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Cardiac rehab helps change risk factors Saint Francis program ofers encouragement and results
S
usan Bonner has been helping people heal from their broken hearts for 40 years. Cardiac care has been her specialty since 1976. She is clinical manager at the Heart Hospital at Saint Francis and manages the Cardiac Rehabilitation program. That means she likely won’t be the irst person you see if you enter the hospital at 61st and Yale with chest pains or shortness of breath. And you won’t ind her standing over you during emergency heart surgery. But if you are admitted into the Heart Hospital, then you ought to be grateful when she or someone on her team comes by to introduce themselves. It means you have received a “wake-up call” and been given another chance at life. Bonner knows the wide range of responses from patients who have survived a heart incident. They go through the stages of grief, including denial. “How could this happen to me?” they might ask. Others may take a diferent approach and igure that since they lived “through it” that they can continue their same lifestyle without changing any of the risk factors that led them there. Bonner and her staf counsel these patients and help them work through their initial emotions, whatever those might be. That’s the beginning of a rehabilitation process. “Cardiac rehab is not just a ‘nice thing to do’ after a heart event,” Bonner says. “It’s the best thing you can do.” Bonner says the most important thing is helping heart patients understand “we don’t have a cure for heart disease. There’s no pill to prevent it.” But patients can reduce their risks of another heart problem occurring and live long, full lives. Cardiac rehabilitation involves three distinctive phases. The irst phase occurs during the patient’s hospital stay. That’s when the cardiac rehabilitation process is explained. Phase two involves the immediate period after being discharged from the hospital. The cardiac rehabilitation team puts together a customized plan of action, using a holistic approach of exercise specialists, dieticians and counselors. “You can’t prescribe the same script for everyone to follow,” Bonner says. “It doesn’t work that way for everybody.” Each patient is unique. Patients typically schedule visits to the Heart Hospital three times a week for up to three months to exercise in a specialized cardiac workout room. “We put them on a heart monitor and watch them while they exercise,” Bonner says. The third phase is continued maintenance. “This is when we help them think
“Cardiac rehab is not just
a ‘nice thing to do’ after a heart event. It’s the best thing you can do.”
Susan Bonner, clinical manager at the Heart Hospital at Saint Francis and manager of the Cardiac Rehabilitation program, helps patients make lifestyle changes so they can better recover. Photo courtesy of Saint Francis ahead to their long-term care,” Bonner says. Patients are encouraged to make lifestyle changes that involve exercise, proper nutrition, a reduction in stress and other things. The ultimate goal is for patients to create a consistency in continuing to do these on a daily basis. Bonner says many people start out right but then give up, especially when they skip a day of exercise or eat something unhealthy. It’s OK. They just need to pick up the habit again the next day. “We have a lot of work to do here in Oklahoma,” Bonner says. “Oklahoma is always among the top three states annually in coronary heart disease.” And that’s what Bonner hopes she and her staf can help change. Staying active is the key, she says. People need to engage in 30 minutes of physical activities per day. It doesn’t even have to be exercising in a gym and getting all sweaty, Bonner explains. The activity needs to elevate the person’s heart rate and get the
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muscles and bones moving. It could be two 15-minute walks – one in the morning, and the other later in the same day. “You don’t have to be at an extreme level of exercise to get the beneit,” Bonner adds. She recalls a former cardiac patient who began his rehabilitation unable to do much of any exercise. He moved around using an electric scooter because he had orthopedic problems that made it diicult to walk even a few steps. But the man lost some weight, got stronger and started walking slowly on a treadmill. That allowed him to get strong enough to have orthopedic surgery. Afterward, he was able to walk more, exercise more and eventually he was able to drive a motor vehicle again. “Those are the kind of stories we love,” Bonner says. They show that every patient can be helped, no matter where they start.
D6 THURSDAY, FEBRUARY 2, 2017
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tulsaworld.com/hearthealth2017 Oklahoma Heart Institute Hospital is located on the campus of Hillcrest Medical Center, offering the latest techniques in cardiac care. Photo courtesy of Hillcrest Medical Center
Overcoming Heart Failure Oklahoma Heart Institute program helps strengthen heart’s ability to pump blood
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ore Americans die of heart disease each year than all forms of cancer combined, and yet the word “cancer” often strikes more attention than any other medical diagnosis. “That’s because there’s a lot more awareness of cancer, but heart disease is the No. 1 reason for deaths in the United States,” says Dr. Mrudula R. Munagala, director of the Advanced Heart Failure program at Oklahoma Heart Institute. Heart failure is a common and life-threatening condition. “Once diagnosed, the risk of death from advanced heart failure is greater outside of two types of cancer – pancreatic and lung. And it’s certainly higher than for breast cancer, which sees quite a bit more advocacy.” Dr. Munagala would like more people to understand this so that they will take more seriously the risk factors that lead to cardiovascular diseases, including her specialty – heart failure. Heart failure occurs when the heart fails to pump adequate blood to meet the needs of the body. Dr. Munagala says heart failure is often confused with a heart attack, which is more likely associated with a blockage of blood vessels, plaque building or hardening of the arteries. Or the words “heart failure” might be confused with “sudden cardiac death,” which is mostly associated with rhythm abnormality of the heart. The American Heart Association estimates 6.5 million American adults are currently living with heart failure. Most people with heart failure irst notice fatigue, weakness and shortness of breath during normal activities, Dr. Munagala says. Some experience swelling in their legs and might begin using more pillows as they ind it diicult to lie lat, with some experiencing a choking sensation in the night. All of these symptoms are consistent with heart failure because the blood backs up in the lungs due to the heart muscle not working properly. That means the lungs cannot adequately send oxygenated blood to the various parts of the body. These episodes may warn of a serious problem. “It can get better with the help of a cardiologist,” Dr. Munagala says. “Many people adjust their life around their symptoms. They try to correct the situation themselves instead of seeking help.” If a person, for example, is used to walking a few blocks around the neighborhood but begins getting short of breath and tiring easily, he or she might simply stop taking those walks to alleviate the discomfort. They adjust to a “new normal” and this leads to a delay in seeking appropriate medical attention. “It’s a symptom you are masking,” Dr. Munagala says, “without correct-
ing the problem.” the heart. In other cases, patients might People experiencing these warning signs improve with procedures such as cardiac need to seek help for possible heart failure. ablation or the insertion of a pacemaker to The irst thing cardiac specialists, such keep the heart beating correctly. as those at the Oklahoma Heart Institute In extreme cases of heart failure, Dr. Muon the campus of Hillcrest Medical Center, nagala says, a patient might require open might do is perform an echocardiogram. heart surgery to insert an LVAD (left venThey might also order a cartricular assist device). This diac catheterization or MRI new surgery is not yet availto view what’s happening able in Tulsa, but Dr. Muwith the circulatory system. nagala hopes to introduce Doctors will look for any it here in the near future. signs of leaky heart valves, She has received training blocked arteries and other for LVAD management at heart problems, which could Philadelphia, Pittsburgh and be reason for heart failure. University of California Los Dr. Munagala says that Angeles (UCLA). might be caused by one of “It has changed the face of two things: the heart muscle heart failure,” Dr. Munagala is too weak to pump normally Dr. Mrudula Munagala says of this new device. “These or the heart muscle is not repatients (with advanced laxing well after it contracts, heart failure) now have hope. which results in the heart It’s saving lives.” chamber not illing up with All heart failure patients, blood. however, can improve the A normal heart pumps 55 quality of their lives, Dr. percent of the blood out of Munagala says, by paying the heart with each conattention to their lifestyle traction of the heart. This is choices and following docalso known as the “ejection tor’s recommendations for fraction” of the heart. If this common medical conditions. measures 35 percent or less, Reducing salt consumption, it’s considered to be signiieating healthy food and cantly weak, Dr. Munagala exercising regularly go a long says. If the squeezing funcway toward improving heart tion is measuring less than 20 health. percent, the patient may develop “advanced “Prevention is what we are hoping for,” heart failure.” she says. Treating common health condiIn cases of heart failure associated with a tions such as high blood pressure, diabetes, poor squeezing function of the heart, dochigh cholesterol levels and obesity decreastors might prescribe medicine to strengthen es the risk of developing heart disease.
“Many people
adjust their life around their symptoms. They try to correct the situation themselves.”
KEEP AN EYE ON THESE 2 WARNING SIGNS:
HIGH BLOOD PRESSURE: Examine your lifestyle Your blood pressure is the force of blood pushing against your blood vessel walls. When you have high blood pressure, the pressure in your arteries is elevated. One in four adults, about 50 million Americans, have high blood pressure. When untreated, it can increase the risk of heart attack and stroke.
Risk factors Those at a greater risk for high blood pressure include people with relatives that have high blood pressure; African Americans; people over the age of 35; overweight people; those who aren’t physically active; people who use too much salt or drink too much alcohol; people with diabetes, gout and kidney disease; pregnant women; women who take birth control pills who are overweight, had high blood pressure during pregnancy, have a family history of high blood pressure or have mild
kidney disease.
Avoiding the problem Take steps to live a healthier life and you’ll greatly improve your odds of avoiding high blood pressure later in life. The Red Cross recommends anyone at risk lose weight if they are overweight; eat healthy meals low in saturated fat, cholesterol and salt; limit alcohol to no more than one drink per day for women or two for men; be more physically active; take medicine the way it’s prescribed; know what your blood pressure should be and work to keep it at that level.
Make changes High blood pressure is manageable, and lifestyle modiications are essential. Adopting a healthy lifestyle is critical for the prevention of HBP and an indispensable part of managing it.
HIGH CHOLESTEROL: Connected to heart disease High cholesterol is a major controllable risk factor for coronary heart disease, heart attack and stroke, according to the American Heart Association.
The basics Cholesterol is a waxy substance that comes from your body and food. Your body makes all the cholesterol you need and circulates it through the blood. Cholesterol is also found in foods from animal sources, such as meat, poultry and full-fat dairy products. Your liver produces more cholesterol when you eat a diet high in saturated and trans fats. Excess cholesterol can form plaque between layers of artery walls, making it harder for your heart to circulate blood. Plaque can break open and cause blood clots. If a clot blocks an artery that feeds the brain, it causes a stroke. If it blocks an artery that feeds the heart, it causes a heart attack.
Two types There are two types of cholesterol: “good” and
“bad.” Too much of one type or not enough of another can put you at risk for coronary heart disease, heart attack or stroke. It’s important to know the levels of cholesterol in your blood so that you and your doctor can determine the best strategy to lower your risk. Making healthy eating choices and increasing exercise are important irst steps in improving your cholesterol. For some people, cholesterol-lowering medication also may be needed to reduce the risk for heart attack and stroke.
Connection to heart disease As your blood cholesterol rises, so does your risk of coronary heart disease. If you have other risk factors, such as smoking, high blood pressure or diabetes, this risk increases even further. The greater the level of each risk factor, the more that factor affects your overall risk. Your cholesterol level can be affected by your age, gender, family health history and diet.
A healthy diet that includes plenty of fruits and vegetables and moderate amounts of lean meats, such as chicken and ish, can help lower your risk for coronary heart disease.
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