Secondary Prevention

A number of factors increase the risk of developing or speeding the progression of heart disease. Reducing or eliminating these risk factors can be helpful, even if a person already has heart disease or has had a heart attack.

Follow a heart healthy diet — Diet counseling is helpful for people who need to lose weight or reduce cholesterol levels. A registered dietitian is the best person to consult about foods that are helpful and harmful, appropriate portion sizes, total calorie recommendations, and realistic ways to change bad eating habits.

Most cardiac rehabilitation programs have a dietitian who is knowledgeable and experienced in advising people who are recovering from a heart surgery.

Stop smoking — Cigarette smoking significantly increases the risk of coronary heart disease and heart attack, and stopping smoking can rapidly reduce these risks. One year after stopping smoking, the risk of dying from coronary heart disease is reduced by about one-half and the risk continues to decline with time. In some studies, the risk of heart attack was reduced to the rate of nonsmokers within two years of quitting smoking.

Your GP practice and cardiac rehabilitation programs can recommend a treatment to help stop smoking, such as group programs; nicotine patches, gum, or nasal spray; or a prescription medication.

Treat high blood pressure and high cholesterol — Medicines to control high blood pressure and high cholesterol are usually recommended after bypass surgery. It is important to take these medications exactly as prescribed.

Manage diabetes — People with diabetes are at an increased risk of developing complications after cardiac surgery. Tight control of blood glucose levels can help to reduce the risk of these and other types of complications. Tight control can be achieved by losing weight, managing the diet, exercising, monitoring blood glucose levels regularly, and taking oral hypoglycemic medications (for people with type 2 diabetes) or insulin (for people with type 1 and sometimes type 2 diabetes).

Psychosocial treatment — Feelings of depression, anxiety, and denial are common after bypass surgery, occurring in up to 40 percent of people. Depression can reduce a person’s ability to exercise, decrease energy levels, cause more fatigue, or reduce a person’s quality of life and sense of well-being. Women, and in particular younger women, are at an especially high risk for depression.

These symptoms can cause problems within the family, marriage, and the workplace. Your GP and cardiac rehabilitation programs have trained personnel, including psychologists, psychiatrists, or social workers, to help manage these issues. Treating depression and anxiety can improve a person’s long-term outlook and general sense of well-being.

Reduce stress — Long-term stress in the home, at work, or with finances can increase the risk of heart attack, stroke, and chest pain. Your GP practice and local cardiac rehabilitation programs teach patients how to reduce stress in an attempt to lower these risks.


Antiplatelet therapy and resistance to Aspirin and Clopidogrel

You are advised to continue taking your antiplatelet therapy (Aspirin, Clopidogrel, Ticagrelor) as per your doctors’ prescription.

There are a large percentage of people who may be or may become resistant to the prescribed antiplatelet therapy. Patients who are resistant to aspirin and/or clopidogrel are at a greater risk of clinically important cardiovascular morbidity than patients who are sensitive to aspirin/clopidogrel.

You may be asked by our team to have the effectiveness of the prescribed antiplatelet therapy tested and the dose or the medication used adjusted to meet your personal needs.

You may also find that you have been discharged home on dual antiplatelet therapy, which currently is our usual practice for an initial period of six months, following which you will most probably converted to a single antiplatlet therapy by your local cardiologist or your GP.


After having a new heart valve

For most people, the operation will greatly improve symptoms and quality of life.

Like all operations, valve surgery isn’t risk free. Your own risk will depend on your age, your current state of health and the degree of valve disease. Before your procedure, your surgeon will discuss with you both the benefits and risks of the operation.

Endocarditis is a rare but serious condition where the inner lining of the heart becomes infected. This most commonly takes place in one of the heart valves.

If you have a heart valve problem or have had surgery on your valve, you are at risk of developing endocarditis. You are also at risk if you have had endocarditis before.

Until recently, people at risk of endocarditis were advised to take antibiotics before having dental treatment and some other procedures. However, that is no longer recommended. You can find out more at NHS Choices.


Warfarin (coumadin) 

Warfarin is an anticoagulant, which means that it increases the time it takes for your blood to clot. It works by reducing the effects of vitamin K, which is a vitamin your body uses in the process of blood-clotting.

Warfarin is used to prevent unwanted clots from forming if you have a condition that puts you at risk of this happening, such as atrial fibrillation or presence of a mechanical valve.

You will be given a yellow anticoagulant treatment booklet; read this carefully as it gives you information about when you should contact a doctor for advice. Carry it with you at all times in case of an emergency and a doctor needing to know that you are on warfarin, and at what dose.
You will need regular blood tests to check on how quickly your blood clots. Blood tests may be needed quite often at first, but should reduce in frequency quite quickly. The extent to which warfarin is working is measured by the International Normalised Ratio (INR), which is a measure of the ability of your blood to prevent clotting. The amount of warfarin that you need to take will depend upon the result of these blood tests, and this is why your dose may change from time to time. The aim is to get the dose of warfarin just right for you and a personal tester can be very useful (example: Coagucheck system).
Changing your diet suddenly can affect your INR, especially if you begin to eat more vegetables and salad. You should not begin a weight-reducing diet without discussing it with your doctor first. A major change in diet may mean that you need closer monitoring and may need a change in warfarin dose.
Only drink alcohol in small amounts, as this can affect the levels of warfarin in your body. Limit the amount of alcohol that you drink to a maximum of one or two units in any day, and never binge drink.
Drinking cranberry juice can interfere with warfarin and affect your INR, so it is best if you avoid cranberry juice altogether.
If you buy any medicines, check with a pharmacist that they are safe to take with warfarin.
Because warfarin is used to prevent blood clots from forming, you should try to avoid activities that could cause you to cut or bruise yourself, such as contact sports. Let your doctor know if you have any falls or injuries.
If you are due to have any injections, or any medical or dental treatment, tell the person carrying out the treatment that you are taking warfarin, and show them your anticoagulant booklet. It is important that they know you may take longer to stop bleeding. If you are due to have surgery, you may be advised by the clinic to stop taking warfarin for a few days beforehand.



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