Introduction for Managing Heart Disease
Arteriosclerotic heart disease is defined by reduced blood flow caused by cholesterol plaques, with or without blood clots, in one or more blood vessels of the heart. This situation can lead to insufficient nutrient delivery to the downstream tissues that can cause these very important complications.
- Congestive heart failure develops if there is sufficient death of heart muscle (myocardial infarction) and subsequent inability of the remaining normal heart tissue to pump enough blood to the body. Tissues that die obviously cannot contract, but there are also areas around the infarction, called the peri-infacrtion area, that are in shock and may not be able to contract because blood flow to them is not sufficiently compromised to kill them. They may eventually recover if blood flow can be re-established.
- Abnormal heart rhythms may arise because peri-infarction tissues are very irritable and electrically unstable. These rhythms can compromise cardiac output and be lethal.
- Angina is the pain caused by insufficient blood flow to an area of the heart. While this is not lethal in itself, it can be very painful and disabling, and is also a warning that there is at least one blood vessel that is severely blocked and in danger of closing off entirely. A mycardial infarction may be impending.
- Psychological symptoms related to anxiety, depression, post traumatic stress disorder
MANAGING HEART DISEASE
What is arteriosclerotic heart disease (ASHD) and what are its complications?
- A heart attack occurs when there is insufficient nutrient delivery to sustain energy production in part of the heart and leads to damage or destruction of heart tissue. This is usually caused by a blood clot on a cholesterol plaque that blocks flow in a coronary artery.
- Complications of a heart attack include: Congestive heart failure, abnormal heart rhythms, angina pectoris, and psychological symptoms related to anxiety, depression, post traumatic stress disorder (PTSD), and death.
Symptoms of a heart attack or heart disease
- Severe pain over the left chest that may radiate to the left arm, jaw, teeth, or even back is the classic presentation. Occasionally there is no chest pain at all! It may last from seconds to hours; generally heart attacks have more severe and sustained pain.
- General symptoms such as shortness of breath, nausea and vomiting, sweating, weakness, sense of impending doom and fainting are more often seen with a heart attack than with an impending heart attack.
- If you have any of these symptoms take nitroglycerine if you have it, chew an aspirin unless it is contraindicated, and call 911.
What are the risk factors for heart disease?
- Men over 45 and women over 55
- High blood pressure
- High cholesterol and/or triglycerides
- Family history of heart attacks
- Lack of exercise
- Poor diet that is high in sugar and trans fats and low in fiber
- Stress and depression
- Stimulant drugs such as cocaine, amphetamines,
- Iron storage disease (much more common than appreciated)
- Autoimmune diseases such as rheumatoid arthritis
- Hypercoagulative states
- Inflammatory blood markers that include CRP, fibrinogen, homocysteine, Lp(a),
Tests and diagnosis of ASHD
- EKG (USPSTF guidelines)
- Chest x-ray
- Blood tests for heart enzymes, cholesterol, triglycerides, HDL and LDL with subfractions, CRP, Fibrinogen, Lp(a), homocysteine, fasting insulin and hemoglobin A1C, chemistry panel, magnesium
- Live blood cell analysis
- Heart rate variability
- Vascular stiffness
- Exercise stress test
- Blood tests for elevated heart enzymes
- Nuclear heart scan
- CT scan of the heart
- MRI of the heart
- Coronary artery catheterization
- Carotid artery ultrasound
- What should be done to screen for ASHD?
Conventional medical treatment for an acute heart attack
- Aspirin, unless contraindicated
- Clot busters called thrombolytics, as soon as possible
- Pain relief, usually with morphine
- Beta blockers
- Cholesterol-lowering drugs: statins, niacin, fibrates, and bile acid sequestrants
Surgical treatment for a heart attack
- Surgical stents
- Bypass surgery
- Surgery to remove an aneurysm
CAM support to help treat heart disease
- Infrared light therapy
- Calming essences of oils such as lavender and lemon balm
- Hypnotherapy, meditation, massage, somatic psychotherapy
What about prevention?
- Studies documenting that prevention through lifestyle modification works to prevent heart attacks and reverse the risk of heart attack and death at all ages and for both sexes
- EPIC Study: 23,000 people; walk 30 minutes per day, no smoking, good diet, good weight results in 93% less type 2 diabetes, 81% fewer heart attacks, 50% fewer strokes, 36% less cancer, and more…
- INTERHEART Study: 30,000 people from 52 countries and 7 continents showed that a healthy lifestyle accounts for nearly all risks for men and women and at all ages.
- Dean Ornish studies showed that a healthy lifestyle can reverse ASHD and prevent heart attacks.
- Highmark Blue Cross/Blue Shield Study: Health care costs decreased 50% in the first year using the Ornish program
- Mutual of Omaha Study: Saved $30,000 per patient in the first year of the Ornish program
- Safeway Study: A healthy lifestyle program saved 12% of medical costs beginning in the first year
- Lifestyle is the most powerful healer in the universe (Diet, exercise, adequate sleep, weight management, stress reduction, the inner smile)
- Practice mindfulness meditation to get into the zone of life
- Reduce inflammation through healthy lifestyle measures
- Medication: beta blockers, aspirin, statins, ace inhibitors
After your heart attack
- Cardiac rehabilitation program: exercise, diet, sleep, stress, avoiding toxins, weight, finding the inner smile…