Snowstorms and Heart Disease

If you are a heart patient you might be concerned about how the cold weather affects your heart.  The body constricts blood flow to the skin to conserve heat, which also raises blood pressure. Many experience angina when active in cold weather.

Advice for how to manage angina related to cold includes:

  • Do a warm up indoors to dilate the blood vessels and get heart rate slightly elevated before outdoor exertion
  • Create a zone of warmer air to breath by using a scarf, mask or parka
  • Avoid large meals and alcohol before exerting outdoors. Blood flow gets diverted and doesn’t go to the heart or exercising muscles instead it works to digest the food.
  • Discuss using nitroglycerine before activity with your healthcare practitioner. Using the nitro to dilate the vessels prior to cold air exposure is a method used by some.

Snow Shoveling for Heart Patients

  • Warm up, do some light exertion to dilate the blood vessels and get the heart rate slightly elevated before really “digging out”
  • Dress appropriately in layers, when you feel warm take layers off. Preventing overheating from being overdressed is as  important as dressing for the cold. Your heart  works harder to cool your body down. Sweating excessively will lead to being cold later.
  • Do not eat a large meal or smoke prior to shoveling, these divert the blood flow away from the heart and exercising muscles.
  • Push the snow don’t lift if  you can.
  • Exhale on Exertion.  Breath out when pushing or lifting, don’t hold your breath!!!! Holding breath increases blood pressure even further than the cold and exercise already has.
  • Switch sides keep alternating the shovel in left and right hand. The constant twist to one side produces muscle injury and can be hard to distinguish between muscles and heart. Muscle pain can be reproduced with touch or movement, whereas heart pain cannot be reproduced by touch.
  • Take breaks, listen to your body don’t over do it. The body constricts blood flow to the skin to conserve heat, which also raises blood pressure.
  • Stay fit enough to shovel snow. If you don’t exercise regularly you are not strong enough to shovel wet heavy snow. The cardiovascular demands are even more due to excessive cold temperatures. Train for snow shoveling by performing aerobic exercise and resistance training.
  • If you have symptoms STOP

Dealing with Raynauds in the cold weather

Raynaud’s occurs when the fingers and/or toes come into contact with cold. Beta blockers medications actually can aggravate Raynaud’s by leading to increased blood vessel spasm. This class of drugs, used to treat high blood pressure and heart disease, includes metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and propranolol (Inderal, Innopran XL). It is important to cover your feet and hands before they get cold with warm gloves and socks. Make sure they are not too tight allow for circulation. Prevent the symptoms by creating a barrier between your skin and the cold. Even if you are only going out for a short while keep your fingers covered and wear warm foot protection. Frostbite occurs much quicker in persons with Raynaud’s.

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Atrial Fibrillation is more common in Winter

The likelihood of being admitted to hospital or dying with atrial fibrillation, a life-threatening chaotic heartbeat common among the elderly, increases dramatically during winter months. Atrial Fibrillation is common in persons with heart disease. Be alert for symptoms of irregular heart rhythm, increased shortness of breath, increased fatigue. Additional factors contributing to the winter connection to atrial fibrillation  may include drinking too much alcohol which leads to high blood pressure, heart failure, and possibly even stroke due to the  atrial fibrillation.

http://www.hearthealthywomen.org/am-i-at-risk/am-i-at-risk/hfother2.html

http://www.nhlbi.nih.gov/health/health-topics/topics/raynaud/

Depression and Heart Conditions

Depression is common in heart patients. Most studies show 2 out of 3 patients will experience depression. Does depression cause heart disease or does heart disease cause depression? Probably both. We all have ups and downs, however when one finds them overwhelming and debilitating it is time to get help. According to the National Institute for Mental Health the following are the symptoms of depression:

Signs and symptoms include:

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

One of the best things a person who is suffering from depression can do is to get daily exercise. Yet it is one of the hardest things to do when depressed. I would encourage patients to at a minimum schedule themselves 10 minutes per day of exercise. I know it is a very short duration, but it is a starting point. We build from there.  If you are a significant other of someone you suspect is depressed, don’t nag them to exercise, rather help them to engage in it. Offer to go for a walk, or go to the gym together.

For many suffering from depression winter can be especially difficult. The holidays may trigger episodes, a change in healthy eating habits to the holiday party foods, a change in exercise habits due to weather changes, getting out and socializing less due to weather, loss of loved ones,  and seasonal effective disorder can all be a catalyst for symptoms to worsen. If you note this contact your healthcare practitioner, consider counseling, increasing exercise, getting sunlight every day, and/or medications. It is important because if depression isn’t treated often heart disease worsens.

Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy

 

http://www.nimh.nih.gov/health/publications/depression/what-is-depression.shtml

 

 

Heart disease patients who have anxiety have twice the risk of dying from any cause compared to those without anxiety, according to new research in the Journal of the American Heart Association.

Patients with both anxiety and depression have triple the risk of dying, researchers said.

Many studies have linked depression to an increased risk of death in heart disease patients. However, anxiety hasn’t received as much attention. Studies show that depression is about three times more common in heart attack patients. The American Heart Association recommends that heart patients be screened for depression and treated if necessary.

Depressed heart disease patients often also have anxiety, suggesting it may underlie the risk previously attributed solely to depression. It’s now time for anxiety to be considered as important as depression, and for it to be examined carefully.”

In the study, 934 heart disease patients, average age 62, completed a questionnaire measuring their level of anxiety and depression immediately before or after a cardiac catheterization procedure at Duke University Medical Center. Patients had anxiety if they scored 8 or higher on a scale composed of seven common characteristics of anxiety, with each item rated from 0 to 3 (range of possible scores: 0-21). Depression was measured using a similar scale composed of seven symptoms of depression.

Researchers, after accounting for age, congestive heart failure, kidney disease and other factors that affect death risk, found that 90 of the 934 patients experienced anxiety only, 65 experienced depression only and 99 suffered anxiety and depression. Among 133 patients who died during three years of follow-up, 55 had anxiety, depression or both. The majority of deaths (93 of 133) were heart-related.

Researchers measured anxiety and depression during cardiac catheterization because levels better reflected how patients normally handle stressful situations. Anxiety and depression each influence risk of death in unique ways. Anxiety, for example, increases activity of the sympathetic (adrenaline-producing) nervous system that controls blood pressure.

People who worry a lot are more likely to have difficulty sleeping and to develop high blood pressure. The link between depression and mortality is more related to behavioral risk factors. Depression results in lack of adherence to medical advice and treatments, along with behaviors like smoking and being sedentary.

Future studies should test strategies to manage anxiety alone and with depression in heart disease patients.

Anxiety reducing medications combined with stress management could improve outcome for patients with just anxiety, whereas patients with anxiety and depression may need a stronger intervention involving more frequent outpatient monitoring and incentives to improve adherence.

Slowly getting there, comments from our cardiac health innovators? http://bit.ly/100zip5

Meditation Lessons

Meditation

Just saying this word to new cardiac rehabilitation patients would put them into a stress response. Meditate! Who has time for that? Yeah right some old hippy remedy, or what monks do.  I can’t do that. Most people don’t understand the purpose or how to meditate. Quieting the brain is the key to successful mediation. Many think they are relaxing when reading, watching television, or playing on the computer. These activities engage the brain they don’t quiet the brain. There are many benefits one can receive from meditation benefits:

1- It lowers oxygen consumption.
2- It decreases respiratory rate.
3- It increases blood flow and slows the heart rate.
4- Increases exercise tolerance.
5- Leads to a  deeper level of physical relaxation.
6- Good for people with high blood pressure.
7- Reduces anxiety attacks by lowering the levels of blood lactate.
8- Decreases muscle tension
9- Helps in chronic diseases like heart disease, arthritis etc.
10- Helps in post-operative healing.
11- Enhances the immune system.
12- Reduces emotional distress
13- Enhances energy, strength and vigor.
14- Helps with weight loss
15- Reduction of free radicals, less tissue damage
16- Drop in cholesterol levels, lowers risk of cardiovascular disease.
17- Improved flow of air to the lungs resulting in easier breathing.
18- Prevented, slowed or controlled pain of chronic diseases
19- Relaxes our nervous system

20- Increases serotonin level, influences mood and behavior.

21- Resolve phobias & fears
22- Helps control own thoughts
23- Helps with focus & concentration
24- Improved learning ability and memory.
25- Increased feelings of vitality and rejuvenation.
26-Helps let go of the little things
27- Increased ability to solve complex problems

28- Helps keep things in perspective

29- Provides peace of mind, happiness
30- Helps you discover your purpose
31- Brings body, mind, spirit in harmony
32- Increased acceptance of oneself
33- Helps learn forgiveness
34- Changes attitude toward life
35- Helps living in the present moment

Meditation takes practice

I often talk about having a tool kit, and understanding how the tools work through knowledge and practice.  It may seem hard initially but with practice becomes easy. Then the next challenge is to remember to use your stress management, meditation and relaxation skill when you need them the most.  When stress occurs we rarely think “Oh lets mediate.” No we are busy responding to stress. With heart disease consider using when dealing with the emotional component of accepting the chronic health condition that heart disease can bring. Accepting it, forgiving yourself, letting go of the old you, accepting the new you, changing your lifestyle, the stress of relationships. Use it when anticipating or receiving medical care, waiting during fearful times.

You Can Meditate. Here are some tips for meditation that might make a daily meditation practice feel a little more manageable.

Practice

  • Find or create a quiet, relaxing environment.
  • Sit with good posture.
  • Relax the whole body, muscles, skin, tongue, ears, neck,…everything.
  • Let your attention focus on only the flow of your breath.
  • Silence your mind

“Rest” in the rare silence that meditation offers

  • You should be comfortable enough to concentrate, but not so comfortable that you feel the urge to sleep.
  • The benefits of meditation can be experienced long before the practitioner has been successful in maintaining focus or clearing the mind, simply as a result of the practice.
  • Make time to meditate. Start with 5-1o minutes.If you find it difficult to meditate for the length of time you have chosen, try a shorter time for a while. Almost anyone can meditate for a minute or two without experiencing intrusive thoughts. Then, as the mind calms, you gradually lengthen your meditation session until you have achieved the desired length of time.
  • It is easy to lose track of time while meditating. Being concerned about time can be distracting to meditation. Some people find it helpful to set a timer and let it be concerned about how long you have to meditate.
  • With good posture,you breathe easier as your lungs will have more space. In fact, you may notice how most of the muscles in your torso work to help you breathe, from the muscles in the base of your pelvis to the ones in your neck, centered on the main breathing muscle, the diaphragm. They work just a little, assisting the diaphragm. If you notice this, it’s a good sign you have established a good posture. The right posture is easy and comfortable.
  • Don’t worry about whether or not you are doing it right. Do what works best for you. What works for some people might have other techniques that might not work for you.
  • Trust the process.

 

Being in the present - If you are reflecting on past events – take a time out and be in the present. What around you is positive, is it the sunshine, the breeze, family, friends, a flower, a pet, a companion, a song…take the time to be in the present. Sure the past comes back, but if it is too much to bear and you can tell it is effecting your health, teach yourself through meditation to  be in the present.
Breathe - Sounds like a cliché right? Well it isn’t. When we experience a major stress we often breathe short and shallow only filling the top most portion of our lungs. Take a few deep cleansing breathes. Make your belly extend out when you breath in.  This is a great one to practice and use when you experience a health stress. If you are lying in the ER freaking out about what is happening and feeling powerless, use the breath. Meditate or focus on nothing more than taking a breath in through your nose, feel the air as it travels down into your chest. Try and make it feel like you are bringing the breath right down to your pelvis.Then slowly exhale out through your mouth. Listen to the sound, feel the cool air go in, and the warm air come out.
                                                                               
Imaging  - This one is my favorite for when those stressors haunt me at night and I can’t sleep. Put your focus to where you are feeling peaceful. For me it’s at the beach. What do you see? What do you feel – warm, cold, a breeze, the warm sand, the cool sand below? What do you smell? What do you hear – the waves lapping the shore, the birds, children laughing.  Sure at first you hear the clock ticking and the voices in your head pulling you away from your peaceful place, but the more you practice this the better you are at tuning them out. Initially just stop and acknowledge the things breaking you away, but then go back to your peaceful spot. This is a great one to practice during medical procedures, it helps to keep your heart rate, blood pressure and respiration rate lower, and gives you a sense of control.

Getting through the hard days

What do you do when you are having a hard day? Do you find yourself more emotional, snapping at everyone, crying frequently, using more tobacco or alcohol, eating more comfort foods? The ups and downs are a normal part of living with a chronic health condition. The challenge is to not allow the bad days to promote behaviors that can worsen your health or your relationships. Some days symptoms are more prevalent than others, those are the days to listen to your body and take it easy. Not every day is a record-setting day.

On the bad days consider:

  • What good things are happening in my life?
  • Is the situation really as bad as I perceive it?
  • What can I try to make things better?
  • Who can I talk to who will understand?
  • What is most important for me right now?

Bad days cause us to re-evaluate what is important on this day. What can I do without having symptoms? Can I limit what I had planned to do. Accept the limitations, and don’t ruminate on what you can’t get done. Listen to your bodies needs. Does it need a healthy meal, a rest, a light walk, meditation, a listening ear? Who is your support person? A spouse, a clergy, another person who lives with chronic illness, a support group, social media sites? Admitting limitations to family and asking for help are difficult for many but unless you verbalize your needs no one knows or is likely to give you the support you need. It is ok to cry to grieve, let it out then let it go. Move on from the frustrations and emotional grief. It will come back, and when it does acknowledge it and move on again.

  • Listen to music
  • Write a letter
  • Take a light walk
  • Do something that makes you feel good
  • Focus on what truly matters
  • Envision a better tomorrow
  • Do deep breathing, relaxation or meditation exercises
  • Start over
  • Call a friend

 

 

 

Reducing the risk for a second heart attack

Many patients come through their heart procedures and feel they are cured. Unfortunately for most, heart disease is a chronic progressive disorder of the arteries in which deposits of cholesterol, calcium, and abnormal cells (that is, plaques) build up on the inner lining of the arteries.  Heart disease usually progressively deteriorates over time, whether due to normal bodily wear or lifestyle choices such as exercise or eating habits. This is a hard concept to grasp, and it doesn’t mean it is a death sentence either.

You can do everything right and still have further heart issues.

When patients struggle with this, I point out doing everything right may be why they survived, as approximately 50% of people do not survive their first heart attack.   It is so important for each person to know their body’s signs and symptoms and not ignore them. We don’t really know what makes coronary artery disease aggressive, there seems to be several factors. These factors include inflammation, c- reactive proteins, genetics, lifestyle to name a few.

Some patients will have multiple issues for years requiring frequent interventions and then be fine for many years before having another issue. On average coronary artery bypass  grafts  10 years out will be 50% blocked. Some patients will go 20-30 years before needing another intervention, yet others may not even go a week or month before having symptoms. Thirty percent of open heart surgery patients will continue to have angina symptoms after surgery. The drug eluding stents have  much lower rates of re-stenosis than the bare metal stents which average 25-30% re-stenosis rates, but in both cases the vessels often continue to develop blockages in other locations in the artery. If the bare metal stents are going to re-stenos the usually do so in the first 3-6 months.  It is vital to stay on the platelet inhibitors – Plavix (clopidogrel) as prescribed to prevent complications. Frequently second heart attack occur when patients stop taking their platelet inhibitor medication.

 

Try to adhere to lifestyle changes that will reduce your long-term risk after another heart attack. These  are known  risk factor reduction measures and they include achieving and maintaining an optimal weight, beginning a heart-friendly diet, ending tobacco use, achieving excellent control of diabetes and high blood pressure, and adhering to regular exercise. Lifestyle changes are much more challenging to start and adhere to.  If it were only as easy taking a pill. Keep your risk factors in the best control possible. Try to get blood pressure, blood sugar, cholesterol numbers to national guidelines. Exercise regularly. Eat a rainbow of color in fresh fruits and vegetables each day. Don’t let stress effect your health, manage your stress as best as possible, consider counseling.  

Listen to your body are symptoms creeping up on you?

Be on the lookout for new symptoms, for changes in energy patterns, note if you are becoming less active due to fatigue. I believe many can stave off a second heart attack if they are very tuned in to their bodies signals. Keep a diary or log of your symptoms, look or patterns especially increasing fatigue, increasing shortness of breath, increased use of nitroglycerin,  episodes of sudden weakness or profuse sweating. If you note a pattern don’t wait, contact your healthcare practitioner to discuss. They key is to prevent any further loss of heart tissue by preventing another heart attack. If you think you may be having another heart attack follow the emergency steps listed below:

  • Call 911 and describe what symptoms you’re feeling and where you are located.

  • Chew an aspirin (325 mg) at the first sign of an attack. Aspirin makes blood platelets less likely to stick to each other, assisting blood flow and reducing clots. Chewing the aspirin gets it into your blood stream much faster than if you drink it down with water.