Tag Archives: cardiac

Cool facts about blood vessels

Are you raising a family? If so you want them to grow strong and healthy. When you consider their growth, think of their blood vessels.   I know that seems kind of out of the ordinary, but if we can work to keep not only ourselves healthy and consider those who we share our lives with.  Their health is important! Encourage your family to adopt healthy lifestyles  and prevent disease.

Fact: Every pound of fat gained causes your body to make 7 new miles of blood vessels.

Knowing this, it’s easy to see why obesity and heart disease often go together. Most of the new blood vessels are tiny capillaries, but also include small veins and arteries. This means if you are “only” 10 pounds overweight your heart has to pump blood through an extra 70 miles of blood vessels.

 The good news is that this also works in reverse. If you lose a pound of fat, your body will break down and reabsorb the no longer needed blood vessels. This is encouraging to dieters, as one pound does not seem like a lot to lose, but even that little bit of difference will result in a large benefit for your heart!

But nature and nurture rarely operate independently and this week it was published a large study that further contributes to our understanding of how the complex interplay between genes and lifestyle affect the risk of obesity. Over 12,000 American women and men participated in the study which is published in reputable Circulation. In these researchers identified the 32 so-called “obesity genes”, ie genetic variants that are known to predispose to obesity, and the calculated using these overall genetic risk profile for each participant. This was relatively normal genes that most of us carry to a greater or lesser extent, not rare mutations observed in some cases of morbid obesity. Participants were followed up for two years and as expected the weight proportional to how they were genetically predisposed.

When researchers went deeper in the material and examined the effects of physical activity and inactive time on obesity risk was discovered however, the interaction between genes and the activity level was significant. Silent Sitting, measured as the number of hours participants reported watching TV every day compounded effect of genetic predisposition to obesity significantly. The influence of genes alone were 50% higher for those who put four or more hours watching TV daily. The good news, however, was that a relatively moderate level of physical activity significantly reduced the effect of obesity genes.

The researchers estimated that the difference in weight gain between those who were lucky with maximum genes (no genetic predisposition to obesity) and those who were unfortunate maximum (had all known genetic dispositions) was halved for each hour daily walk, or every half hour of jogging. On the other hand, the difference of 25% for every two hours participants spent on the couch.

Thus, it is particularly important, how unfair it may seem, to reduce sedentary activities and increase physical activity for those that are inherited predisposition to obesity. Just how physical activity overcomes the effect of obesity genes is not known in detail, but there are indications that regular physical activity triggers changes in gene expression so that health becomes more active while suppressing those that are related to weight gain. It is also worth noting that the importance of sedentary TV time and physical activity were independent of each other, that was both influential factors.

Thus, we can not change our genes, but it appears that we can greatly influence the impact they have on us. Therefore, the best advice is still, whatever genetic basis, following the authorities’ recommendations for diet and physical activity and reduce time spent watching television.

Written by Bjarne Nes, Fellow CERG.

Nitroglycerine for Heart Symptoms

Nitroglycerine  Facts

One thing that always surprised me in cardiac rehabilitation was the understanding of using Nitroglycerin (nitro).  I think over the years I saw and heard every way imaginable to ensure nitro tablet wouldn’t work if needed. Or the other one is when patients would carry it for years and then not use it when it is most appropriate to use. The take home message is if you are having discomfort that you suspect is heart related use a nitro ASAP.

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How Nitro works:

Nitroglycerin  dilates blood vessels that supply the areas of the heart where there is not enough oxygen thereby delivering oxygen to the heart tissue that needs it most.  The dilation of  veins and arteries  reduces the amount of blood returning to the heart so that the heart does less work and requires less blood and oxygen. Dilation of the arteries  lowers the pressure in the arteries against which the heart must pump. As a consequence, the heart works less and requires less blood and oxygen.

How to store Nitro:

Here is the thing Nitro is a very volatile compound. It breaks down rapidly with light, heat, oxygen, time and exposure to plastic. It is packed in a glass vial because plastic will leach the active ingredient out of it and all you have left is the inert ingredients that hold the tablet together. Therefore don’t transfer it to a container that is plastic, don’t put a couple in a baggy and put them in your wallet. Yes it is a pain in the butt to carry the bottle everyday, but find a way, or use a metal nitro vial which you can wear around your neck.

Heat will break down the nitro tablets. If you carry your Nitro in your pants pocket every day the heat from your body will gradually make the nitro less potent.  What I teach patients is to take a good marker and write on the bottle the date three months from when they started to carry the bottle. That is when it should be considered to replace. Sometimes it can go six months, but if you look at the bottle…hold it up to the light, don’t open it…and the tablets are looking powdery or crumbled….then replace the bottle. If you leave them in your pocket and they go through the dryer…time to replace. If you leave them in your car and your car is 100* or more…replace the bottle. That was a common one…”I leave them in the glove box in my car.”  NO NO NO!

If you have opened the bottle you have exposed the tablets to oxygen. Oxygen breaks down the nitro. Once the bottle has been opened, label the bottle for six months from the time  you opened it. Replace the bottle at six months. A story I would frequently hear that would make me cringe would be when a patients loved one or child would say ” I poured a couple in a paper cup and have them in my cupboard in case they need one while at my house”…UHG!!!! Won’t work sorry!

The bottle is brown to prevent sunlight from destroying the tablets as well. Don’t transfer them to any other bottle, there is a reason they come this way.

When to use Nitro:

The most common mistake in using nitro is when patients would tell me the pain wasn’t bad enough to use it.  The instructions for nitro don’t say wait until the discomfort is 9 out of 10, the instructions are to use the nitro if you have heart symptoms that do not go away with rest.  This means any heart discomfort, no matter how minor if is present for 5 minutes, would indicate using the nitro.  If you wait until you are really in pain, you probably will have damage done to the heart. The point of this drug is to prevent the damage to the heart by improving the blood flow preventing damage from occurring.

  • Sit down
  • Place one tablet under the tongue – most people experience a burning or tingling feeling under the tongue, a headache, a flushed feeling….If you experience this you should always experience this, as this indicates your nitro is fresh.
  • Wait 5 minutes – if the symptoms resolved rest a bit then gradually become active again
  • If the symptoms persist use a second nitro table, again wait 5 minutes, if needed take a third 5 minutes later
  • If you took a third nitro and still have symptoms call 9-1-1.Try to do some deep relaxing breathing, and thinking try not to panic. It’s a good time to use those relaxations skills.
  • Chew an adult strength aspirin while you wait for paramedics

One discussion I frequently have with patients goes as follows: You may carry your nitro faithfully for years and never need it, but if and when you do need it, you want it to be fresh so it can work. On the other hand some will need to use occasional nitro. This isn’t a bad thing. Your physician prescribed it for a reason. Use it!!!! There are common times when people need one…Exposure to cold air, Exertion that is strenuous, Emotional Stress, and after Eating a large heavy meal. Where the medical community get concerned is if you are requiring 2-3 nitro to clear your symptoms, if you are having more frequent symptoms, or if your symptoms are coming on at rest or waking your from your sleep. The escalation in symptoms should be reported to your physician ASAP.

Keep a log of your nitro  use.  Put on your log, the date, what you were doing when the symptoms occurred, and how many nitro it took to clear the symptoms. When you have a followup appointment with either your cardiologist or your primary care physician present them with the log. Sometimes we are able to find a pattern, do your symptoms come on at a certain time of day? Thus we can probably adjust medication timing to prevent this. Do they come on with a certain level of exertion? We call this your angina threshold and we watch to see is the threshold improving or worsening. Often through exercise we can improve the angina threshold.

What about long acting nitro?

There are long acting nitroglycerin medications that slowly release nitro into your system throughout the day. These are usually taken during the hours you are up and active. Rarely are they used twice a day, as your body needs a period of time in which it is free of nitro, or else it gets to where the nitro doesn’t work as effectively. It is still ok to use the fast acting nitro if you are on this medication.

What about the headache from taking Nitro? 

Take a Tylenol.  The headache won’t kill you but the heart attack might.

Symptoms of Congestive Heart Failure

These are the common symptoms of congestive heart failure.

If you suspect you are in heart failure see your healthcare practitioner ASAP. Ask for a BNP to be drawn this is B-type natriuretic peptide measure which helps to quantify the seriousness of CHF. If it is over 100 it is positive, and the higher it is the more emergent it is. It also helps to determine if the treatment is effective.  With long term use of diuretics it isn’t uncommon for the body to become resistant to a particular diuretic and then medications must be re evaluated. There are many diuretic out there and sometimes it is just a matter of finding the right combination for you. It is vitally important that you not rely solely on the medication but do your part in necessary prevention of CHF.

Prevention Measure of CHF

These include watching sodium intake and striving for 1500 mg in a day and no more, avoiding sitting for long periods of time, being vigilant in High heat and humidity, exercise, eat a diet rich in fruits and vegetables – dash diet. Steps to lower risk for congestive heart failure can be found here.