After the infarct.

After the infarctThe patient with a myocardial infarction is likely to be admitted amid a flurry of activity to the unfamiliar environ- ment of an intensive care unit.After an enforced period of strict bedrest with a cardiac monitor emphasising his mortality he will be transferred to a general medical ward.But what then?"What should I do and not do now, doctor, and how can I prevent this happening to me again?" asks the patient.Booklets of advice for patients recovering from a myocardial infarction are widely available-for example, Back to Normal from the British Heart Foundation.Advice on what not to do is simple.Smokers should stop as stopping clearly reduces the risk of further infarction,' and the shock of a life threatening illness may help break the habit.Obese patients should aim at losing weight gradually, but stopping smoking should take priority.Diet is important in the minds of the public, but it has not been proved that a person reduces his chances of a second infarct by changing his diet.24All patients, but especially young ones, should have their serum cholesterol concentration measured, and ifthe value suggests familial hypercholesterolaemia then first degree relatives of the patient should also be investigated.Patients may drive after waiting two months but special rules apply to those with licences for heavy goods vehicles.5Patients who have had a myocardial infarct are generally encouraged to take regular exercise such as walking and to increase their activity gradually over a few weeks.They should be advised that they may feel fatigued for some days or weeks, especially if they have had a big infarct.More specific advice on what patients should be encouraged to do may be linked to assessing the severity of their disease.Patients may be encouraged to increase their physical activity within a formal rehabilitation programme.This may further restore confidence and patients may even achieve greater physical activity than they were used to before their infarction.Patients with desk jobs may return to work within four to six weeks, but those with more active jobs should take longer.The blocks to a full recovery may be more psychological than physical, and time should be set aside for simply talking to and listening to patients and their families.6Sexual intercourse should be avoided for six weeks, but the cardiovascular changes during intercourse are normally less than during an exercise test, which should reassure patients and their spouses.7