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QUESTION: I had a heart attack about four weeks ago, but fortunately, the doctor gave me something to dissolve the clot and the attack didn't damage my heart. A week after the attack, I went to northern Utah where a doctor used a balloon to open the artery that was blocked and I feel pretty good now. Since I live in central Utah, I can't go to the cardiac rehab program, and I have some questions about what I can and can't do physically. Should I be walking some every day? How about eating? Should I be on a low-fat diet? My wife and I are even concerned about resuming our normal sexual activity. Is this OK at this point? I hope you will address these questions in your article so that I can do what is best for this condition. Thank you.

ANSWER: I can understand your concerns. After the trauma of a heart attack and angioplasty, you really do need some help getting back to a normal lifestyle. I'm surprised that you don't have some information addressing these concerns from the physician who did the angioplasty. But printed material sometimes gets misplaced.The heart attack itself is usually caused by a blood clot that blocks the flow of the blood to some area of the heart muscle. Luckily, the clot can be dissolved with an enzyme if administered soon enough after the blockage and the damage to the heart muscle is minimal. However, the clot usually forms because of buildup of plaque that narrows the artery and precipitates the heart attack. The balloon procedure (angioplasty) is used to open up the artery that was narrowed by plaque so that normal blood flow can again occur. If your heart attack did little damage to the heart muscle, and the artery involved is now open, there should be little restriction in terms of physical activity.

You should begin an exercise program. Start at a low level of work, maybe 10 to 15 minutes of walking at a moderate pace each day for a week. Then increase the time by five minutes a week for several weeks until you are walking for 30 to 40 minutes a day. The biggest concern with angioplasty patients is that the artery will close down again (re-stenosis). If you begin to feel chest pain or any major change in the way you feel, contact your doctor.

You should also change your eating habits to cut down on fats, especially animal fats, and increase the amount of fruits, vegetables and grains you eat. There are many good low-fat cookbooks on the market that could be used to make the new diet interesting and tasty. Remember, the lifestyle practices that caused the problem in the first place should be changed, or the problem will repeat itself either in the artery that was blocked or another artery.

There is no question that sex places a load on the heart, but the load is not unreasonable, being only about five times the cost of watching TV. Most physicians would give you the go-ahead on sex if you could walk up two flights of stairs or walk a block without discomfort. Don't hesitate to call your doctor if you have any questions relating to your heart attack. I'm sure he/she will be glad to clarify things for you. Good luck.