ACS Home Care
Home care for acute coronary syndrome includes:
- Stop smoking
- Avoid exposure to secondary smoke
- Eat a healthy heart diet:
- Low cholesterol diet.
- Low fat diet.
- Eat high quality fats.
- Low salt diet.
- Eat foods rich in omega-3 fats
- If you have been prescribed medications to control high cholesterol, so not skip doses.
- Follow an exercise plan developed with your doctor
- Weight loss if you are overweight.
- Take any prescribed heart medications as directed:
- Don't skip doses of your heart medication
- Avoid running out of your prescribed heart medications
- Don't stop your medication when you feel better
- Talk to your doctor before stopping your heart medication if you feel worse.
- Be aware of potential drug side effects
- Learn how to take your blood pressure.
- If you have high blood pressure, don't skip doses of your medication
- Check your blood pressure every day:
- If you have diabetes:
- Check your blood sugar every day.
- Keep a log of your results.
- Take your diabetes medication as directed
- Learn how to take your own pulse.
- Control chronic stress and anxiety
- Let your doctor know if you are suffering from severe or prolonged depression.
- Avoid alcohol, or drink alcohol in moderation:
ACS BP Checks
Regular blood pressure monitoring is important for anyone who has suffered from acute coronary syndrome. Early detection and treatment of high blood pressure can help prevent damage to the coronary arteries.
Taking your Blood Pressure
A number of devices are available for home blood pressure measurement. Digital blood pressure devices are easy to use: they automatically calculate the pulse and display the systolic and diastolic pressures. However, a simple blood pressure cuff with a stethoscope is the most accurate way to measure blood pressure.
Tips for Obtaining an Accurate Blood Pressure
- Remain seated or lying flat with the arm supported at heart level.
- No smoking or caffeine for 30 minutes prior to measurement.
- Rest for 5 minutes before taking your blood pressure.
- The blood pressure air bladder should nearly encircle the arm: persons with large arms may require an extra large adult cuff. Cuffs are usually marked to indicate the acceptable size range.
- Apply cuff 1/2 inch above elbow crease.
- Locate brachial pulse and place the stethoscope bell at this location.
- With the valve closed, pump up cuff bulb to approximately 210 mm Hg, or a point where no sounds are heard through the stethoscope.
- Open the valve slowly (2-3 mm Hg per second) and listen for the point where the tapping sounds are first heard. The corresponding reading on the dial is the systolic pressure.
- Then, listen for the point where the tapping sounds stop. The corresponding reading on the dial is the diastolic pressure.
- Perform two more readings per session, separated by 5 minutes.
- The blood pressure must be elevated during at least 3 separate sessions to diagnose hypertension.
Systolic Pressure Guideline for Adults
|Systolic Blood Pressure||Assessment|
|Over 140-159||Hypertension Stage 1|
|160 or higher||Hypertension Stage 2|
Diastolic Pressure Guideline for Adults
|Diastolic Blood Pressure||Assessment|
|90-99||Hypertension Stage 1|
|100 or higher||Hypertension Stage 2|
Dietary guidelines for those with acute coronary syndrome include:
- Control calories:
- Eat quality fats:
- Use virgin olive oil and other unsaturated, low-cholesterol fats.
- Eat the right amount of fats, carbohydrates and protein:
- Limit your fat intake to 20 or 30 percent, but don't substitute simple carbohydrates for fat.
- Less than 7% of the day's total calories from saturated fat.
- Up to 10% of the day's total calories from polyunsaturated fat.
- Up to 20% of the day's total calories from monounsaturated fat
- Avoid fad diets:
- Eat a well-rounded diet instead.
- Eat small, frequent meals.
- Avoid large and heavy meals.
- Limit cholesterol in diet:
- To less than 200 milligrams a day.
- Limit iron intake:
- Eat more fiber:
- Whole grains are best.
- Eat plenty of fresh fruit and vegetables
- Reduce salt in your diet
- Optimal: no more than 1,500 milligrams per day.
- Check with your doctor about supplementing your diet with B vitamins:
Lifestyle changes that can slow the progression of acute coronary syndrome include:
- Avoid alcohol except as directed by your doctor.
- Stop smoking
- Avoid exposure to secondary smoke
- Eat a healthy heart diet:
- Maintain a healthy body weight.
- Regular exercise:
- Talk to your doctor about an exercise plan that is right for you.
ACS Taking Control
The successful treatment of acute coronary syndrome and other forms of coronary artery disease requires your participation. Here are answers to some important questions.
Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.
How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.
How can you participate in your health care?
To participate you must:
- Learn to take responsibility for your own health.
- Learn to partner with your doctor.
- Learn how to make active decisions about your health.
How can you learn what you need to know?
- Educate yourself.
- Be skeptical: Learn to separate fact from fiction.
- Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
- Be careful about where you get your health information.
- Some of the best sources for health information on the web are professional societies and non-profit organizations.
- Ask your doctor what he or she recommends.
- Examine the credentials of the authors.
- If you are reading about symptoms and disease, your best source is a licensed physician.
- Pay attention to when the content was last updated.
- Make sure the person is not just trying to sell you something.
Important questions you need to answer:
- What things in your control can increase your risk for disease?
- What can you do to decrease this risk?
- What are vaccines and how can they help you?
- How do your lifestyle choices increase your risk for disease?
- How can you reduce stress?
- What minor health problems can you treat at home?
- When is a medical problem "serious"?
- When should you call the doctor?
How can you find the right doctor?
- Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
- Establish a relationship in advance with your doctor.
- Make sure you are comfortable with your primary care physician.
- The internet contains many resources where you can do research to locate the doctor that is best for you.
- You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
- Be open-minded, and allow your doctor to know you well. This will improve communication.
Important information you need to make your decision:
- Physician credentials:
- Internship and residency training is usually best from respected institutions, universities, and major hospitals.
- Look for board certification in the specialty.
- Ask about membership in medical societies.
- Community and professional reputation are also important.
- Are other patients happy with the doctor?
- Has the doctor been disciplined by hospitals or agencies?
- How long has the doctor been in practice?
- In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
- Does the doctor communicate well? Are your questions answered during busy times?
- Does the doctor welcome you to help make decisions about your care?
- Is the doctor available when you need care?
- What is the doctor's after-hours coverage?
- Is he or she a member of a large group?
- Do the doctors' cross-cover one another?
- Where do they admit patients?
What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.
For any recommended test, medication, or surgery, remember to ask:
- How will this help me?
- How much will it cost?
- Is it covered by your insurance?
- What are the potential side effects and risks?
- What are my alternatives?
For tests, remember to ask:
- Is it done in the office or at another facility?
- Is it painful?
- How will the results of this test influence my care?
For surgery or other procedures, remember to ask:
- How long will it take to heal?
- How many cases has the doctor done?
- What would your doctor do if he or she were the patient?
- Where is it done?
- Who will perform it?
- What are the doctor's qualifications?
What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.
The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
- To be spoken to in words that you understand
- To be told what's wrong with you
- To know the benefits of any treatment and any alternatives
- To know what a treatment or test will cost
- To share in treatment decisions
- To read your medical record
- To refuse any medical procedure
What should you do before an office visit?
- Bring all important medical information with you to the visit.
- Make sure you can answer questions about the following:
- Allergies and side effects to medicines
- Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
- Insurance information
- Marital and sexual history
- Past injuries and hospital stays
- Past medical problems
- Past surgeries and operations
- Pre-visit questionnaires
- Use of tobacco, alcohol and drugs
- Work history
What should you expect from the visit?
- You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
- Bring along a book or toys for the kids. You may also have to wait during busy times.
- Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
- Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
- Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
- Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
- If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
- Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.
What should you know about your medications?
Every year many people become ill because of problems with medications.
Remember to ask:
- What side effects to expect.
- What drug interactions are possible.
- Find out if a new medicine reacts with those that you are taking now.
- Many over-the-counter drugs and dietary supplements can also cause serious side effects.
- Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
- Make sure you can drive or operate machines safely while taking a medicine.
- Ask your doctor how much a prescription costs.
- Is there a less expensive option or a generic version?
What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.
Three simple questions can help you get the most from your treatment plan:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do these things?
Other important points:
- Be sure you understand your treatment plan.
- Stick with the treatment plan and allow time for improvement.
- Don't stop medicines when you feel better; check with your doctor first.
- Call your doctor if your condition is becoming worse.
- Your doctor should tell you what to expect and when to follow-up or call the office.
ACS Warning Signs
Notify your doctor if you have acute coronary syndrome and any of the following:
- Chest pain, arm pain or neck pain that is triggered by exertion
- Chest pain, arm pain or neck pain that lasts more than 10 minutes
- Chest pain, arm pain or neck pain that is accompanied by nausea, sweating or difficulty breathing
- Worsening chest pain
- Palpitations that are accompanied by nausea or difficulty breathing
- Excessive sweating that is accompanied by nausea or difficulty breathing
Continue to ACS Prevention
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- Wallentin L. Prevention of cardiovascular events after acute coronary syndrome. Semin Vasc Med. 2005 Aug;5(3):293-300. 
- Yilmaz H, Basarici I. Troponin levels and acute coronary syndrome. J Am Coll Cardiol. 2005 Aug 16;46(4):741.