This aspect is of vital importance. Gone are the days when the patient was given prolonged rest, say at least six weeks, for a heart attack. Whenever a heart attack Occurs, the patient or his relations should not feel frightened. Even now, home treatment has been advocated in uncomplicated cases of heart attack. Treatment is simple, easy, as long as no complication/ s occur. In such cases, about two weeks of rest is essentially required. Even o~ the second day of the attack, the patient can walk round the bed, and may gradually increase his walk, and in about two weeks' time, he can walk 400-500 yards.

Unnecessary prolonged rest is not at all in the interest of the patient. He becomes markedly weak. There is loss of strength as well as efficacy, i.e. the capacity to work decreases markedly. However, prolonged rest has to be given if the patient has developed complications, or if the patient's condition becomes more serious as a result of the heart attack. Climbing of stairs needs special mention/precaution in the case of a CAD after recovery from a fresh attack. The patient is advised to initially climb stairs once a week, and the difference of pulse rate should not be more than 20 before and after the climbing of stairs.

The patient must be encouraged to resume his work/ normal life-style as soon as possible, whenever he is declared fit by his physician. He may be advised light work and his daily duration of work may be reduced in the beginning. The patient may even need psychological assistance. It is also good for the patient to take light regular exercises. However, sports requiring heavy exertion should not be undertaken. The patient in any case should not overexert himself, should take good rest/sleep, and should feel happy and contented. Emotional outbursts, undue anxiety or depression, etc. must be avoided as far as possible.

In a nutshell, all aspects of the patient must be looked into, including the economic aspect, if possible, by all concerned. And it is only with the co-operation of all that we can hope for a comfortable lifespan for such patients.

Recapitulating the topic of CAD, it may be emphasized that since the disease process starts right in childhood, and though clinical manifestations appear around middle age, various preventive steps should observed from early in life. The child must be made aware of the various preventive aspects of CAD. It is easier to mould a child for a specific lifestyle, including the behavior pattern, and it must be seen that such a cultivated manner/pattern of life continues throughout life. Besides, the general public must be made aware of various aspects of CAD through the media, talks, camps, seminars etc., from time to time, and all hidden cases of CAD must be unearthed. This is the only way to curb the incidence of this fatal disease.

Sex and Coronary Artery Disease (CAD)

A usual question is asked by the patient about the performance of sex. One may lead a fairly normal life in this regard, of course with precautions. However, it depends upon the severity of the lesion of CAD. As a rough guide, following a recovery from a heart attack, if the patient is able to climb one, preferably two full flight of stairs without any feeling of discomfort, he may indulge in coitus. More precisely, the heart rate should not be more than 120 per minute during the period of sex, and the patient should have no pain/discomfort.

To avoid additional stress, sex should be avoided immediately after meals, and even extra-marital sex should be abstained from. If suitable precautions are not taken, or the lesion happens to be more severe, an attack of angina may be precipitated during sex, and one may have to keep a quick-acting coronary dilator i.e. glyceryl trinitrate under the tongue (or chewed). If severe pain occurs during sex, follow the steps of first-aid treatment for heart attacks. Although rare, an unaware patient may even die in orgasm, i.e. during the climax of a sexual excitement, the so-called coital death. The idea of writing this is only that such type of exertion should be kept in mind by the concerned patient. It is an important step of secondary, or even primary prevention, especially in highrisk cases. In any case, the patient should not feel hesitant to ask any questions in this regard from his physician I family doctor. He should also not feel embarrassed to discuss with his physician, in case he has any problems during the the performance of sex.

From the above account of prevention of CAD, it is evident that both primary and secondary steps of prevention are necessary to keep the fast-increasing cases of CAD under control, thus saving people both from morbidity and mortality.