Off the Charts is a series featuring expert answers to questions about heart and brain health. This week we explore healthy living after a heart attack, and how to avoid a repeat.

Q: I had my third “widowmaker” heart attack. … I’ve had an active and wonderful life and would like to keep living. I’ve been an on-and-off vegan for years but now intend to be much stricter with my diet. I don’t know what else I can do. … Any suggestions?

A: There are many ways to safeguard against a second heart attack, which occur in the United States about 720,000 times a year, according to the American Heart Association’s latest heart disease and stroke statistics update.

At the top of the list are a healthy diet and lifestyle. These two actions can help lower your risk for the blood-flow blockages that cause heart attacks.

The recent AHA guidelines about blood pressure include a raft of recommendations for a heart-healthy diet – including reducing salt and incorporating potassium-rich foods such as bananas, potatoes, avocados and dark leafy vegetables. Choosing nutrient-dense foods lower in calories and higher in minerals and proteins can help with weight, cholesterol and blood pressure.

The high blood pressure guidelines also give specific suggestions for weight loss, quitting smoking, cutting back on alcohol and increasing physical activity.

Physical activity, especially formalized cardiac rehabilitation, is critical. One study found patients who completed rehab were 42 percent less likely to die within an average of eight years. Others have shown that rehab helped reduce a repeat heart attack by 47 percent.

It’s not just working out at the gym. Typically, a doctor gives a cardiac rehabilitation referral, which can be a phased program that includes doctor-supervised, outpatient monitored activity during the four months after discharge. Patients usually undergo up to 36 sessions in graduated exercise and receive nutritional, psychological and smoking cessation counseling, as well as cholesterol and blood pressure management.

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Along with taking care of your diet, lifestyle and cardiac rehab, it’s important to take stock of how you are feeling.

It’s not uncommon for heart attack survivors to feel a raft of emotions such as fear, anxiety, anger and loneliness. Depression is three times more common in patients after a heart attack than in the general population. About 15 percent to 20 percent of heart attack survivors experience clinical depression.

So, make sure to get emotional support from your family and community.

It’s also important to know that not all heart attack symptoms are the same, so you and those closest to you should know the signs and be ready to call 911.

What does a heart attack feel like? Most involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Other symptoms can include shortness of breath, breaking out in a cold sweat, nausea, lightheadedness or pain or discomfort in one or both arms, the back, neck, jaw or stomach.

What can sometimes be confusing – and dangerous – is that women and men can feel different symptoms. A recent study showed women tend to have more non-chest pain symptoms, such as nausea, shortness of breath, and jaw or neck pain.

Check out these resources for more information on heart attack recovery and support:

Had a heart attack? Now what?

Support Network

My Cardiac Coach is a smartphone app that gives progress trackers for monitoring blood pressure and weight; tools for logging physical activity and managing medications; and connections to other survivors through the Support Network.

–A printable medication map so you and your caregiver can see at a glance what, when and how much to take.

Have a question for Off the Charts? Contact For specific answers about your condition, diagnosis and treatment, always seek help from your doctor.