Tag Archives: Heart Health

Heart Health: Function & Benefits Of Pacemakers

“The likelihood of needing a pacemaker increases with age,” says Dr. Sunil Kapur, a cardiologist at the Heart and Vascular Center at Harvard-affiliated Brigham and Women’s Hospital. “The good news is that today’s pacemakers have evolved from fixing irregular heartbeats to helping the heart maintain its normal function, which allows many men with certain heart conditions to stay active longer.”

December 1, 2022

A pacemaker monitors the heart’s rhythm and, when necessary, generates a painless electrical impulse that triggers a heartbeat.

The most common use for a pacemaker is when the heart beats too slowly or pauses, which triggers dizziness, shortness of breath, or fainting. (You should see your doctor immediately if you have any of these symptoms.) A pacemaker also can help your heart chambers beat in sync and improve blood flow if your heart isn’t pumping enough blood. In some cases, a pacemaker may be needed to treat a heartbeat that is too fast or irregular.

These issues can stem from problems with the heart’s electrical signaling, a heart defect, an enlarged or thick heart muscle, heart failure, or a heart attack.

Several tests can help your doctor determine if you need a pacemaker: an electrocardiogram, which measures the heart’s electrical activity; Holter monitoring, in which you wear a small device to track your heart’s rhythm; or an echocardiogram, which uses sound waves to produce images showing your heart’s size, structure, and motion.

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Health: American Heart Association Checklist

The American Heart Association (AHA) recently revised its checklist for achieving optimal heart health, introducing its new Life’s Essential 8. The list replaces the AHA’s decade-old Life’s Simple 7.

Sleep health is the new addition to the cardiovascular health scoring tool, which now advises that adults get seven to nine hours per night. The organization updated four of the categories:

  • Diet: More emphasis was given to following heart-healthy diets like the DASH and Mediterranean.
  • Nicotine exposure: Secondhand smoke and vaping were added as risk factors.
  • Blood lipids: People now can get a non-fasting blood sample that measures total, HDL, and non-HDL cholesterol. Non-HDL cholesterol can provide similar risk information as LDL cholesterol.
  • Blood sugar: Measurements now include hemoglobin A1c, a key component to assessing type 2 diabetes risk.
  • Three categories were unchanged:
  • Physical activity: The optimal weekly level is at least 150 minutes of moderate activity or 75 minutes of vigorous activity.
  • Body mass index (BMI): A BMI of 18.5 to 24.9 is ideal for heart health.
  • Blood pressure: Levels less than 120/80 millimeters of mercury (mm Hg) remain optimal. Stage 1 hypertension is 130 to 139 mm Hg for systolic pressure (the first number) or 80 to 89 mm Hg for diastolic pressure (the second number).
  • You can calculate your heart health score at mlc.heart.org. The guidelines were published online June 29, 2022, by Circulation.

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NEJM: Atrial Fibrillation And Catheter Ablation

In this instructional video, Drs. Jane Leopold, Elliott Antman, William Sauer, and Paul Zei provide an overview of the classification and diagnosis of atrial fibrillation, management strategies, and mitigation of stroke risk with anticoagulation therapy.

Video timeline: 0:00 Pathophysiology and Symptoms 3:11 Stroke Risk, Anticoagulants, and Arrhythmia Control 6:32 Catheter Ablation 10:11 Post-Procedural Monitoring and Care

The video also focuses on the new rhythm-control strategy of catheter ablation therapy, with attention to the success rate, potential complications, postprocedural monitoring for recurrence of atrial fibrillation, and consideration of ongoing anticoagulation therapy in these patients. The New England Journal of Medicine is the world’s leading general medical journal.

Continuously published for over 200 years, the Journal publishes peer-reviewed research along with interactive clinical content for physicians, educators, and the global medical community at https://NEJM.org.

COMMENTARY:

This is a very good video well worth watching by general physicians and interested patients. There are several general and some specific comments I would like to make.

First, in my opinion, the best physician is none too good. In any operative or serious procedure, the decision to operate should be made by the patient in conjunction with a physician that does not do the operating. In my case, as a physician, I consulted an electrophysiologist.

Second, in my opinion, a good medicine is better than surgery. For atrial fibrillation, there has been no new medication treatment for decades. The main drugs are still amiodarone and Propafenone. The latter is less consistently effective, but has a better long-term safety profile; amiodarone often produces ‘floaters”  in the eye, and Propafenone merely a bitter taste which you’ll get used to.

Third, it must be realized that catheter ablation is often not curative, especially as you get older, which was rather glossed over in this video. Ablation also requires a great deal of expensive equipment, which is constantly evolving, hence the importance of getting your ablation at a major center where it is done all the time. These major centers have less complications such as  atrial wall perforation; Yes, you can rarely wind up worse off after any operation.

I am a physician, currently 90 years old. I developed atrial fibrillation of the persistent type when I was in my late 70s. I had a cardioversion to get me into sinus rhythm, and then tried Propafenone, which kept me in sinus rhythm for less than a month. My main motivation to get a radio frequency ablation was to stay off of anticoagulants. I had my ablation, and remained in sinus rhythm, and off anticoagulants, for three years. I could always tell when I went into atrial fibrillation from normal sinus rhythm because I produced a lot of urine and had to go to the bathroom all the time; atrial fibrillation causes release of a hormone called atrial naturetic peptide. I could also tell by taking my own pulse, which was quite irregular in comparison to my very regular sinus rhythm pulse, which ticked along with a rate in the high 50s. I had always thought my rate was low because I exercise a lot. Actually, my EKG shows a second-degree heart block which is probably partially responsible.

After three years, I returned to atrial fibrillation, and needed a another ablation. They found very few areas of abnormal electrical activity, and gave me a “touchup”, which lasted another two or three years after which I went back into atrial fibrillation. Probably as a result of my age, a fibrillated at a slow rate, and at least did not need any extra medication for rate control, although I did, of course, need to take a regular anticoagulant, in my case Eliquis.

In summary, atrial fibrillation is a common electrical storm in the upper chambers of the heart, causing a rapid, irregular beat. AF increases in frequency as you get older. In the video they mention the “substrate”, which is the structure of the atrium. In my own case, this was an enlarged atrium, and probably a tendency towards atrial fibrillation; my brother also has AF. The main complication is stagnation of blood in the atria, resulting in increased tendency toward stroke. Fibrillation therefore requires an anticoagulant.

There is some discussion about the irregular rate causing an inefficiency of cardiac action, contributing to heart failure, This is logical, but not clear cut statistically.

—Dr. C.

Heart Disease: Symptoms & Types Of Cardiomyopathy

Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart failure.

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The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Treatment — which might include medications, surgically implanted devices, heart surgery or, in severe cases, a heart transplant — depends on the type of cardiomyopathy and how serious it is.

Types

  1. Dilated cardiomyopathy
  2. Hypertrophic cardiomyopathy

Symptoms

There might be no signs or symptoms in the early stages of cardiomyopathy. But as the condition advances, signs and symptoms usually appear, including:

  • Breathlessness with activity or even at rest
  • Swelling of the legs, ankles and feet
  • Bloating of the abdomen due to fluid buildup
  • Cough while lying down
  • Difficulty lying flat to sleep
  • Fatigue
  • Heartbeats that feel rapid, pounding or fluttering
  • Chest discomfort or pressure
  • Dizziness, lightheadedness and fainting

Signs and symptoms tend to get worse unless treated. In some people, the condition worsens quickly; in others, it might not worsen for a long time.

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Diet: Consuming Olive Oil Daily Lowers Heart Risks

Consuming just a half-tablespoon or more of olive oil a day is linked to a lower risk of dying from heart disease and other chronic health conditions, new research suggests.

photo of a hand holding a bottle of olive oil and drizzling it on a dish of quinoa

The study included more than 92,000 women and men from the Nurses’ Health Study and the Health Professionals Follow-up Study, who filled out diet questionnaires every four years for 28 years. Olive oil intake was calculated from how much they reported using in salad dressings, on bread and other food, and in baking or frying.

Compared with participants who rarely or never consumed olive oil, those who consumed the most (about a half-tablespoon or more daily) had a 19% lower risk of dying from heart disease during the study. Researchers also noted lower death rates over all among people who substituted olive oil for a similar amount of margarine, butter, mayonnaise, or dairy fat. The findings, published Jan.18, 2022, in the Journal of the American College of Cardiology, lend further support for choosing olive oil — a key component of the heart-friendly Mediterranean diet.

Read more at Harvard Health

Elevated Pulse Rates: The Causes And Concerns

In otherwise healthy people, a heart rate at rest should be less than 100 beats per minute at rest. Heart rates that are consistently above 100, even when the person is sitting quietly, can sometimes be caused by an abnormal heart rhythm. A high heart rate can also mean the heart muscle is weakened by a virus or some other problem that forces it to beat more often to pump enough blood to the rest of the body.

Usually, though, a fast heartbeat is not due to heart disease, because a wide variety of noncardiac factors can speed the heart rate. These include fever, a low red blood cell count (anemia), an overactive thyroid, or overuse of caffeine or stimulants like some over-the-counter decongestants. The list goes on and includes anxiety and poor physical conditioning.

Heart Disease: Molecular Mapping To Predict Risk

Vulnerability to heart disease can be projected before symptoms occur, Mayo Clinic discovered in preclinical research. This proof-of-concept study revealed that heart muscle changes indicate who is vulnerable to disease later in life. These changes can be detected from blood samples through comprehensive protein and metabolite profiling. This exploratory mapping, conducted in the Marriott Family Comprehensive Cardiac Regenerative Program within Mayo Clinic’s Center for Regenerative Medicine, is published in Scientific Reports.

“The team implemented state-of-the-art technologies to predict who is vulnerable and who is protected from heart disease,” says Andre Terzic, M.D., Ph.D., a Mayo Clinic cardiologist and the senior author. “In this era of post-genomic medicine, the acquired foundational knowledge provides guidance for development of curative solutions targeted to correct the disease-causing maladaptation.” Dr. Terzic is the Marriott Family Director, Comprehensive Cardiac Regenerative Medicine, for the Center for Regenerative Medicine and the Marriott Family Professor of Cardiovascular Research.

Heart Health: Sudden Cardiac Arrest Risks

You may think the most common single cause of death in the United States is heart attack. Or cancer. Or stroke.

But it’s actually sudden cardiac arrest (SCA). SCA is a problem with your heart’s electrical system (usually called ventricular tachycardia or ventricular fibrillation).

Most SCA victims survive if they get help very quickly. But SCA is fatal 95% of the time.

Cardiac Tests: B-Type Natriuretic Peptide (BNP)

B-type natriuretic peptide (BNP) belongs to a family of protein hormones called natriuretic peptides. These natriuretic peptides have an important role in regulating the circulation. They act on blood vessels, causing them to dilate, or widen. They also work on the kidneys, causing them to excrete more salt and water. In addition, the natriuretic peptides reduce the production of various hormones that narrow blood vessels, boost the heart rate, or affect fluid retention; examples include adrenaline, angiotensin, and aldosterone.