Monthly Archives: November 2013

SUDDEN DEATH

Cardiac arrest

Are there warning signs before the heart stops?

A study reported at the American Heart Association’s Scientific Sessions this month showed sudden death isn’t so sudden after all. Fifty-six percent of the men in an Oregon study had chest pain and didn’t report it. Others had: dizziness, fainting, palpitations and shortness of breath. These may be unrecognized heart symptoms in women, too.

Nearly 400,000 people have cardiac arrests each year and 88% of the events occur at home. Unless medics are called and CPR is started immediately survival is low. Fewer than 10% of those suffering a cardiac arrest survive.

 What can you do?

Learn the symptoms and seek attention before a heart attack or cardiac arrest occurs.

Chest pain is not always the first symptom of coronary artery blockage. More than 50% of people having heart attacks die before reaching the hospital. To improve your chances for survival, pay attention to possible symptoms of reduced heart blood flow. These vary and in women are often subtle.

            Possible heart symptoms: May be mildchest-pain

            ♥ Indigestion, nausea

            ♥ Upper back or abdominal discomfort

            ♥ Aching in neck, jaw, or either arm

            ♥ Short of breath or weak with activity

            ♥ Weakness with mild activity

            ♥ Chest discomfort or pressure

What causes the heart to stop?

Heart disease develops over a lifetime. The slow narrowing within heart arteries is silent — no symptoms. When the blood flow is decreased to the point when symptoms are recognized, the actual blood flow may be restricted by more than 90%. When increased oxygen is needed such as with exercise or stress, the heart beats faster but cannot supply enough blood and the heart muscle suffers. Sometimes sudden death is caused by abnormal fatal rhythms generated by the irritable oxygen-starved conduction system. In a heart attack, the vessel has closed, stopping all blood flow to a portion of the muscle and the heart stops beating.

What are common factors increasing risk for heart disease and sudden death?

Untreated High Blood pressure

Smoking: All tobacco use & second hand smokecigarette smoking quitting

Obesity and high fat diet

Diabetes

High LDL cholesterol

Low HDL cholesterol

Inactivity

Illicit drug use

Excess alcohol

LEARN CPR YOU MAY SAVE A LIFE

www.Heart.org/cpr

Hands-Only® CPR instructional video recommended for adults since 2008

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Heart Disease in Children

Overview

The Bogalusa Heart Study reported obese children as young as five show artery changes seen in early heart disease. Additional studies show obese children, in particular, have the same metabolic disorders as adults leading to early heart disease.

Many factors contribute to cardiovascular diseasethe leading cause of death in adults. A lifetime of excessive eating and not enough exercise combined with smoking are three leading causes of early heart attack and death. Many people with arteries nearly closed have no symptoms. Some have multiple heart arteries with blockages above 90% and don’t know it. A key to living longer is recognizing risk factors and lowering your risks by making healthy choices and seeing a physician for a physical and laboratory studies.

Inherited Risk with High Cholesterol Genes

Some families have faulty cholesterol genes placing them at risk for early heart disease. High cholesterol levels increase the risk of early death. In my family, males had heart attacks in their 30’s and 40’s and died very young, but today, that statistic can be changed. Today, children who carry the inherited trait for high cholesterol can be diagnosed early and treated. When treated, they are living longer than their parents did.

A new National Heart, Lung and Blood Institute recommendation is to test the cholesterol level (called a lipid panel) in children between the ages of 9 to 11. Previously, lipid testing beginning at age 20 was recommended.

Note: There are experts who disagree with this recommendation but if your child has familial and other risks, discuss cholesterol with your child’s pediatrician or family doctor.

Parents don’t often think about their child’s cholesterol levels but heart disease can develop in childhood. The test involves taking a blood sample to analyze for different kinds of fats (lipids) in the blood. Cholesterol is a lipid or fat. High levels of cholesterol are known to contribute not only to heart disease, but also strokes.

Over time as cholesterol accumulates within the wall of heart arteries, blockages starve the heart muscle of oxygen and nutrients. For most people, the process occurs over a lifetime of eating the wrong food and too much of it, with inadequate exercise. But in families with faulty cholesterol genes, the problem becomes evident at a young age and shortens life.

 Treatment

Drugs called statins may be prescribed in adults and in some high risk children and teens to lower cholesterol levels and prolong lives. The primary treatment in all ages is proper eating and an active lifestyle. Taking statins helps, but a low fat nutritious diet with predominant fresh fruits and vegetables is most important.

Additional Obesity Health Risks in Childrenobesity

A study published this year from the University of Eastern Finland showed obese children as young as six had already developed high blood pressure, high glucose and high insulin levels showing insulin resistance like adult Type 2 diabetics. In addition, the children had high triglycerides (a fat contributing to heart disease) and low HDL-cholesterol, the good cholesterol – the one you want high. They found blood pressure, triglyceride and insulin level elevations contributed to stiffening even in young arteries. This leads to cardiovascular disease.

 High blood pressure is a silent disease in both adults and children. Treatment decreases risk for the development of cardiovascular disease. Pediatricians now recommend measuring blood pressures in children at every visit beginning at age three. High blood pressure in children is more common in obese children and must be a part of the child’s health evaluation.

Type 2 diabetes accelerates cardiovascular disease. It was formerly a disease of older adults. Now Type 2 diabetes is common in overweight teens.

 Researchers in a Washington University study found a link between teen depression and obesity. With inactivity and smoking, the study also found teens are twice as likely to die by age 55 than non-smokers. Recognizing and treating depression, stopping smoking, avoiding second hand smoke, normalizing weight and increasing exercise can lower heart disease risk for at risk children and teens.

Early diagnosis with physician monitoring and appropriate interventions along with healthy food choices beginning in childhood and an active lifestyle are the keys to better health and a longer life.

dinner-on-healthy-platechildren kids bicycling

SAVE A LIFE – LEARN CPR – IT ONLY TAKES A MINUTE

The American Heart Association is a terrific source for up-to-date information for heart health. Heart disease is the leading cause of death in adults and most people don’t know they have it. More than 60% of women who died suddenly had not complained of heart symptoms. This is true for many sudden death male victims, too. The problem is so common, you are likely to be nearby when someone collapses. Do you know what to do?Chest Compression

An instruction video produced by the AHA will only take a couple minutes to watch. I encourage you to do it. You may save a life.   http://tinyurl.com/oneminuteCPR

If you have trouble with the link. Go directly to the AHA.

Dr. Betty

NEW CARDIOVASCULAR DISEASE GUIDELINES

LINKS TO LIVING LONGER

♥ ♥ ♥ ♥ ♥

 WHAT TO DO TO LOWER RISKS and LIVE LONGER

Yesterday, experts in cardiovascular disease prevention published new guidelines for heart and vascular health. Based on hundreds of clinical research studies, this is the latest science-based analysis on heart disease and stroke prevention. Source: American College of Cardiology and the American Heart Association.

 My father died in 1960 of coronary heart disease. He was 52 years old. His first heart attackIMG_5818 occurred at age 46. Like many people today, he had familial cholesterol elevation and smoked. Had he known what actions to take to improve his health and the opportunity to take a statin drug to lower his cholesterol, I’m sure he would have added many years to his life. With the new guidelines, we all have the Links to Living Longer.

 The information below is provided to help others take steps to improve cardiovascular health and live longer through healthy actions. I appreciate feedback and questions.

 Thank you,

Betty Kuffel, MD

♥ ♥ ♥ ♥ ♥

 Cardiovascular disease is the number one cause of death.

It is preventable and treatable.

Many people do not follow lifestyle recommendations and do not take medications known to prolong life. These guidelines provide a standardized basis for the best approach to reduce risks and save lives.

 LINKS TO HEART HEALTH

Eat Healthy

Vegetable heartCalculate your calorie requirements and follow a Mediterranean or plant-based diet that includes a predominance of fresh foods with 4-5 servings of fruits and vegetables per day, high fiber and whole grain foods, fat-free or low-fat milk products, nuts, lean meat/poultry/fish, limit saturated fat and trans fat, limit sweets and added sugar.

Reduce High Blood Pressure

See your physician for a health evaluation and laboratory studies. Blood pressure monitoring and treatment may be necessary. Reducing salt/sodium intake below 2,000/ day is recommended for most adults. Monitor your own blood pressure and read food labels. Avoiding processed food and salty soups will help reduce blood pressure.

Reduce High Cholesterol

Because of common inherited disorders many people cannot reduce cholesterol to healthy levels even when eating a low fat vegetarian diet and attaining low weight. Some must take a drug to treat the abnormal lipids. (Lipid is a generic term for fat and cholesterol.)

If Necessary, Take Statins

Statins are the most effective drugs to reduce harmful LDL cholesterol. The new guidelines strongly recommend the use of statins while at the same time decreasing your intake of all types of saturated fat including full fat milk products, coconut/palm oil, and all trans fats found in “partially-hydrogenated” fat products. These include margarine and many commercial baked goods. Under new guidelines statins are indicated for people diagnosed with heart disease, Type 2 diabetics aged 40-75, and an LDL of 190 or higher, and other factors if determined to be at risk. LDL is the bad cholesterol. Remember – taking a statin does not mean you can continue to eat bacon cheeseburgers – healthy eating is imperative to reduce risks of heart disease even when taking statins.

Lose Weight

If you are overweight like most Americans, no matter what your age, you are at higher risk for arterial heart disease and vessel disease throughout your body. Children as young as five years old, who are obese, are at risk for early heart disease and diabetes.

With weight gain, fat accumulates in the body contributing to high LDL (bad) cholesterol, higher triglycerides and high blood pressure. All are known to be detrimental to health.

In addition, weight gain correlates with the development of Type 2 diabetes and blood glucose elevation making your risk of heart disease even higher. Avoid diabetes. Treat pre-diabetes (mild elevations of blood glucose).

 To calculate your ideal weight and develop a plan for better heart health, see your physician for guidance. Note: Many websites such as www.realage.com  provide calculators for calorie needs and BMI to determination obesity range. BMI is Body Mass Index. Knowing these guidelines will help you take appropriate action to reduce your health risks.

Be Active

Risk reduction recommendations include activities such as brisk walking for 40 minutes at least 3-4 times a week.

Factors contributing to cardiovascular health include: race, gender, age, total cholesterol, HDL cholesterol, blood pressure, diabetes and smoking.

Uncontrolled high blood pressure, cholesterol abnormalities, excessive weight, diabetes and tobacco use are high risk factors contributing to arterial narrowing, heart disease and stroke.

GOOD NEWS – YOU CAN CONTROL YOUR HEALTH RISKS

 EAT HEALTHY

STOP SMOKING

EXERCISE REGULARLY

ATTAIN NORMAL WEIGHT

AVOID SUGAR AND SATURATED FATS

AVOID BLOOD GLUCOSE ELEVATION

TAKE BLOOD PRESSURE MEDICATION IF NECESSARY

TAKE A STATIN MEDICATION IF NECESSARY TO CONTROL CHOLESTEROL

PLEASE SHARE THIS INFORMATION WITH FAMILY AND FRIENDS.

Family heart healthIF HEART DISEASE RUNS IN YOUR FAMILY, A NEW RECOMMENDATION IS TO DO BLOOD LIPID LEVELS IN CHILDREN SO INTERVENTIONS CAN START AT A YOUNG AGE. IT IS VERY IMPORTANT TO EDUCATE CHILDREN ON DIET AND EXERCISE BECAUSE OBESE CHILDREN HAVE INCREASED HEART DISEASE, BLOOD PRESSURE AND DIABETES RISKS THAT CAN BE IMPROVED WITH PROPER CHOICES.

HOW TO IMPROVE HEART HEALTH – PART 3

THERE IS HOPE

Even if you have been diagnosed with Type 2 diabetes, coronary artery disease, peripheral vascular disease, or have had a heart attack, stents or a stroke, there is hope for improvement.

 Major risk factors for coronary artery disease are all factors under your control:

♥ Tobacco use – stop smoking or chewing

♥ High blood pressure – meds, weight loss & exercise help lower blood pressure

♥ Cholesterol abnormalities – statin drugs & a low-fat diet help reduce cholesterol

♥ Obesity – exercise and reduced calorie intake help reduce obesityObesity Concept

 ♥ Type 2 diabetes – lower blood sugar with proper diet and insulin

♥ Low activity – take walks, join a fitness center

♥ More than one alcohol drink per day – limit all alcohol consumption

♥ Illicit drug use – get help – stop using illegal drugs

♥ High levels of calcium supplements (over 1200mg/day) – limit supplements

 LINKS TO HEART HEALTH:

smoke-091Quit using tobacco of any kind, normalize blood pressure, weight and blood glucose. In addition, a medication regimen to improve lipids may be necessary. All these factors contribute to lowering risks and reducing the closure of arteries and stents.

 Stents are inserted into diseased plaqued-blocked arteries to buy time. Bypass grafts provide a route around the blockage. Both are temporary methods used to save lives.

The body accepts the stent and forms a smooth covering over the interior like the natural vessel. If lifestyle changes and medications are not made to keep the stent open, the stent will close just like the diseased artery. Bypass grafts also develop cholesterol plaques. New plumbing buys you time and allows you to take control and improve your health.

 Taking a statin to lower your cholesterol is not a ticket to eating fried foods, bacon cheeseburgers or eggs.

Taking a glucose-lowering medication or insulin, is not a ticket to eating sweets and carbohydrates

 Stents and grafts are not tickets to continue your past eating and lifestyle habits

 ANOTHER TYPE OF CORONARY ARTERY DISEASE:

In addition to cholesterol narrowing in large arteries, microvascular disease  makes small coronary arteries stiff. More common in women, this disorder can also affect men. The cause is not known but is more commonly seen in conjunction with Type 2 diabetes and inflammatory disorders related to autoimmune diseases such as: rheumatoid arthritis, MS and lupus. In addition, anemia, polycystic ovary disease and hormones can contribute to microvascular dysfunction.

Microvascular disease is treated with medication, lifestyle changes, and normalizing all risk factors. Exercise and healthy food choices are key.Family exercise

CHANGING THE COURSE OF TYPE 2 DIABETES – PART 2

Diabetes Health in your handsType 2 diabetes is preventable, treatable and partially reversible in many people. If you have prediabetes or borderline blood glucose without aggressive treatment including weight loss, you will likely progress to full blown diabetes within ten years. With proper medical care, exercise and healthful food choices, you can take control and improve your health.

 Until the epidemic of obesity around the world occurred, Type 2 diabetes was a disease of older people, not teenagers. We are now seeing overweight adolescents with Type 2 diabetes. Of grave concern is evidence of heart disease present in overweight 5-year-olds.obesity

Bad food choices and lack of exercise contribute to Type 2 diabetes & heart disease.

Even if heart disease runs in your family you have the ability to reduce hereditary risks and live longer. Interventions need to begin in childhood and continued throughout life, but it’s never too late to start. The American Heart Association recommends children should have a blood lipid panel before age twenty to help determine risks and begin treatment when appropriate. Do you know your lipid numbers?

You can offset “bad cholesterol genes” by making healthy choices.

 When vessels become narrowed with inflammatory cholesterol plaques, symptoms can be intense with crushing chest pain radiating into the neck and down the arms, weakness, sweating and collapse. However, that is not always the case. In fact, arteries may be more than 90% closed and generate no symptoms. Just because you have no chest pain, it doesn’t mean you don’t have cardiovascular disease.

 Major risk factors for coronary artery disease include: tobacco use, uncontrolled high blood pressure, cholesterol abnormalities, obesity, diabetes, low activity, alcohol and other drugs, high levels of calcium supplements (over 1200mg/day) and hereditary factors. In addition, microvascular dysfunction, a form of coronary artery disease in small vessels is common in women. This is because women more often develop autoimmune disorders such as rheumatoid arthritis, MS and lupus. In addition, anemia, polycystic ovary disease, hormone changes and Type 2 diabetes all contribute to the metabolic mix.

Even if you have been diagnosed with Type 2 diabetes, coronary artery disease, peripheralMed.Food vascular disease, or have had a heart attack, stents or a stroke, there is hope for improvement. Exercise and normalizing weight, blood pressure and blood glucose, in addition to a medication regimen to improve lipids — all contribute to lowering risks and reducing the closure of arteries and stents. Taking a statin to lower your cholesterol is not a ticket to eating fried foods, bacon cheeseburgers or eggs. Good dietary practices are essential to long term health.

YOUNG WOMEN WITH TYPE 2 DIABETES: BEWARE OF HEART DISEASE

PART 1 — PREVENT HEART DISEASE & SAVE YOUR LIFE

A recently released study from Johns Hopkins University not only confirms the relationship of coronary artery disease to Type 2 diabetes but emphasizes the importance of preventing progression of associated heart and vascular disease in young women.

When researchers analyzed data on 10,000 men and women without a history of heart disease, clear gender differences surfaced. Men with Type 2 diabetes did not develop the same increase in heart disease they found in women. Under age sixty, when women are usually at less risk for heart disease than men — they found presence of Type 2 diabetes increased female risk up to four times.

 Uncontrolled glucose in diabetes stimulates an inflammatory process affecting the whole body. Tissues become insulin resistant and blood sugar rises. This contributes to the development of artery narrowing and reduced blood flow to the heart and other organs. Arteries stiffen, cholesterol accumulates and arteries develop thick areas called plaques that begin blocking blood flow.

Coronary arteries supply the heart with blood and nutrients, when the arteries become too narrow to carry enough oxygen, discomfort may occur. At first the disease is silent. There are no symptoms. In some women, symptoms are subtle and not recognized as heart-related. These include: jaw aching, upper back discomfort, breathlessness or upset stomach. When these potential heart symptoms are recognized, both patients and their physicians must search for the cause.

In women, a special type of coronary artery disease called microvascular dysfunction may occur. This problem involves tiny branching arteries supplying the heart muscle. Often large surface arteries are open and even a specialized invasive study of the inside of the vessels called a coronary angiogram is normal. Further testing is needed to identify the cause. Risk factors must be reviewed, other reasons must be ruled out and an exercise tolerance test combined with nuclear medicine or echocardiogram is needed to make the diagnosis.

Women must be cognizant of symptoms and seek medical attention for full evaluation of heart risks and laboratory studies to evaluate blood glucose, blood lipids (cholesterol) and other silent diseases such as thyroid abnormalities and anemia.

♥  Sixty-four percent of women who die of sudden death had no recognized heart symptoms.

 ♥  Fifty percent of people who have heart attacks die before reaching the hospital.

 With cardiovascular disease the leading cause of death in adults, it is past time to take control, make lifestyle changes and improve health.

 Dr. Betty