Recovery after a heart attack
Most people who reach hospital survive a heart attack, and most of those get back to a full life. Recovery is partly about the heart healing and partly about you finding your confidence again. Both take a few weeks. Here's what to expect.
Cardiac rehabilitation: the single most important thing
Cardiac rehab is a free NHS programme, usually 6 to 12 weeks, starting a few weeks after you leave hospital. It combines supervised exercise with education about medicines, diet, stress and what to do if symptoms return. People who complete it are significantly less likely to have another heart attack or to die in the following years. It's also where you'll meet other people going through the same thing, which many find the most valuable part. Some areas offer home-based or online versions. If you haven't been contacted within 3 weeks of discharge, phone the hospital's cardiac rehab team and ask.
Driving
These are legal requirements from the DVLA, not just advice. Your insurance may be invalid if you ignore them.
| Situation | Car / motorbike | Bus / lorry (Group 2) |
|---|---|---|
| Heart attack treated with a stent, good recovery | Stop for 1 week. No need to tell DVLA. | Stop for at least 6 weeks. Must tell DVLA. Needs tests before relicensing. |
| Heart attack without stent, or stent not fully successful | Stop for 4 weeks. No need to tell DVLA. | Stop for at least 6 weeks. Must tell DVLA. |
| Bypass surgery | Stop for 4 weeks. | Stop for at least 3 months. Must tell DVLA. |
| Cardiac arrest | Stop for 6 months (or 4 weeks if a treatable cause was fixed). Must tell DVLA. | Usually a permanent bar, reviewed case by case. |
| Angina | Stop only if symptoms occur at rest, when driving, or with emotion. Restart when controlled. | Must tell DVLA. Barred while symptomatic. |
Rules change: check gov.uk/heart-attack-and-driving and ask your cardiac team. Tell your insurer too.
Work
Most people are back at work within 2 to 12 weeks, depending on the job and how much damage there was. Desk jobs often within 2 to 4 weeks. Heavy physical work, and jobs where a sudden collapse would be dangerous (driving, working at height, some safety-critical roles), take longer and may need occupational health input. Ask about a phased return. Your employer must consider reasonable adjustments, and a heart condition can count as a disability under the Equality Act, which protects you from being treated unfairly because of it.
Exercise
- Week 1 to 2: short walks on the flat, a few minutes several times a day, building up gradually.
- By week 4 to 6: most people are walking 30 minutes a day comfortably.
- Cardiac rehab will assess you and set safe limits. Follow them, then build.
- Long term: 150 minutes a week of moderate activity is the target, and it roughly halves the risk of another heart attack.
- Stop and rest if you get chest pain, unusual breathlessness, dizziness or palpitations. Use GTN if you've been given it. Follow the angina plan if pain doesn't settle.
Sex
Usually safe to resume once you can climb two flights of stairs briskly without chest pain or breathlessness, typically 2 to 4 weeks after a heart attack. The strain on the heart is about the same as a brisk walk. Loss of interest and erection problems are common for a few months, partly the heart attack, partly worry, and partly beta blockers. Talk to your GP: it's routine and treatable. Never take Viagra-type tablets within 24 to 48 hours of GTN, and tell your doctor before starting them.
Flying
After an uncomplicated heart attack with a stent, most airlines and the UK Civil Aviation Authority accept flying after 3 days if you had no complications and after about 10 days in most other cases. After bypass surgery, 10 to 14 days. After complications (heart failure, arrhythmias), wait until you're stable and have been reviewed. Carry your medicines in hand luggage, carry your discharge letter, and check your travel insurance covers heart conditions: you must declare it.
Your medicines
You'll go home with several tablets. Each one does a different job, and stopping any of them without advice increases your risk of another heart attack.
| Medicine | What it does | For how long |
|---|---|---|
| Aspirin 75mg | Stops platelets sticking together and forming clots | Life |
| Ticagrelor / clopidogrel / prasugrel | Second antiplatelet, protects the stent while it heals into the artery | Usually 12 months. Don't stop early, even for dentists or surgery, without cardiology advice. |
| Statin (atorvastatin, rosuvastatin) | Lowers cholesterol and stabilises the plaques in your arteries so they don't rupture again | Life |
| Beta blocker (bisoprolol, metoprolol) | Slows the heart and lowers blood pressure so the heart works less hard | At least 12 months, often life |
| ACE inhibitor (ramipril, lisinopril) or ARB | Lowers blood pressure and helps the heart remodel after damage | Life if there's heart muscle damage |
| GTN spray | For chest pain if it happens | Carry it always. See angina. |
Side effects like tiredness, cold hands, muscle aches or a dry cough are common in the first weeks and often settle. Don't just stop: ring the cardiac rehab nurse or your GP, because there's nearly always an alternative.
How you'll feel
Tiredness for several weeks is normal: your heart is healing and your body is adjusting to new medicines. Emotionally, about one in three people feel low, anxious or frightened after a heart attack, and many describe hyper-awareness of every twinge in the chest. This is a normal reaction to a frightening event, it usually improves over 2 to 3 months, and it responds well to talking therapy if it doesn't. Tell your rehab team or GP. Depression after a heart attack affects recovery, so it's treated seriously.
When to call 999 again
- Chest pain like your heart attack, not relieved by two doses of GTN 5 minutes apart
- Sudden severe breathlessness
- Collapse or blackout
- Palpitations with dizziness or chest pain
Call 111 or your GP for: swollen ankles, breathlessness lying flat, bleeding or bruising that seems excessive on your blood thinners, or side effects that are bothering you.
Useful links
- BHF: Cardiac rehabilitation
- DVLA: Heart attack and driving
- BHF: Travel and heart conditions
- Cardiomyopathy UK (if you've been told your heart is weakened)