Creating a coping strategy: the second stage of heart attack recovery

by Carolyn Thomas   @HeartSisters

Earlier this week, I revisited Dr. Wayne Sotile’s excellent book, Thriving With Heart Disease – a favourite of mine since I discovered it several months after my own heart attack, and particularly the book’s second chapter, The Four Stages of Heart Illness.  Dr. Sotile, a cardiac psychologist, describes the newly diagnosed heart patient’s journey through a series of four separate stages.

Dr. Sotile believes that your recovery will have fewer surprises if you are familiar with these commonly-experienced stages and know what to expect.  The stages may not occur in any particular order.

Today, we consider the second stage of cardiac recovery*:

Stage 2:  Creating a Coping Strategy Everyone starts to grasp what heart illness is, what’s involved in treatment and recovery, and that the patient and family must work as a team.

According to Dr. Sotile, once your heart condition has stabilized and your fears of imminent death have eased, you start asking:

“What happens next?” 

Most people enter this stage within a few days of the onset of the illness, either while you are still in hospital or shortly after receiving the diagnosis. Or you may not start developing a coping plan until you come home. While this is a relatively brief stage, it is crucial for both the patient and the family.

It’s at this point that you begin to understand what heart illness is, and what your recovery and treatment will involve. You may be confused and overwhelmed. Because your emotions may be fluctuating wildly, you may not be able to focus on what you need to do to get well.  For example:

  • a dietitian may be offering tips on heart-healthy cooking, while all you can think about is when you’ll be able to return to work
  • an exercise therapist might be praising the benefits of daily walking, while you’re quietly panicked about whether you’ll be able to resume your sex life (yes, you will!)

When heart disease has shaken your world and you’re trying to re-orient yourself to the new terrain, it’s sometimes hard to grasp information that doesn’t pertain to the step you’re taking right now.  Remember that things will eventually get back to ‘normal’ – albeit a new normal – and, believe it or not, you will one day pull yourself together again.

During this stage, powerful emotions surge to the surface. You and your family begin to contemplate how heart disease will affect your lives, and this inevitably opens a vein of grief.

Many people report feeling profoundly sad upon learning they have heart disease. This sadness is actually grief for your lost sense of invulnerability. None of us is invulnerable, of course, but heart disease is visceral, in-your-face proof of your own mortality and a humbling loss of innocence.

Grief is intensely personal. Each person handles it differently.  Some are outwardly emotional and  experience a wailing-and-gnashing-of-teeth variety of mourning; others report a pervasive melancholy that descends and envelops the whole family.  Many become obsessed with thoughts about life in general and their lives in particular – past, present and future.  This grieving may even continue into the next stage of your recovery, but you should be aware that now, the second stage, is when it starts.

You may not feel confident that you can cope. This insecurity is compounded by the fact that many heart patients are released from hospital after only a few days, often before they feel ready to go home.

Dr. Sotile recommends focusing on these two concepts:

  • 1.  You have made it this far.
  • 2.  You should have some idea of what you will and will not be doing for the next few days, weeks and months.

And remember that you must be an active participant in your recovery.

* Excerpt from the book Thriving With Heart Disease  © 2003 Wayne M. Sotile, PhD

Here is how Dr. Sotile describes the progress of the four stages of heart illness:

  • Stage 1:  Surviving The Crisis –  Illness strikes, and patient and family begin the journey.
  • Stage 2:  Creating a Coping Strategy – Everyone starts to grasp what heart illness is, what’s involved in treatment and recovery, and that the patient and family must work as a team.
  • Stage 3:  Handling the Homecoming Blues (This blog post): You’re suddenly on your own; reality sets in and the team must adapt to its new normal.
  • Stage 4: Learning to Live With Heart Disease – Patient and family have accepted the diagnosis and committed themselves to living with the illness, not in spite of it.



NOTE FROM CAROLYN:  I wrote much more about creating our own coping strategies after a cardiac event in my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017). You can ask for this book at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or or order it directly from Johns Hopkins University Press (use their code HTWN to save 30% off the list price when you order)

4 thoughts on “Creating a coping strategy: the second stage of heart attack recovery

  1. Pingback: World University Info
  2. This sure came at the right time. Yesterday at Cardio Rehab, I was asked to fill out a paper as to how I was feeling emotionally. It asked if I was depressed. I said no because I’m not. I described myself as being “sad” and truthfully that is how I feel.

    I think I could understand if I felt depressed, but I just don’t understand the sadness. I have no family support and my friends are leaving me at a fast rate because I can’t keep up with them right now. They don’t seem to understand how and why I feel the way I do. I have ordered Dr. Sotiles book and can’t wait until it arrives.

    Thank you for giving me a little better understanding of how I feel.


    1. Hi Sandy – have you checked out the WomenHeart online support group? Click on their logo in the right column. There are always many topics covered under emotional/psychological issues of heart disease that you might find helpful.


    2. This could be me talking. I felt the same way. Not really depressed, just sad. Sad that now I felt vulnerable, and that my life had changed irrevocably. No one around me really gets that, my husband, kids, etc. Their lives just go on, but I view mine differently now.

      I now know that I will die. Of course, we all know that, but we live our lives without clear in-your-face knowledge of that. Those of us who have had cardiac events get it. We have looked it in the eye. The up side of this though, and I am still getting there, is that we have survived! Many don’t. We have a chance to go on and it does get better. I have stopped jumping at every little twinge. I have stopped thinking I am dying at every turn or weird feeling.

      I am 10 months out and still a work in progress, but it is getting better. Womenheart has helped me so much. Go there.


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