Tag Archive for: heart health

Treating a Woman’s Heart Disease

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The paper I’ve been using as a primary source for this week’s Memos is titled “Sex Differences in Ischemic Heart Disease. Advances, Obstacles, and Next Steps”; the purpose of this paper is to provide the current state of the science to clinicians when it comes to preventing and treating heart disease in women. A team of experts combed the medical literature to let their colleagues know where we stand in treatment and where future research should go, and you could look at it as a roadmap for improving prevention and treatment. You could also look at this as an indictment for less-than-quality care for women with heart disease.

There were seven categories of treatment options for various phases of heart disease, from diagnosing heart disease to mortality. I’m going to talk about just two but understand that even though the mortality from heart disease has decreased over the past 30 years, there are still gaps in treatment between men and women.

The first was a 30-minute delay in restoring the flow of blood to the heart in women who were having a heart attack with ST- segment elevation, a distinct change in the EKG. The time from the onset of symptoms and arrival at the hospital as well as time from arrival at the hospital to needle insertion for a percutaneous coronary intervention was 30 minutes or longer compared to men. That means women don’t get to the hospital early enough, so that’s on them. Ladies, you need to make that 911 call a little quicker. But it also means that once they’re there, it takes longer to get the arteries open again. That creates the possibility of more damage.

One of the problems is getting the correct diagnosis. There are 11 other conditions that can cause ST-segment elevation including takotsubo syndrome also known as broken heart syndrome. Still, 30 minutes seems way too long and needs to be improved.

The second is the one that really stunned me: fewer women are given recommendations for cardiac rehabilitation after a heart attack. Not only that but fewer women register to take part in cardiac rehab. They also attend fewer sessions than men do. When I read that, I was almost apoplectic. The heart is a muscle that can be damaged by a heart attack. When it’s time to rehabilitate that muscle, it’s not like restoring range of motion after knee surgery. If this muscle isn’t rehabbed and then trained for the rest of a women’s life, the death rate increases for those women.

That has to change today. If you have any type of coronary event, from atrial fibrillation to a full blown heart attack, the first question you ask is “When can I begin cardiac rehab?” I understand that every insurance plan may be different but you need to understand any limitations, how to exercise after a heart attack, and how to progress. That’s important, not just for the muscle, but also for the nervous system, the lungs, increasing the number of blood vessels, and even to reduce the depression that occurs after a heart attack.

And then you’re going to do it until you get every session you qualify for and get a plan to take home with you to keep improving. When that’s done, you’re going to get a plan from your physician as to how to progress from that point. These are non-negotiable. This has to change and it has to change today. The quality of your life depends on it.

Next Tuesday I’ll finish American Heart Month with a question I get a lot: does taking my calcium supplements increase calcification in my coronary arteries? I’ll let you know on Tuesday.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2018;11:e004437.

 

Emerging CVD Risk Factors for Women

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The paper I referred to in Tuesday’s Memo provided a list of emerging risk factors for heart disease that apply only to women. But first, I wanted to define exactly what a risk factor is and what it means.

As defined by the World Health Organization, a risk factor is any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury. The key word is likelihood. It does not mean cause and effect, and that includes genetic tendencies. Lifestyle contributes close to 80% when it comes to raising or lowering risk. You’re not doomed; you just have to be aware and take action.

There were several emerging risk factors for cardiovascular disease (CVD):

  • Gestational diabetes: your risk of getting type 2 diabetes increases four-fold later in life; type 2 diabetes is a risk factor for heart disease.
  • Hypertension during pregnancy: hypertension and preeclampsia increase the risk of heart disease three-fold.
  • Early menopause: women’s hormones are protective against heart disease. When they change during menopause, the risk of heart disease begins to increase; the earlier that happens, the sooner the risk rises.
  • Autoimmune disease: diseases such as rheumatoid arthritis and lupus increase the risk of heart disease. Autoimmune diseases increase inflammation, and that may partially explain this connection.

You can see why these emerging risk factors are primarily associated with women. While depression is also associated with an increased risk in women, it may be that women seek help more than men.

Keep in mind that these conditions don’t make heart disease a given, just a risk. But if that gives you the oomph you need to get to the gym today or skip that sweet roll, I’m okay with that.

What happens after a woman has heart disease or a heart attack? We’ll take a look at that on Saturday including one thing that stunned me and has to change.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2018;11:e004437.

 

It’s American Heart Month

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February was declared American Heart Month by President Lyndon Johnson in December 1963. As I’m searching the recent research in preparing to update the Women’s Heart Health audio, I’ve found new research on women’s hearts. I’m not ignoring men, but the research on women has lagged behind what we know about the risk of heart disease in men, because women’s bodies react differently to heart issues. Now we’re starting to catch up on women’s hearts.

Let’s look at the same risk factors for heart disease and see the differences between men and women. In a paper published this month, researchers looked at the differences in how risk factors for heart disease are managed in women. Here’s what they found:

  • Blood lipids: after menopause, women are less likely to achieve goals in reducing triglycerides and LDL-cholesterol and increasing HDL-cholesterol.
  • Blood pressure: as women get older, those with hypertension are less likely to lower blood pressure; only 29% achieve healthy blood pressures.
  • Exercise: 25% of all women get no regular exercise.
  • Obesity: carrying extra weight impacts the risk of heart disease more in women than men—64% compared to 46%.

There are more risk factors, but what makes these four important is that they can be improved through changes in lifestyle. Eating less. Eating better. Moving more. Even a 10% change can help reduce a women’s risk of getting heart disease.

Some new risk factors are emerging that are unique to women. I’ll cover those on Thursday.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2018;11:e004437.

 

How Long Does Fitness Last?

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Does exercise when you’re young have any impact when you’re older? That’s the question researchers sought to answer in a very unique study. They recruited men who competed in running events in the 1968 Olympics and evaluated fitness variables to see how they had changed since then. The subjects were tested in 1993 and retested in 2013. Did their fitness and cardiovascular measures decline at the same rate as their age would predict?

Maximal heart rate is calculated by subtracting your age from 220. There are formulas that make it a little more precise, but the shortcut is close enough for most purposes. At every retest, the runners measured max heart rate was significantly higher than predicted. The maximal amount of oxygen they used was also higher than would be expected for their age.

What does this mean? The fitness you attain when you’re younger can impact your fitness when you’re older. This study shows that there are some measures related to the cardiovascular system that can be sustained. You may never have trained like an Olympian, but even if you start later, the fitness you gain may yield benefits years later. Improving your fitness now will still pay dividends twenty or thirty years ahead when you may have more physical restrictions than you have now.

That raises another question: will being fit help you live longer? We’ll tackle that on Saturday.

If you want the best way to combine a change in your diet with an exercise program to maximize fat loss, no matter what your current fitness level may be, make sure you sign up for the Super Bowl Webinar.

What are you prepared to do today?

Dr. Chet

 

Reference: Med Sci Sports Exerc. 2018 Jan;50(1):73-78.

 

What to Do After a Bypass

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A family friend recently had a quadruple bypass surgery or CABG for short; CABG stands for coronary artery bypass graft. In case you’re thinking all our friends are old, I have to tell you this man is 47; we met him through our kids.

So what happens now? He’ll go through recovery and rehab. Here are the things that I think he has to do short and long term, including some lifestyle changes:

  1. Be patient. It’s going to take time from having your chest split open, your heart stopped, veins from the leg grafted to bypass the blocked arteries, getting sown back up, and then staying out of commission for a while. This was serious surgery and recovery is going to take time.
  2. Do the cardiac rehabilitation. It’s not just exercise to recover from the surgery—exercise should become a permanent part of life. Ask plenty of questions. Know your limitations and don’t exceed them, especially when it comes to weight training. The bones of the sternum have to heal just like any broken bone. As an aside, always exercise with your cell phone. My daughter-in-law made me promise to carry mine when I’m running after I took a tumble. In this case, always means always.
  3. Eat a better diet. Plants rule because of the benefits they provide, so always begin with those. Less saturated fat and fewer refined carbohydrates are also part of the better diet. This is a time to learn how to do it better.
  4. Take your medications as prescribed; this is not the time to start doing things the “natural” way.
  5. If you haven’t been taking a high-EPA fish-oil supplement, start now. Your daily supplements also should include 100 mg of coenzyme Q10 and a good multivitamin-multimineral to fill in nutritional gaps, all with your doctor’s okay.
  6. Expect to be depressed. Nothing gets into your head more than facing your own mortality. Depression is common after surgery. Keep a support group of friends around and work on getting your attitude right; your fellow rehabbers can be a source of commiseration and encouragement. If you need professional help, get it. Depression doesn’t necessarily mean medication; there’s plenty you can do to help yourself, and talking tops the list.
  7. Enjoy your life without reservation. You cannot live your life listening to your heartbeat or constantly checking your pulse. You already know what it feels like to have a compromised heart. If something is wrong, you’ll know and that means you immediately get it checked out. But you can’t live in fear because that’s not living.

Let me repeat an important point about cardiac rehab: it’s never over. Rehab teaches heart attack survivors how to exercise to stay healthy, and it’s important that they never quit.

For those of us who haven’t had to deal with CABG, what we do related to exercise, diet, and stress may help reduce our risk and may prevent it altogether. It really depends on one thing:

What are you prepared to do today?

Dr. Chet

 

How to Fix a Broken Heart

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What causes broken heart syndrome (BHS)? Most types of cardiomyopathy are idiopathic—no one really knows how it happens. In the case of BHS, there’s a severe stressor, good or bad, that precipitates the symptoms. But what is actually going on? I found two potential explanations.

First, an excess amount of catecholamines are released in response to the stress. The theory is that this stuns the heart muscle and temporarily causes the muscle weakness. The second theory involves an increase in sympathetic activity in the heart. In short, the nerves that stimulate the heart to beat faster keep firing. Between the two factors, the heart tissue gives the symptoms of BHS.

Another factor may be hormone levels; BHS mostly happens to post-menopausal women over 55 years old. More research is needed to find out whether this is truly a factor or not.

The most important thing to know is that the effects are temporary; the heart tissue is not permanently damaged and can recover. Here’s the important point: the person still needs to be treated in a hospital. Left untreated, the person can die. Typical treatments may be medications to slow down the heart rate and reduce blood pressure. While there may be no blockages, all those tests may show excessive plaque, so changes in diet and medications may be warranted. Typically the heart can recover in a month or two with no permanent damage.

Can you prevent BHS? After all, not everyone who has a severe stress event gets BHS. It’s hard to say with certainty, but there are three things that may help. First, have a strong heart to begin with; exercise is critical for that. Second, find a way to deal with stress on a regular basis: yoga, prayer, meditation, counseling, whatever works for you—do it. It can help with the stress response.

Finally, never, never, ever ignore chest pain. In this case, I’m talking to my women readers. I rant all the time about men who ignore chest pain. Don’t be like them! Women take on the role of caregivers, and that’s so important to our society, but this is a time when you have to take care of yourself first. When in doubt, check it out.

What are you prepared to do today?

Dr. Chet

 

Broken Hearts and Octopus Traps

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Broken heart syndrome (BHS) has several names, such as stress-induced cardiomyopathy. One you’ve probably never heard is takotsubo cardiomyopathy.

BHS is similar to other forms of cardiomyopathy in that the heart gets significantly weaker. If you view the appearance of the heart during echocardiography, the bottom of the heart, specifically the left ventricle, is weaker and balloons out more than normal when the heart contracts. Healthcare professionals in Japan thought it looked like the takotsubo, a pot used by Japanese fishermen for trapping octopus, thus the name.

The symptoms of BHS are severe pain deep in the chest along with shortness of breath. For some, there may be a build-up of fluid in the lungs that causes coughing and an inability to sleep lying down. It feels like a heart attack. Some of the changes in the EKG may look like a heart attack, but an angiogram will show no blockages causing a heart attack. Enzymes that rise during a heart attack will not follow the same pattern. The diagnosis can be confirmed by an echocardiogram which will show the ballooning effect.

On Saturday, I’ll finish up the treatment of BHS and what may help to prevent it.

What are you prepared to do today?

Dr. Chet

 

Broken Heart Syndrome

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This week’s focus is on American Heart Month and specifically heart disease in women. While heart disease is the leading cause of death in both men and women, there’s one type of heart disease that affects more women than men: broken heart syndrome. Can you die from a broken heart? Absolutely. We’ll find out how this week.

Cardiomyopathy is a weakening of the muscle tissue of the heart. There are four major forms of cardiomyopathy and several minor ones that can affect men, women, and even children. Cardiomyopathy affects up to one in five people and most don’t know that they have it until serious symptoms start to develop. Shortness of breath, fatigue, and swelling in the ankles are the first symptoms people may notice, and the symptoms get more severe as the heart continues to weaken. Treatment can range from medications to a heart transplant in severe cases.

Broken heart syndrome is a special type of cardiomyopathy. The primary cause is severe stress such as the death of a loved one, hence the name. It’s not limited to extreme bad news; extreme good news can initiate the process as well. I’ll explain what happens to the heart in Thursday’s post. Until then, give your loved ones extra hugs and kisses today. More than anything, give them the most important thing above all else: time.

What are you prepared to do today?

Dr. Chet

 

Reference: http://bit.ly/2kWCbsT

 

How Exercise Affects Menopause: Heart and Brain

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In the last post, I talked about the effects of menopause on the muscles and bones; in short, the changes in the muscles reduce physical abilities, and exercise can help that. But there’s another factor when it comes to physical performance: the heart and cardiovascular system. Once a women passes 30, her aerobic capacity declines every decade. That means oxygen doesn’t reach the muscles and brain as often. Her physical reserves wane.

Exercise can have a positive impact on the heart . . .

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Do You Make Enough Coenzyme Q10?

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There’s one major difference between coQ10 and other vitamins, minerals, and nutrients such as omega-3s: we can produce coQ10 ourselves. The problem is that we may not produce all the coQ10 we need, especially as we get older.

CoQ10 is used in the production of energy from both carbohydrates and fat in the mitochondria of the cells. You remember mitochondria from science class; they’re often called the powerhouse of the cells. And coQ10 is the substance that’s used to produce that power. It’s critical in the steps where oxygen is used to produce ATP, the . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.