Valentines not the only hearts that need care
Des Moines Register
DES MOINES, Iowa — February is American Heart Month and a good time to learn about cardiovascular disease, which will kill an estimated 452,000 Americans this year. Learn how to keep a heart healthy.
- Smoking. Smokers have two to four times greater risk of developing heart disease than non-smokers.
- Cholesterol. Studies have confirmed the connection between high blood cholesterol and increased risk of heart disease. This risk is compounded if a person has high blood pressure, diabetes or smoke.
- High blood pressure. Elevated blood pressure increases the workload of the heart, causing the heart muscle to thicken and become stiff.
- Diabetes. Even if blood sugar levels are under control, diabetics have five times the risk of heart attack and stroke than nondiabetics.
- Obesity. Excess body weight places a significant stress on the heart, both directly through increased work load and indirectly through elevated blood pressure.
- Physical inactivity. Studies show that people who undergo even mild amounts of physical activity have a much lower rate of death and heart disease. Keeping the blood flowing at a higher rate for a minimum of 10 minutes can help reduce fatty deposits that eventually can form plaque on the vessels.
- Stress. Increased pressures at work or home can contribute to heart attack or stroke.
- Alcohol consumption. A daily glass of wine or an ounce of alcohol can raise the level of good cholesterol in the blood, but excess alcohol intake can raise blood pressure, increase triglyceride levels and contribute to liver and heart disease.
- Aspirin. Taking a baby aspirin each day reduces the risk of heart attack or stroke by discouraging platelets from sticking together.
- Blood tests. Blood tests can check for anemia, which can contribute to low oxygenation of heart tissues, or cardiac enzymes, which can be found in the blood one to three hours after a heart attack. A doctor may also draw blood to test insulin levels. Studies have found an association between high fasting insulin concentration in the blood and the risk of ischemic heart disease. Doctors may also look for elevated levels of homocysteine, C-reactive protein, fibrinogen and a type of LDL cholesterol.
- Electrocardiogram. This test measures the electrical activity of the heart. It detects an enlarged heart muscle, skipped beats and irregular rhythms. Injured heart muscle won't conduct electrical impulses properly, so this is a quick way to diagnose critical cardiac problems.
- Chest X-ray. This simple test can check the size and shape of the heart, and help detect fluid that may be backing up into the lungs as a result of heart failure.
- Echocardiogram, or ECG. An ECHO test produces a video display of the heart as it is beating, giving an illustrated view of the function of the heart muscles and valves.
- Exercise stress tests. This involves monitoring the heart by ECG before, during and after stressing the heart through exercise — or medication for patients unable to undergo physical exertion. This test is 60 percent to 70 percent accurate in identifying blockages in one or more coronary arteries if the patient can achieve the appropriate heart rate.
- Nuclear scan. This stresses a patient through exercise after small amounts of radioactive material are injected into the bloodstream. The amount of radioactive material ending up in the heart muscle depends on the health of the vessels leading to the heart tissue. Different levels of radioactive material between exercise and rest indicate the possibility of diseased vessels.
- Electron Beam CT Scan. An EBCT is designed to measure calcium deposits that lie within plaques in the heart arteries. Elderly people may have calcium deposits in the lining of many vessels without significant narrowing of the diameter. Therefore, this test results in many "false positive" findings and remains a controversial test.
- Cardiac catheterization. The best way to determine the degree of blockage in heart vessels. A catheter is threaded up to the heart through a puncture in the groin or arm. Dye is injected, which lights up the vessels and reveals areas of blockage.
- Medicine. Cholesterol-lowering medications, in conjunction with a low-fat diet, are commonly prescribed. Other medications decrease the workload of the heart through reduced blood pressure or heart rate, so less oxygen is needed. Nitrates can be prescribed to dilate the heart arteries to help compensate for the partial blockage.
- Angioplasty. If an angiogram reveals severe disease that requires immediate intervention, a catheter is threaded down the diseased vessel and centered over plaque, the balloon is inflated. This pushes the plaque away from the center of the vessel in an effort to increase the opening. Often a stent is installed after angioplasty to keep the vessel open.
- Plaque removal. By placing a small auger within a heart vessel, deposits can actually be physically ground. This method has a greater incidence of complications and is used much less than other means.
- Coronary artery bypass grafting. Commonly called bypass surgery, this procedure involves use of an alternate vessel to jump over areas of blockage and successfully provide blood supply to distant heart muscle. Often, multiple bypasses are performed at one time. There is now a minimally invasive coronary bypass available if only the right side of the heart is afflicted.
- Transmyocardial laser revascularization. This is an alternative treatment for people who are not candidates for either angioplasty or bypass surgery. A laser catheter is used to create multiple pinpoint holes in the heart muscle, which encourages growth of new vessels into the diseased heart tissue.
Heart-healthy diet tips
According to the American Heart Association:
- Begin the day with whole-grain bread or cereal and fruit.
- For lunch and dinner, make whole grains and vegetables the main course. Add a salad or vegetables if a meal is mainly meat. Add leafy salads, pasta salads, chickpeas, beans or soy products, all of which help reduce LDL (bad) cholesterol.
- Eat a fruit plate or low-fat yogurt for dessert. Reduce sweets and refined sugars to a minimum.
- Cook foods in olive oil or canola oil, which are high in monounsaturated fats (lowering LDL and total cholesterol levels).
- Eat one to two servings of fish or seafood each week.
- For a snack, have a small handful of nuts rich in monounsaturated fats - hazelnuts, almonds, pecans, cashews, walnuts or macadamia nuts.
- Cook foods with garlic for a possible slight cholesterol-lowering effect.
Calculate the risk
People also can use the National Heart, Lung and Blood Institute's risk assessment tool for estimating their risk of having a heart attack within the next 10 years: hp2010.nhlbihin.net/atpiii/calculator.asp.
Dr. Roberta Wattleworth, chairwoman of the family practice department at Des Moines University, writes a monthly column for Health. Before joining the university faculty in 1999, she had a solo practice in rural Iowa for 10 years and was the medical director for a fire and rescue squad.