A resource for patients recovering

from a cardiovascular event

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 Introduction 4
Dr Angie Brown, Consultant Cardiologist and
Medical Director with the Irish Heart Foundation

Introduction to Cardiovascular Disease 6

Cardiac Rehabilitation Phase 1 9

In Hospital

Cardiac Rehabilitation Phase 2 12

Going Home
“What happens when I go home”?
“What happens if I get chest pain?”

Cardiac Rehabilitation Phase 3 17

Education and Exercise programme

The multidisciplinary team in Cardiac Rehabilitation

Exercise assessment and monitoring during
Cardiac Rehabilitation

Cardiac Rehabilitation Phase 4 24

Community or Home Based Programme

Important lifestyle messages 27

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 Introduction to risk factors 28

Smoking and your heart 30

Cholesterol 36

Understanding your weight 38

Eating for heart health 44

Alcohol consumption 46

High blood pressure 48

Diabetes 50

Physical inactivity 54

Stress 56

Medications 60

Sex and heart disease 64

Exercise 72

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 Introduction
This educational tool is designed
to help patients who are
recovering from a cardiovascular
event, and family members.
It contains a wide variety of
information that relates to your
heart health.

During the
cardiac rehabilitation
programme, you will learn
about your individual risk
factors and what lifestyle
changes you may need
to make.
Dr Angie Brown

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 Although cardiovascular disease continues to be one of the
leading causes of death and disability in Ireland, and in most
European countries, more and more patients survive their cardiac
event. This is due to advances in medications, medical treatment
and procedures, such as stenting, and surgical techniques.
Cardiac rehabilitation programmes are designed to help both
patients and their families recover fully from a cardiac event, while
identifying their personal cardiovascular risk factors and adopting
the necessary lifestyle changes. The support of the cardiac
rehabilitation team helps to ensure that patients understand that
the immediate threat to their life is over, and that they can now
concentrate on taking care of their heart health.

If you have not been able to attend a cardiac rehabilitation

programme, and would like to do so, or if you require more
information on your heart health, please contact the Irish Heart
Foundation:

PHONE EMAIL WEBSITE

01 668 5001 info@irishheart.ie www.irishheart.ie

The Irish Association of Cardiac Rehabilitation may also provide

more information at www.iacronline.ie

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 Introduction to
Cardiovascular Disease

Cardiovascular disease is a lifelong process that starts in

childhood, progresses slowly and can affect people at all
stages of life. The good news is that healthy lifestyle choices
are helpful at any age.
Your heart is a muscle that pumps the blood around the
body. Like all muscles in the body, the heart has its
own blood supply which comes from the coronary
arteries.
As we grow older, these arteries can narrow and
inflammation and damage can occur. This may
lead to small cracks forming on the inside of
the artery wall. Particles in the blood such as
cholesterol and blood clots can stick to these
cracks and plaque develops. This fatty plaque
build-up narrows the arteries, reducing the blood
flow, leading to a reduction in the supply of blood
to the heart muscle. This results in a cramp like pain
around the chest. This is called angina.
This reduction in blood supply may be more noticeable
when the heart has to pump harder for example when someone
is walking up a hill. The heart is working harder and demanding
more oxygen for the muscle. Increased demand and reduced
supply often lead to attacks of angina.
If the plaque ruptures, platelets (blood clots) collect at the site to
try and block the plaque rupture. This blood clot can block the
coronary artery so there is less blood or NO blood getting through
to the heart muscle. This is called a myocardial infarction or heart
attack.
The good news is that the heart can recover and there are many
medical and surgical treatments available. You can do a lot too,
by leading a healthy lifestyle, taking plenty of exercise, limiting
alcohol, not smoking, lowering salt, sugar and fat and taking all
medications as prescribed.

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 Stroke, Peripheral Arterial Disease and other heart
conditions

Similarly, the narrowing or blocking of the arteries in the brain may

result in a stroke or a mini-stroke called a TIA or trans-ischaemic
attack.
Narrowing of the arteries to the legs is called PAD or PVD -
peripheral arterial disease or peripheral vascular disease which
presents as a cramp type pain in the calf, thigh or buttock.

Cardiovascular disease can also include other types of heart

problems such as heart valve disease, irregular or abnormal heart
rhythms or a weak heart muscle leading to heart failure.

Heart Valve Disease

The valves in the heart allow the blood to flow from one chamber
to the next and allow for ejection (pumping out) of blood from
the heart. These valves may become damaged due to a variety
of causes and may narrow, restricting the blood supply flowing
through them. This is called stenosis. Alternatively, they may
become incompetent and not shut properly, allowing the back
flow of blood. If the valve is severely damaged it will require
surgical repair or replacement with a tissue or metallic valve.

Atrial fibrillation (AF)

If you have atrial fibrillation (often called AF), you’re not alone, as
it is the most common type of arrhythmia (irregular heart beat).
Atrial fibrillation occurs when the upper chambers of the heart,
the atria, have an irregular heartbeat. This may lead to less blood
being pumped from the heart around the body. The blood may
pool in the atrial chamber and a clot may form. This clot may
travel to the brain and block an artery, causing a stroke. Someone
with AF is five times more likely to have a stroke than someone
without this condition. Detection and ongoing management of AF
is vital to reduce the risk of stroke.
AF is usually treated with medication and lifestyle changes. Most

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 Introduction to
Cardiovascular Disease
continued

people with AF will have medication to control the heart rate

and will be prescribed a blood thinner to reduce their risk of
stroke. Non-surgical and surgical treatment options may also be
considered. During the cardiac rehabilitation programme, you will
receive more information about this condition and how to manage
it.

Heart failure

Heart failure means your heart is not pumping as well as it should.

This can lead to symptoms such as fluid building up in the body
causing leg swelling or in the lungs causing shortness of breath.
Combined with fatigue, these symptoms can make everyday
activities more difficult.
Weight gain is a key sign of fluid build-up so it is important to
weigh yourself every day. Noticing a weight gain and reporting it,
is one of a number of important self-management skills that can
help you get better and avoid admission to hospital.
There are a variety of medications available to help improve the
function of the heart and to remove the extra fluid from the body.
Other treatments include special pacemakers or defibrillators. All
treatments are designed to improve the quality of life for patients
with heart failure.

There are lots

of treatments
and medications
available to help
each of the above
mentioned heart
conditions.

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 Cardiac Rehabilitation Phase 1

In Hospital

“Have you had a heart

attack? Have you had a
stent or heart surgery? Have
you had a stroke? Do you
have angina? If the answer
is yes, cardiac rehabilitation
is here for you.

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 Cardiac Rehabilitation Phase 1
In Hospital

If you are in hospital recovering, or waiting for a stent or heart

surgery, this can be an anxious and worrying time for you, your
family and your friends. The medical and nursing staff will be there
to help you at this time.
Remember that you are not alone. Rates of coronary artery
disease in Ireland are high and many people have had a heart
attack, stroke, heart surgery or a stent inserted. Because so many
people have heart disease, there is a wide range of experience to
learn from.
Remember this is not the end, but a beginning. With proper care
and a healthy lifestyle, you can live a long and happy life.
During your hospital stay, a member of the cardiac rehabilitation
team will visit you and explain the cardiac rehabilitation
programme in detail before you go home. All patients are invited
to attend the programme, which is designed and proven to help
you recover from your cardiac event.
Cardiac rehabilitation is a programme of exercise and education
which will enable you to return to a full, active and healthy
life. If you have not been seen by a member of the cardiac
rehabilitation team, please contact your local cardiac
rehabilitation centre. Remember your
physical ability or
age is not a barrier
to participating
in cardiac
rehabilitation

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 Plans for your discharge will include a home exercise programme.
NDLS Advice about returning to work, if applicable, may also be
discussed at this time. Driving guidelines following a cardiac event
Cardiac Conditions
and Driving
are outlined on the Road Safety Authority website (www.rsa.ie),
This is an overview of driving with cardiology (heart)
conditions. The complete standards are published in
and can be discussed in relation to driving a car or company/
Sláinte agus Tiomáint: Medical Fitness to Drive (MFTD)
Guidelines available at www.ndls.ie public vehicle.
It may have been a big shock or surprise to learn that you have
heart disease. You go straight from being a person to being a
patient. You wonder will I ever be myself again, what is going to
happen to my life, how will I cope?
It is only human nature to feel confused, upset and worried, even
feel guilty, but this is a good time to think about the things in your
life that might have brought you to this point, and what changes
you can make. This might be a wake-up call – a second chance.
The cardiac rehabilitation nurse will discuss certain risk factors
that may have contributed to your condition.

Do I
Am I
overweight? Ask smoke?

yourself?
Do I feel
stressed?

What is my
cholesterol
level?

Did
anybody else
Do I take in my family
enough Have I got Is my have heart
exercise? high blood diabetes well problems or
pressure? controlled? diabetes?

Remember there is a lot that you can do to help your recovery.

Follow the advice given to you in hospital and start walking, after
you are discharged home, gradually increasing the time as the
days’ go by. The cardiac rehabilitation programme will help you in
making any necessary changes.

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 Cardiac Rehabilitation Phase 2

Going Home
What happens when I go home?

Following your discharge

from hospital, it is normal
for you to feel a little
worried or anxious over the
coming weeks. This can
lead to tension and stress at
home. This is often called
‘homecoming depression’
and is usually temporary.
However, if you are
concerned about this contact
your GP or team for support.

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 Talk things over with
your family, partner or
friends and explain how
you are feeling. This will
help them understand
what you are going
through.

Following your discharge from hospital, it is normal for you to feel

a little worried or anxious over the coming weeks. This can lead
to tension and stress at home. This is often called ‘homecoming
depression’ and is usually temporary. However, if you are
concerned about this contact your GP or team for support.
Members of your family are concerned about you and are anxious
that you don’t overdo things. Sometimes it feels like you are being
wrapped in “cotton wool”.
Talk things over with your family, partner or friends and explain
how you are feeling. This will help them understand what you are
going through.
Remember there is a lot that you can do to help your recovery.
Follow the advice given to you in hospital and start walking
slowly on a daily basis, following the home exercise
information you have been given in hospital, even 10
minutes a day is a good start. You can build this up
gradually over time, but pace yourself, as it takes time.
Returning to a full active life will vary depending on your
cardiovascular event. You can seek individual advice
from your cardiac rehabilitation team.
You may have a lot of hospital appointments to attend,
whether it is going back to see the medical team,
dietitian or perhaps the psychologist.

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 Cardiac Rehabilitation Phase 2
Going Home continued

The cardiac rehabilitation team will contact you for an assessment

before commencing the exercise and educational programme.
As part of this assessment you may have an appointment for
an exercise assessment – this test is to check that the heart is
functionally fit for the cardiac rehabilitation programme.
You may have questions that you wish to ask the doctor or cardiac
rehabilitation staff. It might be helpful to write them down and
bring with you on the day of the appointment. You may experience
symptoms such as chest discomfort, shortness of breath, dizzy
spells, or fatigue. Please record these events and bring this record
with you, when returning to the hospital for your check-up.
The cardiac rehabilitation programme will build your confidence
and help you in making any further changes. You are encouraged
to attend the exercise and education programme as it has been
proven scientifically that patients who complete a cardiac
rehabilitation programme live longer, feel better and are much less
likely to have cardiac problems in the future. You’ll also enjoy it.

The cardiac
rehabilitation
programme will build
your confidence and
help you in making any
further changes.

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 What if I get
Chest Pain?
It is common for people who have heart disease to get chest pain or discomfort
now and then.

If you experience:
. Crushing pain, heaviness or tightness in your chest
. Pain in your arm, throat, neck, jaw, back or stomach
. Sweating, lightheadedness, sickness or shortness of breath, you should:

> Stop what you are doing. > P

 lease remain seated as GTN may
cause dizziness
> 
Sit down and rest. or headache.
(Sometimes resting relieves the
pain/discomfort) > 
If you do not have GTN spray,
sit and rest, and if pain is still
> Locate your GTN spray present after 5-10 minutes, phone
(if prescribed) and take 1 spray an ambulance 112 or 999.
under the tongue.
> S
 tay resting until the
> W
 ait 5 minutes. If you are still ambulance arrives.
experiencing pain, take a second
spray. > If the pain does ease following
spray or rest but occurs again
> If the pain does not ease after or more frequently, inform your
the second spray, phone an GP or your Cardiologist as this
ambulance 112 or 999. requires further investigation.

> Never drive with chest pain. > K

 eep a written record of your
symptoms/pains.

> 
A maximum of 2 sprays of
GTN over 15 minutes may be > R
 emember, report any symptoms
administered. that do not feel right.

> D
 o not use the GTN spray > R
 emember, if at any time
if you have taken any you think you are having a
phosphodiesterase inhibitor such heart attack, call 112 or 999
as sildenafil (Viagra), tadalafil immediately.
(Cialis) or vardenafil (Levitra) in
the last 24 hours.

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 Cardiac Rehabilitation Phase 2
Going Home continued

After you go home you may feel vulnerable without the security of
the hospital staff around you.
It is important to know what symptoms to act on.
You should always report these changes to your healthcare
provider:
.  ny new chest discomfort or chest pain, or any change in
A
how often, how intense or how long you have the pain or
discomfort
. Any new shortness of breath, especially with physical activity
. Feeling extremely tired
. Feeling dizzy or fainting
. Feeling fluttering/pounding in your chest
Keep a record of these type of events in a diary, page or note
on your phone, as these can be very useful to bring along to a
medical check-up.
It is important to have the phone number of your GP or family
members in a handy place especially if you live alone. It is also
useful to write down the Eircode for your house.

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 Cardiac Rehabilitation Phase 3

Exercise and
Education
Programme

Heart disease is one of the

leading causes of death in
Ireland and Europe. Once
diagnosed, heart disease
is a lifelong condition that
needs ongoing management
for people to live longer and
healthier lives.

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 Cardiac Rehabilitation Phase 3
Exercise and Education
Programme

Once the immediate threat to your life is gone, you need to be

very clear that ongoing management of heart disease involves
a lifelong commitment to diet and activity/exercise. Taking your
prescribed medications is essential. Patients who successfully do
this have much better outcomes.
Participating in a cardiac rehabilitation programme should be the
first critical step in a patient’s recovery from a cardiac event, and
ongoing management of their cardiovascular disease.
Cardiac rehabilitation programmes are much more than just
supervised exercise. Attention is also given to modifying risk
factors such as smoking, high cholesterol, high blood pressure
(BP), high blood sugars, stress and depression. These are all
addressed by individual counselling and/or group education.
Referral to specialists can also be arranged if patients are newly
diagnosed with diabetes or wish to quit smoking. While these
programmes are successful in reducing both stress and depressed
mood, further specialist support can be arranged as required.
Cardiac rehabilitation is an individualised programme and suitable
for a variety of patients, both young and old. Patients are treated
with respect at all times on their journey to recovery.
Most hospital programmes involve attending exercise sessions
twice to three times per week over a 6-10 week period in a safe
and structured environment. Exercising on the other days of
the week is important to build up fitness levels and improve
stamina.
The exercise starts slowly and
progresses over time. Warm-up
exercises, a supervised circuit,
and a cool down session takes
place at each visit. The warm- Cardiac rehabilitation
up exercises and stretches is an individualised
are guided by the exercise programme and suitable
specialist, who may be a for a variety of patients,
Physiotherapist, Nurse or both young and old.
Exercise Physiologist, trained in
clinical exercise.

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 Other members of the team may include a dietitian, occupational
therapist, psychologist, social worker and pharmacist. Each staff
member contributes to the cardiac rehabilitation programme
according to their expertise. With this comprehensive approach,
patients are encouraged, monitored and helped to regain their
confidence and ability to return to their normal daily lives.
It is important you take control by finding out as much as you
can about your heart condition. Attending the educational
sessions during the cardiac rehabilitation programme will help
you understand more about your heart condition and how best
you can help yourself. You will learn about the importance of diet
and exercise for good heart health. The cardiac rehabilitation
programme will help you on the road to recovery, with the support
of other patients and the cardiac rehabilitation team. This will help
ensure that you feel in control of your health again.
In addition to improving fitness, cardiac rehabilitation
programmes also help patients successfully manage their new
medications and a heart-healthy diet. Studies consistently
show that cardiac rehabilitation also reduces levels of anxiety
and depression in cardiac patients. Together, all these changes
ensure that patients live longer, with a better quality of life and
fewer admissions to hospital. Therefore, cardiac rehabilitation
programmes are considered an essential part of the cycle of care
for cardiac patients, along with regular visits to the GP and the
Cardiologist. Staff in cardiac rehabilitation communicate with all
of these health providers so everyone is kept informed.

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 Cardiac Rehabilitation Phase 3
Exercise and Education Programme continued

The multidisciplinary team in cardiac rehabilitation

While you are in the exercise and education programme you will
meet members of the cardiac rehabilitation multidisciplinary
team that are in your local cardiac rehabilitation centre. Some
of the multidisciplinary team members include the dietitian,
physiotherapist, pharmacist, psychologist, occupational therapist
and social worker.
The speed of recovery will depend on your heart condition – what
brought you into the hospital and your previous level of fitness.
Exercise can have a positive effect on health, on risk factors such
as blood pressure, cholesterol levels and blood glucose and helps
with the activities of daily living such as housework, gardening
and shopping. You feel fitter and stronger over time. Activity is
your friend and an investment in your future
Your medication will be explained by the pharmacist or the nurse,
for example, what tablets you have to take, why you have to take
them, and for how long you must continue to take them.

The speed of
recovery will depend
on your heart condition
– what brought you into
the hospital in the first
place and your previous
level of fitness.

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 This is just the start
of your journey on the
road to recovery.

He/she will also discuss the importance of taking your medication

every day and what to do if you miss a dose. The consequences
of missing a dose may be mild but may be harmful. Taking
medicines may be a new concept for you and there may be a lot to
remember. It is important to decide on a way to remember when
to take the medicines.
Following a cardiac event, its normal to feel lost and lacking in
confidence. By attending the cardiac rehabilitation programme
and talking to the medical team, you will realise that help is
available. In addition to family and friends, talking to other
patients who are also going through the same experiences as you,
can be very helpful at this time. During cardiac rehabilitation,
patients also learn to manage stress more effectively so that it
doesn’t adversely affect their health. Many cardiac rehabilitation
programmes have a dedicated psychologist who can help with
various difficulties that emerge after a cardiac event. For example,
sleep problems, anxiety, low mood, or even just difficulties
adjusting to their heart condition.

Remember, the cardiac rehabilitation team are there to help

you and to increase your confidence. This is just the start of
your journey on the road to recovery. In addition, your support
network, your GP, family and friends can all play an important
role in your recovery.

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 Cardiac Rehabilitation Phase 3
Exercise and Education Programme continued

Exercise assessments and monitoring during the

cardiac rehabilitation programme

It is important to assess a patients’ level of fitness before

they attend the cardiac rehabilitation exercise and education
programme, known as phase 3 cardiac rehabilitation. There are a
few different methods of doing this.
An exercise stress test is commonly used where a patient walks
on a treadmill, while wearing a heart monitor. The speed and the
incline of the treadmill is increased in order to put the heart under
“pressure” and check that it is safe to proceed with the phase 3
exercise programme.
The test is stopped if the patient reaches the allocated target
heart rate or develops any symptoms or there are any changes on
the heart rhythm on the monitor.
Other tests to check patients’ fitness include a specific walk test
or a step test.

An exercise stress test

is commonly used where
a patient walks on a
treadmill, while wearing
a heart monitor.

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 The heart rate achieved at the assessment, guides the
level of training for each individual and will help improve
strength, stamina and allow progression to long term
fitness.
Monitoring is generally done in a number of ways. Staff in
the cardiac rehabilitation programmes have received specific
training and have expert knowledge and experience to observe
patients exercising in the gym. Cardiac monitors are commonly
used in cardiac rehabilitation programmes in Ireland. The patient
attaches leads to their chest, which are connected to the portable
monitors. The heart rhythm and rate is displayed on a screen and
Borg Scale provides invaluable information for the staff observing.
Portable watches or other devices may also be used to capture
Rating Perceived
Excertion
the patients’ heart rate and rhythm. Patients’ blood pressure is
checked before and after exercise for a period of time.
6 No exertion
Some cardiac rehabilitation centres may use a questionnaire to
7 Extremely light
establish patients’ activity or request patient complete an exercise
diary for a week.
8 Easy
It is important that patients become aware of how hard their body
9 Very light
is working, particularly as they progress during phase 3 cardiac
rehabilitation programme, or if they are following a home exercise
10 Sort of Hard programme. The cardiac rehabilitation staff will guide you in
understanding the “BORG” scale.
11 Light
It is important that patients exercise the days they are not
12 attending the cardiac rehabilitation programme, and as part of
their future self-care.
13 Somewhat Hard
Recommended long-term choices include either a daily structured
14 walk, join a local walking programme or gym, use an exercise
bike at home, or attend recommended phase 4 community-based
15 Hard programmes available regionally. Other phase 4 programmes are
listed on Irish Association of Cardiac Rehabilitation website
16
www.iacronline.ie
17 Very hard A home based programme is on the accompanying media
programme attached to this manual. Other home based
18
programmes are currently being developed.
19 Extremely hard Please ask the cardiac rehabilitation staff for information
regarding individual fitness levels required for returning to work,
20 Maximal exertion
or for certain heavy physical activities.

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 Cardiac Rehabilitation Phase 4

Community or
Home Based
Programme
Phase 4 represents the
continuation of the exercise
and dietary patterns that
have commenced during the
phase 3 cardiac rehabilitation
programme.

This home based

programme can be
used for a lifelong
exercise prescription.

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 Patients may be referred to a community ‘maintenance’
programme with specifically trained phase 4 cardiac rehabilitation
instructors. Other patients may prefer to revert to their original
pattern of exercise (i.e. walking, cycling, dancing, tennis,
swimming, hill walking) or attend a gym in their own locality.
The important point is that patients continue to exercise either in
a formal setting, with a local organisation, or independently.
A home based programme can also be prescribed with the
exercise intensity gradually increased over a period of time.
This home based programme can be used for a lifelong exercise
prescription and is available on the media platform accompanying
this manual.

Returning to work

If you are looking after the family home, you can gradually resume
housework, commencing with light duties. Once you have been
reviewed by the medical team in the hospital following your stent,
for example, or by the surgical team post bypass surgery, then you
can progress to more strenuous tasks such as hoovering, cleaning
the windows or washing the car.
Ideally, returning to work can occur gradually, if this facility is
allowed at your workplace. If you are self- employed, this may
or may not be an option. Depending on the physical nature of
your work, a specific time may be required to elapse before it is
deemed safe for you to resume your duties.

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 Cardiac Rehabilitation Phase 4
Community or Home Based Programme

If you are employed by a public transport sector, a medical review

is usually required by the employer, and an optional exercise stress
test may also be required.
You can talk to the cardiac rehabilitation staff regarding any issues
or concerns that you may have in relation to returning to work.
They may be able to advise you, and also can refer you to the
social worker or the occupational therapist for further information.

Insurance

It is advisable to tell your mortgage, health and motor insurance

company that you have had a cardiac event. It is also advisable to
declare this information when taking out travel insurance.
The Irish Heart Foundation has a list of insurance companies
that patients can contact if they are having difficulties.

Driving

Driving guidelines are available on the Road Safety Authority

website www.rsa.ie. Driving guidelines will depend on your
particular condition.
Returning to normal driving is usually not a problem
but if you drive commercially or for public transport
provider, other concerns may need to be addressed.
It is important to speak to your Doctor or the staff
in the cardiac rehabilitation who may be able to
answer your queries.

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 Important lifestyle
messages
Be active for at least 30 minutes each
day, and at least 5 days per week

Quit smoking tobacco or

other substances

Eat a healthy balanced diet

Maintain a normal weight

Consume alcohol in moderation

Keep blood pressure, cholesterol, and

diabetes well controlled

Take prescribed medication

Take time to relax

Remember this is your second chance

– enjoy every moment

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 Risk Factors
There are many risk factors that
can lead to the development of
heart disease and stroke. Some
of these risk factors can be
changed, such as your lifestyle,
the amount of exercise you take
and the food you eat. Some risk
factors cannot be changed such
as age, gender and genetics.

A large study
called the
INTERHEART study
showed that greater than
90% of risk factors for
heart disease can be
controlled.

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 In this section, we discuss the risk factors and the lifestyle
changes you can make to reduce your risk of heart disease and
stroke. These include stopping smoking, moderating alcohol
consumption, managing your diet or losing weight, taking up
exercise and controlling diabetes, blood pressure and cholesterol.

During the cardiac rehabilitation programme, you will learn about

your individual risk factors and what lifestyle changes you may
need to make.

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 Smoking and your Heart
Stopping smoking is the
single most important
thing you can do to
improve your health and
extend your life.

In this section, we talk about different ways you can work with
your healthcare team to reduce your risk of having a second
cardiovascular event, such as a heart attack or stroke. As
part of the cardiac rehabilitation programme, you can receive
guidance on how to quit smoking.
Whether you are thinking about quitting, have tried many times in
the past or are actively trying to quit smoking, we can help you to
get to the next stage.

Getting the
In this section of the manual we will discuss
right help could
.  he damaging effects smoking tobacco can
T make you four times
have on your heart, blood vessels and body, more likely to quit
causing cardiovascular disease. cigarettes and stay
. The benefits of quitting for you and your family. off them for good
. Passive smoking and the damaging effects it has
on the health of all those who are exposed to it.
. The importance of using appropriate treatments and
resources that can make quitting easier.

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 So how does smoking affect your
body and your heart health?
There are more than 7,000 chemicals in a cigarette. When you
light a cigarette, the burning tobacco releases a number of highly
toxic chemicals. These are distributed throughout the body,
changing and damaging cells, causing harm to every organ and
increasing the risk of cancers. If you are a smoker, this may also
interfere with the benefits of the medication that you have been
prescribed.
Let’s consider carbon monoxide, a poisonous gas that is released
from burning tobacco. It affects your body in three ways.

When inhaled, carbon monoxide binds itself to the haemoglobin in

1 your blood and blocks off the oxygen in your bloodstream. When
the heart and other organs are starved of oxygen, they have to
work harder – causing breathlessness and sometimes angina, or
chest pains.

It damages the lining of the blood vessels making it

2 easier for fatty deposits to build up in your arteries
making you more prone to heart attack and stroke.

It makes your blood ‘stickier’, which can cause

3 a clot to form. The clot can break loose, travel
through the blood vessels and cause a heart attack
or a stroke.

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 Smoking and your Heart continued

Tobacco also contains nicotine, which is an addictive drug. It is a

stimulant and will increase your blood pressure and pulse when
you smoke which means your heart has to work harder.
Smoking can also increase the ‘bad’ cholesterol (LDL) level and
decrease the ‘good’ cholesterol (HDL) level in your blood. When
you quit, your cholesterol levels may improve.
Inhaling smoke from other people’s cigarettes is known as passive
smoking. It is dangerous, especially for pregnant women, children,
the elderly and those with health conditions. People who breathe
in second-hand smoke regularly are more likely to get the same
illnesses as smokers, such as lung disease, cancer or heart disease.

It doesn’t take long to see the benefits

.  ithin 20 minutes, your circulation

W .  ithin two or three months, your
W
improves, your heart rate and lung capacity can increase by up
blood pressure return to more to 30%.
normal levels. This reduces your . Within one year, your chance of
risk of heart attack straight away. heart attack drops by half.
. Within eight hours, the carbon . Within five years, the risk of
monoxide level in your blood will smoking-related cancers will be
drop and the oxygen level will greatly reduced.
go up. . Within 10 years, the risk of having
. Within one to two days, all the a heart attack drops to almost the
carbon monoxide will have left same as a non-smoker.
your body. . In most cases, between five and 15
. Within a few days, your sense of years after you stop, your stroke
smell and taste will start risk becomes almost the same as if
to improve. you had never smoked.
. After three days, your breathing
will improve, and your energy
levels will increase.

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 Your mental health

It has also been shown that quitting smoking can improve mental
health. Shortly after stopping smoking, patients experience lower
levels of anxiety, stress and depression, particularly if they attend
a cardiac rehabilitation programme. Your mood improves and
quality of life increases.
Did you find this information surprising? Now that you have this
knowledge, maybe you will consider quitting? If you would like
to, talk to us we can help you devise a plan to suit your particular
needs around quitting. We can help you to set a quit date, learn
how to cope with withdrawal symptoms and come up with
effective strategies to stay on track.
There are many treatments available to support you on your
journey. You might want to consider nicotine replacement therapy
in the form of patches, chewing gum or lozenges. Or you could try
an inhaler, spray or prescription medication. These medications
make quitting easier.
Many cardiac rehabilitation programmes include
excellent stress management programmes that
patients find very helpful when trying to give
up smoking. We can also refer you to support
Giving up smoking can
services in your local community.
be hard, but may feel even
harder if you try to do it
alone. Make sure you have
the correct support so that
you are set up to succeed,
not to fail.

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 Smoking and your Heart continued

What about electronic cigarettes?

An electronic cigarette (e-cigarette) is a device which
vaporises and delivers a chemical mixture known as an
“e-liquid” to the lungs in the form of an aerosol. Electronic
cigarettes are relatively new, and there is not enough
research to be sure they are safe to use. Evidence tells us
that the most effective way to quit is to get specialist support
and to use the treatments mentioned on the previous page.
These are safe for cardiac patients and only need to be used
temporarily.
Giving up smoking can be challenging but, with
the right support and treatment, many people do
quit and stay off for good.

In Ireland, we have more ex-smokers than smokers.

Remember, getting the right support and using appropriate
medication will make you four times more likely to quit for
good. Speak to a member of the cardiac rehabilitation team
or another health professional for advice.
You can also get help by calling the National Smokers Quit
line at 1800 201 203. Staff can help you to get one-to-one
support over the phone or they can link you in with your local
stop-smoking support services.

1800 201 203

Or you can go to www.quit.ie, which has lots of information
and support. You can sign up for an online quit plan to guide
you through the quitting process day by day.

www.quit.ie

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 In Ireland,
there are more
ex-smokers than
smokers.

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 Cholesterol
What is cholesterol?

Cholesterol is a fatty substance found

in the blood. A certain amount of
cholesterol is important for a healthy
body, but too much can increase your risk
of getting heart disease or a stroke.

Cholesterol is mainly made in the body by the liver. Eating foods

high in saturated fat increases the amount of cholesterol
the liver makes and can increase blood cholesterol levels.
Foods high in saturated fat include cream, full-fat cheese,
butter, fatty red and processed meat, cakes, pastries,
chocolate, crisps, mayonnaise and salad dressings. To
help improve your cholesterol level, it is also important
to reduce foods containing transfats where possible.
These fats are most likely to be found in processed
foods such as biscuits and cakes, fast food, pastries
and some margarines and spreads.
Some foods, such as eggs, shellfish, liver and kidneys,
also contain cholesterol but they do not usually make a
great difference to the level of cholesterol in your blood. If
you need to lower your cholesterol level, it is much more impor-
tant that you eat less foods that are high in saturated fat.
However, if there is a history of high cholesterol in your family, you
may need to be more careful when it comes to eating foods that
are high in cholesterol. Talk to your doctor or a dietitian for advice
on these foods.
The tendency towards high levels of cholesterol in the blood can
be inherited from your parents, but this can be treated effectively
in consultation with your doctor.

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 Lipoproteins
Cholesterol is transported in the blood by proteins that allow the
lipid (fat) to bind to them. There are two types of lipoproteins in
the blood:
.  ow-density lipoprotein (LDL or bad cholesterol). LDL is
L
involved in the build-up of plaque in the body’s arteries,
which are the blood vessels that deliver blood from your
heart to the body. High levels can increase your risk of heart
disease or stroke.
. High-density lipoprotein (HDL or good cholesterol). HDL
helps to remove cholesterol and to slow down the build-up
of plaque in the body’s arteries. Higher levels protect against
heart disease and stroke.

What are triglycerides?

There is also a group of fatty substances in the blood called
triglycerides. Triglycerides can contribute to the narrowing of the
artery walls and high levels of these can damage your heart. If you
carry excess weight, eat a lot of high-fat and high-sugar foods,
or drink too much alcohol, you are more likely to have a high
triglyceride level.

The best way to reduce cholesterol is to follow a healthy lifestyle:

exercise daily, eat healthily and take cholesterol-lowering tablets as
prescribed.
All three are essential to reduce your cholesterol levels.

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 Why your weight matters
If you are an unhealthy weight,
you can gain important health
benefits by losing 5-10% of your
weight.
This will help to reduce your risk of getting diabetes, decrease
your blood pressure and help to control your cholesterol level.
Remember that you are on a long-term journey to improve
your health and gain control of your weight. Your efforts to lose
weight can continue from phase 3 of the cardiac rehabilitation
programme into phase 4. Simple strategies such as walking for
longer or sitting for less can help to make a difference.

Being overweight is a
risk factor for:
. Coronary heart
disease – angina,
heart attack
. High blood pressure –
stroke
. Diabetes
. Impotence –
erectile dysfunction
. Sleep apnoea
. Cancer

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 How do I know if I need to lose weight?

There are two main ways to tell whether you need to lose
weight, your body mass index and waist circumference.

1
Body mass index (BMI)
BMI is a measurement that considers the relationship between
your weight and your height. It gives an estimate of your risk of
developing weight-related diseases. To work out your BMI, you
will need to know your height and weight. A nurse or GP can help
you determine your BMI.
. Ideal: 18.5 to 24.9
. Overweight: 25 to 29.9
. Obese: 30 and above

2
Waist circumference
Your shape, as much as your weight, can affect your health
risk. Weight around your middle can increase your risk of
getting heart disease, cancer and type 2 diabetes. That’s
because fat cells around the organs in the abdominal cavity
produce toxic substances that cause damage to your body.

You can work out if you are at increased risk by simply

measuring your waist. Find the bottom of your ribs and the top
of your hips, and measure around your middle at a point mid-
way between these. For many people, this will be at the level of
the belly button.

HEALTHY WAIST MODERATE RISK HIGH RISK

MEASUREMENT

Men Men Men

Less than 94cm Between 94cm More than 102cm
(37in) and 102cm (40in)
(37in and 40in)

Women Women Women

Less than 80cm Between 80cm and More than 88cm
(32in) 88cm (32in and 35in) (35in)

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 Why your weight matters continued

Why have I put on weight?

Despite what you might read, the

problem of obesity isn’t caused by
any single food. It’s not a question of a
lack of willpower either. Many factors
influence what we eat.
Our environment and lifestyles have changed in recent decades
which means healthy choices are not always the easiest to make.
Shops encourage impulse buying of sweets and crisps through
marketing cheap and processed food, using price promotions
and placing products near the checkouts. Fast-food outlets
are often clustered around our neighbourhoods. These often
serve up larger portion sizes of processed foods that are high in
fat, sugar and salt compared with home-cooked meals.
At the same time, we are becoming less physically active than
previous generations. Our jobs and leisure activities have
become more sedentary and we are less likely to travel on foot or
by bicycle.

This means that we need to make conscious choices about what

we eat and how we stay active. A good first step is to think about
why you might have put on weight. Is this a recent change or
something that has happened over the longer term? Did you start
doing something differently, such as being less active or eating
different foods?

Shops are often laid out to

encourage impulse buying
of sweets and crisps,
which are placed near the
checkouts.

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 What can I do to maintain a
healthy weight or to lose weight?
There are many things you can do,
so start with these first steps:

1 6
Eat a nutritious, Stay hydrated
balanced diet Make sure that those feelings
Include lots of fruit, vegetables of hunger are not thirst. Ask
and salad along with lean protein, yourself, “Am I hungry or just
whole grains and healthy fats in thirsty?”

7
appropriate portions. Half of your Be more active
plate should be vegetables or This can help you to control your
salad. You don’t need to give up weight in the long term. It is good
foods you enjoy, you can still have for your mood, blood pressure
treats as part of a balanced eating and heart health. It can also help
plan. you to manage or prevent type 2

2
Be prepared diabetes. Find a form of physical
The key to achieving your activity you enjoy, so you are
nutritional goals is preparation. more likely to make time in your
Make sure to have a weekly meal routine for it.

8
plan so you know what you will Try to get enough sleep
be eating. Write a shopping list Aim for seven to eight hours
before going out so you can make per night.

9
sure to have healthier foods in
the house. Make sure your

3
plan is sustainable
Look at your portions Think of your weight-loss
If you are eating too much at journey as a lifestyle change
meals, you may struggle to lose that you can keep going over
weight. Try using a smaller plate the long term, rather than a
or bowl to help you cut down “diet” which you may struggle to
without feeling deprived. stick with. Make changes that

4
Keep a food diary you can follow every day such
Try using a food diary to help as drinking skimmed instead of
identify the foods that you eat semi-skimmed milk or using low-
too often. Try not to purchase fat spreads instead of standard
these products. ones. These tweaks may seem

5
Check food labels and try to insignificant, but they can make a
make healthy choices, not just big difference over time.
lower-calorie ones
Use our Irish Heart Foundation
food shopping card.

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 Why your weight matters continued

Even if you lose weight slowly or hit a plateau, making these

healthy lifestyle changes will benefit your heart health.

Weight management is a lifelong challenge for most of us. If

you are thinking about making changes to your food or activity
levels, plan ahead. Be realistic about your plans and focus on
making sustainable changes. Getting knocked off track is normal
from time to time, but it is important to learn from it and get
back on track.

It can take time and determination to lose weight. It may require

lifelong effort to maintain your ideal weight. Sometimes people
have high expectations and feel frustrated when they do not see
results quickly. Losing weight can be a challenging process, but
the benefits are worth it. Life will be less tiring, and you will look
and feel younger. A healthy diet does not have to be limited. You
can still enjoy treats as long as they are part of a healthy, balanced
diet.

Weight
management is a
lifelong challenge
for many people.

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 Realistic advice
about losing weight
 osing weight or managing your
L I t is important to set yourself a
weight differently isn’t easy. realistic weight-loss target. Trying
High-calorie, processed foods are to lose more than 10% of your current
inexpensive. They are also heavily weight may be unrealistic. Worse, it
marketed and very accessible for could lead to you not achieving your
most of us. If we indulge often, goal, feeling that you have failed and
we can gain weight easily without giving up completely.
really noticing. Once we have put
on weight, the body likes to protect I t is important to know that losing
that weight. This means it can be 5-10% of your weight can bring
difficult to lose more than 10% of your lots of health benefits. It can take
bodyweight with lifestyle changes pressure off your joints and heart,
alone. reduce pain, help with blood glucose
levels in type 2 diabetes and reduce
 hat is why it is important to make
T blood pressure.
realistic plans and think about how
you can make the food environment
around you – at home or at work – as
encouraging as possible. Expecting
yourself to resist tempting, high-
calorie foods if they are all around
may be unrealistic, so remove the
temptation.

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 Tips for healthy eating
Eat more fish for a healthy heart Swap bad fats for good fats
Fish, especially oily fish, is a great Swap saturated fats and trans
source of omega-3 fatty acids, fats for monounsaturated and
which help to protect your heart. polyunsaturated fats. Saturated fats
Adults should aim to eat at least are found in animal products such
two portions of fish per week, as meat,full-fat dairy, and coconut
including at least one portion of oil. Trans fats are found in processed
oily fish such as salmon, trout, foods. The Mediterranean diet,
mackerel or sardines. It is which is based on long-term research
not recommended to take around the best diet for heart health,
omega-3 supplements as advocates using unsaturated fats
there is not enough evidence found in olive oil, rapeseed oil, nuts,
for their use. seeds and avocados, in place of
saturated and trans fats such as those
found in processed foods such as
Eat five to seven portions of fruit butter, cheese, cream, mayonnaise,
and vegetables daily crisps and pastries.
Fruit, vegetables and salad add
vitamins, minerals and fibre to your
meals. Eating a healthy diet can help Limiting processed meats, such as
to protect your heart from further ham, bacon and sausages is also
problems by helping you control recommended. These changes will
cholesterol and blood pressure levels help to reduce cholesterol and slow
as well as manage your weight. plaque build-up in the walls of the
blood vessels. Remember even with
heart healthy fats, it is important
So, what does a portion of fruit or to monitor serving sizes as they are
vegetables look like? A standard still high in calories and can lead to
portion is 80g. An apple, banana, unwanted weight gain if you have
pear or other similar-sized fruit more than the recommended portion
counts as one portion. Or you could sizes.
have a dessert bowl of salad or
three tablespoons of vegetables.
Remember every little Get more fibre
portion counts whether Fibre is found in carbohydrates such
it is fresh, frozen, tinned, as wholemeal flour, bread and oats.
dried or juiced fruit and It is also found in plant foods such as
vegetables. fruits, vegetables, beans and lentils.
Fibre is extremely important; it helps
to keep your digestive system and
bowels in good working order. An
increased amount of soluble fibre,
which is found in oats and some fruit
and vegetables, can also help to

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 lower your cholesterol and protect Use less salt and sugar
your heart. Here are our top tips on Too much salt can increase your
how to get more fibre into your diet: blood pressure. The higher your
.  heck the labels. If you are
C blood pressure, the greater your
buying ready-made products risk of having further problems with
such as bread, pasta or breakfast your heart. The maximum daily
cereal, check the nutritional recommended amount of salt for an
information on the back of the adult is 6 grams or one teaspoon.
pack. Try to choose the higher- About 70% of the salt we eat is
fibre options where possible. A already in foods so make sure to
product must have 6g per 100g avoid it or eat less of those foods
to claim it is high in fibre. that have more than 1.5g salt (or 0.6g
sodium) per 100g. The Irish Heart
.  hoose wholegrain bread
C Foundation food shopping card is
instead of white bread. a useful tool to tell you whether a
product is high or low in salt.
.  ave a wholegrain breakfast
H Rather than adding salt to foods,
cereal such as porridge oats, either in cooking or at the table, use
wheat biscuits or bran flakes. herbs such as black pepper, paprika
Why not try adding a handful of or flavourings such as balsamic
fruit or nuts for extra fibre? vinegar, especially if you have high
Load up on fruit and vegetables. blood pressure.
Try keeping chopped fruit and
vegetables on hand as snacks. Too much sugar can lead to high
Throw some frozen vegetables triglycerides which is a bad type of
into your stews and curries. Add fat in our blood vessels. This is why
some salad to your lunchtime you should reduce concentrated
sandwich or a handful of fresh forms of sugar such as fruit juice,
fruit to your breakfast cereal. sugary drinks, biscuits and cakes. If
you wish to have these treats, try to
.  hoose good quality
C have them only occasionally.
carbohydrates. Have
wholegrain or high-fibre starchy
carbohydrates such as potatoes
with the skin on, whole wheat
pasta or brown rice with your
evening meals.
If you are increasing the fibre in your
diet, you should do so gradually, as
going from a little to a lot can cause
discomfort. It is also important to
drink enough water as fibre needs
fluid to do its job.

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 Alcohol consumption
If you drink alcohol, the good news
is that you don’t have to give it up.
Consuming a moderate amount of
alcohol that keeps you within the
recommended maximum weekly limits
is considered low risk, unless a doctor
has advised you against it.

It is important to keep within the guidelines for safe consumption

and to have at least three alcohol-free days per week.
For drinking to be considered “low risk”, the Health Service
Executive advises that women have fewer than 11 standard drinks
or units of alcohol in a week and men have fewer than 17 standard
drinks or units.

1 standard
1 glass of beer 100ml glass 25ml measure
drink or unit of
(a half pint) of wine of spirits
alcohol

Drinking too much alcohol over time may damage your health.
Excessive alcohol consumption disturbs healthy sleep and may
raise your blood pressure. This makes your heart work harder to
pump blood around the body.
High blood pressure can significantly increase your risk of stroke
and heart disease. It can affect how quickly your heart beats, and
can even cause the heart muscles to weaken. This can lead to
heart failure or sudden cardiac death. Drinking too much alcohol
can also lead to liver disease, early-onset Alzheimer’s and certain
cancers.
Alcohol may raise triglyceride levels (blood fats) but provides
no nourishment. One standard drink contains 100-150 calories.
Having 17 standard drinks in one week can add up to at least 1,700
extra calories. This can lead to weight gain of 1.5 stone or about
9.5kg over a single year.

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 Do you know how much you drink?

There can be a gap between what people think they drink

and what they actually drink. The Health Service Executive
has developed a website to deliver information about the
effects of alcohol on the heart and general health. It is called
askaboutalcohol.ie and it has a drinks calculator that can be
used to find out if your level of drinking may be putting your
health at risk.

Here are some questions to ask yourself if you are worried about
your drinking:

 Is my drinking
Do I know
affecting my life,
how much Do I know
my work,
alcohol is when to stop?
my relationships
too much?
or my health?

It is usually safe to take a small amount of alcohol when taking

heart medications. You may require specific advice if taking blood
thinners, such as Warfarin, Dabigatran, Rivaroxaban, Apixaban or
Edoxaban.
For more information, visit: www.askaboutalcohol.ie

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 High blood pressure
High blood pressure (BP) is
one of the main risk factors for
cardiovascular disease.

High blood pressure is common as we get older and can also be

hereditary. The good news is that, in addition to lifestyle changes,
there are many medications available to lower your blood pressure
and prevent this happening.
The heart is a muscular pump. It squeezes and pumps blood out
of the heart around the body. The heart then relaxes and fills again
with blood, ready for the next pump. Blood pressure is the force
that the blood exerts on the inside of the blood vessel or artery
wall as the blood flows around the body. When you exert yourself,
your blood pressure rises, and the heart has to work much harder
to pump the blood around your body. If your blood pressure
is always high, then the lining of the blood vessel will become
damaged. If you smoke or have high cholesterol, this damage,
which is described as increased wear and tear, may be increased.

How to understand a blood pressure reading

Blood pressure is measured in millimetres of mercury (mmHg)

and is written as two numbers. So, your reading might be
120/80mmHg, though we usually say simply “120 over 80”.
The first number is the systolic reading and is the highest pressure
when your heart pumps. The second number is the diastolic
reading, it records the lowest pressure when your
heart is relaxed between beats.
For people with heart disease, the first reading
should be less than 140 and the second should

140/90 be less than 90. Ideally, it would be less than

130/80. If you have diabetes, then the reading
should be 140/80 or less.

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 Lifestyle factors can increase the risk of developing high blood
pressure. These include, smoking, being an unhealthy weight,
not getting enough physical activity, drinking more than the
recommended limits of alcohol, having too much salt in your diet
and stress. Sleep apnoea, a condition that affects your breathing
when you are sleeping, can also be a factor. Kidney disease may
cause high blood pressure in a small percentage of people, but
often there may be no particular cause.
It is important for adults to have their blood pressure checked
regularly and to take the prescribed medication if high blood
pressure is diagnosed. You may have to wear a blood-pressure
monitor for 24 hours to find out whether you have the condition.
It is also important to make any lifestyle changes that you can,
such as stopping smoking, managing stress, reducing your salt
and alcohol intake, and getting regular exercise.
It is important to continue to take prescribed medication in order
to control your blood pressure, even if you do not feel any benefit.
When you go for regular check-ups with your GP, they can show
you how these medications are helping to control your blood
pressure.

Controlling high blood pressure with lifestyle changes and taking

prescribed medication correctly greatly reduces your risk of
developing heart disease or having a stroke.

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 What is diabetes?
Diabetes is a condition where the
amount of glucose or sugar in the blood
is too high.

Diabetes develops when the body cannot break down and use
glucose properly, because there is a lack of insulin, or the insulin
produced is not working properly.

Types of diabetes

There are two types of diabetes.

Type 1 diabetes Type 2 diabetes

Occurs when the body Occurs when the body stops
completely stops producing producing enough insulin, or
insulin and the level of the produced insulin does not
glucose (sugar) in your work properly. This usually
blood becomes too high. happens later in life and is
Daily injections of insulin are often related to lifestyle and
required to keep your blood weight. Type 2 diabetes also
glucose levels under control. occurs in children and is
Type 1 diabetes is usually directly related to lifestyle.
seen in children and is often
a genetic condition, which
cannot be prevented.

You may also hear the term called pre-diabetes. Pre-diabetes

happens when blood glucose levels are higher than normal, but
not yet high enough to be classified type 2 diabetes. Cardiac
rehabilitation programmes are an ideal opportunity to learn about
your blood sugar level and what you need to do to control it, if it
is high. You can reverse pre-diabetes by making effective lifestyle
changes.

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 Important diabetes terminology

Diabetes is all about managing your blood sugar levels. Normal

blood glucose levels should be 4-6 millimoles per litre (mmol/L)
before meals and no higher than 10 millimoles per litre two hours
after meals.
Another term you will hear is HbA1C, which is a measurement of
the amount of glucose being carried by the red blood cells in your
body. This gives an estimate of your blood glucose control over the
previous two to three months. The target is less than 53mmol/L
or 7% and possibly as low as 48mmol/L or 6.5% for some people.
Keeping it below this level has been shown to reduce the risk of
complications of diabetes such as heart disease.

Management of type 2 diabetes

The management of type 2 diabetes includes healthy eating,

exercise and lifestyle changes. You may also need tablets or
injections to help control your blood glucose levels. It is important
to also control your weight, blood pressure and cholesterol.
Cardiac rehabilitation programmes are ideal for you to learn about
diabetes and recommended lifestyle changes, particularly if you
have recently been diagnosed with diabetes.

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 What is diabetes? continued

Complications of diabetes

You will need to manage your diabetes and maintain control

over your blood sugar levels if you are to avoid the common
complications that can be associated with diabetes. Having raised
blood glucose levels for a long time can cause damage to the blood
vessels and nerve endings. If it continues for years, it can lead to
eye, kidney and foot problems, as well as cardiovascular disease.

Eye disease Foot Disease

Diabetic eye disease is known as If your blood glucose level is above the
retinopathy. Retinopathy happens when target for a long time, the nerves and the
the tiny blood vessels in the lining at blood vessels that supply the feet can
the back of the eye are damaged. Your become damaged, potentially leading to
sight will not be affected in the early foot ulcers. In extreme cases, it may be
stages of retinopathy, so it is essential necessary to amputate or remove your
that you attend eye screening regularly. foot. Everyone with diabetes should have
Diabetic Retina Screen is the national an annual foot assessment by a medical
diabetic retinal screening programme that practitioner, such as a podiatrist, who
offers free, regular diabetic retinopathy checks for problems related to circulation
screening for those with diabetes who are and sensation. You should be advised of
aged 12 years and older. your risk of developing foot problems and
also given instructions on how to take
care of your feet. This advice will include
Kidney disease looking after your feet by examining them
each day, washing feet in lukewarm water
Diabetic kidney disease is known as and drying them thoroughly, moisturising
nephropathy. Over time, high blood the skin, not walking around barefoot and
glucose levels can damage the small wearing good footwear.
blood vessels in the kidneys causing them
to work less efficiently. It is important
to have your kidney function checked
regularly. This is done by having a blood
and urine test carried out by your GP.

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 Heart disease

Damage to the large blood vessels in the . Maintaining healthy blood sugar levels
body is known as macrovascular disease . Making the dietary changes discussed
and it can be the cause of heart attack earlier
and stroke. As part of your diabetes . Keeping your cholesterol levels under
appointments, your heart should be control
checked by having your blood pressure and . Being physically active every day
cholesterol levels checked regularly. . Aiming to achieve or maintain a
If you have diabetes, you are three to four healthy weight and waistline
times more likely to develop cardiovascular . Stopping smoking
disease than someone who does not have . Keeping your blood pressure readings
diabetes. If you already have diabetes, at less than 140/80
you can reduce your risk of cardiovascular . Keeping within the recommended
disease and other complications of alcohol intake limits
diabetes by: . Taking your medications as prescribed
by your doctor
. Attending your appointments for
review of your diabetes, eye care and
foot care.

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 Physical Activity
Regular exercise is essential for your
cardiovascular health. It is as important as your
medication and will make a positive difference
to every aspect of your health.

For good health, National Physical Activity Guidelines recommend

to get 30 minutes of moderate exercise at least five days per
week. This could be walking at a moderate pace for 30 minutes,
for example. Remember you must always warm up the muscles for
five minutes before walking and warm down for five minutes after
the walk.
This activity can be divided into shorter segments throughout the
day, but the main aim is to get more movement into every day. The
best forms of aerobic activity are walking, cycling and swimming.
A home exercise bicycle can be very helpful, especially when the
weather is bad.
Just being on your feet is not enough, however. You will need to
get up and keep going, rather than stopping and starting. Strolling
and stopping often can be pleasant but is not enough for
your heart health. Sitting down resting for too long is not
advisable.

For good health,

National Physical Activity
Guidelines recommend to
get 30 minutes of moderate
exercise at least
five days per week.

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 Are you aware that sitting for long periods of time is now
considered a risk factor for cardiovascular disease? A recent study
identified that we spend about two hours more sitting down per
day than we estimate.
More detail regarding fitness and stamina levels required in order
to return to physical work and activities, will be available at your
cardiac rehabilitation programme.
If you have had a heart attack, a stent or surgery, a cardiac
rehabilitation programme is an opportunity for you to avail of
advanced levels of assessment, monitoring and supervision by
a clinical team. Your risk factors for heart disease are assessed,
measured and treated. There may also be psychological support,
such as stress management, or mindfulness available as part of
the programme.
Following that, it is recommended that you get involved in at
least one of the many exercise programmes in your community
such as local walking groups or exercise classes. Your cardiac
rehabilitation unit will have a list of all local options.

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 What is Stress?
Stress is a natural part of everyday life,
though it can mean different things
to different people. A certain amount
of stress can be good for the body as
it motivates us to get things done.
However, too much stress is harmful for
physical and mental health.

Stress occurs when demands or worries begin to overwhelm us

and we feel unable to cope. Some things you may feel stressed
about include work demands, family life, money worries or
illness. The way we deal with these demands will depend on
our personality, the way we think about things and our own
experience of life.
Some people experience stress following a cardiac event, such
as a heart attack or stroke. This is a natural part of recovery and
this emotional distress should eventually go away. There are many
ways to cope with stress. Firstly, you need to learn to recognise
the signs that you are stressed. These may include feeling
tense, experiencing disrupted sleep, feeling worried or irritable,
forgetting things, having difficulty making decisions, avoiding
problems or feeling that you need an alcoholic drink.

Learn to accept that

there are some things
or people that you
cannot change.

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 Manage your Stress
You can learn to manage your stress levels.
Here are some suggestions:
 ake sure to get enough
M  e realistic with your time
B
sleep and rest in order to and perhaps say
recharge your batteries. “no” more often.

Eat a balanced diet.  o things that help you

D
to relax such as listening
 rink less tea, coffee
D to music, or practicing
and alcohol. relaxation and meditation
exercises.
 ake more exercise.
T
Physical activity  alk about difficult
T
improves mood and problems with a trusted
increases energy as the friend or family member.
body produces its own
happy hormones called  sk for help and support
A
endorphins. when it is needed.

 lan your day. Get

P  earn to accept that there
L
involved in pleasurable are some things or people
activities such as a day that you cannot change.
out with friends or family,
shopping, cinema or
soaking in the bath.

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 Typical psychological
reactions after a
cardiac event I don’t feel
like myself
A cardiac event is an emotional
experience, and you will need
anymore. Is this
to recover both physically and normal?
psychologically to feel “back to normal”.
Everyone reacts differently. There is no right way or wrong
way to feel. While some people are barely affected by their
heart problem, for many others it can be a major life event.
Some of the most common psychological reactions include:

Numbness Anxiety
Your cardiac event may seem unreal to You might be fearful of having more
you, like you are experiencing a dream – heart problems or even going through
“This can’t be happening”. surgery again. For many people an
unexpected brush with death can leave
Shock them feeling vulnerable and uncertain
You might even doubt that you really about the future – “What happens now?”
have a heart problem – “They must have
made a mistake”. Increased awareness of your body
It is very possible you will start to notice
Anger every minor ache and twinge now –
You might feel angry about your heart particularly in your chest – and you might
problem, or even towards yourself – even think these are signs of a heart
“Why did this happen to me?”; “Life is so attack.
unfair”; “Why didn’t I look after myself
sooner?” Sleep difficulties
Increased worries may cause your mind
Guilt to race before bedtime and a lot of
Many patients feel guilty for having patients feel afraid to go to sleep in case
survived (“as others did not survive”), they don’t wake up. On the other hand,
or about their unhealthy lifestyle if they sleeping for too long can sometimes be
smoked or worked long hours. You may an indication of depressed mood, but this
even start to feel guilty about the effect can be treated.
of your health on your family.

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 Sadness problems, or maybe heart disease runs in
Sometimes sadness after heart problems your family?
is actually grief for a loss of innocence –
that sense of invincibility we might have
when we feel healthy. You may also feel Emotional
saddened by the thought of having to Patients sometimes feel exposed and
make future changes to your life at home vulnerable if they notice they get more
or at work – “Will things ever be the easily upset or are more tearful than
same?” before.

Feeling isolated Increased need for privacy

You might feel quite alone while you are You might find that you want to be on
trying to get better and this can worsen a your own more now, or just to confine
low mood. At these times, support from yourself to the company of loved ones.
family and friends is vital to ensure a
good recovery.
Relationship changes
You may feel that your role in the family
Helplessness has somehow changed. For example,
Perhaps you feel powerless or a lack of many patients struggle to balance
control over your life now, particularly if keeping their independence versus
there’s no obvious cause for your heart feeling “wrapped up in cotton wool”
by family members.

If you experience any of these feelings, you are not alone. These are common
psychological reactions and can produce good days and bad days. Getting
back to normal – even a new sense of normal – can take several weeks or
months.
Studies show that patients recovering from heart problems fall into roughly
three groups of people:
.  ne-third of people are not too affected emotionally. They take on a pos-
O
itive attitude soon afterwards and start to make healthy lifestyle changes.
. Another third of people take longer to move on, and that’s where the help
and support of family and friends becomes really important.
. Finally, about one-third of cardiac patients experience significant psy-
chological difficulties including anxiety, depression or insomnia. These
patients may benefit from professional psychological support. Ask your
medical team for advice here – many cardiac rehabilitation teams have
psychologists who specialise in helping patients recover from heart prob-
lems.
It is important to say too, that many patients can feel extremely grateful or
that they have been given a new lease of life. For example, patients can come
to look at their heart problem as a wake-up call and refocus their time and en-
ergy on the things that are truly important to them such as their relationships,
health or hobbies.
For these people, their initial medical problem actually leads to an unexpect-
ed improvement in their quality of life.

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 Medications
Managing your medication is just as important to
protect your heart health as getting enough exercise
and eating a healthy diet.

There are many different medicines used to treat heart disease.

Some medications are used to reduce your cholesterol such
as statins. Others are used to treat blood pressure or manage
symptoms, such as diuretics (or water tablets) to reduce fluid
retention, and nitrates to improve blood flow to the heart.
If you have heart disease you may need multiple medications.
You will learn about these during the cardiac rehabilitation
programme. It can be quite confusing, but lots of help is available
from your doctor, cardiac rehab nurse and your pharmacist. Keep
asking until you have all the information you need to know about
your medications.
Medications can act in the body in different ways and sometimes
a medication can be used for different jobs e.g. antiplatelets
(including aspirin, clopidogrel, ticagrelor and prasugrel) prevent
clots in the blood vessels. Anti-coagulants do the same job but in
a different way.
Sometimes the same medication is used for a variety of jobs, for
example beta-blockers may be used for angina, irregular heart
rhythms, high blood pressure and after a heart attack.

This is why it is very important not to share your medicines with

anyone, even if someone is taking the same medication as you it
might not be for the same reason.

Important things to know about your medications:

The name and strength Aspirin 75 milligrams
How and When to take it Once daily in the morning
Why you are taking it To thin the blood
Where to get more information Pharmacist, G.P. Cardiac rehabilitation staff

The Irish Heart Foundation have published a book called Step by Step
through Heart Medicines which will provide all the information that you need
to know.

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 Important points when taking medications:

.  arry an up-to-date list

C medicine back to your
of your medicines (your pharmacy
pharmacist can help you . Keep two weeks supply
with this) of medicines at all times
. Ask pharmacist to blister and be aware of the
pack your medication, if expiry dates
you are having difficulty . Plan ahead for travel,
. Check all your tablets bring an up to date list
with your pharmacist of medications, carry
before leaving the medicines in hand
pharmacy luggage in original
. If your prescription containers (don’t transfer
changes bring old from containers)

Tips for building a strong medication-taking habit

Sometimes we forget to take our medications. Here are some

strategies you can use to make taking your medicines easier to
remember.

. Get a weekly pill box

. Set reminders for yourself ---- use notes or phone or calendar
. Develop a routine for taking your medication and try to take
at the same time every day. Connect taking your medication
with an activity you do at the same time every day (e.g.
brushing your teeth in the morning).
. Keep your medications somewhere you will see them can act
as a reminder to take them (e.g. keeping your pill box next to
your toothbrush).
. Making an ‘Action Plan’ can also help you to build a strong
medicine habit. Form a plan in your mind or even on paper
(e.g. “If I have finished eating my breakfast, then I will take
my medication”). With just a little repetition, this will quickly
become automatic.

Get to know your pharmacist, they have lots of information on

all your medication. Pharmacists are also able to advise on side
effects and interactions, as well as what to do if you cannot
contact the prescriber.

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 Treatment for
.  ontinue to take your medication even if you feel
C heart disease includes
well and have no symptoms. Don’t stop taking a balance of lifestyle
medication suddenly, remember most heart changes, diet, exercise
medicines are for long term treatment. and medications. But
. Tablets may cause additional side-effects, which medications only work
are infrequent and usually short lived and easily if you take them as
managed by your Doctor. The most common side- directed.
effects are tummy upset, constipation and headache.
Your doctor will prescribe the most suitable medication
for you. But if you suspect you might be experiencing a side-
effect – report it to the prescriber. If this medication doesn’t
suit, there are always alternatives.
. Many factors influence how your medications work for you.
Tablets interact with other medications, herbal remedies
and sometimes with food and alcohol. This may result
in medication being ineffective. Always check with your
pharmacist before buying “over the counter” products and try
and maintain interaction with one pharmacy only.
. It’s so important to be honest with your doctor, pharmacist or
cardiac rehab staff if you are finding it difficult to stick to your
plan. If you are not taking your medications, you probably
have a reason e.g. doubts, concerns, side-effects. Explain this
to your doctor. They will be able to advise. There is usually a
reason why you need to take this medication. Heart disease
is serious so if you have concerns, discuss them with your
doctor.
Treatment for heart disease includes a balance of lifestyle
changes, diet, exercise and medications. But medications only
work if taken as directed. You will benefit most by participating in
all components of the cardiac rehabilitation programme.

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 Taking Medications
as Prescribed
If you take medications regularly, you probably know how easy it
can be to miss a dose or take the wrong dose by accident. You also
may know how tempting it can be to adjust or skip doses on your
own, without your doctor’s consent.

Failing to take your medication Lastly, if you are having trouble

properly can have a negative impact sticking to your regimen, here are
on your treatment. some helpful tips:
It is important to follow the exact .  evelop a medication schedule
D
instructions given with regard to so that it becomes part of your
your medicine prescription. You daily routine. Take medication
may hear your doctor use the term after eating breakfast, or before
“medication adherence.” This term going to bed.
means taking the proper dose . Create reminders for yourself
of medication at the right time —notes, checklists, journals or
and in the right way for as long alarms.
as you’re supposed to take it. For . Ask family and friends to remind
example, your doctor may advise you to take your medication
you to take one tablet with food, regularly, as they can be a
morning and night, until further source of support.
notice. To properly “adhere” to
these instructions, you must take
one tablet with food twice a day at
the correct times. Adjusting these
instructions at all, for example taking
one tablet once a day may lead to
the tablet not working effectively.
If you’re having trouble taking
medications properly or are
experiencing side effects, be sure
to discuss these concerns with your
doctor. He or she may adjust your
medication accordingly. However,
you should never make adjustments
to medications yourself. Always
consult first with your health care
provider.

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 Sex and heart disease
If you have recently had a cardiac
event, you may be coming to terms with
many changes in your life.

You may also be concerned about resuming sexual activity. Try

not to worry. This chapter should give you peace of mind by
addressing any questions or concerns you may have. It is perfectly
normal to be worried about being intimate after a cardiac event,
and you may wish to talk to a medical practitioner about these
concerns.
Sexual problems affect our quality of life, psychological
wellbeing and relationship satisfaction. Patients and their
partners are often worried about how sex can affect your heart,
after a cardiac event. it is important to speak to your partner about
your concerns.
Evidence shows that it is very rare for a person to have a heart
attack or die during sexual activity. When this occurs, other
factors may be involved such as large quantities of food or alcohol.

When is it safe to resume having sex after a

cardiovascular event?

Sex is considered to be a form of moderate exercise. It is generally

considered safe to resume sexual activity when you can climb two
flights of stairs or walk briskly for a short duration without feeling
faint, dizzy, have chest tightness or shortness of breath. If you
experience these symptoms during sexual activity, it is important
to report these to your doctor or medical practitioner.
Sometimes patients experience sexual difficulties after a cardiac
event, but there are several things that can help. Here are some
tips to reconnect and become intimate with your partner once
again:
.  void rushing into sex to prove things are “back to normal.”
A
You or your partner may be a little anxious about sex. It’s
important to take your time and ease back into sexual activity.

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 Sexual
problems affect
our quality of
life, psychological
wellbeing and
relationship
satisfaction.

Take the pressure off yourselves and don’t expect too much at
first. Resume sex slowly and allow it to happen naturally.
. Most people think sexual activity means intercourse. But you
can express your sexuality in many ways. You may just want
your partner near you. Or you can touch, hold and caress
without the goal of orgasm. You and your partner can feel
loved and secure without feeling pressure to perform.
. Sex begins in the brain and is a journey. So, stay connected to
your partner, continue to love and desire them and tell them
so. This goes for both of you. Stay in touch, literally. Kiss, hug,
and hold hands.
. Reassure them that they are still lovable. That’s a first and
very vital step.
. Both partners should be willing and happy to engage in the
process.

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 Sex and heart disease continued

Tips to make resuming sex

easier and more successful
.  hoose a time when you are
C .  hould you experience chest
S
both rested and free from pain or symptoms of angina –
stress. stop and rest.

.  ait two to three hours after

W .  se your glyceryl trinitrate
U
eating a full meal before having (GTN) spray as prescribed and
sex. This gives your body time if the pain doesn’t ease get
to digest your food. Like other emergency help.
physical activities, digesting
food requires more blood, .  void stimulants or cocaine.
A
which diverts it from elsewhere These may cause chest pain
and makes the heart work and, in some cases, a fatal heart
harder. attack.

.  void large amounts of alcohol

A .  esuming sex often helps you
R
before sexual activity. feel emotionally closer to your
partner. It lets you rekindle
.  hoose a familiar, peaceful
C tenderness and romance.
place where you won’t be
interrupted. .  eep in mind, sex after a
K
cardiac event may help manage
.  ake your medicines as
T stress and boost your self-
prescribed. esteem.

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 These feelings
are common,
but in most cases,
they go away as you
recover and start
to feel more like
yourself.

Emotional challenges

Many people have sex just as often as they did before their heart
problem, some are less active, and some stop entirely. Emotional
and psychological factors, such as anxiety and depression, that
can occur following a heart attack or cardiac event can lower
sexual interest and ability. Feeling tired and being unfit also
reduces desire.
The passing of time, effective medical treatment, attending a
cardiac rehabilitation programme and psychological support can
all help.
While you are recovering from a cardiac event you may:
. Feel depressed, sad and/or afraid
. Have trouble sleeping or sleep too much, especially during
the day
. Eat more or eat less than usual
. Gain weight or lose weight
. Feel less interested in life
. Feel tired all the time especially after activity
These feelings are common, but in most cases, they go away as
you recover and start to feel more like yourself. If you are feeling
depressed, talk with a medical practitioner about treatment
options. Cardiac rehabilitation has been shown to be effective in
reducing depression, but you may also benefit from medication or
psychological support.

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 Sex and heart disease continued

Coping as a couple

.  our partner may also be anxious or depressed about your

Y
health. Your feelings, as well as those of your partner, can add
stress to your relationship.
. It is important that both of you accept, respect and try to
understand what the other is feeling. Your partner plays a big
part in how you adjust. Research tells us that the support of
a partner reduces your risk of having cardiac problems in the
future.
. Your partner may struggle to strike a balance between being
overprotective and not helping enough. In many cases,
partners are overprotective. They don’t like to make demands
and risk upsetting or injuring you. Sometimes they don’t let
you return to normal activity. Your partner may even feel
guilty about your heart disease and wonder if it could be their
fault.
. Your partner may feel angry and frustrated. Unresolved issues
can lead to more complex physical, emotional and social
problems.
. Perhaps you could begin by increasing the time spent
together. Take a daily walk together. This builds physical
fitness, better communication and promotes intimacy.

Medication
Some medicines make it difficult for men to achieve an erection.
For some men, they may have premature ejaculations or none at
all. Women may not have enough lubrication, which can make
intercourse painful. Some women find they may not be able to get
sexually aroused, or they may be unable to have an orgasm.
Medication to treat the following may affect sex drive and sexual
function:
. Blood pressure
. Heart attack or cardiac surgery
. Water tablets (diuretics)
. Sedatives and antidepressants
. Chest pain or irregular heartbeat
If you feel your new medications are affecting your life, please
don’t stop taking your medications without talking with your
medical practitioner first.

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 It is understandable to be shy or embarrassed to talk about
this topic but remember that your medical team are trained to
discuss and advise you about these common problems. Solving
the problem may be as simple as changing or reducing the
medication, but it is vital that you do this under your doctor’s
supervision.

Erectile difficulties
It is common for men who have been diagnosed with
cardiovascular disease to have erection difficulties. Studies show
that rates of erectile dysfunction among men with cardiovascular
disease are twice as high as those in the general population. By
erectile dysfunction we mean the recurrent inability to achieve a
hard penis to complete sexual intercourse.
This can be caused by several factors that often work in
combination. Physical factors can result in a narrowing of
the arteries and/or a lack of blood flow to the penis. Some
medications can also have an effect.
Chronic stress produces changes in the body that make it difficult
to achieve or maintain an erection. Unfortunately, worrying about
this issue can make matters worse. Depression, which is common
after a cardiac event, can also affect your sexual drive.
Many men find talking about such intimate matters very difficult,
but your GP or cardiac rehabilitation staff are well used to
dealing with this topic and will put you at ease. You could start a
conversation with one of the following:

Since I had my I am worried that

I am not able I may not be able
cardiac event, my
to have sex like to get an erection
normal sex-life has
I used to anymore
been affected

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 Sex and heart disease continued

There are several options of treatment to help with erectile

dysfunction, these include:
Lifestyle changes:
.  ome lifestyle changes are worth considering – heavy alcohol
S
consumption, smoking and poor sleep all play a significant
role in erectile dysfunction.
. Stress plays a major role in problems with erections.
Relaxation techniques have been shown to help with erectile
dysfunction and premature ejaculation.
For some men, achieving an erection is easier in the morning.
Some couples have found that an episode of success builds
confidence and reduces anxiety based around future performance.
Counselling: Your GP can refer you to an appropriate qualified
counsellor such as one specialising in sex therapy.
Medications: There are several medications that can be
prescribed to treat the condition. Ask your doctor to discuss these
options with you.
. Always ensure medication is prescribed by a doctor who
knows your medical history and the other medications you
are taking.
. Phosphodiesterase inhibitors can be very effective and
safe in treating erectile dysfunction when taken under a
doctor’s supervision. It is very important not to take any
phosphodiesterase inhibitor such as avanafil (Spedra),
sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra) if
you have taken GTN spray in the last 24 hours as this can
have a dangerous lowering effect on your blood pressure.

Specialist Clinics
There are specialist clinics where you can be prescribed products
to help with erection difficulties, these include injections and
insertions, vacuum pumps and urethral pellets. Ask your GP for
further information.
Erectile dysfunction is a man’s condition but a couple’s concern.
By discussing your problem with your partner, the pressure may
be relieved and erectile function may improve.

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 How to make this work for you
.  ttending a cardiac rehabilitation programme is an important
A
factor in your recovery. It is ideally designed to help address
new sexual difficulties that can occur after a cardiac event.
Attending a cardiac rehabilitation programme reduces
anxiety and depression, improves sleep and increases
confidence and fitness.
. Additional components of these programmes such as
medication reviews, stress management and smoking
cessation are very likely to bring improvements in this area.
. If you are unsure about your symptoms, or if it is safe for you
to have sex, then ask your doctor or cardiac rehabilitation
team for advice.
. Remember to take your time. It’s as important to experience
the journey as the destination.

For more information and advice see:

www.sexualwellbeing.ie
The sexual wellbeing website was developed in partnership with
the HSE Sexual Health Communications Working Group and
leading professionals in the field.

www.sexualadviceassociation.co.uk

Specialist advice
If your GP feels you may need specialist advice, you may be re-
ferred to a sexual clinic or a consultant urologist.
Additional suggested reading by Dr Mary Rogan, GP and medical
sexologist
.  he Relate Guide to Loving in Later Life by Marj Thoburn and
T
Suzy Powling
. Enduring Desire: Your Guide to Lifelong Intimacy by Barry
McCarthy and Michael Metz
. Sex for Simple Humans by Dr Mary Rogan

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 Exercise

Welcome to the physical activity

component of this programme
It is important to exercise throughout
the cardiac rehabilitation programme, in
hospital and at home.
National Physical Activity Guidelines recommend
adults should engage in at least 30 minutes of moderate
Borg Scale
intensity activity, 5 days per week.
Rating Perceived
Excertion

What are moderate levels of physical activity? 6 No exertion

You should feel your heart rate increase a little, feel 7 Extremely light
warmer, but always be able to walk and talk when
8 Easy
exercising.
The Borg Scale: This is a measurement of how exercise 9 Very light
feels for you in terms of muscle strength, endurance and
10 Sort of Hard
breathing. Ask the question: how hard does this exercise
feel for me? 11 Light

12

13 Somewhat Hard

14

15 Hard

16

17 Very hard

18

19 Extremely hard

20 Maximal exertion

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 Home exercise
programme
Warm Up
Complete the warm up exercises to raise your heart rate,
loosen the joints and stretch out the muscles.

Circuit of 10 exercises
Complete each exercise for one minute
Complete the circuit three times

Warm Down
Complete the warm down exercises to gradually reduce your
heart rate and temperature, and help prevent stiff, sore muscles.
Hold each stretch for 8-10 seconds
Listen to your body and if you feel any
of the following, sit and rest: If the
. Dizziness symptoms
. Faintness do not start to
. Shortness of breath ease off, please
. Chest, jaw or arm pain seek medical
attention.

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 Acknowledgements

Thank you to the Irish Association of Cardiac Rehabilitation

committee members for their dedication to this project.
Noeleen Fallon, Tallaght University Hospital (Chair)
Ann Marie Brown, Mayo University Hospital
Mary Connor, Cork Bon Secours Hospital
Kate Corrigan, Connolly Hospital
Anne Gallagher, Mater Hospital
Jonathan Gallagher, Beaumont Hospital
Maria Daisy Gamis, Our Lady’s Navan Hospital
Mary Kerins, St James Hospital
Mairead Lehane, Mallow General
Rosemary Thorpe, Roscommon Hospital
Ruth Harkness, IACR Secretariat

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 Notes

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 This educational booklet is designed to help patients
who are recovering from a cardiovascular event,
and family members. It contains a wide variety of
information that relates to your heart health. This
explanatory booklet is accompanied by a DVD.

The Irish Heart Foundation is Ireland’s national charity fighting

heart disease and stroke through advocacy, research, prevention
and care. For more information, visit www.irishheart.ie
Irish Heart Foundation
17-19 Rathmines Road Lower
Dublin 6.
D06C780

Phone: +353 1 6685001

Email: info@irishheart.ie
Website: www.irishheart.ie

Registered Charity Number (RCN): 20008376

CHY 5507

CBP002053

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