An unbroken heart: Learning to live fully after a heart attack
Resource persons: , Dr Yew Kuan Leong and Dr Shathiskumar Govindaraju, both Consultant Cardiologists at Bukit Tinggi Medical Centre Klang (BTMC)
The heart attack is over. So why are some survivors still anxious about living normally again? Every patient’s recovery is different. The procedure went well, follow-up results are reassuring, and the cardiologist says recovery is progressing. Yet the staircase once climbed without a second thought can suddenly feel like a decision. By every measure on a medical report, the treatment has worked. What the report cannot capture is whether it feels that way to the patient.
In Malaysia, the 2020–2021 National Cardiovascular Disease (NCVD) annual report recorded more than 15,000 admissions for acute coronary syndrome, including heart attacks, during that period. Behind every one of those admissions is a patient who, once the emergency has passed, faces the quieter side of recovery.
Recovery doesn’t end when the artery reopens
That clean report, however, is not the finish line. “Recovery actually begins before the patient leaves the hospital,” he said. “It is not just about the angioplasty or stent procedure being successful, but also about what the patient does afterwards, “according to Dr Yew, recovery has in fact already begun, long before it is issued.
That means adopting a healthier lifestyle, taking medication as prescribed and, where appropriate, beginning cardiac rehabilitation while still in hospital and continuing after discharge.
Recovery varies from person to person. Some may return to usual activities within weeks, while others need longer, with exercise, driving, travel and work gradually reintroduced according to their condition and physical ability.
Heart healing but trauma nudges
A patient can do everything right and still not feel ready to go back to living. Dr Shathiskumar said that gap between doing well and feeling well is common. “A heart attack is not only a physical event, it can also be an emotional shock similar to a traumatic event,” he said.
It can show up as fear, sadness, irritability, poor sleep or a constant awareness of one’s own heartbeat, alongside a nagging question, “What if it happens again?” These feelings do not mean the patient is weak, but they do matter medically, as significant psychological distress has been linked to poorer cardiovascular outcomes.
“When I see a patient after a heart attack, I don’t just ask, ‘How is your chest?’ I also want to know, ‘How are you sleeping? How are you feeling? Are you afraid?'” Dr Shathiskumar said.
Anxiety can also make ordinary sensations feel alarming. Dr Yew says patients sometimes worry that chest discomfort, headaches or numbness in the hand, signal another heart attack. While not every sensation is heart-related, patients should not self-diagnose. New or worsening chest pain, breathlessness or fainting should always be medically assessed.
Anxiety of having another heart attack
Fear of another heart attack is very common, especially soon after discharge. Some caution is healthy, as it keeps patients on their medication and follow-ups. The problem starts when it stops protecting a patient and starts running their life.
“The key distinction is whether fear is helping the patient protect their heart, or preventing them from living their life,” said Dr Shathiskumar.
Persistent anxiety can affect sleep, physical activity, medication adherence and other healthy habits. Warning signs that fear is taking over can include constantly checking one’s pulse, repeatedly seeking reassurance, avoiding exercise, travel or social activities, or becoming afraid of being alone.
Family members can help by not dismissing the fear, as the experience was real, and by offering reassurance based on the patient’s medical assessment. If anxiety, low mood or poor sleep lasts several weeks or interferes with daily life, it is worth raising with a doctor. Persistent hopelessness, panic or thoughts of self-harm should never be ignored and need prompt professional help.
Rebuilding confidence one step at a time
Physical healing has a rough timeline. Confidence does not. For patients who are medically cleared but still afraid, Dr Yew’s advice is simple, “Do not be afraid, but do be patient and take things one step at a time.”
Cardiac rehabilitation can play an important role in that process. Dr Shathiskumar describes it as one of the most important, yet sometimes underused, parts of recovery, helping patients improve risk factors, understand their condition and gradually rebuild confidence in what their body can do.
Angioplasty and other therapies
A common misconception, according to Dr Yew, is that angioplasty means the heart disease has been fixed. It has not. “I would describe angioplasty as creating a good ‘highway’ for the coronary artery, but the patient still has an important role in looking after that highway,” he said.
Angioplasty treats the blockage. It does not mean coronary artery disease has disappeared. Healthy living, medication and regular follow-up remain important in slowing its progression and reducing future risk.
Treatment today also goes beyond reopening the artery. Dr Shathiskumar says protecting heart muscle from permanent damage is another priority. For selected patients, this may include SuperSaturated Oxygen (SSO₂) Therapy, which delivers highly oxygenated blood to the heart after angioplasty to support the injured heart muscle. It complements, rather than replaces, timely angioplasty.
As coronary cases grow more complex, keeping pace with new techniques also depends on cardiologists continuing to learn from one another, including across borders.
Moreover, Dr Yew has witnessed a shift over the past decade with heart disease now being seen in younger patients and in an increasing proportion of women.
Treatment has also evolved as cardiologists see more complex disease, including heavily calcified arteries and multiple blockages.
Newer imaging tools allow doctors to see inside the artery more precisely, while technologies such as intravascular lithotripsy can help treat hardened calcium that may make conventional angioplasty more difficult.
For high-risk and complicated cases, having 24/7 cardiology and cardiothoracic support means patients can receive timely care.
Survive, recover, live
For Dr Shathiskumar, the definition of success has changed. Years ago, it meant opening the artery and surviving. Today, that is only the beginning. “We want them eventually to say, ‘I survived it, I recovered, and I’m living my life again,'” he said.
An open artery does not tell the whole story of recovery, and neither does a clean medical report. If fear, low mood or uncertainty is stopping you from returning to everyday life after a heart attack, speak to your cardiologist rather than simply living around the fear. Recovery is not only about protecting the heart, but rebuilding the confidence to live again.
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