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.

Exercise Induced Angina

Do you get chest discomfort with activity?

This is known as exercise induced angina. Angina is generally caused from not getting enough blood through the arteries to supply the walls of the heart with enough blood flow to adequately pump. Angina can be caused by blockage, injury or spasms. It can be particularly irritating when it comes on with exercise. Here are some things to know about symptoms you might experience when exercising.

• Warm up adequately to prevent angina with activity/exercise.Try to do 5-10 minutes of very light exercise with minimal resistance before pushing the intensity up and before increasing the resistance on your exercise equipment. This allows the arteries to dilate – or widen thus increasing the ability to bring more blood flow to the heart.
• Never try to push through angina, as it is a warning that your heart isn’t getting enough oxygenated blood. When symptoms come on reduce your exercise intensity to see if it will resolve. Many patients can back down for several minutes and the symptoms resolve. If the symptoms do not resolve use your nitroglycerin medication as prescribed.
• Keep documentation of the frequency of the symptoms. In particular you are looking to see if the symptoms are coming on at a specific workload, or if the frequency of the symptoms is increasing.
• If you watch your heart rates, most physicians will advise you to keep your exercise heart rates 10 points below where you get the onset of symptoms. It is recommended you purchase a heart rate monitor – a watch and strap for the chest to be able to gauge your exercise intensity from your heart rate. I am old school and hold allegiance to the Polar Heart Rate Monitors, they will run you about $50.
• Recognize you are not a perfectly tuned machine, some days are going to be rough and you will need to take it easy. Many factors contribute to increased angina symptoms including increased  physical and emotional stress on the body, fighting illness, blood pressure, sleep, temperature being very cold or high heat and humidity, timing of medications, timing type and amount of food in the system, blood sugar, hormones…you get the picture.
• Some patients will always have angina symptoms due to the injury to the heart, the size of the vessels, or spasm. It is important to work with you physician to determine what amount of angina is acceptable. With small vessel disease (microvascular angina) many have to accept a certain amount. It is often graded on a 1-10 scale with 10 being the worst, and some patients were allowed by their physicians to exercise with symptoms of 1-3 on the 1-10 scale if they did not have abnormal blood pressure or ekg changes and were free of symptoms such as shortness of breath. Gradually as they improved their physical conditioning their angina threshold (the intensity of exercise which produces symptoms) increased to where they could tolerate more intense workloads without symptoms worsening.

When is it angina dangerous?

There is a difference in stable and unstable angina. Stable angina is predictable. It can be triggered by emotional stress, exercise, exposure to cold air, after eating large heavy meals. It is relieved with rest, and doesn’t usually have other symptoms such as shortness of breath, profuse sweating, nausea associated with it.

Unstable angina is angina that is different as it can occur at rest or wake you from sleep. It is a change in the stable angina symptoms meaning the symptoms are more frequent, more intense – may require more nitro than usual to relieve symptoms. It may be paired with other symptoms, profuse sweating, nausea, shortness of breath, weakness, a feeling of doom, lightheadedness. If you are experiencing symptoms of unstable angina you must contact your medical provider ASAP. Time is muscle and you don’t want to risk losing heart muscle.

Winter Exercise for Heart Patients

Winter is upon us. It is cold, blustery, snowy, rainy, grey outside. This makes it very hard to be motivated to go outdoors and walk. Keep in mind it is very important to go outdoors and get approximately 10 minutes of natural light every day. This gives you Vitamin D. It is beneficial in preventing seasonal effective disorder. Interestingly seasonal effective disorder peaks in February. So there is a cumulative effect of getting natural light. Depression sets in and then people stop exercising entirely. I would always hear my heart patients say they will begin their home exercise when the weather improves. Uhg….your health should not be dependent upon the weather!

 

Do you feel better after you exercise? I believe when we go outdoors for a walk, run, bike ride, etc. it is more beneficial than exercising indoors.  I feel the best after outdoor exercise.  Not only does the exercise kick in your metabolism, but the bodies need to warm itself, then cool itself due to the exercise can only help the metabolism to increase. If your body temperature regulation system never gets the opportunity to kick in, it slows down and becomes less effective. Again kind of the principle use it or lose it.

A few winter exercise tips, yes I am sure you have heard them before, but here goes.

• Layer your clothing, start off cool, and when you get warm peel off layers before you overheat. Often winter exercise fatigue is related to being overdressed and the body is working extra hard to cool itself.
• Wear good shoes or boots- maintain traction, keep feet warm and dry
• Drink extra water — winter dry air leads to dehydration occurring more quickly
• Carry your nitro with you, just in case
• Walk with ski poles for extra intensity, better stability and posture

On really nasty weather days, have a back up plan. Indoor exercise that day, do weights, yoga, calisthenics, stretching, or take a drop in class at your local gym. Sign up for the gym or an exercise class for the worst weather months. Get out and walk the mall, hit the pool

If you get angina in the cold weather,  start your exercise by doing a warm up while indoors, do 5 or 10 minutes of activity that brings your heart rate up and dilates your vessels. Then when you go outdoors wear a parka, scarf or keep mouth covered. Maintain good posture. Engage your arms and legs…really think about pumping that blood throughout all your muscles.

I don’t recommend that heart patients use snow shoveling as their exercise.

You should exercise to stay fit enough to perform snow shoveling. That is why many heart attacks occur while shoveling. Many are not fit enough to perform this activity. The energy demands can be equivalent to running a marathon. If you are fit enough to run a marathon, then ok go ahead and shovel. The other thing is you can’t count on enough snow to go out and shovel every day…nice try with that one…doesn’t work.

Facts about cold weather and heart disease

Cold temperatures cause arteries to tighten, restricting blood flow and reducing the oxygen supply to the heart, all of which can set the stage for a heart attack.

In cold weather, there is more oxygen demand by the heart because it is working harder to do the work and maintain body heat.

Research suggests that the early-morning rise in blood pressure, or “a.m. surge,” that occurs in most people may dramatically increase the risk of having a heart attack or stroke. In the winter, people tend to exert themselves or do yard work in the morning because it gets dark earlier.

 

 

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.

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

 

Cold Weather Posture Causing Angina Like Symptoms?

Cold weather changes our posture causing aches and pains, but how can you tell if it is angina?

Having poor posture when it is cold can contribute to aches and pains in the same areas that people complain of angina discomfort. When the cold weather hits many cardiac rehabilitation patients begin having complaints of discomfort that is felt between the shoulder blades, neck pains and chest discomfort. It is tough to tell the difference for many between angina and muscular skeletal pain.

Let talk about posture

What is your posture when you are cold? Do you pull your shoulders up to your ears, roll your shoulders and neck forward to hide in the warmth of our clothes or chair? Do you cross your arms shortening the chest muscles and hold them in these positions for prolonged periods of time? All of these can cause the muscles to spasm and give sensations of pain. Remember most of the time angina pains follow the same pattern, but as with anything human it can change. So your angina should usually present the same way, if it is in the chest or arms, then expect angina to primarily present this way.

               

This posture held for any prolonged pain will cause upper back discomfort, neck pain, possibly chest and arm discomfort.

So is it angina?

Well lets review  first what angina is.

Angina may feel like pressure, squeezing, or heaviness in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

Stable Angina

Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (“Pattern” refers to how often the angina occurs, how severe it is, and what factors trigger it.) Stable angina usually presents itself with exercise, after eating large meals, emotional stress, and a cold environment such as exertion in the cold air.

If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.

Stable angina isn’t a heart attack, but it suggests that a heart attack is more likely to happen in the future.

Unstable Angina

Unstable angina doesn’t follow a pattern. It is a change from your usual angina pattern, it  is when angina occurs more often and may be more severe than stable angina. Angina occurring while resting is considered unstable angina, or when it occurs with lighter amounts of workload or effort than usual.  If it takes more nitroglycerin than usual to relieve the discomfort, or nitro doesn’t relieve it at all than that too is considered unstable angina. Rest may not relieve the pain.

Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.

Skeletal Muscular Symptoms

Can be reproduced by touching the area with symptoms and creating pain. You can’t touch your heart, but you can touch your chest, arms, back and jaw. If you touch it and it hurts that is a sign of muscular skeletal symptoms. Can you move a certain way and cause the discomfort to either show up or go away? This too is less likely to be related to the heart.

Does stretching or improving your posture help the symptoms? Consider adding a small pillow to the low back area of your favorite chair, desk and car  this forces your upper body to maintain better posture. Widening and opening up the chest. If you note you have had very poor posture try the chest stretches below.

Be fluid in your upper body movement

Allow your arms to swing when walking, wiggle those shoulders and neck. Dress warm enough that you can maintain good posture. Wiggle your hips, consciously think about your body. Is it stiff and tight? If so loosen up, relax, stretch, workout.

Be Safe

If you cannot tell the difference and suspect you are having angina, follow your care plan established by your health care practitioner, and if necessary seek medical attention. If the symptoms include shortness of breath, nausea, profuse sweating, lightheaded, dizzy contact your healthcare provider ASAP or call 911.