Exercising with heart disease

Start slow and add a little more over time. Make it feel  as if when finished feel like you could have done more easily. Begin exercising at this intensity for several sessions before making large increases in your intensity or effort required to be physically active. . Remember the whole goal is to adapt, and by doing so the body is changing how it responds. In the early recovery stage  the exercise prescription is very light. Do you know What exercise prescription is best for you?

Since exercise should be part of your everyday routine in order to make it a lifelong habit  injury avoidance is important to be aware of overuse signs and symptoms, to rest those muscles when needed.  Occasionally cardiovascular disease patients develop Peripheral Artery Disease and symptoms can present similarly to overuse. Pain should signal the body to be aware that something is going on.  Take some time to evaluate that pain, what happens with it, does it always come on at a certain time or point of the exercise or activity? How long does it take to go away? Can it be avoided while being active by another means for instance switching from walking to biking?  Make sure you communicate these findings with your healthcare practitioner as they could be signals of other health conditions related to heart disease and it’s recovery.

Some exercise and activity is better than none, so start slowly. Even a warmup is better than no exercise session here is why  warming up before strenuous activity helps your heart.

Don’t expect results overnight, but do take small steps each day. Move that blood around, push it through the muscles. Make the muscles use the oxygen in the blood  more efficiently. Exercise helps the the heart recover and stay strong.

You might not notice any big changes—especially in your weight—for a few weeks or even months. It is still good for your heart health! It is not all about weight loss. Forget the scale for a while. In fact many who initially start to exercise following hospitalization are  Sedentary at the start and will gain a couple of pounds. It is their muscles getting pumped up, holding and utilizing more blood flow. Generally the focus on how you feel.

 When not to exercise is if you are presenting with Signs and symptoms of heart problems. Exercise should be avoided if  if you are presenting with congestive heart failure, or are presently sick. When returning to exercise following illness 

Symptoms to be alert for include these.

Thanksgiving Reflections

Happy Thanksgiving!

Thank you all for reading my blog.  I reflect back a year and consider what  blessings I am thankful for. This blog is one of them. It has provided me a good outlet for all the information I enjoy learning, sharing and teaching. So to the 11,ooo viewers to day, a very grateful thank you.

The Heart: An Incredible Electric Machine

A quick primer on the electrical system of the heart followed by two major breakthroughs in pacemaker technology this year.

What makes the heart beat? Learn about the conduction system, an incredible machine.

A leadless, subcutaneous defibrillator makes the list of 5 biggest medical breakthroughs of the year.

Boston Scientific has begun marketing a FIRST-OF-ITS-KIND DEFIBRILLATOR after receiving FDA approval in September. The implantable device, which protects against sudden cardiac arrest, was developed by a California firm purchased by Boston Scientific and is expected to be a financial win for the Natick-based company. Unlike others on the market, the S-ICD does not touch the heart, instead sending electrical pulses to correct abnormal rhythms through wires implanted just beneath the skin.

http://bostonglobe.com/magazine/2012/10/27/biggest-medical-breakthroughs-year/pLJDenlFAN3XFwwsxfU7CI/story.html

No More Batteries: Piezoelectric Pacemaker Powered By The Heart

An experimental device converts kinetic energy from beating hearts into electricitythan can power a pacemaker, meaning the chance for no more batteries in the future, according to a talk at the American Heart Association’s Scientific Sessions 2012.

The study is preliminary but a piezoelectric approach is promising for pacemakers because they require only small amounts of power to operate. Batteries must be replaced every five to seven years, which is costly and inconvenient.  Piezoelectricity might also power other implantable cardiac devices like defibrillators, which also have minimal energy needs.

“Many of the patients are children who live with pacemakers for many years,” said M. Amin Karami, Ph.D., lead author of the study and research fellow in the Department of Aerospace Engineering at the University of Michigan in Ann Arbor. “You can imagine how many operations they are spared if this new technology is implemented.”

Researchers measured heartbeat-induced vibrations in the chest. Then, they used a “shaker” to reproduce the vibrations in the laboratory and connected it to a prototype cardiac energy harvester they developed. Measurements of the prototype’s performance, based on sets of 100 simulated heartbeats at various heart rates, showed the energy harvester performed as the scientists had predicted — generating more than 10 times the power than modern pacemakers require. The next step will be implanting the energy harvester, which is about half the size of batteries now used in pacemakers, Karami said. Researchers hope to integrate their technology into commercial pacemakers.

Two types of energy harvesters can power a typical pacemaker: linear and nonlinear. Linear harvesters work well only at a specific heart rate, so heart rate changes prevent them from harvesting enough power.

In contrast, a nonlinear harvester, the type used in the study, uses magnets to enhance power production and make the harvester less sensitive to heart rate changes. The nonlinear harvester generated enough power from heartbeats ranging from 20 to 600 beats per minute to continuously power a pacemaker. Devices such as cell phones or microwave ovens would not affect the nonlinear device, Karami said.

http://www.science20.com/news_articles/no_more_batteries_piezoelectric_pacemaker_powered_heart-96003

 

Chest Pain after having Stent

Chest pain following successful balloon angioplasty or stent is a common problem. Although the development of chest pain after coronary interventions may be not a problem, it is disturbing to patients, relatives and hospital staff.

Possible Causes of Pain:

  • acute coronary artery closure,
  • coronary artery spasm
  • heart attack,
  •  local coronary artery trauma

The distinction between these causes of chest pain is crucial in selecting optimal care.  Early intervention can limit the damage. Management of these patients may involve repeat hospitalization for  coronary angiography and/or additional intervention.

Commonly, repeat coronary angiography following Angioplasty (PTCA) in patients with chest pain demonstrates  lesion to be widely patent/open  suggesting that the pain was due to

  1. coronary artery spasm,
  2. coronary arterial wall stretching
  3.  non-cardiac 

 Coronary arterial wall stretching is common and occurs significantly more often after stent implantation than after PTCA or coronary angiography alone. This may be a result of the overdilation and stretching of the artery caused by the stent implantation and the consecutively high degree of stretching and the elastic recoil is minimized. Kind of like a deflated balloon, the artery doesn’t go back to original circumference.

sciencedirect.com

After getting out of the hospital every little ache and pain makes you think  “Is my heart giving me problems?” It is really difficult not to panic.

Here are some tips that should be of help you to know when to seek emergency care:

  •  Is the discomfort you are feeling the same  or similar to the discomfort that brought you to the hospital? If so, this could be a problem. It is more likely to be a problem if it is similar…don’t wait until it is bad to seek treatment. Time is muscle and we don’t want  you to lose any muscle.
  •  Does the discomfort also have other symptoms that pair up with it? These symptoms might include shortness of breath, profuse sweating, nausea, radiating discomfort into neck, jaw, arms or back.  If there are multiple symptoms you should call 911.
  •  Can you reproduce the pain or discomfort with touch or movement of body. It is less likely to be a heart symptom if you can make it hurt through touch. This is usually muscle or skeletal origin or what is referred to as non cardiac chest pain.
  •  The 4 E test…does the discomfort come on with Emotional stress,  Exercise, after Eating, or with a cold Environment? If so these are common triggers of heart symptoms. If you rest and they go away it probably isn’t emergent but you should notify your doctor as soon as possible. Keep a log of the frequency of these symptoms..when they come on, how frequently, what were you doing when they occurred, how intense was it, and what made them go away.
  • Unstable Angina….this is angina or heart pains that are coming on more frequent, occurs at rest or wakes you from sleep, or you need more nitro than usual to relieve discomfort.                                                                                                                                                                                       

If your symptoms are that of unstable angina you contact your doctor  - call 911

If you suspect you are having a heart attack chew up an adult strength aspirin and call 911.

Do not drive yourself to the emergency room. The ambulance crew is your first line of medical treatment, they will provide you with emergency medications, alert the hospital to your condition so they can manage your care quickly and efficiently. Time is muscle don’t waste any time.

Chew the aspirin even if you take an aspirin a day as regular medicine. The extra one helps more than it hurts. Only chew one not a handful that could causes more problems.

Antiplatelet effect of chewed, swallowed, and dissolved aspirinChewing aspirin hastens its antiplatelet effect, as measured by the reduction in blood thromboxane B2 levels. It took only 5 minutes for patients who chewed aspirin to achieve a 50% reduction in baseline levels, versus almost 8 minutes after they took it in a solution and 12 minutes after they swallowed it whole.Source: American Journal of Cardiology Vol. 84, p. 404.

May 2005 Update

It is best not to lie down. Try to stay calm, do some relaxation deep breathing – think belly breathes – make belly go out when you breath in. Avoid short shallow chest breathing. Focus on staying calm. If you think you are going to pass out try coughing or bearing down like you are having a bowel movement.

If you have Nitroglycerin tablets or spray that were prescribed by your doctor use them.  I can’t tell you how many people forget about their nitro when they need it the most. Place one under your tongue, do not chew it. It should make you have a headache, or cause a flushing feeling, or tingle under your tongue. These are indications that your nitro is fresh. If you suspect your nitro is old (over one year if bottle unopened, or greater than 6 months since bottle was opened) find a fresh bottle. Nitro is a very volatile compound and breaks down rapidly if in contact with air, heat, light, or plastic.

Healthy eating tips for heart patients

After heart surgery most patients have a very poor appetite for the first three months.

The first month the medical advice is to eat anything. This isn’t a problem as the body needs extra fuel for healing, but in reality many don’t eat much because food doesn’t taste the same or smell the same. This is thought to be an effect from anesthesia. Most of the time is takes 1-3 months for the taste and appetite to come back to normal. After the first month, patients are instructed to eat a heart healthy diet. That can be a little vague, and different health care practitioners have conflicting ideas of what a heart healthy diet is. In my career it was challenging as one physician  might promote a Dean Ornish vegetarian diet, and the next might promote a Mediterranean  diet, or American Heart Association, Dash diet etc. There are common nutritional principles that all heart patients should try to adhere to.

 

Tip #1: Know your Caloric needs.

How many calories do you actually need every day? Here are a couple of resources that will help guide you:

Tip #2: Enjoy your food, but eat mindfully

Take the time to fully enjoy your food while you’re eating it (instead of just devouring everything on your plate). Pay attention to hunger and fullness cues before, during and after meals. Be mindful of them and use them to tell you when you’re should be full. Remember it takes about 20 minutes for the food you heave eaten to signal your brain if you are still hungry. For this reason eating slowly, and being aware of the quantity, rather than listening for your body to say it is full. It is ok not to finish everything on your plate.

#3: Avoid oversized portions.

Learn what is the true portion size of the food you are eating. If you are going to overeat eat a larger portion of vegetables. Try using a smaller plate, bowl and glass.  When you’re eating out, try splitting a dish or take home part of your meal.

Tip #4: Foods to eat more often.

 These are all the foods you know are good for you: fruits, vegetables, whole grains, low-fat dairy, etc. Make them the basis for meals and snacks. Try getting 2 cups of veggies, 1.5 cups of fruit and 3 servings of low-fat dairy or lean protein each day.

Tip #5: Decrease the unhealthy foods in the diet

Foods high in solid fats, added sugars, and salt (e.g. cakes, cookies, ice cream, pizza, fast food, sweetened drinks, etc.) should be cut back in the diet. Try to avoid these as part of your daily meal intake.

Tip #6: Hydrate with healthy fluids

Drink water, sparkling water mixed with a splash of juice, tea, or sparkling water instead of high calorie drinks. High calorie drinks include soda, alcoholic beverages, juices, energy drinks and sports drinks. If you are on a fluid limitation, poor the recommended amount of fluid in a container and use it to help you visualize the amount of liquid you should have each day.

Tip #7: Pay attention to added sodium in foods

 Read the labels and choose the lower sodium option for breads, canned goods, and soups. Choose packaged products with labels like “low sodium,” “no salt added,” or “reduced sodium.” Fresh, foods have the least sodium. If it comes from a box, a can, or is ready to eat, it is probably loaded in sodium. Water added usually means sodium added, this is common in poultry. 1500 mgs a day is the recommended amount for heart patients. I had one patient that lost 45 lbs, simply by tracking sodium and adhering to recommendations, it has so far saved him from the disabling CHF symptoms he was experiencing.

Sodium sources are not only food! The medicine cabinet is often an unrecognized source of sodium. Many prescription and non-prescription drugs, such as antacids, ibuprofen, sleep aids, heartburn relievers and cold medicines, have large amounts of sodium. Some antacids have upwards of 250 mg of sodium per tablet. Before taking any medication, it’s always best to consult a doctor, especially if you’re watching your sodium intake for health purposes.  

Most people are unaware of the amount of sodium that comes from our tap water. It varies significantly from state to state, but the public health department in any area should be able to provide information on the exact amount of sodium in the water. Even if a home employs a water-softening system, there’s still a certain amount of sodium in the drinking water, since many of these units use sodium as a softening agent. The amount is solely dependent on the type of system installed and the hardness of the water in that area. Bottled waters, especially mineral waters, can also contain significant amounts of sodium.

Tip #8: Keep your dairy low-fat 

Drinking whole milk is the equivalent of 3 pats of butter, 2% is 2 pats of butter, 1% is one pat of butter. And low-fat cheese is a good substitute for full-fat cheese, but if you are going to use regular cheese, try using a smaller quantity.

 

Tip #9: Get healthy fats in your diet every day

 When you’re cooking, choose oils high in monounsaturated fats like olive or canola oil. These are better choices, but don’t use large amounts, as oil is high in calories. A pump oil spray is a good way of adding a little oil and avoiding chemicals. Avoid products containing trans fats. Read the labels and avoid hydrogenated oil or shortening or partially hydrogenated oils. This is the same as eating shortening.

Tip #10: Get out of  your comfort zone

Many people won’t try new or unusual foods. They are stuck in a rut of eating the same foods, because it is what they know and like. Try new foods regularly. Especially try different vegetables. If you always cook your foods a certain way, challenge yourself, try sauteing, steaming, fresh, juicing, combining with other foods, adding nuts or seeds to foods.

Tip #11: Know your issues

Some heart patients have to be very aware of vitamin Kin diet, if they are on coumadinKeep your intake of foods rich in vitamin K about the same each day. For example, you may plan to eat only ½ cup of these foods per day. If you like these foods and eat them often, you can eat more, but be consistent. It is a common misconception for patients to think they have to avoid foods rich in Vitamin K, it is more important however to get these in the diet, but as mentioned be consistent and get the same amount each day.

Other’s need to be more aware of the potassium or protein contents of foods.  Certain diseases (e.g., kidney disease and gastrointestinal disease with vomiting and diarrhea) and drugs, especially diuretics (‘water pills’), remove potassium from the body. Potassium supplements are taken to replace potassium losses and prevent potassium deficiency. If you can meet with a dietitian to help you understand what the sources of these nutrients are. If you can’t meet with a dietitian do your research, but don’t ignore the recommendations as many can be life threatening if not adhered to.

http://www.cdc.gov/salt/pdfs/Salt-tistics.

http://www.vaughns-1-pagers.com/food/vitamin-k-foods.htm

 http://www.livestrong.com/article/10349-identify-sources-sodium/#ixzz27lT6ptHG

A lesson about the heart: Cardiac Output

Here is some information that is useful to know. It is a little in-depth when it comes to heart function, but I believe education is power and/or a sense of control when it comes to managing a chronic disease.  The more you know, the better you can work with your health care provider to help to manage it. 

Why are certain tests performed? An example is an echo is often performed 3-6 months following a heart attack. This allows the heart time for recovery and remodeling, and gives the healthcare provider a good idea of your cardiac output. Is your ejection fraction diminished, is the stroke volume lower thus decreasing the output? Is the cardiac output lower because the heart chamber is stretched, and weaker – inotropic effect, or due to medications? Does this place additional risk to you? When the ejection fraction is below 30% the risk for arrhythmia increases, thus precautionary measures such as Implanted Cardiac Defibrillators become an issue. Or vise versa if the heart function improved back to safe levels since the event there may no longer be the need, or those wearing external defibrillator vests may no longer be necessary.

The following came from Jewels of Clinical Medicine

What Is Cardiac Output?
Cardiac output is defined as the amount of blood pumped by the ventricles, the lower chambers of the heart, in one minute. Two factors determine cardiac output: stroke volume and heart rate. The equation used is: heart rate x stroke volume = cardiac output. A normal adult heart will have a cardiac output of approximately 4.7 litre( 5 quart) of blood per minute. Exercise will increase cardiac output, since it increases heart rate.

Heart rate
• The number of times the heart beats in one minute is the heart rate. In adults, the average heart rate is 60 to 100 beats per minute. Heart rates are usually higher in children and women. Differences in gender, size, age and fitness can affect the heart rate, as can some medications and conditions. Very fit people have lower resting heart rates. Heart rates increase when people are upset or excited.
Stroke Volume
• Stroke volume is the amount of blood pumped by the ventricles with each heartbeat. An average resting stroke volume is about 2 ounces (60 to 80 milliliters) per beat. Usually only 65 percent of the blood is pumped out of the ventricles during each beat. This is the normal ejection fraction value. Starling’s law of the heart and the inotropic effect are two things that can alter the force of the contraction, causing more of the blood to be expelled with each beat.

Starling’s Law of the Heart
• Starling’s law depends on the amount of stretch in the cardiac muscle fibers. If there is an increase in the volume of the blood pumped into the heart, that increase causes the ventricle to stretch, which in turn increases the force of contraction and the cardiac output. If less blood volume enters the heart, the ventricle does not stretch as much, the contraction is less forceful, and the cardiac output is decreased. This is important to ensure that the heart pumps out only what it receives at a given time.

Inotropic Effect
• If the strength of the contraction is increased without increasing the stretch of the cardiac fibers, cardiac output will be increased. Certain hormones and medications can cause this to happen. Sympathetic nerve stimulation of the heart, for example when a person is scared or excited, is another mechanism of the inotropic effect. Some drugs may also cause a negative inotropic effect and will decrease the cardiac output, which can lead to heart failure. It is extremely important to closely monitor the usage of any medication that has a negative inotropic effect on the heart.

Interesting Fact
• The amount of blood pumping though the body of the average adult is about 5 liters. That is equivalent to the average cardiac output. That means that the heart pumps the total amount of blood in the body every minute.

Heart Disease Health Centre- Dr.Yaseer SK