Post heart attack anxiety and how I dealt with it (and still do)

Surviving the Heart Attack Was the Easy Part

Everyone assumes the scary part is the heart attack itself. The ambulance ride, or the moment in the ER when someone finally tells you what's actually going on. And it is scary, don’t get me wrong. Some people don’t make it. I was extremely lucky.

Nobody warns you about what comes after.

Surviving is step one. What comes after is, in some ways, harder, and it's mostly this: your body just did the scariest thing it's ever done, and now you're supposed to trust it again. For well over a year or two, every twinge, every weird ache, every moment I got a little short of breath, my brain went straight there. Is this another heart attack? Do I need to go to the hospital?

That's not you being dramatic. That's not "just anxiety," whatever that is supposed to mean. I used to think I was broken. That my heart had let me down.  Well, the reality was, in many ways, I had let my heart down. And now I needed to do a lot of work to get not just my body and heart back to where it needed to be but also, my brain. To get over this ongoing anxiousness and freaking out

Here's what actually helped–for me:Not one big thing but a host of smaller ones that added up over time. Initally, I probably tried to do too much and realized I needed to, literally, pace myself as these were likley changes that I neeed to make for the rest of my life so I needed to be able to stick to them..

1. Find a good cardiologist. Then actually listen to them.

This one's really two steps, and I didn't realize that until I was living it.

Step one is finding someone the moment you're out of the hospital (or still there depending on your situation). Don't wait, don't coast on the discharge paperwork, go find a cardiologist you can actually get in front of.  You might even meet with a few because you need to find someone you trust and can have some honest conversations with and that you both have the same mindset on what you can and should be doing.

Step two is the harder part. Listen to him/her. Trust him/her  (I actually have had two cardiologists, male and female hence the him/her). There will be at least a few times that you read some post online that might not align with what your doctor has suggested. And you should do the research and check with him or her on it.  But trust the fact that they’relooking out for you.That relationship might end up being one of the most important ones you have outside your own family. Treat it that way.

2. Cardiac rehab. It gave me back my confidence, not just my fitness.

Six weeks. For me, that meant showing up to the hospital's exercise room every single session and working out for an hour, sensors on my chest the whole time, nurses and fitness therapists watching my heart rate and vitals in real time.

I didn't expect what it actually gave me. It wasn't just cardio. It was proof. Proof of what my body could handle and what it couldn't, measured by machines instead of guessed at by my own anxious brain. That's a different kind of confidence than anything I could've talked myself into.  Cardiac rehab can be anywhere from two to twelve weeks. Most insurance covers it especially if it’s prescribed. Ask your doctor.

3. Fix your diet. Direction, not perfection.

Less saturated fat, less processed and packaged food, and honestly less sugar and alcohol than I used to think was fine. (you might not think of sugar as affecting the heart but it causes a lot of inflammation, and that’s a real problem for your heart).  On the flip side, more soluble fiber, more fatty fish like salmon and tuna for the omega-3s, and more of the stuff that actually supports your heart instead of working against it. A quick lunch could be tuna and fresh sliced tomato on toast (with a good quality extra virgin olive oil as a splurge which has important heart health benefits). It’s easy, it’s cheap, and can be made in a hurry if you have a busy lifestyle. I try to get fish in a couple times a week now. Didn't used to think about it that much at all.  Turns out that whole Mediterranean diet business might be right.

Don't try to overhaul everything in week one. That's the fastest way to quit by week three. This is a marathon, not a sprint, and the version of eating right that actually works is the boring, sustainable one, not the dramatic one. It’s the one that works for you.

4. Exercise. Take what rehab taught you and build on it.

Once cardiac rehab showed me what my body could actually do, I used that as the floor to build a real routine on. A mix of cardio and weights, four to five days a week. But if you didn’t get to cardiac rehab, that doesn’t mean your body can’t exercise. Start slow and build.

One add-on I'd genuinely recommend to anyone that is super easy and great for you: a ten minute walk after meals. Small thing. Does more than people think, for your blood sugar and honestly for your head too.

5. Sleep. Still working on this one, honestly.

Seven hours is what I aim for. Not five and a coffee, seven, most nights, though I won't pretend I hit it every time.

The 3am part is still the hardest for me. That's when the drama shows up, when you're just lying there and your brain decides now's the moment to run through everything that could go wrong in every area of your life. I still use melatonin some nights. Other nights it's meditation or my wife’s trick of a boring audio book. Whatever gets me back down, honestly, because there's no single trick that works every time. What I don’t do is reach for my phone. My heart health isn’t worth any amount of midnight doom scrolling.

Here's what got me to actually take sleep seriously, though. Sleep isn't just rest. You’ve probably heard that it's when your body does its repair work. Cortisol, your stress hormone, is supposed to rise in the morning to get you moving and drop at night so your body can heal and recover. That's the rhythm it wants. Post-heart-attack anxiety, or any anxiety, messes with that rhythm, keeps cortisol elevated when it should be dropping, which means your body never fully gets the signal to switch into repair mode. There's a whole insulin resistance piece tied into this too, elevated cortisol messing with your blood sugar over time, is worth looking into on your own if you're curious. But the short version is the anxiety isn't just keeping you awake. It's actively getting in the way of the healing your body is trying to do.

Like everything else on this list, it took time before it got easier. And to be honest I am still working on it.

6. There isn't one big thing. It's all the small things, stacked.

If you're waiting for the one breakthrough moment that fixes the anxiety and makes you feel like yourself again, I hate to tell you, it's probably not coming in that sort of lightning bolt way. What comes instead is a cardiologist you actually trust. Rehab and workout habits built slowly. Better food most of the time. Taking your medications, and if appropriate, adding nutrients your body could use more of. Moving your body regularly and finally treating sleep like it matters. None of it may be dramatic on its own but it adds up when you're not looking. 

So remember – if you try to do all of it perfectly on day one,  you probably won't stick to any of it. Do a little of it consistently and build over time and you’ll start to feel better and better, getting your confidence back.

If you're in it right now

You're not broken. Your body didn't betray you, even though it feels that way at 3am when your chest does something weird and your brain runs straight to the worst place. It just takes some time to trust it again, and that's a completely normal thing to be working through.

Read inspiring research about heart health. Talk to your doctor, and actually listen when they answer. But for what it's worth, from someone who spent well over a year or two getting over the anxiety of my heart attack : it gets better. Maybe not all at once, and not in a straight line, but it does. You'll get there.

Because you only get one heart. Till next time, Stephen.