Ask A Doctor Health

‘How much activity is okay after a heart attack?’

My father, who is 75 years old, has had hypertension for more than 35 years, with a couple of episodes of blackout. A year ago, he was diagnosed with 80 to 90% blockage in two arteries and stents were inserted. Ever since, he has lost a lot of weight and the blackouts have returned. Does it indicate something serious?

Blackouts, especially at that elderly age, may not be related to the blockage in the blood vessels of the heart. They may be related to slowing of the heart rate due to disturbances in the electrical cables of the heart (conduction system). Conditions such as sick sinus syndrome (a sluggish natural pacemaker in the heart) or heart blocks (in the cables), which cause such slowing, are more common in the elderly.

Sometimes, rapid heart beat triggered by electrical short circuits in the heart can also cause blackouts, as can neurological disturbances. Even medicines taken for lowering blood pressure may cause a marked drop in blood pressure when an elderly person stands up (postural hypotension) and cause a blackout.

Do consult a cardiologist who can clinically examine and investigate to find out which of these is the cause of blackouts. Tests, such as Holter monitoring, often help in the diagnosis of heart rate and rhythm disturbances.

If cardiac causes are ruled out, the cardiologist will refer your father to a neurologist. The elderly also tend to suffer from hyponatremia (low level of blood sodium) which can cause unconsciousness — blood tests will reveal that. The cause of severe weight loss also needs investigations beyond the cardiac tests.

I am 47 years old and I suffered a heart attack in November last year. My family is constantly worried and is always asking me to reduce my activities and work load. How much activity is usually okay?

The amount of activity you can safely do is determined by the cardiac function, which is usually assessed by measuring the pumping efficiency of the heart (ejection fraction) that can be assessed by echocardiography (Echo test). That efficiency is determined by how much of your heart muscle was affected by the heart attack.

Whether you can undertake a certain level of exercise without experiencing deficiency of blood flow to the unaffected portion of your heart is usually assessed by an exercise test (also called a ‘stress test’). Echo and Exercise tests are a part of the standard assessment for a person who has recovered from a heart attack. Your cardiologist would have performed these on you. That assessment will guide you on the permissible level of activity.

In general, being physically active is beneficial after recovery from a heart attack, unless there are specific reasons for which your doctor has advised you not to. Regular physical activity reduces the risk of a future heart attack and strengthens the heart muscle. So, consult your doctor and liberate your family from their fear. It is understandable that they are concerned but they should not make you inactive, as that is not good for your heart. Do, however, reduce mentally stressful work tasks.

Dr K Srinath Reddy is the President of Public Health Foundation of India; former president World Heart Federation; former Head of Cardiology at the All India Institute of Medical Sciences, New Delhi

Nothing in this column is intended to be, and is not, a substitute for professional medical advice, diagnosis or treatment. Please seek independent advice from a licensed practitioner if you have any questions regarding a medical condition. Email us at

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Printable version | May 6, 2021 6:42:03 PM |

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