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Heart Health Month

February is Heart Health Month 

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What You Should Know About Heart Disease

Since it’s February, you may be thinking about sweetheart candy and heart-shaped boxes of chocolate. Did you know that it is also a great time to think about your own heart? February is Heart Health Month!

It’s important to know the risk factors and signs of heart disease as it’s the leading cause of death for both men and women with 610,000 Americans dying from heart disease each year. Continue reading “Heart Health Month”

‘If it hadn’t been for them, I wouldn’t be here today’

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Happy Reunion: Patient Andrea Wheaton (third from left) with ExpressCare team members Ana Miranda, MA, Jenny Evans, PA, and George Summerlin, MA.

Waking on the morning of May 19th, out of breath and heart racing, Andrea Wheaton knew she needed medical attention. Looking back on it now, the 62-year-old Registered Nurse sheepishly admits that she should have called an ambulance, but ExpressCare was just down the street from her North Andover home. She drove. 

“The receptionist took one look at me,” she says. “I guess my color was terrible. Someone came immediately out of the clinic and took me in, I was never even checked in.”

Front-line staff are watchful for potentially life-threatening situations, says Garrett Bomba, MD, Medical Director of ExpressCare. 

“Any patient is brought immediately back to the doctor,” he says, “if they present with signs of distress, or tell us that they have any symptoms that suggest a more serious condition.”

It’s a policy that Andrea credits with saving her life. 

Medical Assistant George Summerlin brought Andrea into Room 12, took her vitals and triaged her, immediately alerting Physician Assistant Jenny Evans. 

“I found Andrea short of breath and sweaty,” Jenny recalls, “…and her vitals were abnormal – we were concerned she had lung or heart problem that needed to be emergently addressed. Because her vitals were abnormal we did an EKG, which wasn’t normal either. We gave her some aspirin just in case she was having a heart event. Her oxygen was low so I was thinking pneumonia, but her lungs were clear. She’d had recent surgery we were worried about a lung clot, having no idea that the clot was as big as it turned out to be.”

“She agreed to go to the hospital,” Jenny continues, “and that was the last we heard of her until she came to see me. She came in after she was discharged, before an appointment with Dr. Goldman. She told me what had happened and thanked me.” 

“When I got to Lawrence General,” Andrea says, “The back pressure from the lung was so bad, they thought I was having a heart attack.  They called Dr. (Seth) Bilazarian, who did a D Dimer – a test for blood clots then they sent me to for a CT scan. My right lung completely occluded by blood clots, and the left was down to 25 percent clear.” 

“As a nurse,“ Andrea says, “I’ve seen people die from just one blood clot. The clotting I had was massive. I realized how serious this was when the hospital had my daughter come in to co-sign a living will, DNR and health care proxy.”

Andrea stopped in at ExpressCare recently to say hello and have her photo taken with some of the staff who helped her back in May. She said she was returning to work the next day. 

“I just can’t say enough about the way I was cared for at ExpressCare,” says Andrea. “Right from the front staff… I never felt like they were interested in money, just making sure I’d be OK… all the way to Jenny – if had not been for them, I wouldn’t be here today.” 

How Stress Can Affect your Heart

Stress is an inevitable part of life; Work, family, finances and relationships can all cause unnecessary stress and anxiety. While not all stress is bad for you, ongoing, chronic stress can negatively affect your heart.

How Does Stress Affect the Heart?

Stress that goes unmanaged can cause the following health conditions that also impact your heart health:

  1.   High Blood Pressure: The surge of hormones produced when in a stressful situation increases your blood pressure by causing your heart to beat faster and your blood vessels to narrow. High blood pressure can lead to both coronary artery disease and hypertensive heart disease. 
  2.  Irregular Heart Rhythm:  Irregular heart rhythms, also known as heart palpitations and arrhythmia, can result in feeling like your heart is skipping a beat, pounding or speeding up quickly. While it is not known exactly why stress can cause irregular heartbeats, the adrenaline caused by a surge in hormones is the most common reason.
  3. Damage to Arteries: Chronic stress causes direct aging of the arteries. According to recent research by Johns Hopkins Medical School, individuals who react to stress with anger and frustration has 20 times of arterial aging. Extensive damage to the arteries can cause elevated blood pressure and heart disease. 
  4. Higher Cholesterol Levels: Studies show that mental stress can raise LDL (bad cholesterol) and lower HDL (good cholesterol). If stress is impacting the amount of HDL your body is producing, how effectively HDL cleans up additional LDL is also affected. 

Tips to Manage Stress and Improve Heart Health

Here are some simple tips you can use to manage stress and keep your heart healthy:

  • Keep a positive, realistic attitude when a stressful situation presents itself. You might not be in control of the situation, but you’re in control of how you respond.
  • Start an exercise routine. The endorphins released during exercise can counteract the negative hormones released during stress. 
  • Spend time with the people you love. Laughing and being around positive people might undo the effects of stress on your body.
  • Focus on getting an adequate amount of sleep so you can handle stressful situations better. 

Do you have questions about your heart? Contact Pentucket Medical Cardiology at (888) 227-3762 to find out more about stress and heart health.

Heart Attacks in Women

heart attacks in women

Heart Attack: Under-Recognized Killer of Women

Heart attacks are by far the most common cause of death in females, three times greater than breast cancer, for example.

Signs and symptoms of a heart attack is vital information that should be known by every woman.

The most common symptoms of heart attacks in women are pain, pressure or discomfort in the chest. But it’s not always severe or even the most prominent symptom, particularly in women. And, sometimes, women may have a heart attack without chest pains. Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

  • Neck, jaw, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Right arm pain
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue

These symptoms can be less pronounced than the obvious crushing chest pain often associated with heart attacks. Women may describe chest pain as pressure or a tightness. This may be because women tend to have blockages not only in their main arteries but also in the smaller arteries that supply blood to the heart — a condition called small vessel heart disease or microvascular disease.

Women’s symptoms may occur more often when women are resting, or even when they’re asleep. Mental stress also may trigger heart attack symptoms in women.

If you suspect you are having a heart attack: Call 911 or your emergency services number immediately.

Know the Difference: Cardiac Arrest Vs. Heart Attack

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Do you know the difference between Cardiac Arrest and a Heart Attack?

Cardiac Arrest

Sudden Cardiac Arrest is when the heart malfunctions and suddenly stops beating unexpectedly. It strikes immediately and without warning.

The main sign is: Sudden loss of responsiveness (no response to tapping on shoulders.)

Heart attack

A heart attack is when blood flow to the heart is blocked.

Heart Attack Victims may experience a diversity of symptoms that include:

  • pain
  • fullness
  • squeezing sensation of the chest
  • shortness of breath
  • sweating
  • vomiting
  • indigestion or heart burn
  • arm pain (more commonly the left arm, but may be either arm)
  • upper back pain.

If you suspect someone is having a heart attack or has sudden cardiac arrest: Call 911 or your emergency services number immediately. Stay with the person until the ambulance arrives. DO NOT drive them, if they should need assistance you can not help them while driving.

Eating Eggs to Stay Heart Healthy

are eggs good for your heartAre eggs good or bad for the heart? People with a risk of heart disease may avoid eating eggs because of their saturated fat and cholesterol content. But did you know it is egg yolks that have the cholesterol and saturated fat? Egg whites are safe and a good source of protein.

Consider cooking methods when including eggs in your diet. 

  • Poaching
  • Boiling
  • Pan Frying with a light cooking spray

These are all healthy ways to cook your eggs without contributing to your daily amount of saturated fats. Avoid cooking methods that include using oils or dairy. In order to keep your sodium down remember to limit the amount of salt you add to your eggs, as the recommended daily amount is under one teaspoon. 

Best Exercises for Cardiovascular Health

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Moderate exercise can improve your strength, flexibility, endurance and cardiovascular health. Even though any amount of exercise is beneficial to your health, experts recommend doing a minimum of 75 minutes of aerobic exercise per week for your heart to reap the rewards.

The following exercises improve the way your body uses oxygen and strengthen your heart:

  •  Interval Training – Combining short bursts of high-intensity exercise with longer periods of active recovery prevents heart disease, diabetes, promotes weight loss and efficiently improves fitness. So, if you focus on taking brisk walks, add one to two minutes of sprints for every five minutes of walking.

 

  • Weight Training – Similar to interval training, weight training increases your heart rate during reps, then you recover in between sets. While machine exercises are helpful, using free weights engages your core and builds balance for extra benefits.

 

  • Swimming – Swimming is a great, total-body, low-impact sport. Because so many muscles are involved in this total-body workout, the heart needs to work harder to fuel them. Other activities, such as rowing and cross-country skiing, provide similar cardiovascular benefits.

 

  • Yoga – Yoga is a calming exercise that burns a lot of calories, lowers blood pressure and promotes heart health. It also strengthens your core.

 

  • Stay active all day – Staying active all day when you have a desk job can be difficult. To combat the negative impact of sitting at a computer, try to get at least 30 minutes of exercise every day and run errands after work to make up for being sedentary.

What Exercises are Bad for your Heart?

There are very few exercises that are actually bad for your heart. However, those who are at risk for a heart attack should avoid any type of vigorous exercise that they haven’t trained for.

Some examples include:

  • Running long-distance
  • Swimming long-distance
  • Shoveling snow for extended periods of time
  • Biking more than 20 miles.

Consult your physician for information on keeping your heart healthy through exercise.

 

Atrial Fibrillation

what is atrial fibrillation

What is atrial fibrillation?

Atrial fibrillation falls under the broad category of cardiac rhythm abnormality or arrhythmia. It is one of the most common arrhythmias that we see in Cardiology practice. Atrial fibrillation is characteristically a very irregular heartbeat. It can cause a variety of symptoms including palpitations, dizziness, shortness of breath, weakness, fatigue and chest pain.
Our hearts have an electrical system that generates an electrical current to make the heart muscle squeeze. This electrical impulse begins in one of the upper chambers of the heart in an area called the sinus node. The impulse then travels to the middle of the heart to a cluster of electrical tissue — the AV (atrioventricular) node. From there, the electrical impulse travels into the left and right ventricles (the pumping chambers) to activate contraction of the heart.
When atrial fibrillation occurs, there is disorganized electrical activity in the upper chamber of the heart. The AV node at mid-level of the heart is bombarded by electrical activity but only some of the impulses can get through. That causes the heart rhythm to be very irregular and sometimes very fast.

Can it happen to me?

There is a long list of things that can cause atrial fibrillation. Some of the more common causes include hypertension, stress and anxiety, dehydration, alcohol excess, excess caffeine intake and thyroid disease. Atrial fibrillation is more likely to occur as we get older.

How is atrial fibrillation treated?

Treatment is usually divided into two main categories. The first is referred to as “rhythm control.” This means that we do everything possible to return the heart to normal rhythm and keep it in normal rhythm. Sometimes this is a simple as treating the underlying cause. For example, if someone became very dehydrated at the beach on a very warm day and developed atrial fibrillation, the initial treatment would be hydration.
Many times, initial treatment requires hospitalization in order to be able to use intravenous and oral medications to treat the rhythm disturbance. Sometimes, a procedure called cardioversion is necessary to restore normal rhythm. This means shocking the heart to return it to normal rhythm. This procedure is usually done under anesthesia.
There are other procedures including ablation to treat atrial fibrillation when it is very difficult to manage it any other way. Ablation means interrupting electrical currents in the heart to prevent recurrence of atrial fibrillation. This procedure is successful 70-80% of the time.
The second major treatment strategy is “rate control” of atrial fibrillation. This means that atrial fibrillation persists and we use medication to control the heart rate. When the heart rate is controlled, you are less likely to experience any symptoms. Several large clinical trials have shown that this approach is definitely a satisfactory method of treatment.

What about anticoagulation (blood thinners)?

Along with “rhythm control” and “rate control,” we always need to decide whether anticoagulation or blood thinning is necessary. Atrial fibrillation can be associated with blood clots and the biggest concern is stroke. We have two risk scores that we can use to calculate stroke risk. Depending upon the score, we decide whether full anticoagulation is necessary. These scores take in to account factors such as congestive heart failure, hypertension, age, gender, diabetes and previous stroke.

Choices of anticoagulants- Is it just warfarin?

Coumadin or warfarin has been the main stay of anticoagulation for many years. However, there are now 3 new anticoagulants to choose from. These all work in a very different way compared with warfarin and are equally effective. Many of you have probably seen advertisements for these new medications.
I hope this answers many questions you may have about atrial fibrillation.

Kenneth Adams, MD, FACC
Pentucket Medical Associates Cardiology

 

 

e-Cigarettes

are e-cigarettes healthy

What is an electronic cigarette?

  • Designed by Chinese pharmacist Hon Lik in 2003
  • Electronic device that simulates the act of smoking a real tobacco cigarette by producing an inhaled vapor offering the “freedom to smoke anywhere”
  • Gives the appearance, physical sensation, and even flavor of a real cigarette

How does it work?

  • User inhales on the mouthpiece, triggering the liquid to be heated, and the atomizer turns the liquid into a vapor
  • The vapor is inhaled by the user, which gives the effect of smoking a real cigarette
  • Users are “vaping,” not smoking

What’s the attraction?

Price difference:

  • Price of cigarettes are past $5.00, and a major factor in people’s choice to switch to change to e-cig is that economical advantage.
  • The cartridge to refill an e-cig is roughly $3.00 apiece and can last three to five times as long as a traditional pack of cigarettes.
  • Many estimates say an e-cigarette habit costs one-third as much as a smoking habit.
  • One benefit is also that you are in charge of how much you smoke. You don’t have to smoke the entire cigarette in one sitting, you can take one or two puffs and be done.

What do people see in them?

  • No burning tobacco
  • No CO2 in your lungs; no secondhand smoke
  • Adjust the amount of nicotine
  • More economical (user can take as many “hits” as desired and need not smoke the entire thing in one sitting)

Attraction to youth:

  • The economic reason above appeals to high-schoolers
  • Attractive for youth to smoke however much they want
  • Students MAY feel there is a lower risk of addiction
  • No smoke smell and feeling in lungs
  • Easy to buy online or in a mall and come in flavors ranging from chocolate to bubble gum; you can buy them in pink, gold, or blue
  • Presumption of safety because it is not burning tobacco, even though its consequences are not known

The negative aspects of e-cigarettes

  • After the FDA analyzed brands, it found diethylene glycol and other cancer-causing agents in some samples

  • The nicotine cartridges emit an inconsistent amount of nicotineLike secondhand smoke, particles from the vapor can land on surfaces like clothing, furniture, and carpets and have the same effect as secondhand smoke

    • For example, if you are using a low-strength nicotine cartridge, you may actually receive the same amount as a higher dose
  • The FDA remains concerned about how e-cigs are marketed and about how they are encouraging youth tobacco use

  • Essentially no data on use as cessation strategy (J Med Case Rep 2011; 5:585) n=3

  • Harm-reduction data limited (BMC Public Health 2011; 11:786) n=40

Cardiologist’s Conclusions

May be harmful to public health.
Smokers have been advised by the FDA not to use them.
E-cigs promote increased airway resistance after five minutes of use
More research is needed on the cost/benefit equation of these products and the appropriate level and type of regulation for them. The harms have tended thus far to be overstated relative to the potential benefits.
Concern over repeated inhalation of propylene glycol.
Concern that e-cigarettes may promote continued smoking by allowing smokers to cope with no-smoking environments is countered by the observation that most smokers use these products to try to quit and their use appears to enhance quitting motivation.
Concerns over low nicotine delivery are countered by evidence that the products provide significant craving reduction despite this in some cases; and e-cigarettes may help reduce toxin exposure to nonsmokers.
E-cigarettes are a new trend on high school campuses.

To Vape or Not To Vape?

  • Although “vaping” might be safer than smoking, e-cigarettes are definitely not healthy.
  • E-cigarettes might work as a strategy to quit smoking, similar to nicotine replacement, like the Nicotrol inhaler. If you try it, commit to short-term use.
  • If you are interested in quitting smoking, try evidence-based treatments such as counseling and nicotine replacements like a patch or gum, rather than e-cigarettes.
  • It may be called an e-cigarette, but it’s still a cigarette!