eNews June 2008

Some say it’s like an elephant walking on your chest. Others report shortness of breath, extreme fatigue or symptoms similar to heartburn. In some cases, a heart attack comes on with no symptoms.

Most Americans carry in their minds an image of what a heart attack–their heart attack–might be like. Heart disease remains the number one killer of both men and women, and despite advances in treatment, 38 percent of heart attack victims die, many on their way to the emergency room.

Unfortunately, there’s no way to predict a heart attack. As a health-conscious person, the best you can do is know your risks so you can make the lifestyle changes necessary to control them.

AGE and GENDER are major risk factors over which you have no control. An elevated risk for men starts by age 45 while women are offered some protection by virtue of hormones until about age 55.

A healthy 68-year-old male with normal blood pressure and cholesterol and no additional risk factors has an 11 to 13 percent risk of having a heart attack within the next 10 years. A female the same age with a similar health profile has only a 5 percent risk, and the woman’s risk doesn’t catch up until about age 75.

BLOOD PRESSURE, CHOLESTEROL, HDL: These three risk factors are usually linked, and all can be controlled by lifestyle.

High blood pressure may develop during middle age, or even sooner, in otherwise healthy persons who are salt sensitive, basically an inherited condition. It can also develop because of high blood cholesterol, kidney problems, excess weight or other disorders.

When high blood pressure is undetected or uncontrolled, it can quickly lead to other problems such as atherosclerosis, kidney damage and a weakened heart muscle. When BP is kept under control, it generally causes little harm–although treatment must usually continue throughout life.

Systolic blood pressure, or the first number, is considered most important in terms of heart disease. Normal systolic pressure is under 120, with readings between 120 and 130 considered prehypertension.

To prevent high blood pressure, get regular exercise, control your weight and limit your intake of sodium and saturated and trans fats. If your blood pressure starts to creep into the prehypertension range, see a doctor and follow carefully all treatment recommendations.

Like high blood pressure, high cholesterol comes on silently. Most Americans today know their cholesterol numbers. It’s equally important to do something about them should they become too high.

Of the numbers in a total cholesterol profile, the HDL, or good cholesterol, is probably most important. While total cholesterol under 200 mg/dL is considered normal, it may not be low enough if your HDL is less than 40. On the other hand, an HDL over 60 will cancel out high total cholesterol or another risk factor.

Diet, exercise and weight control–as well as heredity–influence cholesterol. HDL is particularly sensitive to exercise.

Probably the ideal eating plan for HDL is the Mediterranean diet, stressing moderate use of monounsaturated fats such as olive oil and nuts along with fruits, vegetables and whole grains.

SMOKING: As important as all the other risk factors are, smoking usually ranks at or near the top of any list. The 68-year-old female with normal cholesterol and blood pressure will nearly double her risk simply by smoking. But, of course, smokers rarely have normal cholesterol or blood pressure so the problems multiply.

Even persons exposed to second hand smoke exhibit damage to arteries and an increased vulnerability to blood clotting with just 30 minutes of exposure. If you smoke, quit–for the sake of yourself and everyone around you.

DIABETES is another major risk factor. Type 1 diabetes can’t be prevented, but you can minimize your cardiovascular risks by keeping your blood sugar under tight control.

Type 2 diabetes often occurs in individuals who are overweight and/or physically inactive. Exercise and weight loss are considered the best ways to prevent or delay the onset of disease and keep blood sugar under control in the early stages.

While there’s no way to prevent a heart attack, there is much you can do to improve your odds. In one way or another, these strategies all involve healthy eating, regular exercise and careful monitoring of chronic medical condition

Source: Healthwire

Terri, 47, got up at 5:30 every morning so she could run five miles before getting ready for a long day at the office. She was normal weight and her diet was generally low-fat, so she was shocked when her blood pressure started creeping above 130/85.

Her doctor inquired about her stress at work (it was substantial) and her sodium intake (she was eating a lot of salty prepared food). And when he asked how much sleep she was getting, she had to admit it was less than five hours a night. All of those factors may have contributed to her elevated blood pressure.

Blood pressure fluctuates constantly, rising with strenuous activity or excitement and falling with rest. A diagnosis of high blood pressure or hypertension, as a result, must be made on an average of many readings over an extended period.

Normal blood pressure is anything under 120/80, and when readings creep higher, as they did in Terri’s case, it’s usually a sign that lifestyle changes are needed. Otherwise, blood pressure will continue to increase and eventually produce harmful changes in the structure of the heart and blood vessels. High blood pressure is a major risk factor for heart attack, stroke and kidney failure.

The effect of sleep on blood pressure–or any aspect of health–has not been well studied, but that is changing. A 2006 study published in Hypertension found that middle-aged persons who slept five hours or less a night tended to have higher heart rate and blood pressure than other subjects, setting them up for chronic health problems. The researchers stressed that the results do not prove that the subjects’ sleep habits affected their blood pressure.

These subjects exercised less and were more likely than other subjects to be overweight and to have diabetes or depression–all factors that can influence blood pressure.

For Terri, however, the issue was rest. Sleep is a time when the heart has a chance to slow down, letting heart rate and blood pressure drop for an extended period.

As early as 1996, researchers found that subjects tended to have higher than usual blood pressure and heart rate the day after a night with insufficient sleep. The authors speculated that this might be a result of increased activity of the sympathetic nervous system.

One major reason that many Americans have inadequate sleep–often without their knowledge–is sleep disordered breathing or sleep apnea. The person with sleep apnea stops breathing for 10 seconds or longer hundreds of times a night.

A study of 140 children found that those with sleep-disordered breathing had significantly higher blood pressure and signs of thickening of the left ventricular wall of the heart–a structural change often associated with hypertension that can lead to serious heart problems.

Treatment of sleep apnea ordinarily involves night-time use of a mask that provides continuous positive airway pressure (CPAP). Another study found that use of CPAP not only improved sleep in subjects but lowered their blood pressure.

The normal diurnal pattern is for blood pressure to “dip” or decline by 10 to 20 mmHg each night between 8 p.m. and 2 a.m. and then start rising throughout the early morning in response to increased production of hormones that cause a tightening of blood vessels throughout the body.

Some individuals, for reasons that are not entirely understood, are “non-dippers.” Their blood pressure remains elevated, or may even rise, throughout the night.

Non-dippers have an increased risk of blood-pressure-related damage to the heart, brain and kidneys. But persons who have an extreme dip (a decrease of 20 percent or more) during the night may also be at risk of problems related to the morning surge of blood pressure. An extreme surge of blood pressure in the morning hours is a strong predictor of stroke.

A majority of persons with hypertension are salt sensitive, and these persons are also more likely to be non-dippers. A non-dipper who goes on a low sodium diet or starts medical treatment for hypertension usually reverses the pattern and becomes a dipper.

Most of us, of course, have no clue what our blood pressure is during sleeping hours, and the only way of finding out is by wearing an ambulatory blood pressure monitor 24 hours a day, a test that may not be needed. A better strategy is focusing on what you can control: getting a good night’s sleep, lowering your salt intake and taking your prescribed blood pressure medications.

Source: Healthwire

(Sioux Falls, SD) While visiting South Dakota from central Minnesota in June 2007, David Zylstra had a life changing experience. After his evening meal, he began experiencing severe abdominal pain and vomiting. By 8 p.m., he was rushed to Sanford USD Medical Center because the pain became unbearable. What happened next is a “miracle” according to Zylstra, thanks to the Sanford team.

“I had an abdominal aortic aneurysm (AAA), and it had ruptured causing massive internal bleeding. At Trauma 5, I heard a voice over the radio calmly say ‘I’m just minutes out, and I’ll be right there.’’ That was Patrick Kelly, MD with Sanford Clinic Vascular Associates who took me into surgery shortly after midnight. Two hours later, I was out of surgery and in the intensive care unit. Later that morning, I awoke to my whole family standing by my bedside. At that point, I knew how serious my condition had been the night before. Dr. Kelly performed a miracle during the middle of the night and saved my life.

In the hospital, everyone from the nurses to the janitors treated me and my family members as though we were visiting royalty from another country. The nurses and staff members that checked on me were so courteous and caring every time they came into my room. I was also very impressed being able to pick up the phone, call down and order each meal from a menu. A half an hour later, in walks someone with the meal I ordered. It was like being at a fine hotel instead of a hospital!

Since my surgery, I have been asked countless times about how I am feeling and about my experience. My response is always the same. God positioned me to be at the right place at the right time so Dr. Kelly and the Sanford staff could save my life. One out of three patients does not survive the condition that I had. I tell everyone God gave me a second chance. From my personal experience, if I had to do it again, I’d ask to go to Sanford USD Medical Center and let Dr. Kelly and the rest of the staff perform their God-given abilities.”

Click here for more information regarding Sanford's Heart & Vascular services.