Optimum Life Blog

Heart health is a major concern of Americans, especially as we get older. Coronary artery disease (CAD), which causes heart attacks, is the number one cause of death in the United States. Eighty percent of deaths from CAD occur in persons over 65 years of age. Yet there are many things that we can do to reduce our risk for heart disease. Today I invite your questions related to heart health.

Q: Maxine, PA - For a 69 year old female with no health issues what is the optimum amount time daily for cardio/weight training? Right now I do daily exercise totaling 1.5 hrs alternating between machines and cardio classes like dancing and weights or weight classes like water aerobics.

A: Dr. O'Neil - Maxine, wow!!! You are a great example of what cardiovascular fitness is all about. The current recommendations of the AMA and the American College of Sports Medicine is 30 minutes of moderate activity on most if not all days of the week. Of course if someone has not been active, they should start slowly and gradually build up and should consult with their doctor before beginning. Current recommendations include resistance training (weights, resistance band etc) at least two days per week and flexibility-stretching and range of motion for ten minutes prior to aerobic and resistance exercises. You are doing a great job Maxine. Not only is this good for you heart, but for your brain as well.

Q: Ron, OK - I take a blood thinner, and have for many years, for reasons other than a bad heart. I am concerned about long distance travel, and blood clots. I am taking 5 mg. of simvastatin, could there be a problem with my blood being too thin, even if my protime is correct, and causing problems on that end of the scale?

A: Dr. O'Neil - Ron, long distance travel greater than six hours may be a risk factor for blood clots. However if you are on an anticoagulant this significantly reduces the risk. It is important to make sure that your anticoagulation levels are appropriate, but if your pro-time is in therapeutic range you should not have cause for concern. I would also advise that if you are flying you should get up and move around periodically to keep the blood flowing. If you are driving in the car for an extended period get out and walk around periodically. Some physicians might suggest compression stockings which have been shown in some studies to reduce the risk of blood clots in the legs.

Q: Barbara, NC - I have had recurrent episodes of anxiety related heart palpitations since 1986. They were diagnosed as atrial fibrillations. Is it possible that these heart beat irregularities are causing permanent long term heart damage?

A: Dr. O'Neil - Atrial fibrillation is the most common heart rhythm disturbance of adults. The prevalence increases with age. More than 8% of persons over age 80 have atrial fibrillation. It is characterized by a very irregular pulse. Because the small chambers of the heart (atria) do not contract properly, blood clots may form in the heart and then travel to the brain, kidneys, or legs. The most feared complication is a stroke. Anticoagulation with Coumadin significantly reduces the risk of forming blood clots and thus reduces the risk of stroke and other complications. Barbara, it is unlikely that your atrial fibrillation is causing any structural abnormality of your heart.

Q: Sara, IL - Hi Dr. O'Neil, What role does heredity play in heart disease?

A: Dr. O'Neil - Sara, the most significant risk factor for coronary artery disease (CAD) is a strong family history of premature CAD (before the age of 55 for a male first-degree relative and before the age of 65 in a female first-degree relative). Other risk factors include: age (men over 45; women over 55), cigarette smoking, hypertension, obesity, and hyperlipidemia (elevated cholesterol, triglycerides, or both).

Q: Judy, MA - Do certain asthma medications effect one's heart health?

A: Dr. O'Neil - Judy, There are certain asthma medicines that can cause an increase in heart rate and some types of heart rhythm disturbances in susceptible persons. It is always important to weigh the benefits and risks of treatment with your physician. Fortunately there are now more asthma medicines that cause less cardiac stimulation. There are some heart medicines that can have an adverse effect on asthma, particularly beta blockers. These are best avoided by persons with asthma.

Q: Eleanor, NC - Is it normal for a woman that is almost 78 years old to be gradually losing weight? Is this an age related problem?

A: Dr. O'Neil - Eleanor, It is important to discuss this with your physician. There are many things that can cause weight loss but we don’t want to write if off to aging. Conditions such as overactive thyroid, GI disease, and even more serious diseases such as cancer can present with weight loss. It is very important that this be evaluated.

Q: Mary, MA - Should aides be more educated about the medications they give to people?

A: Dr. O'Neil - I believe it is the responsibility of all of us, physicians, nurses, pharmacists and consumers to be knowledgeable and actively involved in their medical care. This is especially true when it comes to medications. We should be aware of what we are taking, how we should take it (with our without food for example), how often and for how long. In addition, we should be informed and knowledgeable about potential side effects and report these to our physicians if they occur. I recommend that we not put anything in our bodies without checking with our doctors to be sure there are no dangerous interactions. This includes vitamins and nutritional supplements.

Q: Holly, WI - Can diet help with heart health? What are the foods that have the most impact?

A: Dr. O'Neil - Holly, I would recommend a Mediterranean style diet. In other words a diet rich in vegetables, whole grains, and fish. We recommend at least two fish meals per week especially cold water fish such as salmon, mackerel and herring. Other good sources of omega 3 fats are nuts such as walnuts, almonds and peanuts. However, unsalted varieties are best because too much salt can cause high blood pressure or have other adverse effects.

Q: Peter, MA - What is the best exercise for your heart?

A: Dr. O'Neil - Peter, there is not one single best exercise. I would follow the recommendations that we mentioned earlier from the AMA (www.ama-assn.org) and the American College of Sports Medicine. Moderate exercise has been shown to be almost as effective as vigorous. The most practical thing for most older adults to do is walking. However, swimming, biking, and rowing are other good examples. Studies have also shown that dancing is not only good for our hearts but for our brains.

Q: Sandy, AZ - What causes heart attacks?

A: Dr. O'Neil - Heart attacks are usually caused by atherosclerosis, a build-up of bloodstream fats, in the coronary arteries. Atherosclerosis causes blockages (plaque) in the arteries that can impede blood flow to the heart muscle. A heart attack is usually caused when a plaque ruptures and triggers the formation of blood clots that totally block the blood vessel. This blockage damages the muscle supplied by the blood vessel.

Q: Mary, MA - Can not getting enough sleep negatively affect your heart health?

A: Dr. O'Neil - Mary, insomnia can actually lead to high blood pressure which is one of the risk factors for heart disease so getting a good night’s sleep is important. The average requirement is about 7 or 8 hours per night. If this is a problem for you or someone you know, a conversation with your doctor is important because there is a host of reasons and potential interventions that can help. Mayo Clinc (http://www.mayoclinic.com/health/sleep/HQ01387)

Q: Mary, FL - How would I know if I had coronary artery disease?

A: Dr. O'Neil - The most common symptom of coronary artery disease in the general population is chest discomfort. Although some describe pain, the discomfort may be experienced as a squeezing sensation or pressure in the chest. Occasionally the discomfort can radiate to other places such as the arms, the back, or the jaw. Some people even misinterpret it as indigestion. In older adults, the symptoms may be atypical. Shortness of breath with exertion may be more common. Unusual fatigue may be present. In some cases, there may be no symptoms at all. If a person has suggestive symptoms or multiple risk factors for CAD, a doctor will often suggest special tests.

Q: Greg, IL - What are the tests to diagnose CAD?

A: Dr. O'Neil - The “gold standard” is a cardiac catheterization (also called coronary angiography) since it can precisely define the anatomy of the coronary arteries as well as identify where the blockages are. However, doctors may suggest non-invasive tests first such as an exercise test, Thallium scan, and echocardiogram (sound wave test).

Q: Carol, CA - Should I take aspirin to reduce my risk of a heart attack?

A: Dr. O'Neil - You should do this only if recommended by your doctor. Many doctors recommend a daily aspirin to reduce the risk of heart attacks and strokes. However, aspirin even in small doses can have some potentially dangerous side effects including bleeding and ulcers. The decision should be made by you in consultation with your doctor only after you have both weighed the benefits versus the risks.

Q: Ethel, KS - What is congestive heart failure and what causes it?

A: Dr. O'Neil - Congestive heart failure (CHF) means that the heart cannot keep up with the normal metabolic demands of the body. It may be due to stiffness of the heart muscle related to longstanding high blood pressure or it could be related to weakness of the heart muscle due to previous heart attacks or even viral infections of the heart. Severe disease of the heart valves can also cause CHF.

Q: Eric, MT - What is Angina?

A: Dr. O'Neil - Angina is the term given to chest discomfort related to the heart. Usually it is described as squeezing or pressure in the chest. It may sometimes radiate to either arm, to the jaw or even the back. Sometimes it can be associated with shortness of breath. Anyone who experiences these types of symptoms should consult a physician immediately. If the symptoms are more severe getting directly to the emergency room is important.

Q: John, FL - What tips can you give to someone who is recovering from a heart attack?

A: Dr. O'Neil - It depends on the nature and severity of the heart attack. In other words how much damage was done to the heart muscle and whether there was any rhythm disturbance. Cardiologists will usually recommend a program of cardiac rehabilitation which is exercise supervised by cardiac rehabilitation specialists. It is important to follow your doctor's advice related to level of activity, diet and medications.

Q: Judy, MA - How can you tell if someone has had a heart attack?

A: Dr. O'Neil - When a doctor evaluates someone in the emergency room, blood tests to check for heart muscle damage, an electrocardiogram, and often other tests depending on the situation. For example we may do a sound wave test (echocardiogram) to check the pumping action of the heart and to look for any disturbances of the heart valves. In some cases we proceed to coronary angiography in which we squirt a dye in to the arteries of the heart to look for the areas of blockage. Treatment at that point may include medicine to dissolve clots in the artery, stents to open the blockages or even bypass surgery.

Q: Ray, PA - How does an AED help someone who has had a cardiac arrest?

A: Dr. O'Neil - The automatic external defibrillator (AED) delivers an electrical shock to the heart muscle in an attempt to restore a normal heart rhythm. AEDs have been designed so that a built-in computer recognizes if someone has a life-threatening rhythm disturbance (ventricular fibrillation or ventricular tachycardia) and delivers the shock if necessary. Thus, in an emergency situation almost anyone can provide potentially life-saving treatment. The device has diagrams to show where the electrodes should be placed.

Q: Eric, IL - What are the chances of survival when an AED is used?

A: Dr. O'Neil - The chances for survival are directly related to the time it takes from when the cardiac arrest occurred and the defibrillating shock is given. Time is critical. Survival approaches 50% when the shock is initiated within 2-3 minutes, 25% when administered within 4-5 minutes, and less than 10% after 10 minutes.

Dr. O'Neil - I really enjoyed being with you today. These were great questions related to heart health. I hope the information is useful to you in your day to day life and I look forward to next month’s session on August 19th when we will discuss Getting a Good Nights Sleep.

Best wishes for an Optimum Life,

Dr. Kevin.

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