Advice and support for Rebecca

Advice for Rebecca

1) Safe exercise levels: 

• Rebecca is advised on the benefits of engaging in a supportive cardiac rehabilitation programme which includes moderate intensity aerobic exercise using an interval training approach, plus light resistance training.
• She can continue with yoga, but return to endurance running / marathon should be approached cautiously.
• During yoga, Rebecca should avoid the head down position, and isometric poses. She should also avoid abrupt, high intensity burst of activity, particularly where there is breath holding / valsalva. All of these things can cause sudden blood pressure changes. Valsalva manoeuvre is performed by a forceful attempt of exhalation against a closed airway, usually done by closing one’s mouth and pinching one’s nose shut while expelling air, as if blowing up a balloon.

For more information on exercise after SCAD visit: Beat Scad

2) Include her husband in all discussions (if Rebecca consents to this):

• Healthcare providers should include Andrew in discussions if Rebecca consents to it. By including him in discussions, it can be key in helping to alleviate his frustration around, and understanding of, Rebecca’s SCAD diagnosis and management – enabling him to feel in a better position to support her.

3) Psychologist referral:

• Some rehabilitation teams offer a stepped approach to psychological referral, with other team members (e.g. occupational therapist) able to provide low level support if escalation to psychology is not deemed to be necessary. Rebecca was offered a referral to psychology services, but for the moment has chosen not to. However, it is made clear to Rebecca that she can still be referred in the future to help her manage her anxiety.

4) High blood pressure (hypertension) treatment:

• During her hospital visit, Rebecca’s blood pressure (BP) was measured and recorded as slightly elevated (145/90). Rebecca is not sure what her blood pressure usually is.  
• Rebecca is given a home blood pressure monitor and information about high blood pressure so that she can monitor her BP at home for a period of time. This will help diagnose if she has high blood pressure (hypertension) and if treatment is needed.    
• [NICE Guideline NG136, 2019; plus NG136 Patient decision aid on how do I control my blood pressure? Lifestyle options and choice of medicines (nice.org.uk)] 
• CHSS Resources Hub: High Blood Pressure 

5) Consider beta-blockers in discussion & agreement with a healthcare provider:

• Beta-blockers are a class of drugs which act by blocking the effect of the sympathetic nervous system (fight or flight response) on the heart to reduce the workload of the heart and resting heart rate.
• ACE inhibitors are a class of drugs which inhibit (block) the production of angiotensin (hormone). 
• ACE inhibitors can cause abnormalities in development of babies; so, when prescribing ACE inhibitors for women of reproductive age it is important to ask about pregnancy intention, use of contraception and provide information on how the drug will be managed if pregnancy is considered. 

6) Importance of maintaining a healthy body weight:

• Maintaining a healthy body weight is important to reduce the risk of developing a number of health conditions, including cardiovascular disease.
• Body mass index (BMI) is a commonly used method to check weight. It is calculated from weight (kg) / height (m2).

• Rebecca’s weight is healthy.
• To learn more about healthy body weight, please visit:
  • CHSS Resources Hub: Healthy Weight
  • Body mass index (BMI) | NHS inform
  • NHS: Managing your weight

7) Consider glyceryl trinitrate (GTN) spray and education on proactive management of chest pain:

• Glyceryl trinitrate (GTN) is a type of medicine, called a nitrate, that dilates (widens) blood vessels and is used to prevent and treat chest pain caused by angina. It is not standard treatment for SCAD but could be considered if Rebecca has chest pain. As Rebecca did not have a restriction in blood flow (ischaemia) on her ECG, and did not require angioplasty, her chest pain may not be alleviated by GTN. So, a simple analgesia may be more appropriate to relieve her pain. 

8) Consider aspirin

• Aspirin is an antiplatelet medication used to reduce blood clotting (platelet aggregation and thrombus formation) in SCAD. It can cause heavy menstrual bleeding, and Rebecca should be made aware of this. There are ongoing clinical trials (research) about the use of aspirin in SCAD.

9) Cardiac Rehabilitation Referral 

• Rebecca is referred to a cardiac rehabilitation programme to start attending 6 weeks after she has been discharged from the hospital.  
• The aim of the cardiac rehabilitation programme is to help Rebecca continue to recover from her SCAD and return to living her life as fully as possible. 

Rebecca is discharged from hospital and receives an appointment to attend the cardiac rehabilitation programme 6 weeks later.