After Myocardial Infarction: Cardiac Rehabilitation, Secondary-Prevention Medications, and Warning Signs
Teach referral to cardiac rehabilitation, gradual activity progression, and daily adherence to antiplatelet therapy, a beta blocker, a statin, and an ACE inhibitor. Dual antiplatelet therapy is never stopped without the cardiologist's direction. Call 911 if chest pain is not relieved within 5 minutes after the first nitroglycerin dose, or immediately for new or worsening chest pain.
Who needs this teaching
Every client recovering from myocardial infarction, after percutaneous coronary intervention or medical management, and the caregiver. Secondary prevention reduces the risk of reinfarction, heart failure, and death. Teaching starts before discharge and continues in cardiac rehabilitation.
The priority teaching points
- Cardiac rehabilitation. Every client after myocardial infarction qualifies for a cardiac rehabilitation referral before discharge. The program provides supervised exercise training, risk factor education, and psychosocial support. Participation reduces mortality and hospital readmission. Confirm the referral and the first appointment.
- Activity progression. Walk daily and increase time and distance gradually as instructed. Avoid heavy lifting, pushing, and pulling (isometric activity) for the period the provider sets. Avoid straining during defecation. Stop and rest for chest pain, dyspnea, dizziness, or palpitations. Resume driving and work only after provider clearance.
- Sexual activity. Resume sexual activity when the provider clears it, usually when the client climbs 2 flights of stairs without chest pain or dyspnea. Never combine nitrates with phosphodiesterase-5 inhibitors such as sildenafil, tadalafil, or vardenafil. Ask before using any erectile dysfunction medication.
- Antiplatelet therapy. Dual antiplatelet therapy combines aspirin with a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor). It prevents stent thrombosis and reinfarction and usually continues for 12 months after acute coronary syndrome. Never stop it without the cardiologist's direction, including before dental or surgical procedures. Report bleeding.
- Other core medications. A beta blocker reduces myocardial oxygen demand and the risk of dysrhythmias. A high-intensity statin lowers LDL cholesterol and stabilizes plaque. An ACE inhibitor limits ventricular remodeling, especially with reduced ejection fraction, hypertension, or diabetes. Take each medication daily, including when the client feels well.
- Nitroglycerin. Carry sublingual nitroglycerin. For chest pain, stop and sit, and place 1 tablet under the tongue. Call 911 if pain is not relieved within 5 minutes after the first dose. Repeat every 5 minutes to a maximum of 3 doses as prescribed while awaiting help.
- Depression screening. Depression is common after myocardial infarction and is associated with poor adherence and higher mortality. Screen with a validated tool such as the Patient Health Questionnaire (PHQ-2, then PHQ-9). Report low mood or loss of interest lasting 2 weeks or more.
- Risk factor control. Stop smoking, follow a heart-healthy eating pattern, and keep blood pressure and diabetes at target.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Bleeding gums, nosebleeds, or new bruising during antiplatelet therapy | Chest pain not relieved within 5 minutes after the first nitroglycerin dose |
| Increasing dyspnea, weight gain, or new dependent edema | New chest pain, pain at rest, or worsening angina |
| Dizziness after medication doses or a persistent dry cough | Black, tarry stool or vomiting blood, with weakness or dizziness |
| Low mood or loss of interest lasting 2 weeks or more | Syncope, severe shortness of breath, or thoughts of suicide |
Teach-back questions
- "What happens if you stop your antiplatelet medicine early?"
- "What will you do if chest pain starts while you walk?"
- "When can you lift heavy objects or have sex again?"
- "Why does each of your heart medicines matter?"
- "Which feelings will you tell your care team about?"
Teaching tips
- Make a medication chart that lists each drug and its purpose.
- Confirm the cardiac rehabilitation appointment before discharge.
- Include the partner when you discuss activity and sexual activity.
- Ask about mood at every visit, not only at discharge.
Read more on NCLEXPace
- Cardiac Map: Heart Failure, Heart Attack, and Angina
- Chest Pain on the NCLEX: MI vs Angina vs Pericarditis vs PE
- Coronary Artery Disease on the NCLEX: Angina to Infarction
Sources
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Coronary Artery Disease and Acute Coronary Syndrome.
- Rao SV, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Circulation. 2025;151(13):e771-e862.
- Virani SS, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease. Circulation. 2023;148(9):e9-e119.
- Levine GN, et al. Sexual Activity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2012;125(8):1058-1072.
Why this matters for the NCLEX
Teaching is effective when the client states, "I will not stop my clopidogrel unless my cardiologist tells me to," and "I will call 911 if the first nitroglycerin tablet does not relieve my pain within 5 minutes." Statements requiring further teaching include, "I will stop my aspirin before my dental cleaning," "I do not need cardiac rehab because I feel fine," and "I can take sildenafil with my nitroglycerin."
Frequently asked questions
Can the client stop dual antiplatelet therapy before a dental or surgical procedure?
Only with the cardiologist's direction. Early discontinuation increases the risk of stent thrombosis and reinfarction.
When does the client resume sexual activity?
When the provider clears it, usually when the client climbs 2 flights of stairs without chest pain or dyspnea.
More patient teaching on Cardiovascular
Preventing Deep Vein Thrombosis: Mobility, Prophylaxis, and Pulmonary Embolism Warning SignsTeach venous thromboembolism risk factors, early ambulation, leg exercises, mechanical and anticoagulant prophylaxis, travel precautions, and recognition of DVT and pulmonary embolism.Beta Blockers and ACE Inhibitors: Pulse Checks, Safe Discontinuation, Potassium, and AngioedemaTeach the purpose of beta blockers and ACE inhibitors, pulse and blood pressure checks, safe discontinuation, adverse effects, laboratory monitoring, and angioedema.Digoxin: Pulse Checks, Toxicity Signs, and Potassium SafetyTeach pulse checks before each dose, the hold rule, signs of digoxin toxicity, potassium safety, blood level monitoring, and drug interactions.3,200+ NCLEX questions with think-like-a-nurse rationales, unfolding case studies and adaptive readiness exams. Start with free practice questions, then choose a plan when you are ready.
Create Account →