Binge drinking and heart risk

History of repeated binge drinking in healthy young adults caused alterations in macro- and microvascular function similar to those seen in individuals with recognized cardiovascular risk factors, according to a study published today in JACC. Full coverage:

What people with heart conditions need to know about Atrial Fibrillation

This progressive and debilitating disease can lead to stroke, heart failure, and Alzheimer’s disease, and can double your risk of death. Afib takes a physical toll, an emotional toll, and a financial toll on those who are living with it—not just the patient, but the family, too.

Although atrial fibrillation itself usually isn’t life-threatening, it is a serious medical condition that sometimes requires emergency treatment.

It can lead to complications.

Symptoms of A Fib

• Skipping, fluttering,or quivering of heartbeat
• Heart beating too hard or fast
• Dizziness or lightheadedness
• Confusion
• Shortness of breath
• Chest pain or pressure
• Tired when resting or when active
• Swelling of feet, ankles,and legs
• Feeling anxious

Here is a short video Do you know what Atrial Fibrillation feels like?

What Causes Atrial Fibrillation?

Atrial fibrillation (AF) occurs if the heart’s electrical signals don’t travel through the heart in a normal way. Instead, they become very rapid and disorganized. With atrial fibrillation (AFib),the electrical signals of the heart are abnormal.

• The top and bottom parts of the heart don’t work together as they should
• The heart beats very fast and irregularly
• As a result,blood is not properly pumped to the bottom part of the heart and the rest of the body

Damage to the heart’s electrical system causes AF. The damage most often is the result of other conditions that affect the health of the heart, such as high blood pressure and coronary heart disease.


Understanding the Electrical Problem in Atrial Fibrillation

In AF, the heart’s electrical signals don’t begin in the SA node. Instead, they begin in another part of the atria or in the nearby pulmonary veins. The signals don’t travel normally. They may spread throughout the atria in a rapid, disorganized way. This can cause the atria to fibrillate.

The faulty signals flood the AV node with electrical impulses. As a result, the ventricles also begin to beat very fast. However, the AV node can’t send the signals to the ventricles as fast as they arrive. So, even though the ventricles are beating faster than normal, they aren’t beating as fast as the atria.

Thus, the atria and ventricles no longer beat in a coordinated way. This creates a fast and irregular heart rhythm. In AF, the ventricles may beat 100 to 175 times a minute, in contrast to the normal rate of 60 to 100 beats a minute.

If this happens, blood isn’t pumped into the ventricles as well as it should be. Also, the amount of blood pumped out of the ventricles to the body is based on the random atrial beats.

The body may get rapid, small amounts of blood and occasional larger amounts of blood. The amount will depend on how much blood has flowed from the atria to the ventricles with each beat.

Most of the symptoms of AF are related to how fast the heart is beating. If medicines or age slow the heart rate, the symptoms are minimized.

AF may be brief, with symptoms that come and go and end on their own. Or, the condition may be ongoing and require treatment. Sometimes AF is permanent, and medicines or other treatments can’t restore a normal heart rhythm.

Major Risk Factors

A good question to ask your healthcare provider is what is the cause of my AFib?

Atrial Fibrillation  is more common in people who have:

  • High Blood Pressure
  • Coronary Heart Disease (CHD)
  • Heart Failure
  • Rheumatic heart disease
  • Structural heart defects, such as mitral valve prolaps
  • Pericarditis;  a condition in which the membrane, or sac, around your heart is inflamed
  • Congenital Heart Defects
  • Sick sinus syndrome (a condition in which the heart’s electrical signals don’t fire properly and the heart rate slows down; sometimes the heart will switch back and forth between a slow rate and a fast rate)

AF also is more common in people who are having heart attack or who have just had surgery. The risk of AF increases as you age. Inflammation also is thought to play a role in causing AF.  Drinking large amounts of alcohol, especially binge drinking, raises your risk. Even modest amounts of alcohol can trigger AF in some people.  Sometimes, the cause of AF is unknown.


Treatment Goals

• Slow heart rate
• Regain normal heartbeat
• Treat causes
Lower risk of stroke and heart failure

Warning Signs of Stroke

• Numbness or weakness of the face, arm, or leg ,especially on ONE side
• Confusion
• Difficulty speaking or understanding
• Trouble seeing in one or both eyes
• Trouble walking or with balance
• Dizziness
• Severe headache

Warning Signs of Heart Failure

• Shortness of breath
• Trouble doing usual activities
• Difficulty breathing when lying flat
• Weight gain
• Swelling in legs, ankles, or feet

Treatment options

 Heart Procedures

  • Cardioversion

Cardioversion is done two ways: An electrical procedure,  in which your heart is given low-energy shocks to trigger a normal rhythm. You’re temporarily put to sleep before the shocks are given. This type of cardioversion is done in a hospital as an outpatient procedure. “Outpatient” means you can go home after the procedure is done.

Cardioversion through use of medicines. Using medicines to correct arrhythmias also is a form of cardioversion. This type of cardioversion usually is done in a hospital, but it also can be done at home or in a doctor’s office. It is known as a rhythm controller

  • Catheter ablation

During catheter ablation, a series of catheters (thin, flexible wires) are put into a blood vessel in your arm, groin (upper thigh), or neck. The wires are guided into your heart through the blood vessel.
A special machine sends energy to your heart through one of the catheters. The energy destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.

Catheter ablation often involves radiofrequency (RF) energy. This type of energy uses radio waves to produce heat that destroys the heart tissue. Studies have shown that RF energy works well and is safe.

Lifestyle changes

  • Do I need to change my eating habits?
  •  Should I change my activity level?
  • What else can I do to lower my risk?
  •  Stopping smoking
  •  Limiting/avoiding alcohol
  •  Limiting/avoiding caffeine


Living with Atrial Fibrillation patient educational materials

Learn about Atrial Fibrillation here

A heart away from stroke documentary  Discovery Channel explores the connection between atrial fibrillation and stroke – in order for patients to learn about the importance of stroke prevention



Making Trails for Exercise

Exercise is all about making trails

Recently I encountered a patient who I had worked with 18 years ago, he was back for his second heart procedure. He was very excited to see me to discuss how my advice made such a difference. I couldn’t for the life of me remember what advice I gave him nearly twenty years ago. He proceeded to inform me I told him to go walk the trails in the woods. Here he was looking fit, strong, and healthy. He was here for a quick tune up as heart disease is progressive, tune ups are required. So we set about reviewing his risk factor profile, and he looked good. He had been walking the trails in the woods nearly every day!

This gets me to thinking about making trails.  What kind of trails do you make? Maybe you think you don’t make any trails because you walk a treadmill or ride a bike. Here is how my friend Nate Burns and staff make trails in cardiac and pulmonary rehabilitation programs.  Cardiac and Pulmonary Rehabilitation Walks Trails  Every year they do a different theme walk, and map out interesting stops along the way. You could add up your miles and consider where your travels have taken you, or you could work towards a goal of a certain destination.

My favorite trails are  hiking, biking, cross country skiing, beach trails and are accessible in some form year round. A goal one year was to get a guide of all the hikes at the nearby National Lakeshore Park Sleeping Bear Dunes and walk each one, now that is a yearly goal. This can also be done with your local land conservancy, or your conservation district, your local parkland.

How many trails can you find in your community? Are you up to the challenge?


The Diabetes and Heart Relationship

How does diabetes increase my risk for heart problems?

Both type 1 and 2 diabetes accelerate the progression of artherosclerosis – hardening of the arteries.  Having type 1 diabetes increases the risk for heart disease 10 fold. Heart attacks account for 60% of deaths in patients with diabetes while strokes account for 25% of deaths. Nearly all patients with type 2 diabetes have developed resistance to their own insulin, their pancreases churns out insulin which is a critical hormone in an effort to move glucose into cells, but it is more than the cells can utilize. High levels of insulin in the blood causes damage to the lining of blood vessels that leads to atherosclerosis. Hardening  of the arteries occurs and  sets the stage for plaques  to build.   Evidence shows that patients with diabetes have an increased level of low-grade inflammation of their arterial lining, a process that initiates the blood vessel changes leading to heart disease. Some of the increased susceptibility to blood vessel damage that people with diabetes have  is due to the long-term effects of inadequate control of blood glucose levels on the tissues or as a result of other cell damage related to diabetes.  A chemical reaction between glucose and proteins  exists in the body  to produce compounds called advanced glycosylation endproducts, or AGEs.  Diabetes increases the amount of glucose in your blood that’s available to be glycosylated, people with the disease tend to have high concentrations of AGEs. These compounds  damage arteries, making them more likely to create blockages, in addition to increasing the risk for a long list of other common diabetes complications.

Know your numbers

In the last 10 years, large-scale research studies around the world have shown that optimal control of LDL cholesterol (the “bad” cholesterol) and blood pressure can prevent adverse cardiovascular outcomes by 30% to 50%. The American Diabetes Association and the American Heart Association recommend an LDL cholesterol goal in all adults with diabetes at less than 100 mg/dl. In people who already have heart disease, a more desirable LDL cholesterol goal should be less than 70 mg/dl, based on evidence from more recent studies.

At least half of patients with diabetes have hypertension – high blood pressure. Chronically elevated blood pressure forces your heart to work too hard, which may cause it to weaken over time. High blood pressure also increases wear and tear on the arteries. The blood pressure goal in all patients with diabetes is less than 130/80. In most patients with diabetes, reaching these targets for blood pressure could require two or more medications. With diabetes, high blood pressure  usually develops if the kidneys become damaged. Kidney disease (nephropathy) is a very serious complication of diabetes. With this condition, the tiny filters in the kidney (called glomeruli) become damaged and leak protein into the urine. Over time this can lead to kidney failure. Urine tests showing microalbuminuria (small amounts of protein in the urine) are important markers for kidney damage. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD), occurs in about 20 – 40% of patients with diabetes.

Hemoglobin A1C tests— measure of average blood glucose levels over the preceding two to three months—the goal is less than 7%. Intensive control of blood glucose and keeping glycosylated hemoglobin (HbA1c) levels below 7% can help to prevent complications due to vascular (blood vessel) abnormalities and nerve damage (neuropathy) that can cause major damage to organs, including the eyes, kidneys, and heart.

A healthy eating plan, exercise and medications are the cornerstones of managing diabetes.

Blood sugar regulation through monitoring the diet and exercise  and the relationship to blood sugars levels is what diabetics need to understand to decrease the risk of heart disease. Exercise should be viewed as a medication with the goal of getting the proper dose every day to get the sustained benefits. The more regular one is with exercise the better one can control their blood sugars. Exercise requires close monitoring of blood sugars. They should be measured before, occasionally during and after exercise.

When not to exercise

If your fasting blood glucose is more than 300 mg/dl, no matter what type of diabetes you have, it is in poor control. It may be best to bring your blood glucose level back down or to check with your health care provider before exercising. If you decide to exercise, use caution. Make sure you are negative for ketones and re-check your blood glucose to make sure it is dropping in 10-15 minutes. Drink plenty of water, this can’t be emphasized enough the water helps to “wash out” the ketones from the blood stream.

If you have type 1 diabetes and your blood glucose results are 250 mg/dl before exercise, stop and check for ketones. If you have moderate or large amounts of ketones, do not exercise. Ketones are a sign that your insulin level is too low. Exercise could cause the body to make more ketones.  Ketones add acid to the blood. When too many ketones are produced, they disrupt your body’s chemical balance. This can be  very dangerous. Wait until your tests show negative or trace ketone levels before beginning to exercise.

If your blood sugar is lower than 100 before exercising it is considered too low to safely exercise. Exercise uses the circulating blood sugars to provide sustainable energy for the muscles to function. When the blood sugar drops too low this can be extremely dangerous.  The recommendation is to eat a snack containing carbohydrates and protein 30 minutes before the exercise to sustain prevent the blood glucose levels from crashing. If the exercise is prolonged greater than 30 minutes or symptoms develop such as profuse sweating, shakiness, vision changes, nausea, angina it is best to  stop and check the glucose levels again. Some will require a small amount of carbohydrates during the exercise to sustain the blood sugars above 100. If blood sugars repeatedly drop with exercise a medication adjustment may be required and this should be discussed with your healthcare provider. This is a common issue especially as one becomes more fit. Again many pre-diabetics or type 2 diabetics are able to reduce or stop medication through exercise and diet.


What are my chances of getting Heart Disease?

What Are My Chances of Getting Heart Disease Infographic

The Multiplier Effect

  • 1 risk factor doubles your risk
  • 2 risk factors quadruple your risk
  • 3 or more risk factors can increase your risk more than tenfold
By doing just 4 things – eating right, being physically active, not smoking, and keeping a healthy weight – you can lower your risk of heart disease by as much as 82 percent