Display Patient Information Leaflets

Date issued: April 2025

For review: April 2027 

Ref: C-570/LM/Cardiology/Cardiac Rehabilitation Booklet v2 

PDF: Cardiac Rehabilitation booklet.pdf [pdf] 491KB

This booklet contains information for you and your family to explain what has happened to you and give you information to help you recover and return to a healthy lifestyle. If there is anything you do not understand or would like further information, please speak to your Community Cardiac Nurse. The name of your cardiac nurse will be given to you once you have been discharged. We are all here to help you during your recovery.

The Community Cardiac Team

Once you have been discharged from hospital a referral will be sent to the community team. Once they receive the referral, they will aim to ring you and arrange an assessment, this takes place in a local clinic or on the telephone if you prefer.

Our team are made up of

•    Cardiac Specialist Nurses

•    Cardiac Rehab Nurse

•    Exercise Physiologist

•    Cardiac Physiotherapist

•    Support Worker

•    Administrators

As previously mentioned, we will arrange an appointment to meet face-to-face with your named Cardiac Specialist Nurse, this generally happens in a local clinic (or telephone if you prefer) and the appointment generally lasts 1 hour. This is an opportunity to explain what has happened to you, identify your risk factors, help you set goals and discuss any questions you might have.

Along with the assessment we offer telephone reviews if needed, online information sessions held each week with our team and an exercise programme with a choice of home-based or in a small group environment.

Coronary Heart Disease

The heart is a muscular pump, which circulates blood to your lungs and around your body. Blood carries oxygen and vital nutrients through a transport system, known as blood vessels, called arteries and veins.

The heart also has its own blood supply through coronary arteries and veins, to supply the heart muscle with its oxygen and nutrients.

Coronary Heart Disease (CHD), also known as Ischaemic Heart Disease is where these coronary arteries become narrowed by a build-up of fatty material (known as atheroma), eventually this build-up of atheroma means they can’t get enough oxygen rich blood to the heart muscle.

Coronary heart disease develops slowly over time, and symptoms of CHD can be different for everyone, this is known as Angina. Angina is a warning sign that the heart muscle is temporarily not receiving enough oxygen. These symptoms include:

•   Shortness of breath

•   Chest Pain or tightness, or a feeling of bad indigestion, normally on exertion.

•   Nausea and feeling faint.

Some people have no symptoms before they have a heart attack.

A heart attack is known as a Myocardial Infarction (MI) and is different than Angina. Sometimes a piece of the Atheroma breaks off and this can cause a blood clot in the artery. This cuts off the supply of blood and oxygen to your heart muscle. This usually causes severe pain or discomfort and may not always be felt in the chest (jaw, and/or arm pain are also common). This can be mistaken for severe indigestion and can also cause nausea and sweating.

It is normal to feel very fatigued (tired) following your heart attack / by-pass surgery. This is normal and will pass with time. It is important to listen to your body and rest, it is very important to pace yourself.

Causes of Coronary Heart Disease (CHD) 

There are several risk factors that can cause CHD, which can lead to developing angina and heart attacks.

Your Cardiac Nurse will help you to identify your risk factors and will work with you to set goals that will reduce your risk factors and support you to make lifestyle changes.

Avoidable Risk Factors

• Being inactive / lack of physical exercise Smoking

• High Blood Pressure

• High Cholesterol levels

• Being Overweight Diabetes

• Stress

Unavoidable Risk Factors

• Family history of heart disease

• Ethnicity

• Age Gender

However, some people still have heart disease even if they have none of the above risk factors, research is still ongoing to try and find out further causes.

Treatments for Coronary Heart Disease

If you have had a heart attack or been diagnosed with Coronary Heart Disease there are 2 main treatments for this, Percutaneous Coronary Intervention or Coronary Artery Bypass Surgery.

Sometimes it is decided the best management of your CHD is medical management, your Cardiac Nurse can discuss this further with you.

Percutaneous Coronary Intervention (PCI)

Usually called a PCI, is when a narrow section of the artery is opened up by inflating a small balloon inside the artery which squashes the atheroma (fatty tissue), this allows the blood to flow more easily. A small piece of mesh (coronary stent) is usually placed inside the artery to make sure it stays open.

Following a heart attack sometimes a Primary Percutaneous Coronary Intervention (PPCI) is performed. This is the same as a PCI but is carried out as an emergency procedure following some types of heart attack.

Coronary Artery Bypass Surgery (CABG)

This surgery is done to bypass the narrowed/ damaged sections of the coronary arteries. The surgeon uses other blood vessels in your body. Another vessel in your chest, leg or arm can be used. These are attached to the aorta (the main artery leaving the heart) and passed the narrowing coronary artery, this is known as a bypass graft.

Bypass surgery is major surgery, and the recovery from this takes time. It takes time to recover, and we advise no lifting, pulling or tugging for 3 months. Your Cardiac Nurse will go through in detail the ‘dos and don’ts’ with you following surgery and further information on exercise can be found further on in this booklet.

It is common to experience decline in vision (your normal glasses do not seem to be working) and/or a lack of concentration (you cannot enjoy the newspaper or a television programme). This is normal, and generally improves within 6 weeks. So, we do not advise you see an optician for 6 weeks following heart surgery.

Driving

If you have had a heart attack you cannot drive for 1 week following discharge. If you have heart muscle damage from your heart attack this is increased to 4 weeks. Your nurse in hospital can advise you on this.

If you have just had a PCI (no heart attack) you cannot drive for 1 week.

If you have had by-pass surgery, you cannot drive for 6 weeks.

Medications for the Heart

You would have been discharged on some new medications following

your stay in hospital. Below is a list of some of the common medications used. These are prescribed to treat Coronary Heart Disease and some are known as preventable medication (used to reduce risk factors of CHD).

Aspirin

Aspirin is generally soluble and should be dissolved in a little water before taking, do not take them without dissolving them.

Aspirin is known as an anti-platelet medication; it lowers the risk of blood clots forming by making blood cells known as platelets ‘less sticky’. They do not make the blood thinner, which Aspirin is sometimes mistaken for.

Side-effects

• As Aspirin affects the time a blood clot forms you may find you bleed for longer if you cut yourself. You may also bruise more easily.

• Aspirin may irritate the gut, causing indigestion or stomach pain. It is very important to take Aspirin with or after a meal.

Other Anti-Platelet medication: Ticagrelor, Prasugrel and Clopidogrel

These medications do the same as Aspirin and are given alongside Aspirin following a heart attack or PCI, known as dual anti-platelet therapy. They generally are given for a year, and then can be stopped and you remain on just Aspirin. Your Cardiac Nurse can advise you if you are unsure how long to take them.

They have the same side effects as Aspirin, however Ticagrelor can cause shortness of breath.

Do not drink / eat grapefruit regularly whilst taking this medication as this can affect how the antiplatelet drug works.

ACE inhibitors (Ramipril, Lisinopril, Perindopril, ends in ‘pril’)

Ace inhibitors widen and relax blood vessels; this reduces blood pressure and helps to protect the lining of blood vessels. They are used after a heart attack to reduce the risk of a further heart attack. They are also given even if you do not have high blood pressure.

Side-effects

• As ACE inhibitors reduce blood pressure you may feel dizzy after taking them. This normally settles, but if it continues try taking them at bedtime. Or talk to your Cardiac Nurse/GP/Pharmacist.

• ACE inhibitors can cause a dry cough, which normally settles. But if not, you can discuss switching to another medication which does not cause this cough. Also, some people experience cold like symptoms for a short while once starting them.

• It can cause problems with impotence.

A blood test is taken at your GP surgery once you have commenced on this medication, or the dosage is increased. Your Cardiac Nurse can discuss it further if you need a blood test.

Beta-Blockers (Bisoprolol, Atenolol, Carvedilol, ends in ‘lol’)

Beta-blockers slow your heart rate which reduces the workload of your heart. They are used for several reasons, such as reducing blood pressure, reducing symptoms of angina and to control fast heart rates.

They also reduce the risk of further heart attacks.

Side-effects

•  When first taking them, you may feel more tired than usual and get cold hands and feet. These problems normally settle with time.

•  Some people can experience vivid dreams, which again normally settle.

•  In a small number of people can experience a wheeze or difficulty in breathing. This can happen with people who have a history of asthma, and if this occurs speak to your GP.

Statins (Atorvastatin, Simvastatin, Rosuvastatin)

Statins lower the cholesterol and triglyceride levels in the blood, these are type of fats. High cholesterol and triglycerides can clog up the coronary arteries, which can lead to a heart attack.

Your Cardiac Nurse can discuss your cholesterol levels with you, also they will ask you to have a repeat cholesterol following your assessment with them. If your cholesterol remains high, they can discuss further medication / treatment. Your Cardiac Nurse can provide further information on cholesterol if you would like it. Please ask.

Statins are best taken in the evening or before you go to bed, because it is when you are sleeping cholesterol is produced. Any drug therapy to lower cholesterol should be combined with a low-fat diet, it is best to avoid grapefruit because it can affect the way the medication works.

Side-effects

• Some people experience a mild stomach upset and a rash.

• Can experience generalised muscle weakness, aches, or pains. This can be resolved by changing the dose or type of statin you take.

There are many other heart medications you might be on, and your Cardiac Nurse will happily go through these with you, we have just listed the common medications. You might be given medication to treat existing Angina, or you might have been given a GTN spray. Please speak to your Cardiac Nurse who can provide further information for you.

It is important to take your medication as prescribed and to let your GP/pharmacist know if you take any other over the counter or herbal medications.

If you experience any side effects, it is important to speak to your GP or Cardiac Nurse who will be able to help you.

Prescription Pre-payment Certificate

If you currently pay for your prescriptions, it will be more cost effective if you buy a ‘pre-payment certificate’ from your local chemist. You will pay a lump sum ‘up front’ and then any prescriptions you need during that time will be covered.

List of your Medications, the dose and when you take them

The next part of this booklet will look at the avoidable risk factors of coronary heart disease and offer information about each one. It also contains information on exercise and how to build this up safely and gradually when you are first discharged from hospital.

Some of the sections might not be relevant to you. This is your journey, and these sections are here to help set your own goals to improve or maintain a healthy lifestyle. Again, your Cardiac Nurse can help you with this in the community.

Once you have had an assessment with your Cardiac Nurse you will receive a letter from us inviting you to our information sessions, which looks at these topics in more detail. These are held online, are held ‘live’ with one of our team in small groups on a Wednesday morning. All the information will be in the letter which will follow.

Healthy Eating

Healthy eating applies to everybody, not just people with heart conditions. Eating a healthy diet following Coronary Heart Disease, heart attack or heart surgery is even more important to reduce your risk of developing further heart problems in the future.

Current health guidelines suggest adopting a ‘Mediterranean’ style diet, and this diet helps protect our bodies from future heart problems. It can also help manage cholesterol levels.

•  Reduce your intake of saturated fat (found in processed food, pastries, cakes and biscuits for example).

•  Increase your consumption of healthy fats (oily fish, nuts and seeds, avocado, olives and olive oil, sunflower and rapeseed oil).

•  Have at least 5 portions of fruit and vegetables a day. Fresh, frozen, tinned (in natural juices).

•  Eat more wholegrain foods. These are high in nutrients and can contain 75% more nutritional value than ‘whiter’ cereal. This             includes wholemeal bread, pasta, brown rice and oats.

•  Have less salt and sugar. We should have 6g of salt per day, which is about a teaspoonful. This is not a lot, considering that 75%   of the salt we eat is already in everyday foods we eat. Look at food labels and avoid adding salt to your cooking and food. Recent   media coverage has highlighted the high consumption of sugar in our diets, it is important to check the food label.

•  Reduce your intake of processed foods. These are normally high in saturated fats, high in salt and sugar.

Know your waist measurement!

Evidence suggests that carrying too much weight around your middle increases your risk of heart disease.

 

Know your waist measurements 

Men waist measurements	Women waist measurements	Health Risk
Below 94cm (37”)	Below 80cm (31.5”)	Normal
94-100cm (37-40”)	80-87cm (31.5-34.5”)	Increased Risk
100cm and above (40%)	88cm and above (34.5”)	High Risk

 

• Monitor portion Sizes. What you should be eating is often a much smaller portion than you imagine. You could use a smaller plate.  Some people find writing down what you have eaten helps them stay in control.

• Cut down on pre-packed and processed foods. These should be the smallest proportion of your dietary intake.

• Swap refined carbohydrates for wholemeal varieties.

• Bulk up meals with extra salad and vegetables. Think of the food you eat in a day, the largest portion should be vegetables/salad, then carbohydrates (pasta/rice/ potatoes) and then protein (meat/fish/pulses/eggs).

Your Cardiac Nurse can provide further information on healthy eating, again please ask if you would like this.

More information can be found:

Heart UK Cholesterol Charity

British Heart Foundation 

Alcohol Intake

If you enjoy having alcohol it is recommended men and women should have no more than 14 units per week, spread over 3 or more days. It is recommended to have at least 2 alcohol-free days a week.

Going over this limit or ‘binge’ drinking increases your risk of further heart problems.

It is important to know how many units is in the drink you have.

Find more information about drinking less alcohol 

Smoking

We all know smoking is bad for us and is harmful to your heart. Quitting smoking is something positive you can do to improve your health.

Stopping smoking is the single most important thing a smoker can do to live longer.

There is much help and support available to you. Each GP surgery has a smoking cessation nurse plus there are other organisations. Nicotine Replacement Therapy (NRT) is available to help you quit and can increase your success of quitting by 4 times. These come in many forms, from patches, gum, inhalators, nasal spray, and tablets. These are all regulated.

Unlicensed products for example using a vape, are not recommended as they are not regulated.

Help is available from:

NHS Quit smoking

NHS stop smoking services 

One you Plymouth Quit smoking 01752 437177

Also speak to your practice nurse at your GP surgery.

Blood Pressure

Blood pressure is the measurement of the pressure in your arteries, it rises and falls as the heart pumps out blood.

The top number (systolic) measures the pressure in the artery as the heart pumps and the bottom number (diastolic) measures the pressure in the artery when the heart is relaxed.

140 or below is a normal systolic reading. 85 or below is a normal diastolic reading.

(If you are diabetic you should aim for a BP about 130/80)

These figures are a guide and are a resting blood pressure. It is very normal for your blood pressure to rise and fall depending on your activity.

Controlling your blood pressure is very important, as too high is one of the risk factors of major heart disease and can also lead to other health problems.

• A raised blood pressure can be caused by;

• Being overweight

• Drinking too much alcohol

• Kidney disease

• Lack of exercise

• Too much salt in your diet

• Stress

Improving the above can reduce your BP and reduce your risk. Also, medications can help reduce your blood pressure, which has been already discussed.

Diabetes

If you have diabetes, you have a higher risk of developing Coronary Heart Disease. Diabetics can often have high cholesterol. Maintaining good control of your blood sugars, with diet and medications, can reduce your risk.

Your blood sugar levels are monitored yearly by your GP surgery (HbA1c), and you might already regularly test your blood sugar level at home. A normal blood sugar level is between 4-7mmols.

If you are going to attend our exercise programme, we sometimes will ask you to monitor your blood sugar level before and after you exercise. You should bring your own monitoring kit (if you have one).

We also ask you to bring a sugary snack/ drink with you as sometimes your blood sugar can reduce after exercise.

For more information discuss with your Cardiac Nurse or your diabetic nurse/practice nurse.

Stress and Anxiety

It is quite normal to feel anxious and worried following a heart attack, heart surgery or any other frightening experience. Also, it is normal to feel low in mood following being discharged from hospital. The good news is these feelings

and anxious thoughts usually go away as time passes.

Feeling anxious can cause unpleasant symptoms including, rapid pulse, dry mouth, a sinking feeling in the tummy and strange pains. When we are feeling anxious this can cause a release of adrenaline which prepares our body to ‘run (flight) or fight’. Problems start when we do not need to run or fight, and this adrenaline does not get used up and causes these unpleasant symptoms.

These symptoms can increase your anxiety and make you feel something is wrong and you may be worried that you may have another heart attack.

The important thing to remember is what you are feeling is the effects of adrenaline, they are not dangerous, just unpleasant. Notice what is happening to your body at the moment, not what you fear may happen.

Stress

Stress is a normal part of our lives; our body is designed to deal with stress (Fight and flight response). A moderate amount of stress does not cause long time harm.

The problems start when there is constant stress, for example external pressures (e.g. work, money, other people) and by internal pressures (e.g. our reactions to these pressure, high blood pressure). This constant feeling of being stressed can cause health problems.

Also, some people’s response to stress can lead to unhealthy behaviours, for example, smoking, drinking alcohol and comfort eating.

•  Taking time for yourself, learn to relax. This might be in many forms, exercising, reading, listening to music, or even taking part in     a relaxation technique.

•  Exercise; this improves your sense of wellbeing and makes you feel good about yourself.

•  Learn to say NO, be realistic with your time, remember pace yourself.

•  Talk to friends, family members or health professionals.

Talk to your Cardiac Nurse if you are feeling low, stressed, or anxious. We are here to help and can guide you to other services for more professional help.

Plymouth Options (for people who live in Plymouth) 

Tel: 01752 435419

Email: plymouthoptions@nhs.net 

Talking Health, Depression and Anxiety Service (for people in the South Hams and West Devon)

Tel: 01392 682141

Email: dpt.talkinghealthDAS@nhs.net 

Exercise following discharge

Exercising after a heart attack or by-pass surgery may seem like a daunting prospect, but for most people it’s one of the best things you can do to help you get your fitness back and reduce your risk of further heart problems. However, there are risks if you over-do things and try to do too much, too soon.

When you have your assessment with the community Cardiac Nurse, they will give you more detailed information regarding exercise following your heart attack or your by-pass surgery. This information is some general advice for your first couple weeks at home.

Everyone recovers at a different pace. This may be related to your activity level before your admission, any complications that you had or the amount of damage to your heart muscle.

 It’s really important that you don’t rush or have unrealistic expectations of yourself while you recover. Your heart has been through a massive trauma and needs time to heal, think of it as a broken leg! It needs time to form scar tissue which helps the healing process and if you overdo it as soon as you get home this can interfere with the process and cause problems down the road. So, don’t overdo it,

as you might end up feeling worse, delay your recovery and lose newly built confidence.

If your mobility is limited mainly to the home, and the below walking programme is not

achievable, keep yourself active and moving around the home as much as possible. The more activities of daily living that you can do for yourself the better, and we advise you to avoid prolonged periods of sitting.

First steps…A guide to your walking programme

Walking is an ideal form of exercise after your heart attack or by-pass surgery and can help to give your heart the workout it needs. You could walk in and around your house, in the supermarket, or around the block. Remember to start at a slow, easy pace. You may need to plan rest areas or places to sit along the way. You could also try walking along a bus route and then plan to jump on the bus to get home if/when you feel tired. If you do need to rest, please keep your feet moving/heels moving up and down gently in order to avoid your blood pressure dropping abruptly.

The walking programme shown below is a guide only. Remember that everyone is different and recovers at a different rate. You must exercise at whatever level feels right for you.

Be sensible; if you are finding it hard take things slowly. If you are finding the walking very easy you may progress through each stage quite quickly.

If you feel comfortable and you are coping with your current walking level, try to increase your walk by one or two minutes, and move on to the next stage when you are ready. One example would be to add an extra 2-3 minutes to your walking time every other day. It is important that you increase the time and pace gradually, with more emphasis on increasing the time initially, rather than the pace.

Over time, ideally you should be aiming to accumulate at least 150 minutes of ‘moderate intensity’ activity (such as brisk walking) per week. The Cardiac Nurse will give you more information regarding this during your assessment. We recommend that this is achieved in bouts of 10 minutes or longer. This includes anything that raises your heart rate, and makes you breathe faster and feel warmer. For some people, this could be building up to 30 minutes of brisk walking, 5 times per week, but for others a shorter duration may be more suitable (e.g. building up to 10 to 15 minutes, 2-3 times per day. In the early stages, you should exercise at a

low intensity and gradually build up the time that you are doing the activity.

Please refer to the table below for an example of how you could safely progress your walking:

 

Stages 

Stage and time	Duration	Pace
Stage 1 5 minutes	Twice daily	Gentle pace, ideally flat ground
Stage 2 10 minutes	Daily	Gentle/Leisurely pace
Stage 3 15 minutes	Daily	Leisurely/moderate pace
Stage 4 20 minutes	Daily	Moderate pace
Stage 5 25 minutes	Daily	Brisk pace
Stage 6 30 minutes	Daily	Brisk pace

How hard should I be pushing myself? What is ‘moderate activity’? 

Moderate intensity activity, such as brisk walking, should make you feel warmer, breathe harder and make your heart beat faster than usual, but you should still be able to hold a conversation. If you find yourself gasping and not able to say more than a few words without pausing for breath, then you are working too hard and need to slow down. Try not to stop completely, as this has implications for your blood pressure. Instead, try to just slow your pace until you have recovered.

Warm-up

It is extremely important that when you start a walk (or any activity) you begin slowly and gradually build up to your full pace. Ideally the warm-up should be between five and fifteen minutes long, depending on the length of your walk. The warm-up should be at a slower pace and therefore less effort than the middle part of your walk.

This will give your muscles, specifically your heart muscle time to adapt to the exercise that you are asking it to do. The warmup has very important safety implications, including reducing the risk of angina and disturbing your heart rhythm.

It may be difficult for you to follow this advice if you have to walk uphill immediately, e.g. if you live at the bottom of a hill. If this is the case, you should find a flat spot (e.g. your garden/house) to do a warmup (e.g. slower paced walking) before you attempt the hill (at a slow pace). Alternatively, it may be more suitable to travel by car to somewhere flat to walk.

Cool-down

Similarly, you should never stop suddenly. It is important that you gradually slow your pace as you reach your destination. Ideally the cool-down should last between five and ten minutes. The cool-down helps to bring your heart and body back to its resting state gradually and reduces the risk of post exercise complications, such as a sudden drop in blood pressure and disturbances in your heart's rhythm.

Walking Diary

Use the diary below to write down the total minutes spent walking and keep track of your progress.

As mentioned previously in this leaflet more information will be given to you regarding exercise and our exercise sessions once you meet your community Cardiac Nurse.

Work

Returning to work can be a daunting prospect, and when you return to work is different for everyone, taking into consideration the type of work you do. For example, if you have a manual job, it will take longer to return than if you are office based. The hospital can provide a fit note (sick note) on discharge, and your GP can increase this. Your Cardiac Nurse can discuss this further with you.