Keeping Your Ticker Ticking
Ted was out walking when he felt a sudden crushing sensation in his chest. Olga was in bed coughing when she noticed a tightening sensation in her left jaw. Don, a twice-a-week player, dropped dead on the squash court.
The stories vary, but the diagnosis is the same: angina, a deficient blood flow to the heart muscle.
Your ticker works 24/7 and requires a constant supply of oxygen-filled blood. If for any reason the supply is inadequate, the cardiac muscle starts to complain, usually in the form of chest pain.
The harder your heart works, the more blood—that’s nutrients and oxygen—it requires. Physical activity, including any form of exercise, increases cardiac demands. That’s why symptoms of angina pectoris are at a minimum when at rest, but come on with exercise. However, sometimes pains do occur while at rest, but more often with exercise, cold or stress.
Blood flow can be restricted through the blocking of major arteries carrying blood to the heart, or when narrow or obstructed. It’s a condition that can be treated using medication, and today an excellent once-a-day tablet (Imdur) is used. It rapidly improves the heart’s blood supply and lessens cardiac demands, and symptoms quickly subside. With Imdur, patients can carry on a fairly normal daily routine. It must be prescribed by a doctor, who will also monitor a patient’s progress.
If pain or discomfort occurs in the chest, either alone or in nearby areas such as the jaw, shoulder, arms or breastbone region, don’t ignore it.
Be careful not to confuse it with indigestion (sometimes worrying chest pains are just that.) Anginal pains are insidious. The typical “precordial” pain (left side of the chest where the heartbeat can be felt) isn’t always present to give the right signals. Pain in other parts of the body is common. And although usually related to activity, this is not always the case.
treatments
An enormous range of treatments—tablets, skin patches and oral sprays—are readily available. It’s up to your doctor to decide which is for you. Many people carry pills and suck one in an emergency.
These days, simpler methods of delivery in longer-acting forms are available. One tablet in 24 hours is all that’s needed to give a healthy, ongoing supply of blood to the heart. Usually taken in the morning, this medication acts for 12-16 hours. It is followed by a “nitrate-low” period of several more hours. This is necessary, otherwise the patient’s cardiac system may become accustomed to its constant presence, and its effectiveness diluted.
As with all medication, patients worry about adverse side effects. Fortunately with this medication, they’re minimal. Dizziness and headaches, due to a slight drop in blood pressure, may occur in a proportion of patients (mainly older) starting medication.
Other classes of medication are also available. Beta-blockers and calcium antagonists are two other forms of therapy.
options
Your doctor makes the final decision as to treatment. Medication is often the quickest, cheapest and simplest way to begin. This is especially the case with older patients, as angina and coronary artery disease is essentially a disorder of advancing years, although it may start early in life.
In recent years, there’s been an enormous increase in the use of cardiac surgery. Coronary artery bypass is now quite common, with good results and minimum mortality.
This operation involves opening the chest cavity, locating the obstructed arteries, and replacing them with healthy, normal, unobstructed ones taken from some other part of the body. The bypass grafts grow into the heart tissue in an amazingly successful manner.
During surgery, the heart and circulation are temporarily halted, as an artificial system keeps the patient alive during the procedure. Some believe a reduced blood flow to the brain during the operation may have an adverse long-term effect, so this is continually monitored.
Balloon dilatation (percutaneous transluminal coronary angioplasty or PTCA) is rapidly becoming the operation of first choice in some major cardiac centres. This involves placing a thin tube called a catheter into an artery in the groin. It is gradually fed upwards to enter the coronary circulation, until the point of narrowing is reached. This has been predetermined before with X-ray photographs in which arterial obstructions are clearly seen.
Once the narrowing is reached, pressure via the catheter causes a tiny balloon to pop out and dilate the narrowed segment. This is frequently followed by a piece of thin metal mesh called a stent being set in place to prevent renarrowing.
As open-heart surgery is a major physical undertaking, PTCA is much less traumatic. But even with stents, angina can continue. As most patients are in the higher age bracket, and are not prepared to undergo major surgery, they seek options. Fortunately, medication is an option for many.
other issues
Other factors causing diseased arteries and angina include lifestyle choices. Consequently, it’s possible to avoid problems by altering the way you live and what you eat. Amazing though it may seem, most ways to keep the blood vessels and heart healthy are simple.
Lifestyle changes cost very little (often nothing) and can help prevent other diseases such as cancer, especially in the intestinal system.
Weight. At least half of the Australian and New Zealand population is either obese or plainly overweight. This is a major cause of cardiovascular disease. It’s easy to know if this affects you—simply look in the mirror after a shower, before you camouflage your body with clothes.
The biggest concern is waist fat, or atherogenic fat. This is the dangerous kind, for it is mobile and moves around the system. When abdominal measurement is divided by buttock circumference (called the “waist-hip ratio”), it should be under 1. The ideal is 0.7. The lower the figure the better. (Marilyn Monroe’s was 0.62.) The higher the figure, the greater the risk.
Losing weight isn’t hard. Eat less and exercise more each day. Concentrate on reducing intake of fats of all kinds. Then increase fibre intake.
Fibre. Fibre is found in wheat cereals, like Weet-Bix, muesli, Lite-Bix, puffed wheat or rice, oats and rolled oats, barley products, bran whether alone or incorporated into cereals and food. It is high in wholemeal bread, fruit, vegetables and legumes such as beans, lentils and peas.
Exercise. More than half of adults have no regular exercise routine apart from breathing and eating! A major reason why our parents and grandparents lived so long can be attributed to exercise.
Ideally, exercise in some form for 30-40 minutes a day. Walking is best. Incorporate this into your daily routine—it has been found every bit adds up—it need not be taken in a single block. If you are already doing this, try to extend the duration and intensity. This helps keep weight down, improves cardiac circulation and reduces risks of obstruction, angina, heart attack and stroke.
Blood pressure. One in five people suffer from elevated blood pressure. Often they’re unaware they are at risk. This gradually damages vessels, stealthily throwing an extra burden on the heart muscle, which must pump harder as time goes by. This means it wears out quicker. Usually no symptoms occur. A regular blood pressure (BP) check when visiting the doctor for some unrelated reason is worthwhile. Make this at least an annual or biannual routine.
Losing weight, reducing daily salt intake, reducing alcohol consumption and taking more exercise help reduce BP.
Some use an Omron home BP measuring sphygmomanometer (from pharmacies) to record readings several times during the day and show the doctor. Excellent medication is now available to help reduce blood pressure to a safe level.
Smoking. Smoking is considered the most dangerous preventable cause of blood-vessel and heart disease. Smoking causes serious damage to blood vessels, as well as all body organs and systems.
Taking up smoking while young is a trap, with teenage girls the biggest area of concern. If a person never starts, there’s never a problem. Ways to quit include the skin patch (Nicabate) and chewing gum. Various clinics and organisations offer excellent advice and support.
Passive smoking, breathing the cigarette smoke exhaled by others or from cigarettes smouldering in ashtrays, is also dangerous and should be avoided.
Diabetes. Almost 650,000 Australians suffer diabetes, with perhaps another 350,000 undiagnosed cases. High blood-sugar levels gradually corrode and damage vessels and the organs they supply. The eyes are often adversely affected and this may be the first indication of the disease.
Vessels to the heart, brain, feet, kidneys and other organs are also gradually destroyed. This may cause angina, increased risks of heart attacks, stroke, pains in the legs, ulcers and sometimes gangrene of the feet or legs. It can be readily diagnosed and successfully treated.
Cholesterol. Risks are attached to elevated cholesterol levels, with 5.5 mmol/L the upper level of “normal.” Produced by the body, but also present in animal fats, high levels may gradually clog arteries supplying vital areas.
The heart and brain head the list. But any organ or limb may also be affected. It is a potent cause of angina and heart attacks, stroke, kidney and limb problems.
Fortunately, keeping it normal is not terribly hard. Simple attention to diet is the starting point. Avoiding animal fats as much as possible is recommended, so trim fat from meat and preferably grill. But a vegetarian diet is best.
Soy products are also claimed to contain phyto (plant) chemicals, isoflavinoids and soluble fibre, which are cardio-protective. Soluble fibres—found in many cereals (oats, rice, barley)—as well as fruit, vegetables and legumes are best. They help to raise protective HDL cholesterol and reduce levels of destructive and harmful LDL cholesterol, all of which can be measured.
Aspirin. Aspirin is actually some centuries old. It comes from the ash of burnt willow bark, and was used as a folk remedy for rheumatism and arthritis. As well as being suitable for treating pain and fevers, it has the ability to also reduce blood-cell stickiness, so it’s widely used to prevent heart disorders, strokes and to improve circulation. One quarter of a 300 mg tablet a day is adequate. An enteric coated one (Cartia) dissolves in the intestines, avoiding stomach irritation and nausea.
Rest and recreation. Regular rest, adequate sleep (6-8 hours) and some daily recreation also help. This reduces stress, which is claimed to play a part in adverse cardiac events. The nervous system is interlinked with all parts of the body and shouldn’t be stressed, so never scrimp on rest and relaxation. Take a holiday each year and a day off each week.
Water. Six to eight glasses of water each day costs virtually nothing. It sweeps away toxins, which collectively may reduce metabolic efficiency. The body is largely composed of water, and is a natural component of normal healthful living.
Genetics. Heredity plays a critical role in cardiac health, sound blood vessels and longevity. If your parents lived a long, disease-free life, things are already in your favour.
Many believe that this is the most important factor affecting the bodily systems. But if you lack a positive genetic background, it simply means working harder at maintaining a healthy body. You can’t choose your parents, but you can take advantage of the knowledge of what happened to them.
Peace of mind. A positive outlook on life is vital to good health and longevity. You may need to assess your situation in this regard. Try making a list of ways to improve your mental state, including dealing with relationships and your attitudes toward others. This may also involve adding a spiritual dimension to your life.
In the meantime, stay in touch with your GP; have a regular once-per-year medical, and report any chest pain, no matter how small, to your doctor.
Heart facts
For its size, the heart has the capacity to pump large amounts of blood. In the average adult, the heart:
- Beats 60-100 times a minute
- Will beat more than 2.5 billion times during an average lifetime
- Pumps between 70 and 100 ml of blood with each beat
- Could fill a petrol tanker in one day
- Completely recirculates the 5-6 litres of blood in the body every 1.5 minutes
- Pumps blood to the lungs, back to the heart, out to the body and back to the heart again in about 23 seconds
Heart numbers
- 50,797—number of deaths from cardiovascular causes in Australia in 1998 (40%)
- 27,825—number of coronary heart disease deaths, mainly heart attacks (22%)
- 11,982—number of stroke deaths, the second greatest killer (9%)
- 80—percentage of Australian adults with at least one cardiovascular risk factor—smoking, physical inactivity, high blood pressure or overweight. (Note, rates of high BP, smoking and high blood cholesterol have all declined since 1980.)
- 10—the average number of minutes between deaths
- 7.6—the number of days spent in hospital in 1994
- 7—millions of overweight or obese Australian adults aged 25+
- 5.8—millions of Australians who didn’t undertake physical activity at a level recommended to achieve a health benefit during the past year
- 5.5—the number in 1999
- 3.9—million ”health” dollars spent on cardiovascular disease in1994
Source: The Heart Foundation Interested in knowing more? Contact Heartline, the Heart Foundation’s telephone information service on 1300 362 787, or check their website, <www.heartfoundation.com.au>.
Get active!
Physical inactivity is second only to tobacco smoking in terms of its impact on the burden of disease in Australia, and it is the leading cause of disease in Australian women. In 1996 almost 10,000 cardiovascular disease deaths were attributable to physical inactivity of a total of more than 13,000 deaths related to physical inactivity.
The rate of physical inactivity is increasing, and overweight and obesity are increasing at alarming rates with 68 per cent of men and 49 per cent of women either overweight or obese.
Evidence of the health benefits of moderate activity is compelling: an adult who participates in 30 minutes or more of moderate-intensity physical activity (a brisk walk) on most days has a 35-50 per cent reduced risk of dying prematurely from heart attack. For coronary heart disease alone an increase of 10 per cent in physical activity levels would save 1000 lives and prevent 1100 hospital admissions for heart attack.
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