For my whole life BHA (Before Heart Attack), I can hardly remember feeling real fatigue. Oh, sure, I’d feel sore working long hot days on our fruit farm as a teenager. Or sleepy after pulling those all-nighters in college. Or out-of-my-mind exhausted coping with a teething baby and a sleepless toddler. Or tired at the end of a stressful day juggling deadlines in my public relations career. Or maybe even pleasantly pooped after my running group finished a long road race. But generally speaking, on a day-to-day basis, never ever the kind of severe fatigue I experienced AHA.
I’ve always been one of those disgustingly perky early risers who leaped cheerfully out of bed the minute one droopy eyelid cracked open to discover the clock showed anything past 4:30 a.m. Once I finished leaping, I’d hit the coffeepot and then the shower, in that order. Then away I’d go, tap dancing 90 mph to meet the day ahead, rarely slowing down until I hit the pillow much, much later that night.
But after I was discharged from hospital following my heart attack, I was gobsmacked to suddenly experience daily bouts of extreme bone-crushing fatigue that I could never have even imagined existed before.
I remember, for example, going for a walk one day with my son, Ben, shortly after coming home from hospital. My post-op instructions from the CCU had been to walk outdoors one block a day for the first week, two blocks a day the second week, etc. Ben and I had barely made it to the stop sign at the end of our block when I had to grab his arm to lean on for support all the way home. I couldn’t believe it! I felt like a frail old lady, barely able to shuffle one foot in front of the other. And when we finally returned home (slowest pace in recorded history), I could hardly make it to the couch to recover from the exertion of this simple little walk.
What was happening to me?!?
It’s hard to describe this kind of relentless fatigue to those who have never experienced it, or to explain fatigue that is not relieved by just resting. And nobody had warned me in hospital that this relatively common reality during cardiac recovery was heading my way. I could find only a handful of research studies confirming what I was experiencing.
A 2008 Swedish study out of the University of Gothenburg, for example, found that about half of all patients who survive a myocardial infarction (heart attack) are still experiencing “onerous fatigue” four months after the infarction.*
Dr. Pia Alsén, author of this study, observed:
“Many people experienced the fatigue as new and different, not related to physical effort or a lack of rest; it occurred unpredictably and could not be attributed to any definite cause.”
The elusive cause of the fatigue might also lie in the damage done by the heart attack itself. When heart muscle is damaged from being deprived of oxygenated blood flow during a heart attack, scar tissue is formed on the damaged heart muscle, decreasing the pumping efficiency in the affected area. The resulting reduction of blood flow can produce fatigue, depending on the size and location of the scar tissue.
If you’re a heart patient diagnosed with mitral valve prolapse (MVP – one of the most common conditions that affect our heart valves), your mitral valve is enlarged and unable to close correctly, preventing blood from flowing normally throughout your body. When your organs don’t get an adequate supply of oxygenated blood due to MVP, you can experience extreme fatigue.
Some medications that you are taking for heart disease can also cause fatigue. These include the beta blockers (atenolol, metoprolol, etc.) and statin drugs to treat high cholesterol (Lipitor, Zocor, Crestor).
And if you also have a sleep disorder like sleep apnea (a condition linked to heart disease), you can feel extreme fatigue during the day.
Weakness, fatigue, and shortness of breath are to be expected in virtually all those recovering from a heart attack. Heart patients being discharged from hospital should be advised before going home that they may find just getting out of bed, taking a shower, and dressing can feel utterly exhausting, especially in the early days and weeks. See also: Why Taking a Shower Is So Exhausting for Heart Attack Survivors
It’s important to remember that symptoms like crushing fatigue can also be found in thyroid, depression and other medical conditions. It’s possible to have both heart disease and a second condition that is also contributing to your exhaustion.
Kelly Young, founder of Rheumatoid Arthritis Warrior, describes the kind of fatigue so many patients with chronic illness experience. She wrote:
“All of a sudden on Monday afternoon, it felt like it was 2 a.m. and I should be in bed. This is not the same as being tired. It’s more like being sick with the flu. I can remember the ‘good’ feeling of tired after working hard. This is not it – this is being sick. It can come at any time of day or night.
“This fatigue is not always the result of physical activity. It can suddenly develop for no apparent reason. This fatigue can last hours or days. It makes movement very difficult.
“It is not a psychosomatic condition.”
Here’s Kelly’s list of tips in managing severe fatigue common among those living with a chronic illness (shared by her blog readers at RA Warrior:
- Budget energy wisely. Guard energy.
- Have a regular schedule. Or go to bed early.
- Do gentle modified stretching or yoga.
- Nutritious balanced snacks such as protein bar and fruit.
- Get the best sleep at night possible.
- Get the best bed possible.
- Use heat to fight fatiguing pain.
- Eat on a regular schedule.
- Eat enough protein.
- Take small naps.
- Relaxation or meditation techniques.
- Alternate periods of activity and rest.
- Check for deficiencies such as iron or vitamin B-12.
- Treat the disease as aggressively as possible.
- While resting, plan for what you’ll do when you are more able.
- Fruit juice & sympathy.
- Check for side effects of medicines. Take them at the best time of day to avoid fatigue.
- Accept the reality that the list will not be accomplished today.
- When the body says “No more” – stop.
- Watch a movie.
- Take large naps.
- Delegate and oversee.
- Blue Kryptonite!
* Alsén, P., Brink E. & Persson, L-O. (2008). Living with incomprehensible fatigue after recent myocardial infarction. Journal of Advanced Nursing, 64(5), 459-68.
NOTE FROM CAROLYN: I wrote much more about the surprising fatigue that’s so common among heart patients in my book, “A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 20% off the list price).
Q: Have you had to deal with severe fatigue since your heart disease diagnosis?
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- Exhaustion: the ‘leaky emotion’ of chronic illness
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- Depressed? Who, me? Myths and facts about depression and heart disease