
inserted because you are at
risk of an abnormal rhythm,
but have not yet had one
l6 months after the device
fired correctly for an abnormal
heart rhythm
lYou cannot drive for 2 years
if the ICD was inserted for
an abnormal rhythm which
caused you to become
unconscious
l1 month after a change to the
wires or a change in rhythm
medication
l1 week after a defibrillator
box change.
Please be aware that most of
the cardiac surgeons advise that
you do not drive your car for
six weeks after a CABG or other
cardiac surgery.
You must not drive for 1 week
after PCI (angioplasty / stent).
In a few cases you may drive
your car 1 week after a heart
attack with successful PCI.
This depends on the level of
damage to your heart after the
heart attack.
Angina
Driving must stop if you have
angina symptoms at rest, with
emotion or when driving.
Driving can restart once
symptoms are controlled.
Your doctor or the cardiovacular
rehabilitation team can advise
you about your specific advice.
PAD
Driving can continue unless
there is another disqualifying
medical condition.
If you have had a biventricular
pacemaker inserted without the
ICD then you can drive a car one
week after the device is inserted.
If the pacemaker includes an ICD
then the ICD rules apply.
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There is specific advice on the
DVLA website for people with
heart conditions or PAD with
regard to group 2 licensing.
If you have a group 2 licence
you must inform the DVLA of
your medical condition. Your
licence will need to be returned
to the DVLA. Relicensing will
If you have a type 2 licence (LGV,
be considered after a successful
public service vehicle) then you
exercise or functional imaging
are permanently barred from
test result. It will also depend on
driving after an ICD is inserted.
how well your heart is working.
The cardiovascular rehabilitation
A satisfactory report from your
team can provide specific advice
consultant will also be required.
according to your particular
condition.
If you experience frequent chest
pain when driving you should
Key points:
talk to your doctor or nurse and
l If you drive against
stop driving until your condition
recommendation you may not is stable.
be covered by your insurance
Further information about
company
driving with a heart condition is
l You must inform your
available at:
insurance company of your
heart condition and/or
www.dvla.gov.uk
surgery before you resume
driving
l A “statement of fitness to
drive” from your GP may be
requested
l When starting to drive, try
a short distance at a quieter
time first
l If taking a long journey, stop
and stretch your legs every
hour.
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Returning to work
Fit notes
Fit note is the new name for
a sick note. This note states
whether you are fit for work.
It will advise you whether you
need to see your doctor before
you return to work or not.
The note may advise that you
“may be fit for work”, which
means that you can return
with some support from your
employer e.g. light duties and/
or a gradual return to full time
hours.
Once you have recovered, and
feel well enough and your
employer is satisfied, then you
may return to work.
It is important to follow the
Doctor’s advice as returning to
work too early may affect your
recovery.
l Most people should be able
to return to work 4-6 weeks
after a heart attack, sooner
after a PCI. It may take
longer, however, after heart
surgery
l Returning to work depends
on the type of job you do
l If your job does not involve
strenuous activity you may be
able to return at four to six
weeks
l If the job is physically,
mentally or emotionally
demanding then you may
need to take up to 12 weeks
off work
l Most people with PAD will be
able to continue with their
current job.
continued page 65
If you are unemployed or selfemployed then you can use the
Fit note to make a claim for
benefits.
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Returning to hobbies
Things to think about:
l You may need to make changes
to how you carry out your job
or the hours that you work
l Consider returning to work
gradually - working a few
hours to begin with and then
gradually building up to your
normal hours. This can be
discussed with your manager,
human resources department
or occupational health service
l Take your time if thinking
about returning to work,
giving up or retiring
l Job Centre Plus can give
advice to people who feel
their job maybe too heavy or
stressful.
They can also help with advice
about benefits advice whilst you
are not working.
You can contact:
Most people should be able to
resume their usual hobbies. If
you are concerned about how
and when to resume your
hobbies or to take part in
extreme sports please speak to
a member of the cardiovascular
rehabilitation team.
Key Points:
l It is important to gradually
build up activities and rest
when tired
l Avoid any activity that makes
you hold your breath (e.g. heavy
lifting, pushing or pulling)
l Activities such as fishing,
dancing and bowling can start
at around six weeks. Gradually
build up the amount of these
activities that you do
l It is best to attend some of the
exercise sessions provided by
the cardiovascular rehabilitation
team before starting anything
more strenuous.
Salford Job Centre Plus
0345 604 3719
Information about benefits and
returning to work can also be
found at:
www.gov.uk
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Saunas, steam rooms
and jacuzzi
l Cardiac patients should wait
until after your exercise
treadmill test or other heart
tests and/or outpatient or
cardiovascular rehabilitation
appointment before using a
sauna, steam room or jacuzzi
l You should avoid the sauna,
steam room or jacuzzi if you
are having any symptoms of
angina or heart failure
l Be aware that some of the
tablets you are taking will
lower your blood pressure.
Saunas and steam rooms
can also lower your blood
pressure, so the effect may be
increased when using them
l There is no particular
guidance for people with PAD
but if you are taking blood
pressure lowering medication,
be aware of the advice above.
Holidays
Everyone can benefit from a
holiday. It is a great way to
relax, but remember going on
holiday can also be stressful.
A restful holiday in this country
may be taken a couple of weeks
after going home after a heart
attack or heart surgery.
Key Points:
l Plan how you will get there
and back
l Allow plenty of time for the
journey
l Avoid carrying heavy bags
and suitcases. You can
use bags on wheels, or ask
someone to help
l Try to avoid staying in
accommodation on a steep
hill
l Stay in accommodation that is
easily accessible and close to
amenities
l Avoid extremes of
temperature and stay out of
the sun in the heat of the day
- take a siesta
l Take your repeat prescription
list with you.
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Flying
l It is best not to fly immediately l A repeat prescription of your
after your cardiac event or
medication can also be useful
surgery. You should wait until
l If you have an ICD or
your heart condition is stable
pacemaker then carry a card,
before flying
which gives details of the
l There is specific guidance about
device which you can show
when you are able to fly which
to airport security staff. You
depends on your particular
are safe to walk through
condition and symptoms.
the security arch but do not
Further information
linger. Avoid the security
is available from the
wand being held over the
cardiovascular rehabilitation
device. Interference is
team. There is no specific
unlikely, but could happen.
guidance for people with PAD
l Remember, a short haul flight
can take all day. Arrive at the
airport in good time. Avoid
rushing. Get transport to the
gate if it is a long walk
l Avoid countries with extremes
of temperatures. You may
tire more easily in the heat so
reduce your daily exercise a
little
l Avoid going out in the heat
of the day - do as the locals
do and take an afternoon
siesta
l Take enough medication with
you. Carry your medication in
your hand luggage if you are
going abroad
Travel insurance
l If you are travelling abroad
make sure you have adequate
insurance cover.
You may find it difficult to
get travel insurance once you
have a medical condition. The
cardiovascular rehabilitation
team can provide you with a list
of insurance companies, which
the British Heart Foundation
(BHF) has put together based on
feedback from people who have
found them helpful.
British Heart Foundation website:
www.bhf.org.uk
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Medications for
cardiovascular disease
Missed doses of
medication
This section provides an
overview of the medications
which may be prescribed for
someone with cardiovascular
disease.
In most cases the medicine you
are taking is to prevent something
going wrong, not to make
something better. You may not
notice much difference in how
you feel if you miss a dose.
Medications are given to reduce
the risk of further cardiac events,
such as a heart attack and to
help control and manage your
cardiovascular condition such as
PAD or heart failure. It is very
important that lifestyle changes
are made as well as taking
medications.
More detailed information
is available from your local
pharmacist, doctor or the
cardiovascular rehabilitation team.
In general, if you remember
within 12 hours of your usual
time, take your medicine
straightaway, and then take your
next tablet at the usual time.
If you forget for more than 12
hours, simply take the next single
dose at the usual time. Do not
take a double dose to make up
for the forgotten doses.
If you pay for your prescriptions
a “season ticket” may be cheaper.
These are available for 3 or 12
months by telephoning the:
NHS Pre-Pay Prescriptions
Helpline
0300 3301341
or via the internet at:
www.nhsbsa.nhs.uk
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Sick day rules
If you are unwell with any of the
following:
l Vomiting or diarrhoea (unless
only minor)
l Fever, sweats, shaking.
Please STOP the following
medicines on sick days:
l NSAIDs - anti-inflammatory
painkillers e.g. Ibuprofen,
Diclofenac
l ACE inhibitors - medicine
names ending in “pril” e.g.
Ramipril, Lisinopril
l ARBs - medicine names ending
in “sartan”e.g. Candesartan,
Losartan
l Diuretics - sometimes
called water pills e.g.
Furosemide, Spironolactone,
Bendroflumethiazide,
Bumetanide
l Metformin - a medicine for
diabetes.
Continuing with these medicines
whilst unwell like this can cause
strain or harm to your kidneys.
Restart when well - (within 24 to
48 hours of eating and drinking
normally).
Re-ordering your
medicines
Keep the repeat slip attached to
your doctor’s prescription safe.
You will need it to re-order your
next supplies. If you are going
on holiday, remember to send in
the repeat slip at least 2-3 days
before you leave. This will allow
time to get the prescription
written and dispensed.
Many surgeries offer an online
system to re-order medicines.
Your surgery may ask you to let
them know why you want your
next repeat prescription a week
or more early.
Many surgeries now have links
with a specific pharmacy. They
will pick up your prescription
and can also deliver your
medication to home.
If you have an appointment
in clinic, take the doctor’s
repeat slip with you. This is an
accurate list of what your GP has
prescribed for you. It may be
needed by the clinic staff.
If you are in any doubt, contact
your pharmacist, doctor or nurse.
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Going to a hospital
appointment
If you have an appointment
in clinic, take the doctor’s
repeat slip with you. This is an
accurate list of what your GP has
prescribed for you. It may be
needed by the clinic staff.
Unplanned hospital
admission
If you are unexpectedly
admitted to hospital, make sure
that a relative or neighbour
brings the doctor’s repeat slip to
hospital for you.
The hospital staff will need this
record of what you have been
prescribed. You may take your
medication with you, but this is
not essential.
Allergy or side effect?
Side effects are a nuisance.
They are listed in the patient
information leaflet with the
medicine. You will not get all
the side effects listed on this
booklet and may not get any
side effects at all. The makers
of the drug just want to cover
every possibility by listing
everything reported to them to
date.
Allergy to a drug can be
a serious reaction. It can
produce swelling of the face or
mouth, difficulty breathing or
swallowing, and/or severe rash.
If you suspect you are having
a severe allergic reaction, you
should get emergency help by
dialling 999 for an ambulance.
Hospital staff may decide to give
you another supply if there is
any doubt about how long you
have had the medication stored
at home.
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Herbal remedies / Over
the counter medication
Getting the most from
your treatment
Always tell your doctor about
any herbal remedies or other
medication bought in a shop or
online. Many of these can affect
the condition you are being
treated for, or the medication
you are prescribed.
Take all your medications
regularly at the dose and time
prescribed. Missing a dose
will reduce the effectiveness
of the medicine and may leave
you at higher risk of CVD or
complications.
It is better not to take herbal
remedies e.g. St John ’s Wort,
but if you do, a pharmacist
should check how this affects
you and your prescribed
medication.
Never take more than the
prescribed dose. If you suspect
that you or someone else
has taken an overdose of a
medicine, go to the emergency
department of your local
hospital at once. Take the
container with you, even if it is
empty.
This medication is for you.
Never give it to other people
even if their condition appears
to be the same as yours.
Never keep out-of-date or
unwanted medications. Take
them to your local pharmacy
which will dispose of them
safely.
If you have any questions
about any medications ask
your pharmacist.
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Aspirin
What is it for?
Cautions:
Helps to prevent blockages
due to blood clots forming in
the coronary arteries and the
arteries in the legs.
Aspirin is prescribed at a specific
dose to prevent clots forming.
Do not take anything else with
Aspirin in it. Higher doses stop
the Aspirin being effective in
this way.
Possible side-effects:
Bruising, upset stomach, mild
indigestion, bleeding.
My Aspirin Dose
Take Paracetomol for pain relief
e.g. headache, cold, flu-like
symptoms.
When Do I Take It?
Changes in Dose & Dates
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Clopidogrel
(Plavix)
What is it for?
Cautions:
It makes the blood less sticky,
reducing the chance of any blood
clots. You may be prescribed
Clopidogrel if you have had a
heart attack, unstable angina if
you have had one or more stents
inserted or if you have PAD.
Clopidogrel reduces the chances
of you having a further heart
attack or blocking the stent(s) or
blocking the arteries in your legs.
It can also be used as an
alternative to Aspirin. It is not
unusual to take Clopidogrel and
Aspirin together if you have
coronary heart disease.
It is very important to keep
taking Clopidogrel until you
are told to stop either by your
GP, nurse or consultant. After
a stent, patients are often on
Aspirin and Clopidogrel for up
to 12 months.
Possible side-effects:
l Extreme tiredness
Bleeding - bruising, nose bleeds
and cuts take longer to stop
bleeding. Diarrhoea, indigestion
or heartburn.
l Jaundice (yellowing of the
skin or eyes).
My Clopidogrel Dose
Contact your doctor
immediately:
l If you pass any blackened
stools
l Notice any unusual bruising or
bleeding
l Any unexplained flu-like
symptoms with a high
temperature
When Do I Take It?
Changes in Dose & Dates
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Prasugrel
(Efient)
What is it for?
Cautions:
It stops platelets from clumping
together, and so reduces the
chance of a blood clot forming.
You may have been prescribed
Prasugrel because you have had
a heart attack, have unstable
angina or you have had one or
more stents inserted. Prasugrel
reduces the chances of you
having a further heart attack or
blocking the stent(s). Your doctor
will also give you Aspirin, another
anti-platelet agent. It is not
unusual to take Prasugrel and
Aspirin together.
Contact your doctor immediately
if you notice any of the
following:
Possible side-effects:
Blood in your urine, bleeding
from your back passage, blood
in your stools, black stools, or
uncontrollable bleeding, for
example from a cut.
My Prasugrel Dose
l Sudden numbness or
weakness of the arm, leg or
face, especially if only on one
side of the body
l Sudden confusion, difficulty
speaking or understanding
others
l Sudden difficulty in walking
or loss of balance or coordination
l Sudden dizziness or sudden
severe headache with no
known cause.
All of the above may be signs
of a stroke, which is a medical
emergency. This is uncommon.
When Do I Take It?
Changes in Dose & Dates
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Ticagrelor
Cautions:
Contact your doctor immediately
if you notice any of the following:
l Sudden numbness or weakness of
What is it for?
your arm, leg or face, especially if
It stops platelets from clumping
only on one side of the body
together, and so reduces the chance
l Sudden confusion, difficulty
of a blood clot forming. You have
speaking or understanding
been prescribed Ticagrelor because
others
you may have had a heart attack,
l
Sudden difficulty in walking or
or had one or more stents inserted.
loss of balance or co-ordination
Ticagrelor reduces the chances of
you having a further heart attack or l Suddenly feeling dizzy or
sudden severe headache with
blocking the stent(s). It is usually
no known cause.
given in combination with Aspirin
for up to 12 months.
These are signs of a stroke and
is a medical emergency. This is
Possible side-effects:
uncommon
Nose bleed, blood in your urine,
Discuss with your doctor if you
black stools or blood in the stools, notice the following:
coughing up or vomiting blood,
l Feeling short of breath - this is
vaginal bleeding heavier than
common. It might be due to
normal or at a different time from
your heart disease or another
normal, bleeding gums or ears. If
cause, or it might be a side
this is seen contact your doctor
effect of Ticagrelor. If you are
Other possible side effects include:
feeling short of breath which
bruising, headache, dizziness,
gets worse or lasts a long time,
stomach pain, diarrhoea, sickness,
tell your doctor. Your doctor
rash.
will decide if it needs treatment
or further investigations.
(Brilique)
My Ticagrelor Dose
When Do I Take It?
Changes in Dose & Dates
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Beta Blockers
(Bisoprolol, Carvedilol, Nebivolol,
Atenolol, Metoprolol, Sotalol)
What are they for?
Slows the heart rate, reduces
the force of each heart beat and
lowers blood pressure, helping
to reduce the heart’s workload.
The dose of beta blockers is
likely to be increased up to
the maximum dose tolerated
in order to achieve maximum
benefit. The actual dose will be
different in each person.
Possible side-effects:
Cold hands and feet, feeling sick,
dizziness, drowsiness, disturbed
sleep, vivid dreams, nightmares,
dull headache, fatigue and
may cause erectile dysfunction
(impotence).
My Beta Blocker Name
& Dose
Cautions:
When you first start a beta
blocker you may feel more tired
and breathless. This should last
no longer than a week. If you
are concerned speak to your
nurse or doctor. Do not stop
taking these tablets without
talking to your doctor or nurse.
If you are diabetic it is important
to monitor your blood sugars,
especially if you have low blood
sugar levels (hypos), as beta
blockers can hide the symptoms
of hypos.
If you have heart failure,
asthma or poor circulation, your
symptoms may increase when you
start to take a beta blocker. This
should be temporary, but if you
are worried speak to a doctor.
If you have psoriasis, your doctor
may decide to prescribe a different
medicine, to avoid possible
worsening of your symptoms.
When Do I Take It?
Changes in Dose & Dates
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Cholesterol Lowering Drugs
(Simvastatin, Pravastatin,
Atorvastatin, Fluvastatin,
Rosuvastatin)
What are they for?
Cautions:
Statins lower fats such as
cholesterol and triglycerides in
your blood. Cholesterol plays
an important role in helping
the body to make important
chemicals. Too much cholesterol
in the blood increases the risk
of cardiovascular disease. If
you have had a heart attack or
been diagnosed with angina or
PAD then you will be prescribed
statins for life unless you are
unable to tolerate them. Statins
help to reduce the risk of CVD.
Should normally be taken at
night as this is when your body
makes cholesterol. Muscle aches,
pains and weakness are rare
and should be reported to your
doctor or nurse straightaway.
Avoid grapefruit and
pomegranate juice as they can
increase the levels of statin in
your body, which will make side
effects more likely.
Possible side-effects:
Wind, indigestion, feeling sick,
disturbed sleep, feeling dizzy or
tired, forgetfulness, depression,
itchy rash, hair thinning and
muscle aches, pains and weakness.
My Statin Name & Dose
When Do I Take It?
Changes in Dose & Dates
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A.C.E Inhibitors
(Ramipril, Perindopril, Lisinopril,
Enalapril, Captopril)
What are they for?
Cautions:
Block the effect of a substance
(ACE) which keeps blood vessels
partly closed. Blood vessels are
able to relax, and blood flows
more easily. This lowers blood
pressure and reduces the strain
on the heart.
You will be started on a low
dose, which will gradually be
increased to the maximum dose
you are able to tolerate. Your
blood pressure and kidney
function will be monitored
regularly.
Possible side-effects:
Taste disturbance, ticklish
cough, rash or dizziness when
you start treatment or increase
the dose. A rare side effect is
throat swelling. If this happens
seek immediate medical help
Persistent dry cough; if this lasts
more than 14 days, disturbs
your sleep and is not due to
smoking, heart failure or COPD
your doctor may change the
treatment.
My A.C.E Name & Dose
Potassium levels can rise due
to taking ACE inhibitors. It is
important not to use a salt
substitute (e.g. Lo-salt) whilst
taking this medication. Lo
salt contains high levels of
potassium.
If a ticklish cough is a problem
discuss it with your GP who
may be able to start you on an
alternative medication.
When Do I Take It?
Changes in Dose & Dates
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Angiotensin II Inhibitors
(Losartan, Valsartan, Irbesartan,
Candesartan)
What are they for?
Cautions:
Work in a similar way to ACE
inhibitors but are usually
prescribed to patients who
experience a persistent ticklish
cough whilst taking them.
You will be started on a low dose
which will gradually be increased
to the maximum dose that you
are able to tolerate. Your blood
pressure and kidney function will
be monitored regularly.
Possible side-effects:
Dizziness when you start
treatment or increase the dose,
especially if you take a water
tablet as well.
Persistent dry cough. If this lasts
more than 14 days, and disturbs
your sleep, and the cough is not
due to smoking, heart failure, or
COPD, your doctor may change
the treatment.
My Angiotensin ii
Inhibitor Name & Dose
It is important not to use a salt
substitute (e.g. Lo-salt) whilst
taking these as Lo-salt contains
high levels of potassium.
If a ticklish cough is a problem
discuss it with your GP who
may be able to start you on an
alternative medication.
When Do I Take It?
Changes in Dose & Dates
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Nitrates
(Buccal Suscard, Isosorbide
Mononitrate, Imdur, Chemydur,
GTN tablets or spray)
What are they for?
Cautions:
Open up (dilate) the blood
vessels, which reduces the
amount of work the heart has to
do. This can help to reduce the
number of angina episodes.
Isosorbide tablets can stop
working as the body gets used
to them (tolerance).
Possible side-effects:
Headaches (should improve
after about 10 days), dizziness,
flushing.
My Nitrate Name & Dose
Take the first dose at breakfasttime, and the second dose
between 4pm and 6pm at the
latest, to allow a ‘nitrate-free
period’ of 8 hours overnight.
This helps to stop tolerance.
BUT
If you are taking long-acting
nitrates the full dose should be
taken in the morning.
When Do I Take It?
Changes in Dose & Dates
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General information about GTN
lUse GTN as often as you
require it - you will not
become addicted to it
In order to reduce the chance of
getting a headache: when the
discomfort subsides
lTry to sit down to use GTN
when you first use it as it can
cause dizziness
lRinse your mouth out to get
rid of excess GTN spray
lA supply of GTN spray lasts
longer than the tablets. The
expiry date is printed on the
container
lSwallow the GTN tablet or spit
it out.
lGTN tablets only last for 8
weeks once opened. Write
the date of opening on the
bottle of GTN tablets and
dispose of them responsibly
eight weeks after opening
lHeadaches
lStore GTN in a cool dry place
lDo not carry tablets or spray
in an inside pocket as the
warmth of your body can stop
them working
lIf you know a particular
physical activity that usually
brings on chest discomfort,
you can take your GTN spray
or tablets before you start
the activity to help prevent it
happening.
OR
Possible side effects:
lDizziness
lFlushing.
Cautions:
Do not take Viagra - or similar
drugs such as Spedra - if you use
GTN as it can lower your blood
pressure too much.
Do not store GTN near a flame
or heat as GTN can set on fire.
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Calcium Channel Blockers
(Amlodipine, Diltiazem, Verapamil)
What are they for?
Cautions:
Calcium particles carry an
electrical charge which makes
the artery walls contract. These
medications stop calcium
entering the artery walls,
allowing the arteries to relax
and blood pressure to drop.
This can be used to reduce the
amount of angina and/or help to
lower blood pressure.
Do not suddenly stop taking
calcium channel blockers. This
may bring on angina pain.
Your doctor will advise how to
withdraw it slowly.
Possible side-effects:
Headaches, flushing - this usually
goes away after a few days.
Nausea - eat little and often.
Spicy food can make flushing
worse and increase nausea.
Avoid grapefruit juice. This may
interact with the medication
and increase the risk of the side
effects.
If you find that you are taking
Amlodipine and Simvastatin
then please speak to your
doctor or nurse as these two
medications can react with each
other.
Ankle swelling - make sure you
have a balance of activity and
rest and raise your legs onto a
low stool when sitting.
Tiredness, dizziness.
My Calcium Channel
Blocker Name & Dose
When Do I Take It?
Changes in Dose & Dates
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Potassium Channel Activators
(Nicorandil)
What is it for?
Cautions:
Relaxes the blood vessels and is
used to help prevent angina.
Possible side-effects:
Do not stop taking Nicorandil
without speaking to your doctor
first because this can cause
further angina attacks.
Headache, flushing of the face,
feeling sick, dizziness, weakness
(mouth ulcers - speak to your
doctor) and muscle pain.
It is best not to drink alcohol
while you are taking these
tablets. Drinking alcohol will
increase the chance of dizziness.
You should not take medicines
such as Viagra for erectile
dysfunction whilst you are
taking Nicorandil.
The two medicines together can
lower your blood pressure too
much.
My Potassium Channel
Activator Name & Dose
When Do I Take It?
Changes in Dose & Dates
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Ivabradine
(Procorolan)
What is it for?
Cautions:
It works by reducing the heart
rate by a few beats per minute.
This lowers the heart’s need for
oxygen so an angina attack is
less likely to happen. It can also
be used in heart failure.
Do not take grapefruit juice with
Ivabradine. This may affect how
the Ivabradine works.
Possible side-effects:
If you take too much Ivabradine,
you may feel breathless or tired,
because your heart slows down
too much. Contact your doctor
immediately.
Brief moments of increased
brightness in your vision - take
care if driving at night, or
operating machinery, headache,
dizziness, blurred vision, vertigo,
constipation, diarrhoea.
My Ivabradine Dose
When Do I Take It?
Changes in Dose & Dates
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Ranolazine
(Ranexa)
What is it for?
Cautions:
It is used to treat angina when
other medicines have not been
effective or if they have caused
bad side effects. It does not
reduce heart rate or blood
pressure.
Do not take Ranolazine with St
John’s Wort or grapefruit. This
may affect how the Ranolazine
works.
Possible side-effects:
Constipation, feeling dizzy,
headaches, nausea, vomiting,
blurred vision, breathing
difficulties, confusion, cough,
difficulty sleeping, dry mouth,
feeling anxious, flatulence,
hallucinations, hot flushes, loss
of appetite, muscle cramps,
tinnitus, weight loss.
My Ranolazine Dose
When Do I Take It?
Changes in Dose & Dates
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Diuretics (water tablets)
(Bendroflumethiazide,
Furosemide, Bumetanide,
Co-amilofruse, Metalazone)
What are they for?
Cautions:
Help remove excess water and
salt (sodium) from the body.
This reduces the volume of
circulating fluid, and lowers
blood pressure. It reduces the
strain on the heart, and helps to
resolve swelling (fluid) in feet,
legs or abdomen.
Take in the morning unless told
to take later in the day by your
doctor or nurse.
Check your ankles each morning
for swelling, to see if you are
retaining fluid.
Tell your doctor or nurse if this
happens.
Contact your doctor at once
if you experience an unusual
Increase in passing urine,
flakey rash on your body, or
thirst, dizziness, muscle cramps,
unexplained bruising, bleeding,
nausea, tiredness, rash, increased
or infections.
risk of gout, can raise glucose
levels.
Possible side-effects:
My Diuretic Name & Dose
When Do I Take It?
Changes in Dose & Dates
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Aldosterone antagonists
(Spironolactone, Eplerenone)
What are they for?
These are used when you are
getting more severe symptoms
of heart failure. They work
with the beta blockers and
ACE inhibitors to reduce the
workload of the heart.
Possible side-effects:
Dizziness, sore nipples, swollen
sore breast tissue (in men as well
as women), rash.
My Aldosterone
Antagonist Name & Dose
When Do I Take It?
Changes in Dose & Dates
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Anti-Arrhythmic medicines
(Amiodarone, Digoxin)
What are they for?
Cautions:
Used to control various types
of heart rhythm disturbances,
which may feel like palpitations.
Avoid exposure to the sun or
use high protection sun block
(factor 25 and above) if taking
Amiodarone, as the skin is more
sensitive to sunlight.
A hat and long sleeves are also
advised. You will have to have
regular blood tests for liver and
thyroid function whilst taking
these tablets. Your doctor or
nurse will advise you.
My Anti Arrhythmic
Name & Dose
When Do I Take It?
Changes in Dose & Dates
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Anti-Coagulants
(Warfarin, Sinthrome, Rivaroxaban, Apixaban, Edoxaban, Dabigatran)
What are they for?
Sometimes given to people
after a cardiac event to prevent
blood from clotting. Given
to some people who have
irregular heartbeats, problems
with heart valves or who have
had replacement valves. They
increase the length of time that
it takes the blood to clot.
Possible side-effects:
Bleeding, bruising, skin rash,
hair loss, diarrhoea, jaundice
(yellowing of the skin or whites
of the eyes).
Cautions:
The dose of Warfarin and
Sinthrome varies from person
to person and is determined by
a blood test - the INR. Warfarin
works best if you have a good
daily routine. This is because it
My Anti-Coagulant
Name & Dose
stays in your body for a very
long time. Binge drinking or
sudden strenuous exercise will
upset your clotting more than if
you exercise regularly and drink
within the recommended daily
limits. Do not take cranberry
products or grapefruit juice
whilst taking Warfarin tablets.
If you take cranberry juice e.g.
for bladder infections, your
anticoagulant clinic may need to
monitor you more frequently.
A sudden, major change in your
weight or diet (quantity or food
type) can also affect your INR.
If you are taking anti-coagulants
you will receive a booklet
containing information about
your medication, blood tests and
treatment. You should show the
booklet to your doctor, nurse,
pharmacist and dentist before
receiving any treatment.
When Do I Take It?
Changes in Dose & Dates
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Naftidrofuryl oxalate
What is it for?
Possible side-effects:
Naftidrofuryl oxalate is given
for the treatment of PAD. It
improves blood flow in the body.
It is often used if you prefer
not to have surgery or your
supervised exercise programme
has not led to a satisfactory
improvement in your condition.
lDizziness
My Naftidrofuryl Oxalate
Name & Dose
lHeadache
l Stomach pains
lDiarrhoea
lRashes.
When Do I Take It?
Changes in Dose & Dates
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Self management section
Lifestyle risk factors
Risk Factor
Example
cholesterol
level 8
Goal
Cholesterol
level 4
Plan
Take statins
Change to semi skimmed milk
Use olive oil spread
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Appointments and tests
Appointment Test
Date
Time
Hospital / Clinic
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Further information and support
Benefits advice: Salford Citizens Advice
Calling from a landline
www.salfordcab.org.uk
Calling from a mobile
0844 826 9695
0300 456 2554
British Heart Foundation
www.bhf.org.uk
0300 330 3311
Heart Helpline
British Cardiovascular Society
www.bcs.com
020 7383 3887
The Cardiomyopathy Association
http://www.cardiomyopathy.org/
0800 018 1024
Cholesterol charity
http://heartuk.org.uk/
0345 450 5988
Driver and Vehicle licencing authority
https://www.gov.uk/driving-medical-conditions
0300 790 6806
Government website
no phone number available - please use Citizens Advice
www.gov.uk
NHS choices
www.nhs.uk
no phone number available - please use PALS at Salford Royal 0161 206 2003
Salford City Council
www.salford.gov.uk
Salford Community Leisure
wwww.salfordcommunityleisure.co.uk/
lifestyles/active-lifestyles
0161 294 4711
0161 778 0577
Peripheral Arterial Disease
http://patient.info/doctor/peripheral-arterial-disease-pro
Circulation Foundation
www.circulationfoundation.org.uk/
020 7869 6938
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Support Network:
Salford Royal NHS Foundation Trust
Heart Care Unit - direct line:
0161 206 5005
Salford Royal NHS Foundation Trust
(Switchboard):
0161 789 7373
To find out more about meetings
near you, log onto:
www.salfordheartcare.co.uk
or telephone:
0161 707 7402
Monday to Friday
Salford Heart Care
A registered charity offering
support to people with
cardiovascular disease, their
families and carers.
Regular ‘drop-in’ sessions:
The sessions include:
lTalks and discussions on
subjects of interest
lIndoor games (e.g. pool,
dominoes, indoor bowls)
lTherapists (e.g. Reiki, yoga,
dance instruction
lRelaxation sessions and
lA chance to talk to others.
9am
Midday
The cardiovascular rehabilitation
team are pleased to offer help and
support, and are available for nonurgent advice on:
0161 206 0033
Monday to Friday
8am
4pm
Please leave a message on the
answer phone and we will aim to
return your call within one working
day. Please do not leave urgent
messages on the answer phone.
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References
Notes
ACPICR (2015) (3rd edition) Standards
for Physical Activity and Exercise in the
Cardiac Population. Association of
Chartered Society of Physiotherapists in
Cardiac Rehabilitation.
ACPICR (2012) Swimming and aquaaerobics: A guide for heart patients.
British Association for Cardiovascular
Prevention and Rehabilitation (2012)
Standards and Core Components for
Cardiovascular Disease Prevention and
Rehabilitation.
British Heart Foundation
www.bhf.org.uk (2012).
DH (2011) UK physical activity guidelines.
NICE (2009) Type 2 diabetes.
NICE (August 2011) Hypertension in
adults: diagnosis and management.
NICE (July 2011) Management of stable
angina.
NICE (August 2012) Peripheral arterial
disease: diagnosis and management
NICE (2014) CG181 Cardiovascular
disease: risk assessment and reduction,
including lipid modification.
SIGN (2002) Cardiac Rehabilitation - A
national clinical guideline. Scottish
Intercollegiate Guidelines Network.
Scotland.
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© G15111001W. Design Services
Salford Royal NHS Foundation Trust
All Rights Reserved 2016
This document MUST NOT be photocopied
University Teaching Trust
Information Leaflet Control Policy:
Unique Identifier: MED 49 (15)
Review Date: January 2018
For further information on this leaflet, it’s references and
sources used, please contact 0161 206 0033.
If you need this interpreting please telephone
Copies of this information are
available in other languages
and formats upon request.
In accordance with the
Equality Act we will make
‘reasonable adjustments’
to enable individuals with
disabilities, to access this
treatment / service.
Email: [email protected]
Salford Royal operates a smoke-free policy.
For advice on stopping smoking contact the Hospital Specialist Stop Smoking Service
on 0161 206 1779
Salford Royal NHS Foundation Trust
Stott Lane, Salford,
Manchester,
M6 8HD
If you would
like to become a
Foundation Trust
Member please visit:
If you have any suggestions
as to how this document
could be improved in the
future then please visit:
Telephone 0161 789 7373
www.srft.nhs.uk/
for-members
http://www.srft.nhs.uk/
for-patients
www.srft.nhs.uk