Cardiac Rehabilitation

Otherwise known as Hypertension; this refers to a higher than normal pressure flowing through the arteries of the body. As well as affecting the coronary arteries, it may lead to damage to kidneys, brain, eyes and other organs in the body. If you are known to have high blood pressure, you are likely to require antihypertensive medication to control it. It is not uncommon to require more than one medication, sometimes up to four. It is important this medication is taken regularly as prescribed, and must not be stopped suddenly unless under medical supervision. Your GP may ask you to occasionally monitor your own blood pressure at home. As previously stated eating a low salt/sodium diet will help with high blood pressure.

For more information visit the British Hypertension Society, www.bhs.org.uk.

Diabetes is a condition in which the blood sugar is raised to an extent that it leads to damage of the blood vessels throughout the body. Patients with diabetes are at a higher risk of heart attacks. If the blood sugar is only slightly elevated, you may not be aware that you are affected. Blood sugars are routinely checked after a heart attack and if persistently raised, you will require regular treatment.

If you are diabetic, it is important to gain good control of your blood sugar. This reduces the chance of a narrowing developing in the heart's arteries. All patients diagnosed with, or a suspected diagnosis of, diabetes should have regular reviews of their diabetes with their Practice nurse, GP or with the Diabetic Team at the hospital.

www.diabetes.org.uk

pre-Diabetes

Healthy Eating in Diabetes

Many of us do not take enough exercise. It is important to review just how active you used to be. Some forms of exercise are harmful, particularly those that are associated with sudden extremes of effort or require a lot of straining. e.g. heavy weight lifting. The best exercises involve a lot of free movement, with little resistance i.e. cardiovascular exercise. These include walking, jogging, cycling and swimming.

Physical activity helps:

• Lower high blood pressure and prevent high blood pressure from developing.
• Improve your blood cholesterol levels.
• Maintain, or reach, a healthy weight.
• Control your diabetes, if you are diabetic.
• Improve general well being, and speed up recovery following a heart attack.

Once you have completed a cardiac rehabilitation programme, aim to exercise 5 times a week for at least 30 minutes, at moderate intensity (i.e. an exercise that makes you feel warm and slightly out of breath). Along side this, keep as physically active as possible e.g. housework, gardening, hobbies, golf, bowling. In general be more active more often.

For advice on how to gain the most benefit from exercise, speak to the Cardiac Rehabilitation Team.

Too much alcohol can damage the heart muscle, increase blood pressure and also lead to weight gain. During the weeks after your heart attack or heart surgery it is best to limit the amount of alcohol you drink. Small amounts, for example a half pint of beer or a glass of wine a day, will do you no harm. If you are taking sleeping tablets, remember that alcohol will have a more powerful effect.

If you have heart failure, it is recommended you limit alcohol as much as possible because of the damage it causes to the heart muscle. Should you have heart failure caused by alcohol you should avoid alcohol completely; abstaining may even reverse some of the damage to the heart muscle.

Everyone should avoid binge-drinking but this is particularly important if you are taking anticoagulant tablets (i.e. warfarin). Too much alcohol can interfere with the anticoagulation process so, if you do drink alcohol, it is better to have a small amount on a regular basis.

Remember to drink responsibly, visit: www.drinkaware.co.uk

Top tips for drinking Alcohol sensibly

If you were/are a smoker, you will have been strongly advised, whilst in hospital, that you MUST stop smoking. Although easy to enforce in hospital, once home, it may be tempting to slip back into your old habits. If you continue to smoke after having had a heart attack, you double your chances of having another one compared to if you stopped.

Although it's not something that's going to be easy, this is one of the most important lifestyle changes you can make. Speak to your practice nurse, GP or local Smokestop team for more advice and help regarding quitting and which aids are available to you (e.g. nicotine patches/gum).

Bournemouth and Poole Smokestop is part of the NHS and provides FREE support and advice to assist people wishing to give up smoking. Specially trained staff can help you to understand why you smoke and give you ways to cope when you decide to stop. Tel: 0300 30 38 038

NHS Smoking Helpline Tel: 0800 1690169

Or visit: www.nhs.uk/smokefree

The impact of smoking

Stressors are a part of everyday life. There is some evidence that those who find it difficult to manage their stressors are more likely to suffer from heart attacks. Stress puts an immediate strain on the heart by increasing blood pressure and the pulse rate. Relaxation and meditation may help you to avoid this. For more information and advice on stress and your health visit: www.nhs.uk/Conditions/stress-anxiety-depression.

Breathing relaxation exercise.

This calming breathing technique for stress, anxiety and panic takes just a few minutes and can be done anywhere.

You will get the most benefit if you do it regularly, as part of your daily routine.

You can do it standing up, sitting in a chair that supports your back, or lying on a bed or yoga mat on the floor.

Make yourself as comfortable as you can. If you can, loosen any clothes that restrict your breathing.

If you're lying down, place your arms a little bit away from your sides, with the palms up. Let your legs be straight, or bend your knees so your feet are flat on the floor.

If you're sitting, place your arms on the chair arms.

If you're sitting or standing, place both feet flat on the ground. Whatever position you're in, place your feet roughly hip-width apart.

• Let your breath flow as deep down into your belly as is comfortable, without forcing it.
• Try breathing in through your nose and out through your mouth.
• Breathe in gently and regularly. Some people find it helpful to count steadily from 1 to 5. You may not be able to reach 5 at first.
• Then, without pausing or holding your breath, let it flow out gently, counting from 1 to 5 again, if you find this helpful.
• Keep doing this for 3 to 5 minutes.

If you would like to speak to someone and live in Dorset you can self-refer to steps2wellbeing visit: https://www.steps2wellbeing.co.uk/

Everyone benefits from eating a healthy, balanced diet. Concentrating on certain aspects of the diet can help prevent further narrowing in the heart's arteries from developing. A Mediterranean style diet is a healthy diet that is generally low in fat (particularly low in saturated fat), low in salt, high in fibre (roughage). This can be achieved by eating more wholegrain bread, pasta, fruit, vegetables and fish; less red meat; and replace butter and cheese with products based on plant oils. Research has shown, that following a Mediterranean style diet can reduce the chance of developing conditions such as heart disease, type 2 diabetes, high blood pressure, obesity and even Alzheimer's disease. The following chart is a guide on how to follow a Mediterranean style diet.

Supreme Scientific Health Council 1999

Fruit & Vegetables

Eating plenty of fresh fruit and vegetables not only helps to prevent constipation, by increasing fibre intake; but also provides the majority of the vitamins and minerals required by the body. Current recommendations are to eat 5 (to 9) portions of fruit and vegetables in a day. Typically a portion is a handful of fruit/vegetables. A glass of fruit juice is considered a portion, but potatoes do not count as part of the 5 (to 9) portions. Aim to eat fruit and vegetables of different colours, such as red peppers, green apples, yellow melon etc... This will enable you to obtain a variety of vitamins and minerals from your food.

Salt

No more than 6g/1 level teaspoon of salt per day. People who have a lot of salt in their diet are more likely to have high blood pressure. To cut down on your salt intake, initially try not to add salt to your food at the table. Later on, also try cooking without adding any salt (use herbs and spices to add flavour instead). You may want to check the ingredients' labels on food packaging, to find out how much sodium the food contains. You will find that within about a month your taste buds will have adjusted and you may not like salty foods. You will get all the salt you need from the 'hidden salt' in processed foods and bread.

Cholesterol & Fats

Cholesterol is a fatty substance made mainly in the liver, which circulates in the blood and contributes to the gradual narrowing of the coronary arteries (atherosclerosis). To help reduce your cholesterol level you need to do the following:

• Cut right down on saturated fats (e.g. butter and fats from animal origin). Try using monounsaturated and polyunsaturated fats. e.g. olive oil/ sunflower oil (including spreads). Remember all fats contain calories. Swapping to a lower saturated fat will not, however, reduce the calories.
• Reduce the total amount of fat you eat - especially if you are overweight. For example, you could eat less pastries, crisps or biscuits, and replace them with healthier alternatives such as fruit. Or, at mealtimes, you may be able to cut down on the amount of fatty foods by filling up with starchy foods such as bread, pasta or rice instead.
• Eat lots of foods high in fibre. This helps your body to reduce absorption of fats. Eat 5-9 portions of fruit or vegetables a day, as these contain high levels of fibre.

Examples of changes to diet:

• Change from full fat to semi-skimmed or skimmed milk
• Use half fat cheese (or a smaller portion of full-fat cheese)
• Use skimmed milk for cooking
• Eat fewer cakes and biscuits
• Swap red meat for white meat, e.g. beef/pork for chicken/fish
• Choose leaner cuts of meat, remove the skin from chicken.
• Grill rather than fry foods
• Dry roast meat
• Cut visible fat off meat

Treats are OK e.g. fish and chips, cream tea, and birthday cake, but only occasionally.

For more information on healthy eating visit: www.nhs.uk/live-well/eat-well.

Lose Weight

If you are overweight, reducing your weight will reduce the workload of your heart, help keep your blood pressure down and lower your cholesterol. Weight gain is directly related to the calories you consume. Remember that losing weight involves both eating healthily (by reducing the amount of fat in your diet and reducing your calorie intake) and by increasing your daily physical activity.