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.

After heart attack caring for your heart

The piece below is from a blog is written by Dr. Fogoros. He has presented the information very well. Every person discharged should have a care plan, they or their caregiver should have an understanding of what happens with a heart attack, what medications are necessary including how and why to take them, a plan to address the risk factors that contributed to the disease, and an action plan for recovery. He has summed it up very well. If you had a heart attack and were discharged from the hospital recently did you have a plan like the one listed below? From experience patients often have had such a whirlwind experience  with a rollercoaster emotional response, topped off with plenty of medications that upon discharge they are overwhelmed and confused. This is why the Cardiac Rehabilitation Programs are so important, they help you understand the what, where, why and how, and how to emotionally and physically recover.

 

After you’ve survived a heart attack (also called a myocardial infarction, or MI), you’ve got a lot to learn about and a lot to think about. While in the good old days you might have had a week or two of hospitalization to go through all the testing, risk assessment, education, and initiation of therapy necessary to optimize your long-term prognosis, today whatever is going to get done must happen in the first three (or four, if you’ve got a liberal health plan) days.

Doctors and hospitals have mobilized nicely to provide adequate acute care for the patient showing up with an acute MI. But too often, many have dropped the ball when it comes to giving appropriate care after those first critical hours. As a consequence, all too often patients don’t receive all the assessments, education, and treatment they need to assure an optimal outcome. For instance, recent studies show that less than half the patients who need statin drugs receive them. Other studies show that only a minority of heart attack survivors receivebeta blockers. And the proportion of patients who get an adequate assessment for the risk of sudden death, let alone those who receive the implantable defibrillator when it is indicated, is laughable.

The key to successfully navigating your way to a long, healthy life after a heart attack is you. You need to insist that the appropriate tests are done, the appropriate referrals are made, and the appropriate medications are begun. To this end, here is a convenient checklist of the things that should be done — ideally before you even leave the hospital — after your heart attack.

Doctors really do want to do the right thing. It’s just that, given all the pressure and constraints they’re operating under, from both insurance companies and the government, sometimes you need to remind them of who they’re really obligated to, and what your expectations are in that regard.

The Post-Heart Attack Checklist:

1) Lifestyle changes and other education:

• I have been fully instructed on the warning signs and symptoms of heart attack, and the actions to take if I experience these signs or symptoms. (y/n) _____
• If I am a smoker, I have been counseled to stop, and referred to one or more smoking cessation programs. (y/n) _____
• I have been fully instructed on a heart-healthy diet. (y/n)_____
• I have received detailed activity instructions for the next 4-6 weeks, and have been referred to a cardiac rehabilitation program. (y/n) _____
• The importance of long-term exercise has been explained to me. (y/n) _____
• My doctor has talked to me about when I can resume sexual activity. (y/n) _____
• My doctor has talked to me about when I can resume driving. (y/n) _____

2) Assessing the risk of another heart attack in the near future:

• The status of my coronary arteries has been assessed by either stress/thallium study (y/n) _____ or cardiac catheterization. (y/n) _____
• The condition of my coronary arteries has been explained to me as follows: __________________________
• The plan for following the status of my coronary arteries over time is: __________________________

3) The amount of damage done to my heart has been assessed by:

• Stress/thallium study (y/n) _____
• Cardiac catheterization (y/n) _____
• MUGA scan (y/n) _____
• Echocardiogram (y/n) _____
• My ejection fraction is _______ (Note: if the ejection fraction is 35% or lower, see #6 below.)
• I (do / do not) have some degree of heart failure.

4) Important numbers I need to know:

• My lipid profile has been measured, and the results are: Total cholesterol _______ LDL cholesterol _______ HDL cholesterol _______ Triglycerides _______
• My blood pressure is _______
• My ejection fraction is _______

5) Names and doses of medications prescribed for me:

• Aspirin ___________________________
• Beta blocker ___________________________
• ACE inhibitor ___________________________
• Statin ___________________________
• Note: All of these medicines have been shown to help prevent further heart attacks and reduce the risk of death. If I have not received a prescription for one or more of these medications, the reason is ___________________________.

6) Preventing sudden death

• If my ejection fraction is 30% or less, (or if I have had heart failure, and my ejection fraction is 35% or less) I have been referred to an electrophysiologist to discuss the possibility of an implantable defibrillator on: ______ (date)
• Members of my family have been trained in CPR (y/n): ______

_Sources:

_{Smith, SC Jr, Allen, J, Blair, SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006; 47:2130.}

Richard N. Fogoros, M.D.
Heart Health Center Guide

Love your heart, stay healthy

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

 

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.

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