February is American Heart Month. For this article I’ve enlisted the help of local cardiologist, Dr. David W. Peterson, MD, FACC, of Western Carolina Cardiology. Below, Dr. Peterson answers questions about heart health.
What are the risk factors?
The five major risk factors for cardiovascular disease are age, family history (heart attack under 60 years of age), history of smoking or active smoker, diabetes, and high blood pressure. Other potential risk factors are obesity as well as an inactive life-style.
Are women are more susceptible than men?
Heart disease is the number one killer of both men and women. It is not gender specific, and accounts for nearly one million deaths per year in this country. Women generally suffer their first heart attack on average 10 years later than men, most likely due to the protective effects of estrogen.
Despite the fact that cancer creates such anxiety, heart disease causes more deaths than the combination of the next 5-6 causes of death including cancer.
How do exercise and nutrition factor into heart health?
Exercise and nutrition both play a major role in heart health. You cannot maintain a healthy weight over long periods of time without both exercising and limiting total daily calories. Patients who exercise and watch their diet generally have a lower blood pressure, better lipid (cholesterol) panel, sleep better, and have more energy during the day. The peak performance of your heart is at age 20. You lose 10% of your cardiac reserve every subsequent decade. As one ages, you de-condition faster, resulting in symptoms of shortness of breath with even minimal activity. All of these are reasons to try and exercise at least 20-30 minutes 6 days per week.
What steps can be taken to lower their risks of heart disease?
Lowering the risks of heart disease is a life-long project. There is data to suggest that elementary students under 10 years of age already have evidence of “fatty streaks” in their coronary arteries. As mentioned, a regular exercise program, heart healthy diet, abstaining from tobacco products and maintaining an ideal body weight are all inexpensive ways to lower your risk of heart disease.
You can’t change who your parents are, and you can’t turn back the clock with regard to your age. One needs to concentrate on the “modifiable” risk factors such as tobacco, obesity, high blood pressure, diabetes and high cholesterol.
Are there diagnostic tests that can be done to detect heart disease?
The cardiologist has multiple types of tests to detect heart disease, but they need to be used on a specific patient basis. Many tests have what is termed a “false positive”, meaning the test says there is something wrong when there really isn’t.
This tends to occur more frequently in the younger patients, and leads to more expensive and invasive testing. Besides living a heart healthy lifestyle, I would recommend a blood pressure to be performed at least once yearly starting in your late teens.
A fasting lipid (cholesterol) panel should be performed at least by 25, sooner if someone has multiple risk factors such as active tobacco and multiple family members with coronary artery disease. If someone has symptoms that are concerning for coronary artery disease, a stress test is performed.
We often use ultrasound pictures (echocardiography) to help us in the diagnosis in patients who are young and otherwise healthy.
When should someone see their physician?
Primary care physicians are skilled in dealing with all of the risk factors of heart disease, and are generally the first point of contact. If someone is concerned, I would encourage them to at least see their primary physician rather than ignoring the symptoms they are having. When someone suffers a heart attack, that muscle is forever lost, leading to potential symptoms of heart failure and an overall shortened life span. If symptoms are sudden in onset such as acute chest pain, shortness of breath, dizziness or passing out, patients should proceed to the closest emergency department for further evaluation.
What are the signs of a heart attack?
Signs of a heart attack vary from person to person. The classic symptoms are chest pain or tightness (squeezing sensation) that is generally in the center or left of the chest. It may radiate to the arms, left more than right, neck, back or jaw. Most people have some sense of shortness of breath and may break out in a sweat.
Indigestion is a fairly classic finding for heart attacks involving the bottom part of the heart called the inferior wall. Bottom line is that everyone is different, and classic symptoms tend to be in the minority in many cases. If someone is concerned that they may be experiencing a heart attack, they should not ignore it and seek immediate attention.
Having a heart attack, what immediate first aid is essential?
If someone suspects that they are having a heart attack, they should chew 4 baby aspirin as quickly as possible. Early studies showed that aspirin was nearly as good as the first “clot busting” medications with regard to saving lives. If an individual has been prescribed nitroglycerin to take, they should place one under the tongue every five minutes for a total of three tablets.
Since nitroglycerin does cause a drop in blood pressure, one should sit or lie down prior to taking the medication. 911 should be called for transport, as patients tend to die from a life threatening heart rhythm early in a heart attack. All ambulances have the ability to use medications and a defibrillator (shocking device) to treat these life threatening rhythms. You should never drive yourself to the emergency department.
I want to thank Dr. Peterson for sharing his expertise with us today. If you would like more information on this topic, Dr. Peterson will be conducting an educational seminar on risk factors for heart disease today at 5 p.m. in the Cardio Rehab room at the MedWest Haywood Health & Fitness Center. Stay tuned for my next article when I discuss heart-healthy nutrition tips. Until then, stay healthy.