Being released from the hospital after a heart attack or heart surgery is a big event. You will probably have a lot of questions about how much you can do and when you can do it. Every patient is different, so your doctor and your cardiac rehabilitation team will make specific decisions regarding your case. It is most important to listen to your body. Take it easy and give it the rest it needs. Getting a full eight hours of rest every night is important. For a few months, you may also want to take an afternoon nap. Resting is important and completely normal — it gives your heart the breaks it needs while it's recovering.

When supervised by a physician, a formal program of cardiac rehabilitation can benefit patients with congestive heart failure, angina, a recently implanted pacemaker, as well as heart attack patients who have had coronary artery bypass surgery, balloon angioplasty or drug therapy to dissolve blood clots. Rehabilitation programs may also help patients with congenital heart disease, who may or may not have had surgery.

Although an exercise program is normally included, rehabilitation is usually tailored to each patient's needs. Exercise may be very structured, including ECG monitoring, or it may be less structured, without monitoring. Shortly after your heart attack, you can probably begin some light activities such as walking slowly in the hospital corridors. As you continue to recover, you may resume additional light to moderate activities, such as walking to the mailbox. Usually, your doctor will allow you to gradually add more activities as the days pass. You can probably do light household chores, such as dusting, after about four weeks. Heavy lifting and moving, sports and many household chores are strenuous activities. Avoid them until your doctor gives you the green light.

Heavy lifting usually refers to lifting anything that weighs more than 10 pounds. You will probably be cleared for any activity you like by three months after your surgery. Exercise after a heart attack is an essential part of rehabilitation and your life after an attack. But you shouldn't start exercising without going over your plan with your doctor and a physical therapist. Just jumping back into an exercise routine after a heart attack can be difficult and dangerous. A physical therapist will devise an exercise plan that has you gradually increase the amount you work out.

Combining all aspects of cardiovascular rehabilitation improves your functioning after a heart attack, reduces symptoms and may create a sense of well-being and optimism about the future. Here's what your rehab program should include:

• Counseling and education to increase your understanding of the disease process and its management
• An exercise program
• Ways to alter heart risk factors such as high blood pressure, smoking, high blood cholesterol and physical inactivity
• Vocational guidance to enable you to return to work
• Information on physical limitations and sexual relations
• Emotional support.

About six weeks after your heart attack, it will be time to review your progress. At this time, you will sit down with your doctor and/or rehabilitation nurse to make sure you are on the right track to recovery. During this six-week checkup you may be given an exercise test to estimate your current level of physical conditioning. If you have severe heart disease or unstable angina, the test will be skipped. If the test finds that you experience symptoms at a low level of exercise, your doctor may order an angiogram to determine whether you have more blockages in your arteries. Your weight, cholesterol level and blood pressure will also be checked during the six-week exam.

The six-week exam is only the first checkup after a heart attack. Because you may be taking a variety of medications to reduce your chance of a second heart attack, your doctor will require regular follow-up visits to check medication levels and whether you are following dietary and exercise advice.

How quickly you resume your normal activities will depend on how serious your heart attack was and how successful your recovery. You can probably start light chores and household duties about four weeks after your heart attack.

Bathing is generally a problem only if you've had heart surgery. You should keep your incision as dry as possible. Upon leaving the bath, pat the incision site dry carefully, especially during the first six weeks after the operation.

Even if you haven't had surgery, you may need help getting in and out of the tub and with washing during the first few weeks of your recovery. Avoid either very hot or very cold water. The heart responds to temperature changes by working harder. Remember that the goal in the first few weeks after a heart attack or heart surgery is to rest and rehabilitate your heart.

Driving is usually fine four weeks after your release from the hospital. However, you should check with your doctor before you resume driving. If you plan to be a passenger on a long drive, be sure to stop every hour or so for a brief walk to get your blood circulating. Driving is restricted for a period after bypass surgery to protect the healing incision in the chest

Resuming work depends on the type of job you have. Generally, you can expect to be away from work for about two to three months--even if you have a desk job. If your work requires heavy lifting, it may be even longer. The stress associated with working should be avoided during the recovery phase because the hormones released by your body during stress can harm a recovering heart. When you first get back on the job after your heart attack, your doctor may advise that you work shorter hours or only part time until you feel your strength coming back. Your doctor will help decide when you can return to work.

Sex is a major concern for heart attack survivors and their spouses. If you've had a heart attack, you may be worried about when, or even whether, you should resume your sex life. Many heart attack victims are afraid that sex will put too great a strain on the heart and trigger another heart attack or even sudden death. You should know that simply isn't true. Sexual intercourse exerts about as much strain on the heart as walking briskly up a couple flights of stairs. Most heart attack victims can handle that much activity by the time they leave the hospital.

Within about a month of your heart attack or uncomplicated heart surgery, you should feel free to resume the same forms of lovemaking that you found pleasing before. Remember to take your time, however, and don't feel pressured to adhere to a timetable. Some heart attack victims find that easing slowly into sex is more comfortable for them. Take it slow and go at your own pace. Some other recommendations:

• Choose to have sex at a time when you are rested, relaxed and free from stress.
• In the beginning, wait about one to three hours after a meal so digestion is completed.
• If you are scheduled to take a heart medication, do so before sexual activity.
• Choose a spot where you will not be interrupted, preferably a familiar, quiet setting.
• Consider trying new, more comfortable positions.
• Go easy. Work slowly through foreplay so you and your partner can get reacquainted after a long time apart. You may even consider being intimate for the first few times without having an orgasm.
• Often a spouse is nervous about resuming sex. Discuss these fears together and with your doctor.
• If you experience any heart disease symptoms, such as a rapid heartbeat or difficulty breathing, lasting for more than 20 minutes after intercourse, or if you have angina pain or are very tired the next day, consult your doctor. Most people who have had a heart attack are eventually able to reach the same level of sexual activity they had before the attack.
• Some medications used to treat high blood pressure and angina may interfere with sexual function. Continue to take your medication, but ask whether your doctor can prescribe a different drug.
• If you experience angina during sexual relations, consider taking nitroglycerin, as prescribed, before starting sex.
• Do not take drugs for erectile dysfunction (such as Viagra, Cialis or Levitra) if you are also taking nitroglycerin.