Managing Heart Disease (JR168)
Introduction
Whether
you want to better understand your high blood pressure symptoms or you want to
know the signs of heart attack, better heart health begins with better
information. When you experience tightness in your chest or a pain in your left
arm, your first thought may be, “Am I having a heart attack?”
Heart disease is still the
leading cause of death for men and women. In most cases, a heart attack is the
result of a long process in which the arteries that supply blood to the heart
muscle become blocked. When blood stops flowing to that hard-working muscle, it
stops beating and the result is a heart attack. The sooner blood flow can be
restored, the greater the chances of minimizing heart damage and having a
healthier outcome. That’s why it’s so important to recognize the signs of a
heart attack and to can get help quickly.
Reversal claims
Making
simple changes in what you eat, how often you exercise, how much you weigh, and how you manage stress can help put the brakes on heart disease. Dean Ornish, MD, founder and president of the Preventive
Medicine Research Institute, has written six best-selling books, including Dr. Dean
Ornish's Program for Reversing Heart Disease.
In his book The
Spectrum, Ornish describes patients waiting to undergo a heart
transplant -- those with the worst possible
damage -- who enrolled in his program while on a transplant list. Some of them,
he says, improved so much; they no longer needed a transplant.
“Our studies show that with significant lifestyle
changes, blood flow to the heart and its
ability to pump normally improve in less than a month, and the frequency of
chest pains fell by 90% in that time,” Ornish says.
“Within a year on our program, even severely blocked arteries in the heart
became less blocked, and there was even more reversal after 5 years. That’s
compared with ... other patients in our study, in which the heart just got
worse and worse.”
Ornish's plan includes walking
at least half an hour a day, or for an hour three times a week. Yoga,
meditation,
and stress
reduction are also involved. Diet
may be the biggest thing you'd change. The shift will be drastic if you're used
to a typical diet.
“Just making moderate changes in your diet may be enough
to prevent heart disease,
but it won’t be enough to reverse it,” Ornish says. He puts foods in five
groups, ranging from healthiest to least healthy. To reverse heart disease,
he says, means becoming a vegetarian.
You'll fill your plate with fruits and
vegetables, whole grains,
legumes, soy products, nonfat dairy, and egg whites, and you'll avoid fats,
refined sugar,
and processed carbs.
“You want to eat foods in their natural form as much as
possible," Ornish says. Of course, eating a healthy diet and being active
are part of any heart health plan.
You’ll also need to:
·
Keep up with your doctor visits
·
Stick to a healthy weight
Overview:
How the Heart Works
CORONARY ARTERY DISEASE
Causes of
CAD
Symptoms
of CAD
Diagnosing
CAD
Treating CAD
Stenting and
Surgery
Preventing
CAD
Summary
HEART FAILURE
Types of
Heart Failure
About
Congestive Heart Failure
You may have heard the phrase
“congestive heart failure” used interchangeably with “heart failure.” That’s
because the symptoms of heart failure usually involve congestion throughout the
body. Less blood being constantly circulated means less excess fluid being
filtered by the kidneys into urine. That additional fluid is known as
congestion, and it can start to collect in the lungs and other tissues of the
body. You may notice swelling in the legs, feet and even around the eyes. This
kind of swelling is called edema, and it’s serious. If swelling increases—this
is often noticed by weighing yourself daily—it’s usually a sign your heart
failure is worsening and immediate treatment is needed.
What is Congestive Heart
Failure? Heart failure can develop without their having been a heart attack,
though that is often a cause. The damage done to the heart muscle by the heart
attack can leave it weaker than before. But there are many other causes, too.
High blood pressure, for example, can lead to heart failure. Elevated pressure
in the arteries forces the heart to work extra hard to keep blood moving. The
heart must also pump harder if the valves don’t open and close properly. Valve
disease often means a reduced amount of blood is circulating throughout the
heart, so less blood is being pumped to the body. In an effort to keep up with
demand, the heart works harder… and grows weaker.
Diseases of the heart muscle,
such as cardiomyopathy or myocarditis, can also injure the heart and leave it
unable to pump as it once did. The bottom line with all these causes is that
any damage to the heart, even if you don’t notice any symptoms, can make the heart
weaker.
One other cause of heart failure
that isn’t related to a heart condition you develop over time is a congenital
heart problem. If the structure of the heart isn’t normal and healthy at birth,
the heart muscle may have to work harder to compensate.
Congestive
Heart Failure Symptoms
Diagnosing
Heart Failure
Treating
Heart Failure
Preventing
Heart Failure
CARDIOMYOPATHY
Causes of
Cardiomyopathy
Symptoms of
Cardiomyopathy
Diagnosing
Cardiomyopathy
Treating
Cardiomyopathy
Nonsurgical
and Surgical Procedures
Prevention
Summary
HIGH BLOOD PRESSURE
Causes of
High Blood Pressure
Symptoms of
High Blood Pressure
Diagnosing
High Blood Pressure
Treating High Blood Pressure
Preventing
High Blood Pressure
Summary
Recommendations
·
Keep up with your doctor visits
Height
Weight
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||||
Normal
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Overweight
|
Obesity
|
Severe obesity
|
|
4ft 10"
(58") |
91
to 115 lbs.
|
119
to 138 lbs.
|
143
to 186 lbs.
|
191
to 258 lbs.
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4ft 11"
(59") |
94
to 119 lbs.
|
124
to 143 lbs.
|
148
to 193 lbs.
|
198
to 267 lbs.
|
5ft
(60") |
97
to 123 lbs.
|
128
to 148 lbs.
|
153
to 199 lbs.
|
204
to 276 lbs.
|
5ft 1"
(61") |
100
to 127 lbs.
|
132
to 153 lbs.
|
158
to 206 lbs.
|
211
to 285 lbs.
|
5ft 2"
(62") |
104
to 131 lbs.
|
136
to 158 lbs.
|
164
to 213 lbs.
|
218
to 295 lbs.
|
5ft 3"
(63") |
107
to 135 lbs.
|
141
to 163 lbs.
|
169
to 220 lbs.
|
225
to 304 lbs.
|
5ft 4"
(64") |
110
to 140 lbs.
|
145
to 169 lbs.
|
174
to 227 lbs.
|
232
to 314 lbs.
|
5ft 5"
(65") |
114
to 144 lbs.
|
150
to 174 lbs.
|
180
to 234 lbs.
|
240
to 324 lbs.
|
5ft 6"
(66") |
118
to 148 lbs.
|
155
to 179 lbs.
|
186
to 241 lbs.
|
247
to 334 lbs.
|
5ft 7"
(67") |
121
to 153 lbs.
|
159
to 185 lbs.
|
191
to 249 lbs.
|
255
to 344 lbs.
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5ft 8"
(68") |
125
to 158 lbs.
|
164
to 190 lbs.
|
197
to 256 lbs.
|
262
to 354 lbs.
|
5ft 9"
(69") |
128
to 162 lbs.
|
169
to 196 lbs.
|
203
to 263 lbs.
|
270
to 365 lbs.
|
5ft 10"
(70") |
132
to 167 lbs.
|
174
to 202 lbs.
|
209
to 271 lbs.
|
278
to 376 lbs.
|
5ft 11"
(71") |
136
to 172 lbs.
|
179
to 208 lbs.
|
215
to 279 lbs.
|
286
to 386 lbs.
|
6ft
(72") |
140
to 177 lbs.
|
184
to 213 lbs.
|
221
to 287 lbs.
|
294
to 397 lbs.
|
6ft 1"
(73") |
144
to 182 lbs.
|
189
to 219 lbs.
|
227
to 295 lbs.
|
302
to 408 lbs.
|
6ft 2"
(74") |
148
to 186 lbs.
|
194
to 225 lbs.
|
233
to 303 lbs.
|
311
to 420 lbs.
|
6ft 3"
(75") |
152
to 192 lbs.
|
200
to 232 lbs.
|
240
to 311 lbs.
|
319
to 431 lbs.
|
6ft 4"
(76") |
156
to 197 lbs.
|
205
to 238 lbs.
|
246
to 320 lbs.
|
328
to 443 lbs.
|
BMI
|
19
to 24
|
25
to 29
|
30
to 39
|
40
to 54
|
Lori
Mosca
You’ll need to be
really motivated to make those changes, and to make them last. "You have
to live a very strict lifestyle," says Lori Mosca, MD, director of
preventive cardiology at New York-Presbyterian Hospital.
If you already have
heart disease, Mosca emphasizes slowing it down through a healthy lifestyle
that allows for more variety than Ornish's "reversal" plan. “I don’t
think that dietary approaches that are highly restrictive are
sustainable," Mosca says. She also avoids using the word
"reversal." "I wouldn’t say you can ‘reverse’ heart disease,
because that implies you had something and now you don’t," she says.
"You can’t cure heart disease, but you can slow its progression.”
Ornish agrees that if
you're just trying to slow heart disease, you might have more freedom with your
diet. “If you need to reverse a life-threatening illness, you’re well-advised
to live as much as you can on the healthiest end of the spectrum,” he says.
“But if you’re just trying to stay healthy, it’s [unrealistic] to say, ‘Never
eat certain foods.’ It’s much more sustainable to just move in a healthier
direction.”
Overview:
How the Heart Works
In
simplest terms, the heart is a pump, and one that’s powered by electrical
energy. Therefore most heart problems are either plumbing or electrical. The
plumbing system includes arteries that carry blood from the heart to all the
organs, muscles and tissues, as well as veins that bring blood back to the
heart from the rest of the body.
Inside
the heart are four chambers: two upper chambers (atria) and two lower chambers
(ventricles). The atria fill with blood during each heartbeat. In between the
beats, valves open up between the atria and ventricles and the ventricles fill
with blood. During the next contraction of the heart muscle, the heart pumps
blood out to the rest of the body.
Blood
is fed to the heart muscle by the coronary arteries. Veins return blood to the
heart from the extremities. Blood is then pumped to the lungs to become
oxygenated, and then back to the heart to be pumped out again– multiple
thousands of times a day.
Controlling
all this circulation is a complex electrical system that triggers each
heartbeat, as well as the opening and closing of the valves. Blood that leaves
the heart travels quickly throughout the body’s cardiovascular system, which
includes a vast network of veins and arteries. Problems with any of your blood
vessels can affect the heart, while heart disease can also impact the function
of the arteries and veins throughout the body.
CORONARY ARTERY DISEASE
Coronary
artery disease (CAD), also known as coronary heart disease (CHD) or just heart disease
is a progressive medical condition that reduces or even halts blood flow
through the arteries that supply blood to the heart muscle. When blood doesn’t
reach the muscle, the result is a heart attack and permanent damage to some
heart tissue.
CAD
is slightly more common in men than women, but it’s definitely a major health
concern for both sexes. And a woman’s risk of heart disease increases after
menopause—so much so that among older adults, more women die of heart disease
than men. CAD claims the lives of more than 370,000 Americans annually, but the
numbers of people dying of CAD have diminished in recent years as more people
adopt healthier lifestyles and CAD treatment continues to improve.
Causes of
CAD
Cad occurs because of: High blood pressure
(hypertension); sedentary lifestyle; Diabetes; Smoking; Advancing age; Family
history of heart disease What causes CAD and heart attacks is a process called
atherosclerosis. Often described as, “hardening of the arteries.” That’s
because cholesterol, fats and other substances, such as white blood cells,
collect in the walls of the blood vessels that keep the heart supplied with
blood—the coronary arteries. The cholesterol and other materials form plaques.
This can create two problems for the heart.
When
plaques are first forming, they’re soft. But they can rupture, releasing the
“junk” inside. The rupture can also lead to the production of enzymes that
cause blood to clot. If the clot is big enough it can block the flow of blood. Older
plaques present a different danger. After a while, soft plaques turn hard and
narrow the affected arteries. If the plaque build-up is too great, blood can no
longer flow through a blocked artery. No matter what causes the stoppage of
circulation in the coronary artery, the result is a heart attack.
Symptoms
of CAD
Before
you get to the stage of CAD that ends up with a heart attack, you should learn
about these symptoms of CAD, the signs that suggest heart disease is developing
and a heart attack could be in your future:
- Angina
Symptoms:
The most noticeable and serious symptom of CAD is angina, the clinical
term for chest pain caused by reduced blood flow to the heart. When your
heart muscle isn’t getting quite enough oxygenated blood from the coronary
arteries, you may feel pressure or tightness in your chest. You can have
angina for years without ever having a heart attack. But it’s important to
pay attention to the frequency and intensity of angina episodes because
they can signal a change in your condition. Angina exists in two forms: stable
and unstable angina. Stable angina is pain that is fairly
predictable. If your chest starts to feel tight after you do some yard
work or exercise, but you seldom if ever feel pain when you’re resting,
it’s probably stable angina. Unstable angina can appear at any time. You
might be sitting in your favorite chair watching TV and suddenly feel a
smothering sensation in your chest. That’s unstable angina and it’s much
more dangerous than stable angina. Unstable angina puts you at a higher
risk for a heart attack, so it’s vital that you discuss your symptoms with
your doctor.
- Shortness of
breath:
Shortness of breath may also indicate CAD. If you’re having trouble
catching your breath after walking up a flight of stairs or doing any kind
of exertion, don’t hesitate to tell your health care provider. This can
also indicate respiratory problems, not just CAD, so it’s especially
important not to ignore.
- Heart attack: Of course,
the most obvious symptom of CAD is a heart attack. You’ve no doubt seen
movies or television shows in which a character clutches his or her chest
for a moment and then collapses because of a heart attack.
Signs
of a heart attack vary from person to person. And the symptoms you had during
one heart attack may not be the same ones you experience if you’re unfortunate
enough to have a second. Typical symptoms also differ somewhat between men and
women. Men, for instance, are more likely to feel a sudden pressure in the
chest, while a woman’s symptoms of a heart attack may be more likely to include
pain in the upper back and dizziness.
Signs of
a Heart Attack: Pressure or pain in the back, neck, or jaw; Shortness of breath; Nausea,
sometimes to the point of vomiting; Discomfort in the upper abdomen; Heartburn
or indigestion; Headache; And Arm pain, often in the left arm, but could be in
either or both arms
Another
atypical symptom of a heart attack is a vague feeling that you’re not quite
right. You feel ill, but without specific pains or other complaints. This can
make it difficult to know how to react, but if this feeling persists, trust
your instinct. If you sense that something is wrong, see a doctor.
And
even if the signs of a heart attack you’re experiencing are mild or hard to
define, the heart attack itself may be quite serious. Your heart can experience
just as much injury from a heart attack with no chest pain as one with that
“elephant sitting on your chest” feeling.
If
you are at high risk for a heart attack, it’s vital that you take your risks
seriously and respond quickly when symptoms appear. The sooner you respond to
signs of a heart attack, the more likely it is that you can receive treatment
that will minimize damage to the heart muscle and give you a greater chance of
having a healthy recovery.
Heart Attack Risks: Advancing age; High cholesterol; Smoking; Obesity;
Diabetes; Inactive lifestyle; Family history of heart disease; Previous heart
attack or stroke; Autoimmune disease, such as rheumatoid arthritis; Stress
If
you experience one or more of those risk factors, then you should memorize the
symptoms of a heart attack and make sure those who live and work with you know
them, too. If a heart attack occurs, you may be able to explain your symptoms
and call emergency or a family member or someone else close to you may be the
one who has to call the paramedics. In general, it’s best to call emergency
rather than be driven to the hospital. And under no circumstances should you
try to drive yourself to the hospital if you suspect you’re having a heart
attack.
Diagnosing
CAD
If
you experience angina or shortness of breath, or if you have serious risk
factors, such as high cholesterol, hypertension, obesity, smoking or a family
history of heart trouble, you should talk with your doctor about a screening
for CAD. If you have no symptoms, your doctor may do a routine exam that
includes listening to your heart. But you may be advised to make lifestyle
changes to help lower your risks of CAD.If your physician suspects CAD or some
other kind of heart disease you may be advised to undergo one or more of the
following tests:
- Electrocardiogram
(EKG),
which measures the heart’s electrical activity. An EKG may help detect an
arrhythmia or if parts of the heart are working too hard.
- Echocardiogram
(echo),
which uses sound waves to create a picture of the heart. It can reveal
information about how the heart’s valves are working, how well the heart
is pumping, the presence of any blood clots and the health of the heart’s
outer lining and the large arteries that exit the heart.
- Exercise stress test, which measures how well the heart handles exertion. In this test, you’ll walk on a treadmill or ride a stationary bicycle while hooked up to monitors that measure your blood pressure and your heart function. During exercise, the body demands more oxygenated blood, so the heart has to pump harder. If blood flow is limited during a stress test, that can help the doctor make a diagnosis of CAD.
Treating CAD
As
with most heart conditions, lifestyle changes are often necessary with a CAD
diagnosis. Regular exercise, losing weight, and quitting cigarettes are among
the most important changes you can make. Along with making healthier choices,
you may also be advised to follow a medication regimen that involves several
different types of medications. Some of the more common meds for CAD include:
- Statins to
help control cholesterol. Statins are taken daily, and are
generally well-tolerated, along with being very effective for most people.
Some side effects may include muscle soreness and a slight increase in
blood sugar levels.
- Anti hypertensives to help lower
blood pressure. Among the most widely used blood pressure-lowering medications
are ACE inhibitors, ARBs, diuretics, beta blockers, alpha blockers, and
calcium channel blockers. The type of antihypertensive that’s right for
you depends on the underlying cause of your hypertension (if that can be
determined), as well as any other health problems you might have, such as
diabetes, heart failure or kidney disease.
- Aspirin to help
prevent blood clots. Daily aspirin therapy is a somewhat controversial
issue. Most doctors agree that it’s helpful for people who have already
had one heart attack and want to avoid a second. But medical experts are
split about whether an aspirin a day is right to prevent a first heart
attack, primarily due to the risk of internal bleeding or gastrointestinal
irritation that can accompany aspirin use.
- Blood thinners to help
prevent blood clots. In addition to aspirin, other antiplatelet and
anticoagulant medications are prescribed to patients at high risk for
heart attack or stroke.
- Nitroglycerin to relieve
angina by opening the coronary arteries and veins throughout the body.
Blood flow to the heart muscle increases. At the same time the heart’s
workload diminishes. This can help bring an angina episode to an end.
Stenting and
Surgery
Sometimes
medications aren’t enough. Serious cases of CAD require interventional
procedures to help restore blood flow in blocked arteries. Depending on the
severity of the blockage and its location, your doctor may recommend stenting
or bypass surgery.
A
stent is a flexible mesh scaffold-like device, which can fit inside a coronary
artery. A stent is usually placed at the site of the blockage with a catheter
that is inserted into an artery in the leg or wrist and then guided to the
heart. Once at the narrowed or blocked part of the blood vessel, the collapsed
stent is opened from within by inflating a tiny balloon. The stent pushes the
plaque against the inner wall of the artery, and blood flow resumes in a much
healthier manner.
Sometimes, however, a stent is not the answer. This could be because the blockage is so severe, or because it’s in a Y-shaped part of an artery that can’t easily be helped with a stent. In these situations, you may need to undergo coronary artery bypass grafting (CABG).
Sometimes, however, a stent is not the answer. This could be because the blockage is so severe, or because it’s in a Y-shaped part of an artery that can’t easily be helped with a stent. In these situations, you may need to undergo coronary artery bypass grafting (CABG).
CABG
is usually done with open-heart surgery. A blood vessel is taken from another
part of the body and grafted on to the blocked artery so that blood can move
through the newly attached artery, bypassing the blockage altogether.
Both
procedures have their risks and benefits, but in any event, a healthy lifestyle
is essential for anyone following stenting or CABG. And those same healthy
choices may also help lower the risk of developing CAD in the first place.
Preventing
CAD
Because
you can’t control advancing age or the genes you inherit, some CAD risk factors
are unavoidable. However, most risk factors are manageable. Following your
doctor’s advice may help you avoid the need for interventions or a long list of
medications.
Preventing
CAD:
stop smoking: Talk with your doctor about programs and
products that can help you quit. Remember, too, that most people need several
tries before they can quit permanently; Weight
loss, Getting down to a healthy weight does several things, including
reducing the burden on the heart, lowering your blood pressure, reducing
diabetes risk, giving you more energy to exercise, helping you sleep better and
lowering your cholesterol; Regular
exercise: Exercising 30 to 40 minutes a day will go a long way in improving
your heart health. If necessary, you may need to break up your workouts into
10-minute routines; Healthy diet: Lowering
your sodium intake may help improve your blood pressure, and reducing your
intake of simple carbohydrates and unhealthy fats will help you lose weight and
manage your blood sugar levels.
Heart Rate
whilst walking: Your walking heart rate will go up or down
depending on how quickly you’re moving. In general, however, walking is a low-
to moderate-intensity activity. Exercising at a moderate intensity (i.e.
walking or jogging), your heart rate will fall somewhere between 50 to 70 percent
of your maximum heart rate. Whereas vigorous
exercise will fall somewhere between 70 to 85 percent of your maximum heart
rate.
To figure
out your target heart rate zone while walking, you first need to determine your
maximum heart rate, or the maximum number of times your heart beats per minute.
The
standard formula for calculating maximum heart rate is to subtract your age
from 220. To determine your target heart rate for various
exercise intensities, take your maximum heart rate and multiply it by a
percentage. For example, to figure out what 50 percent of your maximum heart
rate equals, take your maximum heart and multiply it by 0.5.
However,
these numbers are by no means definitive, so use them only as a general guide. Wearable
technology — such as heart rate monitors and fitness trackers — offer an easy
way to track your heart rate during exercise. Otherwise, you’ll have to check
your pulse manually while walking, which can be tricky.
Blood
sugar or glucose control is essential, because too much of it circulating in
your bloodstream indicates diabetes. Your risk of heart disease and other heart
complications rises dramatically if you have diabetes. If you ever get a
diagnosis of pre-diabetes, you should be especially mindful of losing weight
and adjusting your diet and exercise levels to keep your condition from
advancing to diabetes. Pre-diabetes is diagnosed, in part, with a special type
of blood test called an A1C test. An A1C result between 5.7 and 6.4 percent
indicates pre-diabetes.
CAD
prevention also depends on keeping your blood pressure and cholesterol levels
under control. Discussing your target levels with your doctor and developing a
strategy for managing your blood pressure and cholesterol.
Summary
While
coronary artery disease can lead to fatal heart attacks or major surgery, CAD
is also a very treatable condition. The keys to surviving and thriving with CAD
include:
- Recognize
heart attack symptoms and know how to respond.
- See your
physician regularly and follow his or her advice about diet, exercise, and
medications.
- Remember that
CABG or stenting are not “cures,” but treatments that require ongoing
monitoring and a heart-healthy lifestyle.
HEART FAILURE
One
of the possible results of a serious heart attack is heart failure. It sounds
like a condition in which the heart fails to work. But in reality, heart
failure simply means the heart has weakened and can’t pump as efficiently as it
once did. The result, however, is that blood doesn’t circulate as vigorously as
it should throughout the organs, tissue and other parts of the body. It can
also mean that proteins and other substances can build up in the blood. These can
damage the heart and other organs. A weakened heart also tries to work harder
to meet the body’s demand for oxygenated blood, and all that additional work
can make heart even weaker. While
heart failure treatment has improved in recent years, the prognosis for people with
the condition can be grim. About half of the people with heart failure die
within five years of diagnosis.
Types of
Heart Failure
There
are actually a few different types of heart failure. The most common is left-sided
heart failure. That’s because the left ventricle has the biggest pumping
job, sending blood through the aorta and out to most of the body. Within
left-sided heart failure, there are two kinds of heart failure: systolic and
diastolic.
Systolic
heart failure means
the left ventricle can’t contract properly, so a reduced amount of blood is
pumped with every heartbeat. Diastolic heart failure means the left ventricle
no longer relaxes properly in between heartbeats. As a result, less blood fills
the left ventricle, so less blood is pumped out of the heart.
You
can also have right-sided heart failure, though it often develops after
left-sided heart failure. When the left ventricle can no longer pump enough
blood throughout the body, blood and fluid can back up into the veins. This
puts more pressure on the right side of the heart, which accepts blood (into
the right atrium) and pumps it to the lungs (from the right ventricle) to
become oxygenated. All that added pressure makes the right side of the heart
work harder, resulting in right-sided heart failure.
About
Congestive Heart Failure
Congestive
Heart Failure Symptoms
Unlike
a heart attack, which can present suddenly and with obvious symptoms, heart
failure usually develops slowly. However, a condition called acute
decompensated heart failure (ADHF) includes a sudden worsening of symptoms.
You
may have had heart failure and not been aware of the condition until ADHF
appears. Suddenly, you may have difficulty breathing and experience sudden
edema, or fluid buildup in chronic heart failure, unlike ADHF, symptoms tend to
get worse over a period of months or years.
Heart
Failure Symptoms
Shortness of breath: usually with exertion but even when lying down
in some instances. If there’s congestion in the
lungs, lying flat will cause the fluid to spread out across the lungs (think of
laying a bottle of water on its side as opposed to standing it upright). When
more of the lungs are wet, it becomes harder to breathe.
Swelling (edema): especially in the legs and feet. Swelling may
also lead to weight gain.
Persistent cough: sometime with
pink-tinged phlegm.
Fatigue : and less energy
for exercise.
Racing : or abnormal
heartbeat.
Nausea: sometimes with vomiting.
Difficulty: concentrating and
staying alert.
If
the coughing or shortness of breath worsens or you notice an abnormal
heartbeat, you should see a doctor soon. And if any of these symptoms are
accompanied by chest pain, you should definitely seek emergency medical care.
Diagnosing
Heart Failure
A
combination of tests and an evaluation of symptoms will help a physician
diagnose heart failure. It starts with a standard physical exam. Your doctor
should listen to your heart and lungs with a stethoscope to pick up indications
of an irregular heartbeat or congestion in the lungs. A chest X-ray can also
provide a doctor a picture of what’s going on in the heart and lungs.
If
heart failure is suspected, a blood test will likely be ordered to check for
certain indicators, such as the chemical N-terminal pro-B-type natriuretic
peptide. It’s a substance produced by the heart when it is being overworked.
Another
helpful screening is an echocardiogram, which uses sound waves to create a
picture of the heart’s shape, size and the functioning of its valves. An
echocardiogram can be particularly helpful in discerning between systolic and
diastolic heart failure. The test also helps your doctor measure your ejection
fraction, which is the percentage of blood from the left ventricle that is
actually pumped out of the heart with each contraction. A diminishing ejection
fraction usually indicates worsening heart failure.
Treating
Heart Failure
Depending
on the severity and cause of your heart failure, treatment can range from
medications and lifestyle adjustments to artificial pumps implanted in the
chest to compensate for the heart’s declining pumping ability. A heart that has
grown too weak may need to be removed in favor of a transplanted heart.
In
its early stages, heart failure is usually treated with medications, including
angiotensin-converting enzyme (ACE) inhibitors. These drugs widen arteries to
make blood flow easier. This helps reduce blood pressure and lessens the
heart’s workload.
Beta
blockers, which slow the heart down, can also be helpful. Diuretics, which help
the body reduce fluid levels to lower blood pressure, are also commonly
prescribed to heart failure patients. A powerful drug called Digoxin is also a
mainstay of heart failure treatment. It strengthens each heart contraction, and
is often used when the source of heart failure is an arrhythmia.
Treating
the underlying cause of heart failure can sometimes be enough to halt symptoms
and essentially reverse the heart failure. But for many people heart failure is
a chronic condition that can’t be cured. Medications are part of an effective
treatment, but certain procedures may also be necessary.
For
example, coronary artery bypass graft (CABG) may help improve heart failure
symptoms if CAD is the problem. Heart valve repair or replacement may also be
helpful. Certain cardiac devices, including a pacemaker and an implantable
cardioverter device (ICD), may be needed to help keep the heart in a healthy
rhythm and make sure it pumps as efficiently as possible. And when these
treatments are no longer enough to keep blood circulating sufficiently, the
next step is a ventricular assist device (VAD)—an artificial pump that takes
over for the left ventricle. A VAD is surgically implanted in either the
abdomen or the chest, and is attached to the heart to circulate blood
throughout the body. VADs used to be temporary measures to help patients get by
while they waited for a heart transplant. But with improvements in technology,
some heart failure patients are relying on VADs for long-term use.
A
heart transplant is still a possibility for some people, but there are restrictions.
These include the availability of donor hearts and the overall health of the
recipient. Patients who are too frail to handle a heart transplant may not be
eligible for this dramatic procedure.
June 7,2019:
The heart patches could one day help people manage and recover from debilitating heart failure, a condition which affects an estimated 920,000 people in the UK alone, and is on the rise worldwide, say researchers from the BHF. The patches are thumb-sized bits of heart tissue measuring 3cm by 2cm and containing up to 50 million human stem cells. These cells have the ability to turn into fully-functional heart tissue, and are meant to be applied to the heart of someone after they’ve had a heart attack. Used in this fashion, they can limit, and even reverse, the loss of the heart’s pumping ability.
Preventing
Heart Failure
Because
heart failure can develop from any of several heart conditions, the key to
prevention is to strive for the best cardiovascular health possible. This means
controlling risk factors, such as quitting smoking, maintaining a healthy
weight, exercising most days of the week, eating a low-fat and low-sodium diet,
reducing stress, getting enough sleep, and managing blood pressure, cholesterol
and blood sugar levels.
It’s
also important to see your doctor on a regular basis and follow his or her
instructions when it comes to screenings, medications and other healthcare
maintenance. If you have had a heart attack or you have a heart condition of
any kind, it’s vital that you work with your doctor to try to keep heart
failure from developing.
Heart
failure can be a treatable condition. Medications and medical devices are
helping people with heart failure live longer and with a greater quality of
life. But if your heart grows weaker, it’s up to you to take a strong and
optimistic approach to your treatment.
CARDIOMYOPATHY
Along
with heart failure, cardiomyopathy is another potential outcome of a heart
attack. Cardiomyopathy is sometimes referred to as an “enlarged heart,” because
the main sign of cardiomyopathy is a heart muscle that has become thicker and
more rigid.
Bigger
muscles might be what athletes want in their arms and legs. But a bigger heart
isn’t a good thing, as it actually becomes weaker rather than stronger. And as
you just read, a weaker heart leads to heart failure. There are actually
several different types of cardiomyopathy. They include:
- Hypertrophic
cardiomyopathy: An
enlargement of the heart muscle without an obvious cause.
- Dilated
cardiomyopathy: An
enlargement and weakening of the ventricles, which can lead to heart
failure, arrhythmias and blood clots.
- Restrictive
cardiomyopathy: Reduced
blood volume filling the ventricles, which become stiff but not thick.
- Arrhythmogenic
right ventricular dysplasia: A rare, but serious disease, in
which the right ventricle’s muscle is replaced with more fibrous and fatty
tissue. It often leads to arrhythmias.
There
are other types of cardiomyopathy, usually categorized under “unclassified
cardiomyopathy.” Some people with mild cardiomyopathy may never experience any
symptoms, while others develop very serious complications. Typically, the cause
of your cardiomyopathy determines the severity of symptoms and the type of
treatment that you’ll need.
Causes of
Cardiomyopathy
There
are two basic origins of cardiomyopathy. It can either be inherited or
acquired. Inherited, as you might surmise, means the condition is part of the
genes you inherit from your parents. Hypertrophic cardiomyopathy is often
inherited, though it can develop in older adults.
Dilated
cardiomyopathy is sometimes inherited, but is usually the result of CAD, high
blood pressure, a heart attack or other heart condition. A viral infection that
causes inflammation of the heart can also lead to dilated cardiomyopathy. The
condition in women is also sometimes related to complications during the last
months of pregnancy.
The
causes of restrictive cardiomyopathy range from connective tissue disorders,
such as Marfan syndrome and cellulitis, to cancer treatments, such as
chemotherapy and radiation. Other health problems, such as amyloidosis (a
buildup of certain proteins in the heart and other organs), can also result in
restrictive cardiomyopathy. Arrhythmogenic right ventricular dysplasia is
thought to be an inherited condition.
Symptoms of
Cardiomyopathy
In
the early stages of cardiomyopathy, you may not notice any symptoms. But as the
condition develops, you may experience heart failure-like symptoms, such as
shortness of breath, fatigue, and swelling in the legs and feet (and possibly
in the neck and abdomen). Dizziness or lightheadedness may also occur, and arrhythmias
may also develop over time.
Diagnosing
Cardiomyopathy
The
tests and evaluations used to diagnose cardiomyopathy are similar to those used
to identify heart failure. But sometimes using a stethoscope to listen to the
heart can help diagnose particular types of cardiomyopathy. Certain kinds of
heart murmurs may suggest hypertrophic cardiomyopathy. A rattling sound in the
lungs could indicate cardiomyopathy has also brought on heart failure.
Screenings
including a chest X-ray and an echocardiogram can show changes in the heart’s
structure. An electrocardiogram (EKG) measures the heart’s electrical activity,
and is helpful if an arrhythmia is also suspected.
In
addition to an evaluation of your symptoms, one other very important aspect of
cardiomyopathy diagnosis is a look at your family history. Because
cardiomyopathy can be an inherited condition, a detailed knowledge of your
family’s heart health history can be very helpful to your health care provider.
Treating
Cardiomyopathy
If
you’re not experiencing any symptoms, you may not need any treatment for your
cardiomyopathy. You should, however, strive for a heart-healthy lifestyle. This
includes:
- A
heart-healthy diet, such as the Mediterranean-style eating plan or the
Dietary Approaches to Stop Hypertension (DASH) diet.
- At least 150
minutes of exercise a week.
- Smoking
cessation.
- Reducing
stress through meditation, breathing techniques and other methods.
- Maintaining a
healthy weight.
This
advice also applies whether you have been diagnosed with cardiomyopathy or not.
If a healthy lifestyle isn’t enough, you may be prescribed medications. These
includes medicines to help balance electrolytes in the body, maintain a healthy
heart rhythm, lower your blood pressure (including diuretics to also help
remove excess fluid from the body), prevent blood clot formation, lower
inflammation, and slow your heart rate (beta blocks, calcium channel blockers
and digoxin are among the drugs that work on the speed and strength of your
heartbeat).
Nonsurgical
and Surgical Procedures
When
cardiomyopathy symptoms begin to severely interfere with your quality of life
and your overall health, some type of interventional therapy may be necessary. One
nonsurgical procedure that is sometimes effective is alcohol septal ablation. In
this treatment, your doctor will inject a type of alcohol into a tube connected
to an artery that supplies blood to the enlarged or thickened part of the heart
muscle. The alcohol destroys some of the cells, which helps shrink that portion
of the muscle back to a more normal thickness.
Sometimes,
however, surgery is necessary. But the options are limited. For some
hypertrophic cardiomyopathy patients a procedure called septal myectomy may be
helpful. In this operation, a surgeon will remove part of the tissue of the
enlarged septum—the wall that separates the two ventricles. This can make it
easier for the ventricles to fill with blood and pump it out.
Another
surgical procedure that helps certain patients is the implantation of a cardiac
device. If you have cardiomyopathy and an arrhythmia, an implantable
cardioverter defibrillator (ICD) may be placed in the chest or abdomen to help
keep the heart’s rhythm steady. A left ventricular assist device may also be
implanted if cardiomyopathy has led to heart failure and a heart too weak to
pump on its own.
Prevention
The
steps needed to prevent cardiomyopathy are similar to that needed to prevent
heart failure or any heart condition. These include a healthy diet, regular
exercise, no smoking and management of your weight, blood pressure, cholesterol
and blood sugar. And, of course, there’s nothing you can do to prevent
inherited cardiomyopathy.
Summary
Cardiomyopathy
affects an estimated 1 in 500 people, but many never notice symptoms because
their condition is mild. It tends to be more common in men than in women, but
it can affect anyone at any age. Because of that, cardiomyopathy can be viewed
as yet another reminder to follow a heart-healthy lifestyle for as long as you
can.
HIGH BLOOD PRESSURE
High blood pressure (hypertension) can be a
factor in CAD, heart failure and cardiomyopathy. And as you’ll learn,
hypertension is also a major risk factor for stroke. .But what is
hypertension? Well, blood pressure is just the force of blood against the
inside walls of the arteries. It’s measured in two parts: systolic and
diastolic pressure. Systolic pressure is the force of blood against the artery
walls when the heart contracts. Diastolic pressure measures that force when the
heart relaxes and fills with blood for the next contraction.
Your
blood pressure is given as the systolic pressure over the diastolic pressure.
For example, a blood pressure of 120 mmHg/70 mmHg is considered normal blood
pressure. The mmHg measurement refers to millimeters of mercury.
Hypertension
is a condition in which that force is greater than normal. According to the
American Heart Association rates hypertension by stages: prehypertension, Stage
1 hypertension, and Stage 2 hypertension.
Prehypertension
is, of course, the stage just below the level at which a person is considered
to have high blood pressure. It should be looked at as a warning sign that
steps should be taken to avoid advancing into Stage 1 high blood pressure.
Prehypertension is defined as having a systolic pressure of 120 to 139 mmHg and
a diastolic pressure of 80 to 89 mmHg.
Stage
1 hypertension is defined as systolic blood pressure of 140 to 159 mmHg and a
diastolic pressure of 90 to 99 mmHg. Stage 2 hypertension is a systolic
pressure of 160 mmHg or higher, or a diastolic pressure of 100 mmHg or higher.
Causes of
High Blood Pressure
Blood
pressure is dependent on several bodily processes. The kidneys, for example,
must maintain the proper balance of sodium and fluid in the body for blood
pressure to remain normal. If the kidneys don’t excrete enough fluid, the
volume of blood expands and places more pressure on the arteries.
Another
cause of hypertension is due to a change in the renin-angiotensin-aldosterone
system. The hormone angiotensin helps widen or narrow blood vessels. Constricted
blood vessels lead to higher blood pressure. Aldosterone affects the kidneys’
ability to balance fluid and sodium levels.
Researchers
are also looking at whether high blood pressure might be caused by the
sympathetic nervous system, the “fight or flight” part of the nervous system
that controls things like blood pressure, heart rate, breathing rate and other
processes. There also appears to be a genetic component to hypertension, but
that’s not entirely understood. Research continues in that area, too.
An
unhealthy lifestyle is also a major risk factor for high blood pressure.
Obesity and a diet high in sodium are common culprits, as are smoking and
drinking alcohol to excess. A lack of regular physical activity can also lead
to high blood pressure.
Symptoms of
High Blood Pressure
You
can’t count on high blood pressure symptoms to alert you to this serious
cardiovascular problem. You may have heard high blood pressure described as
“the silent killer.” That sounds ominous, but it simply refers to the fact that
hypertension can lead to deadly complications while never presenting with any
symptoms.
In
fact, unless your high blood pressure is well into Stage 2 you probably won’t
notice anything except the numbers on your blood pressure reading. That’s why
it’s important to have your blood pressure checked regularly. Hypertension can
sneak up on you. One year your numbers may be fine. At your next annual
physical, you’ve got high blood pressure.
If,
however, your blood pressure is severely high (usually well above 160/100
mmHg), you may experience symptoms such as a headache, nosebleed and fatigue.
It’s possible you could experience those high blood pressure symptoms at an
earlier stage. It’s also possible that you may not even notice any signs, even
in a hypertensive emergency.
Diagnosing
High Blood Pressure
So
if there are no symptoms to respond to, how do you know if you should be tested
for possible high blood pressure? Hypertension can be identified with a simple
check of your blood pressure. If a blood pressure check reveals hypertension,
you’ll likely be checked again to confirm your numbers. You may have two or
three separate checks on different days to confirm the diagnosis.
You
will probably have your blood pressure checked in both arms to rule out any
problems specific to the blood vessels in one arm. Your doctor may also order a
24-hour blood pressure monitor to note changes. Blood pressure changes
throughout the day and night, depending on your sleep stages, when you eat,
when and how much you exercise, and various other stimuli.
If
high blood pressure is diagnosed, there should be further tests to get a
comprehensive look at your cardiovascular health. Your cholesterol levels
should be checked, as well as your blood sugar levels. You may also be advised
to undergo screenings such as an echocardiogram and electrocardiogram to reveal
more about the structure and function of your heart.
Treating High Blood Pressure
Hypertension
treatment almost always includes medications. The usual approach is to be
conservative, starting with one medication at a moderate dose. But a higher
dose may be necessary. Or multiple drugs may be required to get your blood
pressure under control. You should also know that the drug or drugs that help
you manage your blood pressure at first may need to change over time as your
cardiovascular health changes.
Drugs for High Blood Pressure:
Diuretics;
Angiotensin-converting
enzyme (ACE) inhibitors;
Angiotensin II
receptor blockers;
Beta blockers;
Calcium channel
blockers’
And Renin
inhibitors
But
along with taking medications, successful hypertension treatment depends on
lifestyle adjustments. And among the most important steps you can take are
regular exercise and weight management. If you’re overweight or obese, dropping
even 10 pounds can bring down your blood pressure by a few mmHg. You can also
help lower your blood pressure by exercising daily, or at least most days of
the week.
Follow
a heart-healthy diet that focuses on fruits, vegetables, whole grains, lean
proteins and low-fat or nonfat dairy, and you should be on your way to lower
blood pressure. It also goes without saying, though we’ll say it here, that you
should stop smoking immediately. Smoking damages the blood vessels, and that
injury increases blood pressure.
Preventing
High Blood Pressure
Following
the heart-healthy behaviors above may also help prevent you from developing
high blood pressure. And if you are ever diagnosed with pre hypertension, you
should discuss with your doctor all steps necessary to bring your blood
pressure back down. Medications usually aren’t prescribed for prehypertension,
but a healthy lifestyle may be enough.
The
key with hypertension is to prevent it from getting worse. That means following
the advice of your healthcare provider and not assuming that once medications
and a healthy lifestyle bring your numbers under control that you are “cured.”
High blood pressure is a chronic problem, so if you’re being treated, figure
that you’re going to be on antihypertensive medications for life.
Weight
loss, smoking cessation and other positive changes may reduce the number of
medications you need. But taking some drugs to control blood pressure may be
necessary to prevent a worsening of your condition.
Summary
High
blood pressure affects about one out of every three adult. Many of those with
hypertension don’t know it. And even many of the individuals who know they have
high blood pressure don’t have it under control. Your odds of developing
hypertension increase with age, but it can develop at any time. That’s why it’s
essential to keep track of your blood pressure with regular doctor visits (and
with a home monitor if you’re at risk for hypertension) and to take steps now
to minimize your odds of developing high blood pressure:
- Cut back on the
salt,
- Lose those extra pounds.
- Walk (or swim
or bike or…) more. Walking is by far the best exercise
- Get enough
sleep.
Poor
quality sleep and too much stress can also raise your blood pressure, so relax
and talk with your doctor about a blood pressure target that’s right for you.
Recommendations
Following
a heart-healthy lifestyle starting now and following your doctor’s advice are
two of the most important preventive steps you can take to avoid a heart attack
or other medical problem. Arming yourself with information is the third
important aspect of cardiovascular health. Be Heart-smart; to live a long,
healthy life. It’s not complicated, but it means you have to make good choices
every day.
