cardiac
HEALTH ON TIME
TM
FALL 2014
circulate the news PROTECT YOUR CIRCULATORY SYSTEM AND PREVENT VASCULAR DISEASE
T
he circulatory system, also called
the vascular system, includes 60,000 miles of blood vessels—arteries, veins, and capillaries—that circulate nearly 10 pints of blood through your body 24/7. According to the Centers for Disease Control and Prevention (CDC), a nutritious low-salt diet, exercise, a healthy weight, and abstaining from tobacco help protect your blood vessels’ health. However, certain diseases and chronic conditions increase your risk of vascular disease. Arterial vascular disease affects arteries and is usually caused by plaque buildup. The resulting condition, atherosclerosis, can lead to heart attack or stroke. Vascular disease in the veins can involve a blood clot in a leg vein or poorly functioning
AT R I S K F O R PA D ?
According to the CDC, high blood pressure, high LDL cholesterol, and smoking are among the top risk factors for heart disease, and about half of Americans have at least one of these risk factors.
vein valves. If you suffer from hypertension (high blood pressure), diabetes, or high cholesterol, you are more susceptible to vascular disease.
It is estimated that 53% of Americans with high blood pressure aren’t taking steps to control their disease.
You are at greater risk of developing peripheral arterial disease (PAD) if you: • are over the age of 50 • have high blood pressure •h ave a history of vascular disease, heart attack, or stroke • have diabetes • smoke or used to smoke
Hypertension affects nearly 77.9 million Americans. If not managed properly, it can lead to several vascular diseases, including sluggish blood flow to the legs and feet, which can in turn lead to blood clots in leg veins. The CDC reports that vascular disease is a main cause for sickness and death among patients with diabetes, a disease that affects 29.1 million Americans. When excess glucose collects in the blood vessels, they become thicker and less elastic, restricting blood flow. People with diabetes are at high risk for peripheral arterial disease (PAD), a vascular disease of the blood vessels of the legs that increases the chance of heart attack, stroke, or limb
Avoid Surgery
loss. It is estimated that 1 out of 3 diabetics age 50 or older have PAD. A regular cholesterol Atherectomy therapies check will make you remove plaque from the aware of levels of lowarteries in the legs, density lipoproteins without stents or (LDL, or “bad” cholestersurgeries. Learn more ol) and high-density by calling lipoproteins (HDL, or 706-721-2426. “good” cholesterol). HDL helps the body, while high LDL can build up and obstruct arteries, potentially resulting in heart attack, stroke, or limb loss. The CDC estimates that about 1 in every 3 American adults have high LDL and therefore have twice the risk of heart disease as those with optimal cholesterol levels. To protect your circulatory system, be vigilant about following your physician’s treatment program, know your risk factors, and make sure your cholesterol and blood pressure stay in the healthy zone by checking in with your doctor as recommended.
more active with PAD? GRU RESEARCH UNCOVERS HOW EXERCISE CAN HELP
F
or millions of Americans, simply walking to the mailbox can cause unbearable leg pain as muscles scream for more blood and oxygen. It’s called peripheral arterial disease, and
ironically, one of the best ways to alleviate it is by regularly walking to that point of pain. However, researchers hope a noninvasive measure of oxygen levels in leg muscles will put patients on the road to improvement without the severe discomfort. The idea is to push to the point of leg pain, then rest so the blood requirements of the muscles decrease, said Dr. Jonathan Murrow, cardiologist and faculty member at the Georgia Regents University/University of Georgia Medical Partnership in Athens. “It’s been shown that if you do this over and over again three times a week for an hour per session, after 12 weeks you will be able to walk twice as far as you did when you started,” said Murrow.
“However, if you just tell somebody to do that, many simply won’t.” Murrow is principal investigator on a new American Heart Association-funded study to find out if a sophisticated light sensor that distinguishes which red blood cells are carrying oxygen and which aren’t can also signal when patients have pushed far enough before pain hits. “We want to find a better way to use exercise as medicine for these patients,” said Murrow, who is working with colleagues at UGA and Emory University to directly compare results from the old and new approaches in about 100 patients. “We want to help them to continue to enjoy what they like to do.”
For more information, visit gru.edu/diabetes. GRU-013
Georgia Regents University 1120 15th St., AD 1114 Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID GEORGIA REGENTS UNIVERSITY
Vascular disease is most often caused by unhealthy lifestyle choices or a disease or chronic condition, including hypertension, high cholesterol, or diabetes. That’s why treatments to prevent, control, and reverse vascular disease generally start with controlling the triggers. Many vascular problems can be avoided by making healthy lifestyle choices. That means eating a nutritious, low-salt diet; maintaining a healthy weight; exercising regularly; and quitting smoking. When lifestyle changes alone can’t produce the desired results, your doctor will likely prescribe medications to help manage any chronic condition. In addition to managing pre-existing conditions that increase risk for vascular disease, your doctor may prescribe medications to prevent or break up blood clots, especially if you have existing issues with reduced blood flow, since a blood clot could block an already narrowed blood vessel and cause tissue death, heart attack, or stroke. Endovascular surgery is a minimally invasive process that allows doctors to repair damaged blood vessels by inserting a catheter through a very small incision. One such treatment is angioplasty, which is performed to repair a narrowed or blocked artery. The catheter carries a deflated balloon into the damaged artery, the balloon is inflated to widen the artery, and then the balloon is removed. Stenting is a similar process. To open a vessel, the catheter carries a balloon surrounded by a wire mesh tube that expands the vessel and remains in place. To repair a weak spot, the catheter carries a stent-graft, which is attached permanently spot for strength. additional graphics and KRT products, and KRT to the weak Check out new premium Web feature /online.presslink.com/new-cgi/waisgate/Providers/KRTgate.pl http://www.krtdirect.co http://www.krtdirect.com/weatherquiz If endovascular surgery is not possible, bypass surgery may be done.
DIAGNOSTICS If a physical exam indicates that you may suffer from vascular disease, your physician will likely perform one or more of the following diagnostic tests. • An ankle-brachial index (ABI) compares blood pressures in your ankle and arm. It requires a blood pressure cuff and an ultrasound device. To evaluate blood pressures before and after activity, you may be asked to walk on a treadmill. •U ltrasound imaging techniques, such as the Doppler ultrasound, may be used to take special photographs of the vascular system in order to evaluate blood flow and identify blocked or narrowed blood vessels. • An angiogram creates detailed images of arteries and veins when dye is injected into a blood vessel and X-ray pictures trace the dye as it circulates. The procedure helps doctors identify blockage, narrowing, or disease. •A magnetic resonance angiography (MRA) uses the MRI hardware but with special computer software that delivers only blood-related images, allowing doctors to assess blood vessels. • A computerized tomography angiography (CTA) uses a powerful X-ray machine to produce images of the heart and heart vessels, and is often used to locate narrowed heart arteries related to coronary artery disease.
OPENING CLOGGED ARTERIES WITH A STENT Obstructed Fatty plaque reduces blood flow through the artery. END VIEW
A catheter is threaded through an artery in the leg and to the heart; a deflated balloon is at its end; a stent is around the balloon. Catheter
Blockage in right coronary artery
Balloon (deflated)
SIDE VIEW
VA S C U L A R D I S E A S E S A N D D I S O R D E R S A stroke is defined as a sudden loss of brain function due to artery blockage or rupture, which prevents blood flow to brain cells. If stroke is suspected, call 911 immediately. In the hospital emergency room, the medical team will determine the correct treatment plan for the patient’s type of stroke.
Plaque
Catheter
Varicose veins are enlarged veins near the surface of the skin, usually in the legs and ankles. Mild cases are treated with compression stockings, exercise, and avoiding long periods of sitting or standing. More severe cases might require a procedure called vein ablation.
Stent
Plaque
Stent expanded The balloon is inflated, flattening plaque against the artery wall. END VIEW
Balloon
The stent, an expanding metal cage, spreads open and is pressed against the plaque and into the artery wall. Stent
Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, usually in one of the legs. The cause is generally a blood-clotting abnormality, an injury, or prolonged inactivity. Treatment includes anticoagulants and compression stockings to help keep blood from pooling and clotting.
Plaque
SIDE VIEW
Peripheral vascular disease (PVD) refers to disorders of blood vessels away from the heart and brain. A specific type of PVD, peripheral arterial disease, occurs when fatty deposits in the arteries block blood flow. Treatment involves controlling risk factors, such as high blood pressure, diabetes, high cholesterol, and diet. Blood thinners may be prescribed along with cilostazol to decrease leg pain and increase walking ability. In some cases, angioplasty or stent placement is necessary.
Stent Balloon (inflated)
New tissue After the catheter is removed, the stent holds the artery open. END VIEW
Blood flow improves immediately, relieving heart disease symptoms. Within two to four weeks, the stent is coated by new artery lining. SIDE VIEW
An abdominal aortic aneurysm (AAA) is an abnormal bulge in the aorta, the main blood vessel leading away from the heart. If left untreated, an aneurysm could rupture and result in death. Treatment often involves an endovascular stent graft.
Artery grows around stent
Stent
Coronary artery disease (CAD), sometimes called coronary heart disease, means an artery that carries blood to your heart has plaque buildup and the heart is not getting enough blood and oxygen. In addition to healthy lifestyle choices and medications to treat pre-existing conditions such as diabetes, hypertension, or high cholesterol, your doctor may prescribe anticoagulants and other anti-platelet medicines.
Drawings by American Heart Association, Guidant Vascular Intervention; Source: Dr. John Hirshfeld, American Heart Association, Guidant Vascular Intervention; Graphic: Cynthia Greer, Philadelphia Inquirer/KRT
KEYWOR
RELATED PRODUCTS AND STORIES
heart, stent, balloon, angioplasty, artery, disease, health, surgery, greer, national, ph, contributed, 1999
With HEART5, Knight Ridder by Donald C. Drake With 19991110 ARTERY STENT, KRT News In Motion
ORY: NATIONAL ME: HEART stent.fh8 RATOR: Cynthia Greer CHER: Staff : Philadelphia Inquirer IC SIZE: 3 col. x 4.5Ó 1. The D: 11/24/99
Heart and artery images © 2004 A.D.A.M., Inc.
vascular health
keeping the flow going
how well do you know your heart?
how hard should your heart work?
4. True or False? Vascular disease only affects arteries.
No.1 doctor-recommended way to protect your veins and arteries is: A. A healthy diet that promotes a healthy weight B. Adequate exercise C. Quitting smoking D. All of the above
5. T rue or False? Vascular diseases kill more Americans each year than cancer, AIDS, and traffic accidents combined.
Know if you’re improving your heart and lung fitness by tracking your target heart rate during activity. The most healthful activity level uses 50 to 85 percent of your maximum heart rate. To check, measure your pulse as soon as you stop your activity. Count it for 10 seconds and multiply that number by six to get the beats per minute. Then use the chart to see if you’re in the desired zone according to your age.
2. T rue or False? Diabetics are two to four times790 more likely to develop NATIONAL PRESS BUILDING, WASHINGTON, D.C. 20045 atherosclerosis than those without diabetes, which makes proper 6. TInc. rue or with False? Stents © Copyright 1999 Knight Ridder Tribune, Reprint permission only. placed in an artery cure (202) 383-6064 e-mail: The credit Ï Knight Ridder TribuneÓor Ï KRTÓmust appear with all uses of this graphic image. diabetes management imperative. vascular disease.
ANSWER KEY: 1: D; 2: True; 3: True; 4: False. Veins, too, can suffer vascular disease, usually in the form of blood clots. 5: True; 6: False. Stents as well as angioplasty re-open blocked or narrowed arteries, but they do not prevent future vessel disease.
3. T rue or False? Working with your doctor to achieve healthy cholesterol numbers reduces risk of plaque buildup in your arteries, which significantly decreases heart disease and stroke risks.
TARGET HEART RATE: 50–85% OF MAXIMUM Age (beats per minute) 20 100–170 25 98–166 30 95–162 35 93–157 40 90–153 45 88–149 50 85–145 55 83–140 60 80–136 65 78–132 70 75–128
YOUR HEART HEALTH LIFELINE
0-25 YEARS
25-40 YEARS
Build a healthy body now. Atherosclerosis begins in childhood. To reduce this fatty buildup in the arteries throughout one’s life, cigarette smoking should be discouraged and obesity should be avoided or reduced.
Get moving. In 2012, only 20 percent of American adults met the recommended guidelines for aerobic and muscle-strengthening activity. Consult your doctor about your physical activity.
40-55 YEARS Eat a low-saturated fat, lowcholesterol diet, which can help reduce your risk for heart attack.
Adults younger than age 45 who have risk factors for heart disease, such as diabetes or a family history of high cholesterol, should have their blood lipid levels checked regularly—at least once a year.
DIABETES
55-75 YEARS Women should discuss the pros and cons of hormone replacement therapy (HRT) with their physicians.
New guidelines recommend all men ages 35 and older and women ages 45 and older have regular blood tests to check their cholesterol and triglyceride levels.
Increasing age is a risk factor that cannot be changed. That’s why it’s important to focus on the risk factors you can control like smoking and inactivity.
75+ YEARS Fit physical activity into your everyday life. Take short walks or go for a bike ride during the day.
Comply with your physician’s treatment and medication directions.
blood sugar screening every 3 years after age 45
BLOOD PRESSURE screening annually CHOLESTEROL screening every 5 years
screening more frequently after age 45 for men or 50 for women
HEART DISEASE
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People who have excess body fat—especially if a lot of it is in the waist area—are more likely to develop heart disease and stroke even if they have no other risk factors. If you can lose as little as 10 to 20 pounds, you can help lower your heart disease risk.
For more about the latest vascular therapies, call 706-721-2426 or visit grhealth.org/cardio.
spotlight on our new pediatric heart surgeon Dr. Anastasios Polimenakos Director, Congenital and Pediatric Cardiothoracic Surgery Children’s Hospital of Georgia
Dr. Polimenakos’ passion is children in need, demonstrated by his role as an Honorary Ambassador for UNICEF, which presented him with the 2009 Award for Worldwide Commitment to Medicine and Health Protection of Children in Need. His other cardiac surgery mission work includes the Palestine Children’s Relief Fund and the Mauritian Trust Fund for Specialized Care, a volunteer effort to provide comprehensive management to patients with congenital heart defects. Dr. Polimenakos’ previous roles included positions at The Heart Center for Children at Janet Weis Children’s Hospital in Danville, Pa.; A.I. DuPont Children’s Hospital in Wilmington, Del.; and Rush University Medical College’s Center for Congenital and Structural Heart Disease in Chicago.
Children’s hearts demand specialized care, very different from adult hearts. Dr. Anastasios C. Polimenakos, a seasoned pediatric heart surgeon with expertise in aortic valve repair, specializes in major congenital heart surgeries for newborns, infants, and children.
5
Q&A Why do I need regular blood tests while on warfarin (blood thinners)?
To make an appointment with Dr. Polimenakos, call 706-721-7608.
fast fixes for diet mistakes
Think you know how to diet but are frustrated that you haven’t met your weight-loss or cardiac health goals? Here are some common dieting mistakes and their fixes to help you get back on track.
Blood thinners work by decreasing the activity of vitamin K, lengthening the time it takes for a clot to form. It’s vital to have a lab test frequently to make sure the blood-clotting time stays within the desired range—if too low, you run the risk of blood clots, and if too high, there could be excessive bleeding. The most common test for patients on warfarin is called the INR. A normal, healthy person will have an INR of 1. In warfarin therapy, INR is usually aimed between 2–3. In order to try to stay within the range while on blood thinners, it’s important to keep your vitamin K intake consistent. You should take your blood thinner at the same time every day, check your INR regularly, and limit foods rich in vitamin K.
Mistake No. 1. Skipping breakfast.
My doctor said I have prehypertension. I don’t have to worry yet, right?
Prehypertension—or blood pressure that is slightly elevated—may not be immediately critical, but it will likely turn into high blood pressure, which increases your risk for heart attack or stroke. Taking a diagnosis of prehypertension seriously and making lifestyle changes now may head off a future diagnosis of high blood pressure. Losing weight, maintaining a regular exercise program, and eating a healthier diet can help control prehypertension. Start small—make one healthy change at a time, such as cutting back on alcohol or reducing salt intake. Once you’ve adjusted, move on to additional changes like taking up an exercise program or increasing your physical activity.
breaking news untreated sleep apnea is a big risk for high blood pressure
exercise, but not to excess
A new study reported in an August 2014 issue of the Journal of Clinical Sleep Medicine discovered that severe, untreated obstructive sleep apnea increased the risk of elevated blood pressure, even with the use of medication to reduce blood pressure. Patients who had sleep apnea plus heart disease or cardiovascular risk factors were involved in the study, which found that high blood pressure medications may be less effective in patients whose sleep apnea is not treated. The study’s authors concluded that blood pressure that is resistant to treatment is an indicator of obstructive sleep apnea, which in turn increases risk for cardiac illness such as heart disease and stroke. If you’re having trouble managing your blood pressure, consider your sleeping patterns and discuss the possibility of sleep apnea with your doctor.
A study published in Mayo Clinic Proceedings in August 2014 confirms established findings that exercise improves outcomes in patients with heart disease, but found that heart attack survivors who exercise excessively—such as daily high-intensity training, like competitive running—could be at increased risk of dying of heart problems. The study’s authors cite other studies showing that five hours per week of vigorous exercise is a safe range for heart attack survivors, while making sure to take 1–2 rest days per week. There is no denying that exercise is good for the heart, but discuss your exercise plans with your doctor before starting a more vigorous exercise routine.
Mistake No. 2. Cutting all carbs. Fast fix: Include healthful carbs in your diet, such as fresh fruits, vegetables, and whole grains, but skip the refined sugars such as white breads, pastas, and white rice.
Mistake No. 3. Drinking too many high-calorie liquids. Fast fix: Water is the best option to meet your daily beverage quota. Try sparkling or flavored water or squeeze a wedge of lemon, lime, or orange into your glass. Choose among low-fat or nonfat milk, diet soft drinks, and unsweetened teas.
Mistake No. 4. Shunning snacks. Fast fix: Think of your snacks as mini meals and then plan them with balance, variety, and moderation in mind. Try cut-up raw vegetables or fruit, low-fat yogurt or pudding, popcorn, pretzels, a small baked potato with low-fat yogurt, or whole-grain crackers or breads with hummus or low-fat cheese.
Mistake No. 5. Sticking with strictly cardio workouts. Fast fix: Don’t forget about strengthening activities such as lifting weights, doing pushups and sit-ups, or tackling heavy gardening or household chores. Add these workouts two or three times a week to control body-fat composition and burn more calories.
Get Support Today You’re not alone in your struggle to lose weight. Our Weight Loss Center offers free support group and educational meetings on the fourth Tuesday of every month. For more details, visit grhealth. org/weightloss.
Be proactive about your heart health! Visit us online at grhealth.org/cardio.
Copyright © 2014 GLC, Northbrook, IL 60062 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
Foods very rich in vitamin K include fresh kale, cooked spinach, cooked turnip greens, collards, Swiss chard, parsley, and mustard greens. Limit your intake to one serving per day of these while on blood thinners. Other foods moderately high in vitamin K include brussels sprouts, raw spinach, raw turnip greens, green leaf lettuce, broccoli, endive, and romaine lettuce. Limit yourself to no more than three daily servings of these. Also avoid alcoholic drinks while taking blood thinners as alcohol can increase the effect of these medications.
Fast fix: Data from the National Weight Control Registry (nwcr.ws) has shown that eating breakfast every day is an important trait of successful weight loss. Good options include whole-grain breads and cereals, yogurt and fresh fruit, or an egg wrapped in a whole-wheat tortilla.