Although angioplasty is a quick solution to ACS or angina, in reality atherosclerosis is a progressive disease and one can only hope to retard its progression through healthy diet and exercise. In this article, Dr. Sundeep Mishra provides dietary and exercise tips that doctors can give patients post angioplasty procedure.

Angioplasty stenting is a defining moment in life for most patients undergoing the procedure. Although it is generally a solution to an immediate problem (acute coronary syndrome (ACS) or uncontrollable angina), not only does it provoke a lot of retrospection (on why disease happened in the first place), but also a lot of anxiety for the future; will the disease recur, can I die out of it?

The reality is that atherosclerosis is a progressive disease and all modern medicine can hope for is to retard its progression. In other words, recurrence of symptoms/disease is inevitable but what healthcare can do is prevent this recurrence long enough that the individual dies of natural death/death from other causes.

So the essential question is what can we do to delay its progress?

There are two essential and critically important steps that can be undertaken to retard the progression of disease. Number one is to take all the prescribed medicines in time. After angioplasty, a group of drugs is advised with the aim to decrease clotting, lower lipid level and control blood pressure or diabetes mellitus (if present) because, not only are all of these contributing factors for coronary heart disease in the first place, they are also involved in the further recurrence of disease. Most patients understand the rationale behind the use of drugs and therefore are very careful to follow the first step.

The second important method to alter the course of disease is lifestyle management. This modality also decreases the chances of recurrence because it affects the cause/aetiology which contributed to development in the first place. Unfortunately most patients do not appropriately follow the lifestyle recommendations because one they don’t understand its importance in the first place and second, even if they understand the importance they don’t clearly understand what is to be done. In other words, there is a lot of confusion about what exactly needs to be done. Below are some of the essential components and tips for lifestyle management after angioplasty.

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Heart-healthy diet

Which oil to use?

1. No single oil is perfect but if one oil is used for Indian kind of cooking, it could be rice bran oil or mustard oil. Ground nut oil is better too.
2. Instead of one oil, it is advised to use a combination of oils (2-3 oils as a mixture or separately- each dish cooked in different oil) is much better.
3. Hydrogenated oil or vanaspati ghee is the worst kind of oil and should be strictly avoided. All kinds of street foods and dhaba foods as well as packaged foods like bhujiya, biscuits, cakes should be avoided because they are generally cooked in vanaspati ghee unless otherwise specified.
4. Reuse of oils should be strictly discouraged because frying at high temperature leads to ‘smoking” of oil which makes it extremely harmful.
5. Virgin olive oil is a good only for salads/light cooking because it “smokes’ at a very low temperature and becomes harmful when used for frying of any kind.
6. Natural unprocessed oils are better than refined oils.

Eating 1-2 eggs/day and fish twice/week is not harmful because dietary cholesterol consumption is no longer a matter of great concern because;

1. Any cholesterol in foods is broken down in the digestive system and not absorbed directly.
2. Blood (serum) cholesterol is derived mostly from cholesterol synthesised in the liver.

Thus dietary cholesterol consumption in moderation is permissible.

Fried foods and refined sugar should be avoided

1. Instead, patients should be encouraged to eat lots of fruits and vegetables, and nuts in moderation.

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Exercise after angioplasty

Exercise should only be performed as per recommendations of the treating physician. Rest for minimum of 1-2 days after angioplasty is advised. After 2 days the patient can begin some exercise; generally by resuming some lifestyle activity or any part of normal routine like sitting in a garden, visiting a nearby temple etc.

Some simple tips are: taking a flight or so of stairs, parking further away and walking to pick up groceries, or other similar exercises. The idea is to slowly increase the heart rate and then build up the activity level. With each passing day more steps can be undertaken, or walking distance enhanced, and activity level slightly increased.

1. During early days, patients can resume normal day-to-day activities but avoid certain heavy exertion activities like- carrying heavy groceries, carrying a child, cleaning, and gardening as it can increase heart rate.
2. Ultimately the aim is to achieve an exercise level equivalent to 30 minute walk/day or 150 minutes/week. The patient can also opt for slow jogging, biking, swimming, hiking, or light dancing.
3. In addition to isotonic exercise (walking, jogging, swimming) the patient can also opt for some stretching exercise and some weight-bearing exercises.
4. Yoga is a good stretching and weight bearing exercise. It can be done 1-2 times/week,each session of 45-60 minutes or so. The majority of yogic asanas can be performed but one has to avoid those asanas where one has to lie on the abdomen (lying on back, sitting, standing is acceptable). Yoga is a low-impact exercise which gradually strengthens but without increasing the heart rate too much. Additionally, it also trains breathing and helps relax and de-stress (Pranayam).

Tips and tricks while performing exercise after angioplasty;

1. Patients should be mindful of extreme weather conditions. Extreme hot, cold, or humid conditions can produce symptoms like chest pain, difficulty in breathing, or chest tightness. In that case, exercise inside home is advised.
2. Patients should also be mindful of side-effects or symptoms during exercise, stop exercising and call the doctor if these symptoms are experienced- chest pain, chest tightness, shortness of breath or difficulty in breathing, wheezing, dizziness or light-headedness, palpitations, nausea or discomfort in jaw, arm, shoulder, back or stomach.
3. The patient should always be accompanied by a friend/relative while exercising (especially during early days) who might help if symptoms are precipitated and call for medical help if required.
4. Patients should not venture too far away from home/office and always keep a phone handy.
5. Patients should stay hydrated; take a glass or so of water or drink before and after the exercise
6. Patients should dress for the weather.

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How to start an exercise program

Exercise should be started slowly for first 10 minutes or so, slowly building up the activity. Patients should not sit immediately after exercise but undertake 5 minutes or so of very light exercise (to cool down, otherwise there could be symptoms of palpitations or light-headedness).

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Getting a good night's sleep

1. It is important to stick to a regular bed-time every night. Patients should not travel long distances overseas to avoid jet-lag for 6 weeks or so.
2. Caffeine, alcohol, and big meals should be during sleep time.
3. Doctor should be consulted if sleeping difficulties persist.

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Lifestyle changes

• Quitting smoking
• Reducing weight
• Controlling blood pressure
• Keeping stress in check. Several simple techniques can be applied for stress management;
  • Taking deep breaths (Pranayam)
  • Going for walk
  • Yoga
  • Listening to soothing music
  • Calling a comforting friend

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The writer, Dr. Sundeep Mishra is a Professor of Cardiology.