Education

Topics

• Syncope (fainting)
• Cerebrovascular Accident (Stroke)
• Warning Signs and Symptoms of a Heart Attack
• Cardiovascular Risk Factors
• Smoking Cessation
• Heart Disease in Women

Syncope (fainting)
Syncope is commonly known as fainting or a sudden loss of consciousness. It occurs when the brain does not get enough blood and oxygen. The most common type of syncope is vasovagal syncope which can be triggered by standing for long periods of time, heat, pain, fear, the sight of blood or emotional distress. Other types of syncope include situational syncope (syncope triggered by a specific situation such as coughing), postural syncope (when a person stands up quickly from a lying or sitting position and the blood pressure drops and you faint), carotid sinus syncope (fainting triggered by pressure on the carotid sinus by turning the head), arrhythmias (abnormal heart rhythm), ischemia (lack of blood flow to the arteries in the heart caused by blockages) and structural heart disease (a thick heart or valvular abnormalities).

Symptoms of syncope

• lightheadedness
• nausea
• pale appearance
• sweating
• feeling warm
• weakness
• dimmed vision
• difficult hearing

Is Syncope serious?
If you fall after you faint, you may get cuts or bruises or break a bone. If syncope occurs while you are driving, you may injure yourself or others. People who have syncope but are otherwise in good health generally have a good prognosis. However, people whose syncope is caused by arrhythmias or structural heart disease generally have a serious condition. Your doctor will tell you what type of syncope you have and the treatment that is required.

If you have any questions about the above information, feel free to call Heart Consultants at 402-572-3300 to set up an appointment.

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Cerebrovascular Accident (Stroke)
Strokes are the 3rd leading cause of death and disability in the United States. A stroke occurs when the brain is not receiving enough oxygen and blood flow. A large number of strokes can be prevented each year by aggressively treating your risk factors. The risk factors for a stroke are similar to those of a heart attack. They are either hereditary (non-modifiable) or the result of a person’s lifestyle (modifiable).

Non-modifiable risk factors:

• Age — The chance of having a stroke more than doubles for each decade of life after age 55. While stroke is common among the elderly, a lot of people under 65 also have strokes.
• Heredity (family history) and race — Your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke. African Americans have a much higher risk of death from a stroke than Caucasians do. This is partly because blacks have higher risks of high blood pressure, diabetes and obesity.
• Sex (gender) — Stroke is more common in men than in women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women than men die of stroke. Use of birth control pills and pregnancy pose special stroke risks for women.
• Prior stroke, TIA or heart attack — The risk of stroke for someone who has already had one is many times that of a person who has not. Transient ischemic attacks (TIAs) are "warning strokes" that produce stroke-like symptoms but no lasting damage. TIAs are strong predictors of stroke. A person who's had one or more TIAs is almost 10 times more likely to have a stroke than someone of the same age and sex who hasn't. Recognizing and treating TIAs can reduce your risk of a major stroke. If you've had a heart attack, you're at higher risk of having a stroke, too.

Modifiable risk factors:

• High blood pressure — High blood pressure is the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.
• Cigarette smoking — In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk.
• Diabetes mellitus — Diabetes is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight. This increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke.
• High blood cholesterol — People with high blood cholesterol have an increased risk for stroke. Also, it appears that low HDL (“good”) cholesterol is a risk factor for stroke in men, but more data are needed to verify its effect in women.
• Poor diet — Diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can contribute to increased blood pressure. Diets with excess calories can contribute to obesity. Also, a diet containing five or more servings of fruits and vegetables per day may reduce the risk of stroke.
• Physical inactivity and obesity — Being inactive, obese or both can increase your risk of high blood pressure, high blood cholesterol, diabetes, heart disease and stroke. So go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Try to get a total of at least 30 minutes of activity on most or all days.

Other risk factors:

• Carotid or other artery disease — The carotid arteries in your neck supply blood to your brain. A carotid artery narrowed by fatty deposits from atherosclerosis (plaque buildups in artery walls) may become blocked by a blood clot. Carotid artery disease is also called carotid artery stenosis. Peripheral artery disease is the narrowing of blood vessels carrying blood to leg and arm muscles. It's caused by fatty buildups of plaque in artery walls. People with peripheral artery disease have a higher risk of carotid artery disease, which raises their risk of stroke.
• Atrial fibrillation — This heart rhythm disorder raises the risk for stroke. The heart's upper chambers quiver instead of beating effectively, which can let the blood pool and clot. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results.
• Other heart disease — People with coronary heart disease or heart failure have a higher risk of stroke than those with hearts that work normally. Dilated cardiomyopathy (an enlarged heart), heart valve disease and some types of congenital heart defects also raise the risk of stroke.
• Sickle cell disease (also called sickle cell anemia) — This is a genetic disorder that mainly affects African-American and Hispanic children. "Sickled" red blood cells are less able to carry oxygen to the body's tissues and organs. These cells also tend to stick to blood vessel walls, which can block arteries to the brain and cause a stroke.

Stroke Warning Signs

The American Stroke Association says these are the warning signs of stroke:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

If you or someone with you has one or more of these signs, don't delay! Immediately call 9-1-1 or the emergency medical services (EMS) number so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you'll know when the first symptoms appeared. It's very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.

If you have questions or concerns about your risk for a stroke, please notify our office at 402-572-3300 to set up an appointment.

Information and statistics obtained from the American Heart Association.

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Warning Signs and Symptoms of a Heart Attack
A heart attack occurs when the blood supply to part of the heart muscle is reduced or stopped because of a partially blocked or completely blocked artery. The process begins with buildup of fatty deposits (plaque) inside the artery walls. This plaque develops in most people starting in our first decade of life. Over time the plaque can become unstable and rupture, causing a blood clot to form and block the artery. If the blood supply is cut off for more than a few minutes, heart muscle cells suffer permanent injury. This can cause significant damage to the heart muscle. Some heart attacks are sudden and intense, but most start slowly, with mild pain or discomfort. Often the people affected aren’t sure what’s wrong and wait too long before getting to a hospital. The sooner you get to the hospital the better to help prevent significant damage to the heart muscle.

There are several warning signs and symptoms of a heart attack to be aware of:

1. Chest discomfort can be in the center of the chest that lasts more than a few minutes, or that goes away and comes back. I can feel like an uncomfortable pressure, squeezing, fullness, tightness or pain. Some people may never have chest pain.
2. Symptoms can include pain or discomfort in areas of the upper body (radiation of pain). You can feel discomfort in the arms, the upper back, neck, jaw or even the stomach.
3. Shortness of breath may occur with or without chest discomfort. You may get shortness of breath with or without activity. Shortness of breath may be your only symptom.
4. Other signs and symptoms may include sweating, palpitations, headache, nausea and vomiting or lightheadedness. People may have noticed a decrease in their exercise tolerance and increased fatigue recently. Some people may also have a feeling of impending doom.
5. Women may have different signs and symptoms of heart disease or a heart attack. Your symptoms may be vague such as fatigue, nausea and back pain.

If you have chest discomfort with one or more of the above named signs or symptoms for more than five minutes, you should call for help. Calling 9-1-1 is the fastest way to get lifesaving treatment if you are having a heart attack.

If you have any questions about the above information please feel free to call our office at 402-572-3300.

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Cardiovascular Risk Factors
Cardiovascular disease is America’s number 1 killer and a leading cause of disability. Heart disease, stroke and other cardiovascular diseases devastate millions of people of all ages and kill approximately 602,000 American’s each year. Millions of Americans of all ages and races have risk factors that increase the odds that they will one day suffer a heart attack, stroke or develop another cardiovascular disease. For instance, look at the number of adults who have each of these controllable risk factors:

1. High blood pressure – 72 million
2. High blood cholesterol – about 36.6 million
3. Smoking – 46 million
4. Physical inactivity – 70% report no leisure-time activity
5. Overweight or obese – 66% of Americans
6. Diabetes - about 20 million diagnosed and undiagnosed

Here are some recommendations to help decrease your risk factors.

1. The goal blood pressure is less than 140/90. If you are diabetic the recommendation is 130/80. Decreasing the amount of salt in your diet, exercising and taking your medications on a regular basis help with lowering blood pressure.
2. Total cholesterol less than 200, triglycerides less than 150, HDL (good cholesterol) 40 for men and 50 for women, and LDL (bad cholesterol): no risk factors less than 130, two or more risk factors less than 100, diabetes or cardiovascular disease 60-70. Eating a healthy diet low in fat and cholesterol as well as taking your cholesterol medication if it has been prescribed will help with your cholesterol.
3. There are many smoking cessation classes and aids to help people stop smoking. The nicotine in cigarettes constricts the blood vessels making it difficult for oxygenated blood to get to the organs and muscles.
4. The American Heart Association recommends 30 to 60 minutes of physical activity most days of the week.
5. Weight reduction helps decrease your risk of cardiovascular diseases. Try to loss 10% of your body weight to start.
6. Control your diabetes as well as possible. The recommendation is to have your HgbA1c less than 6.5.

Tips for Lowering Your Cholesterol

1. Eat no more than 6 ounces per day of cooked meat, seafood, or poultry (5 ounces or less if you have heart disease or are at high risk for developing it, or if you have diabetes).
2. Use chicken or turkey (without the skin) or fish in most of your main meals.
3. Choose lean cuts of meat, trim all visible fat, and throw away the fat that cooks out of the meat.
4. Substitute meatless or “low-meat” main dishes for regular entrees.
5. Use fat-free milk, 1%, and low-fat dairy products.
6. Limit your intake of organ (heart, kidney, etc.) meats and other foods high in cholesterol.
7. Read the ingredient list and choose products without partially hydrogenated fats.
8. Eat 10-12 servings of fruits and vegetables daily.
9. Eat at least 2 servings of fish per week.
10. Substitute higher saturated fats and oils with ones containing polyunsaturated and monounsaturated fats such as canola and soybean oils and many types of nuts. Use a minimal amount of fats and oils, usually no more than 2-3 teaspoons per day. Choose those with less that 2 grams saturated fat and 0 grams trans fat.

Tips for Lowering Your Blood Pressure

1. Eat 5 or more servings of fruits and vegetables each day as well as 2-4 servings of fat-free or low-fat dairy products.
2. Use less salt. Read the nutrition facts panel to find out how much sodium is in the food you eat. Limit sodium intake to less than 2,300 mg per day.
3. Maintain a healthy weight. Know what your weight should be. To find your healthy weight, go to http://www.americanheart.org/presenter.jhtml?identifier=4489. Keep it at or below that level.
4. Enjoy at least 30 minutes of physical activity on most days of the week.
5. Limit your alcohol intake. Don’t drink more than 1 drink a day if you’re a woman or 2 drinks a day if you’re a man.
6. Know your blood pressure. Have it checked regularly. Normal blood pressure is less than 120/80.

If you have any questions or concerns about your risk for cardiovascular disease, feel free to contact our office to schedule an appointment.

*Data and recommendations taken from the American Heart Association.

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Smoking Cessation
Cigarette smoking remains the single most preventable cause of death and disability. Almost 70% of smokers want to quit. About 40% of smokers have made at least one quit attempt each year. Many smokers have tried to quit repeatedly and fortunately, almost 50% of smokers do achieve long lasting cessation.

For those who can quit smoking, the health benefits are numerous. Almost immediately, new non smokers suffer less fatigue and shortness of breath. Arterial circulation and libido also increase. Over time those who quit smoking reduce their risk of lung and other cancers, heart disease, stroke, and lung disease including emphysema.

Tobacco dependence is now recognized as an addiction. Years of research on tobacco treatment have determined that to achieve tobacco-free living, smokers need three things:

1. counseling
2. medications
3. follow-up

Both nicotine replacement and non-nicotine medications have proven effectiveness in smoking cessation. Recently a new prescription medication, Chantix has been showing great promise for those going tobacco-free. Chantix works by binding to nicotine receptors in the brain thereby preventing smoked nicotine from affecting the brain. With Chantix, smoking is no longer a pleasurable calming experience. In clinical trials, around 40% of participants treated with Chantix and counseling were tobacco-free after 12 weeks.

If you would like to learn more about Chantix and other treatment options for tobacco-free living please call 572-3300 to schedule an appointment.

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Heart Disease in Women
Heart disease and stroke are not just diseases of men, but are also the #1 and #3 killers of women. One in three women have some form of cardiovascular disease compared with one in 30 women who will die from breast cancer. The risk of cardiovascular disease steadily rises with age but the processes that lead to heart attack and stroke can start at a young age. That is why it is very important to assess and modify risk factors when they are identified. (See separate “Cardiovascular Risk Factors” section).

Men have a greater risk of heart attack than women, and they have heart attacks earlier in life, however, women who have heart attacks are more likely to die from them. The same is true with strokes. This may be true because women are older and often sicker, but often women’s symptoms go unrecognized.

Your symptoms may be different than his. Classic and most common signs in both men and women include an uncomfortable pressure, fullness, or squeezing pain in the center of the chest for a few minutes. The pain may come and go or go into the arms, back, neck, or jaw. Associated symptoms can be lightheadedness, sweating, nausea, and shortness of breath. Signs more common in women than men may include an unusual pain in the chest, stomach or abdomen, and back. Women may simply present with nausea and vomiting or shortness of breath or palpitations with cold sweats. Unexplained anxiety, weakness, or fatigue may also indicate a heart attack.

It is very important for women to become involved in their health care. Know your risk factors and talk to your healthcare provider about how to control them. Take action now to lower the incidence of heart disease and to become a healthier you!

Visit www.goredforwomen.org for more information, including heart-health recipes and the Go Red Heart Check-up to learn your risk for heart disease.

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