Heart Disease

Your Heart Questions Answered by the Women’s Heart Center – pt 2

Heart Failure Live Chat 7/25/17Thank you for your patience and for your participation in American Heart Month! We received so many great questions, it took us a while to get through them all. We hope you find our Part 2 answers helpful. Thank you to our Emory Women’s Heart Center experts  Dr. Alexis CutchinsDr. M Carolina GongoraDr. Gina LundbergDr. Susmita Parashar, and Stacy Jaskwhich for answering these submitted questions.

Review Part 1 questions and answers here!

What are the signs of heart disease? Are there any silent signs? 
Signs of heart disease may include the ones we would typically think about:

  • chest pain
  • shortness of breath
  • palpitations

Some other signs of heart disease that may not be as distinguishable (or considered silent as they are not recognized as a heart problem) could be:

  • dizziness
  • nausea
  • sweating or flushing
  • neck pain
  • jaw pain
  • back pain
  • general fatigue

All symptoms are more suggestive of heart disease when they occur with exertional activity or are triggered by emotional stress.  Some symptoms occur over time and people acclimate to them or shrug them off as “being out of shape” or “going through menopause”.  Progressive symptoms, such as increased shortness of breath with walking up stairs, can be a worrisome change and you should definitely mention to your physician.

How do you know when you have heart disease? 
Bottom line is, you won’t know if you don’t look. Studies have shown that 2/3 of women have no previous symptoms prior to their heart attack. There are many types of heart problems that an individual could have such as an enlarged heart, electrical abnormalities of the heart (arrhythmias) or blood flow issues.  We usually think of heart disease as blood flow issues or blockages that might cause a heart attack. You will likely notice some signs or symptoms in this scenario, but the best way to know for sure is by having a screening or seeing a Cardiologist for testing. Common sense would tell us that the more risk factors that you have for heart disease, the higher the probability.

There are many screening tests which can be performed to give you a better idea of your cardiac status.  You can actually have heart disease for a long period of time prior to having an event.  If you have a strong family history of heart disease or multiple risk factors, it may be a good idea to have a Coronary Calcium Score.  This is a CT of your heart that identifies hard, calcified plaques in your heart arteries.  It really helps to determine if you have the disease and to quantify the amount of disease that is present.  The result will be given in an age-matched reference so that you can see how you are doing in comparison to other women/men in your same age group.  The more plaque you have, the more aggressive your treatment plan should be.  If you are having any type of symptoms, you should have diagnostic testing.  Most people start with a simple EKG, but a treadmill stress test is a better tool.  If the stress test is positive for EKG changes with exercise, further tests may be indicated.

What are the most common kinds of heart troubles? 
In a cardiology practice, we commonly see a multitude of heart problems, many of which are brought about by the risk factors such as:

  • high blood pressure
  • high cholesterol
  • sleep apnea
  • being overweight
  • diabetes
  • depression
  • lifestyle choices

Think of your heart as a house with 3 basic responsibilities: pump, plumbing, and electricity.

  • You can have a pump issue in which your heart muscle is enlarged, thickened or damaged. Consequences of this can result in a condition called congestive heart failure.
  • You can have a plumbing issue in which you have plaque build up that eventually closes your arteries and prevents well-oxygenated blood from reaching your heart muscle. Consequences of this could lead cause a heart attack.
  • You can have an electrical issue in which your heart loses the ability to normally conduct impulses.  These can stem from the upper and lower chambers of the heart and some are more worrisome than others- the most common electrical problem that we see is Atrial fibrillation. Consequences of Atrial fibrillation can lead to blood clots or stroke when the heart beats irregularly and sets up the perfect scenario for a blood clot to form and then be lodged into the systemic circulation.

While all of these consequences seem very frightening, many can be avoided if we prevent risk factors from occurring by maintaining heart-healthy lifestyles in the first place.

By what percentage is the reduction of heart disease changed, as backed by scientific studies, when one makes positive changes.  
It is somewhat difficult to predict because it depends on different variables. Some risk factors are non-modifiable, such as genetics, age, gender, and race.  Of the modifiable risk factors, several studies have highlighted the critical importance of lifestyle modifications in heart disease prevention.  A Nurses’ Health Study demonstrated that women were able to reduce their risk of coronary events by >80% by not smoking, maintaining healthy body weight-BMI< 25, consuming a healthy diet, participating in moderate to vigorous exercise for 30 minutes a day, and consuming no more than a moderate amount of alcohol.

Another study named INTERHEART identified 9 easily measured risk factors (smoking, lipids, hypertension, DM, obesity, diet, physical activity, alcohol consumption, and psychosocial factors) that account for over 90% of the risk for acute heart attack.  This study also demonstrated that although the magnitude of the cardiovascular risks for men and women were similar, the impact of modifying the risks was greater in women.

What are some natural supplements that keep our hearts healthy?  
Heart health starts with exercise and a healthy diet.  The majority of the diet should come from vegetables, lean protein, low glycemic fruits, and some whole grains while limiting carbs and sugars.  Diet should consist of low sodium and high fiber.  It should include healthy fats such as nuts and olive oil.  Certain foods can be especially helpful for different cardiac problems.  For example, blueberries, leafy greens, seaweed, mushrooms, and celery have been shown to be beneficial in lowering blood pressure.

To further support your heart health, certain supplements may be helpful; however, these should always be recommended by a healthcare provider who has experience and training in the use of supplements. If you have a heart condition or are high risk for a heart attack, you must always follow your doctor’s advice before using any supplement.  Some supplements may interfere with blood thinners. Actually being tested for certain deficiencies prior to taking certain vitamins and minerals, may be the safest practice. It is way too risky to treat a serious health condition on your own with over-the-counter supplements. Some commonly used supplements for the heart are:

  • Omega 3 fish oil
  • flax seed
  • plant sterols
  • CoQ10 enzyme
  • Vitamin D
  • certain B Vitamins
  • Vitamin C
  • Zinc
  • Folate
  • Garlic
  • Magnesium
  • Turmeric

What are the best types of vegetables and fruits to eat when you have blood clots?  
If you have a blood clot, you are likely on a blood thinner.  If you are on Coumadin, you will have to be aware of the vegetables that contain Vitamin K as it acts as an antidote for Coumadin (blocking blood-thinning properties).  Most green, leafy vegetables contain Vitamin K.  This doesn’t mean that you should avoid these vegetables if, on Coumadin, you just have to eat them consistently in order to keep your blood levels of Coumadin therapeutic.  We currently have much better options for blood thinners though (Eliquis, Xarelto, Pradaxa) which work on a different bleeding pathway and don’t interfere with foods that we eat.

Many patients are prescribed an aspirin a day to reduce the risk of blood clotting. The component in aspirin that is responsible for reducing blood clotting risk is called salicylates. Salicylates can also be found in a wide variety of fruits and vegetables such as oranges, blackberries, blueberries, pineapple, plums, prunes, raisins, raspberries, strawberries, grapes, cranberries, tangerines, hot peppers, olives, radishes, and tomatoes.

Omega-3 fatty acids are essential nutrients that aid in the regulation of normal blood clotting. Most people believe that in order to receive omega-3 fatty acids, they must consume a high a diet that is high in fish. While fish is a good source of omega-3 fatty acids, they can also be found in many vegetables including brussel sprouts, kale, spinach and salad greens.

Vitamin E is also capable of inhibiting platelets (the cells responsible for clotting) that works as a natural anticoagulant. Vitamin E can be found in spinach, broccoli, kiwifruit, mangos, and tomatoes.

Review Part 1 questions and answers here!

To learn more about Emory Healthcare’s Heart and Vascular Center, please visit: www.emoryhealthcare.org/heart

Emory Healthcare welcomes and encourages open discussions on all of Emory Healthcare’s social media sites. We look forward to any comments, stories, interactions, and experiences you want to share online. Before posting, please be mindful that Emory Healthcare’s social media sites are open to the public. DO NOT disclose any personal information that you do not want to be shared. By sending any content over the internet, you acknowledge that you assume full responsibility related to security, privacy, and confidentiality risks. The information presented here is NOT intended to replace a consultation with a qualified medical professional or take place of professional medical care. Due to a large number of questions we received, we are unable to answer all questions. The questions selected above are (in our opinion) of value to all readers.  

Hope For the Broken Hearted

Heartbreak, heartache, and heartbroken are not words you would typically associate with the day of love (Valentine’s Day)…Or are they?

When February rolls around each year, we’re bombarded with messages and sentiments of love.  Couples, families, and friends begin to plan for Valentine’s Day, the day of love and dinner reservations are made, gifts are purchased, cards are written, and for those that are really lucky, the decadence of chocolate awaits. For some of us though, Valentine’s Day can be difficult if that special someone is no longer around. The overwhelming symbolism of love may cause them to reminisce and feel a deep pain. We know this pain, usually felt in the heart, as a broken heart, but in the medical world, this condition (yes, it’s a real medical condition) is known as acute stress cardiomyopathy.

Acute stress cardiomyopathy or “broken heart syndrome” is a relatively temporary heart condition brought on by stressful situations, such as a death of a loved one, or the complete shock of an unexpected breakup. The syndrome can lead to congestive heart failure, high blood pressure, and potentially life-threatening heart rhythm abnormalities.

It’s been reported that patients, mostly women, have gone to the emergency room due to classic heart attack symptoms caused by the shock, but when doctors performed diagnostic tests, such as an electrocardiogram, the results tended to look very different from regular heart attack EKGs. Furthermore, subsequent tests showed that the heart tissue was not damaged at all.

Luckily, the symptoms of broken heart syndrome are treatable and the condition usually reverses itself in a matter of time. So if you’ve lost a loved one or experienced a break up recently, although Valentine’s Day may be more difficult than most days, fear not–the once a year holiday and the detriment of loneliness will pass. Perhaps take the holiday as an opportunity to do something healthy for yourself. Relax, or knock a few things off your to-do list, try out a new recipe or craft, or even use the holiday as an opportunity to remind a friend how much they mean to you.

Tell us, have you ever experienced the broken heart syndrome? If so, how’d you get through it?

Related Resources

Heart Failure Live Chat Transcript

Heart Failure Live Chat 7/25/17

Thank you to those of you who joined the Heart Failure Live Chat on 7/25/17 hosted by Dr. Divya Gupta from Emory’s Heart & Vascular Center. Dr. Gupta provided valuable insights into the causes of heart failure including contributing factors like heredity and medical conditions, treatment options and lifestyle changes. The live chat had a good turnout and the transcript is now available below.

Heart Failure Live Chat Transcript

 

Overview: If you or a family member has been diagnosed with heart failure you likely have many questions. Here’s your chance to ask an expert about living with heart failure, treatment options, second opinions, prevention; whatever’s on your mind. Join us on Tuesday, July 25 when Dr. Divya Gupta, a board certified heart failure cardiologist with the Emory Heart & Vascular Center, will answer all your questions.

12:01 P.M.
EmoryHealthcare: Hi everyone, please note that all questions are moderated before appearing in the stream, so you may not see yours appear right away, but we will do our best to answer all your questions today.

12:01 P.M.
EmoryHealthcare: We received some questions that were submitted in advance of the chat, so we’ll get started by answering a few of those first.

12:05 P.M.
EmoryHealthcare: Is a patient with pulmonary hypertension more likely to develop CHF than a patient a heart that is comprised?

12:05 P.M.
EmoryHealthcare: A patient with pulmonary hypertension is more likely to develop heart failure on the right side of the heart vs. left side of the heart. Heart failure on the right side is associated with swelling of the legs and abdomen which can cause physical limitations.

12:09 P.M.
EmoryHealthcare: Is heart failure hereditary?

12:09 P.M.
EmoryHealthcare: Yes, heart failure can be hereditary. Many times, we’re not able to figure out what the genetic alteration is that leads to it, but we do have evidence that it can run in families when looking at their family tree.  However, not all heart failure is heredity and different medical conditions can lead to heart failure. If there is a significant concern, genetic testing and counseling is recommended. With this data, the geneticist can identify the genetic alteration that runs in your family and preventative treat

12:12 P.M.
EmoryHealthcare: How safe is it to become pregnant with a leaky heart valve?

12:13 P.M.
EmoryHealthcare: The safety of becoming pregnant with a leaky heart valve depends on which valve and to what extent it is leaking. This would require close monitoring and consultation with cardiologist and high- risk obstetrician.

12:16 P.M.
EmoryHealthcare: We have a dedicated clinic for congenital heart conditions that specializes in treating patients with leaky heart valves, the Adult Congenital Heart Center. These physicians work closely with high-risk obstetricians within the Emory Healthcare system.  Please call HealthConnection to set up an appointment at 404­–778–7777.

12:19 P.M.
Guest5115: Are there differences in symptoms or treatment between heart failure caused by congenital heart defects and acquired heart failure?

12:20 P.M.
EmoryHealthcare: Heart failure is a clinical diagnosis and so the symptoms are similar in both populations. Typically, symptoms include tiredness, shortness of breath, issues with fluid retention.

12:21 P.M.
EmoryHealthcare: Another pre- chat question:  I was recently dx with left sided heart failure with an ejection fraction of 31- 40%.  I’ m on Coreg twice a day.  Is there anything else I need to know to help me improve my condition?  Also, I was working out before diagnosis.  I have literally stopped.  What type of exercise do you recommend?  And I Ian having a pulling sharp pain in the center of my chest.  Could that be relevant to my condition?  Work up show no cardiac relations.

12:25 P.M.
EmoryHealthcare: Coreg is an excellent medicine that has been shown to improve left side heart function, we typically increase the dose of this medicine so that a patient is taking 25– 50 mg twice a day, over several months. Also, we typically put patients on Lisinopril.

12:29 P.M.
EmoryHealthcare: Exercise is strongly recommended to help improve heart function as well.  Aerobic exercise is best, walking, running, biking or swimming are all acceptable forms of exercise. We don’t recommend heavy weight lifting and typically restrict weight lifting to no more than 50 pounds total.  When beginning an excise routine, start slow and increase as tolerated.  Make sure you listen to your body.  If you need to take a break and rest, that’s fine before starting again. The American Heart Association recommends 30 min

12:35 P.M.
EmoryHealthcare: There are two types of implantable devices often used in patients with low ejection fractions, defibrillator, and pacemaker. Anyone with an ejection fraction equal or less than 35% should be considered for a defibrillator, these devices monitor heart rhythm 24/ 7 and will function to save your life in the event of a life- threatening heart rhythm. Patients with low ejection fraction are at greater risk of having these life- threatening heart rhythms.

12:36 P.M.
EmoryHealthcare: Pacemakers are beneficial to some patients with low ejection fractions, the need for a pacemaker would be determined by your cardiologist. If they feel it would be beneficial, the pacemaker would help improve heart failure symptoms and help you live longer.

12:39 P.M.
Carol B.: My 86-yr. old Mom with a valve problem can barely stand without back pain and so tired?  Is this caused by lack of exercise or heart valve?

12:40 P.M.
EmoryHealthcare: The fatigue portion could be attributed to her valve problem, unfortunately, the valve issue could be preventing her from exercising which in turn may cause the back pain.  She would benefit from an evaluation of her valve and cardiac issues. You can make an appointment by calling HealthConnection at 404–778–7777.

12:43 P.M.
EmoryHealthcare: Is a BMT a good tool to diagnose CHF, versus lung disease?

12:44 P.M.
EmoryHealthcare: Yes. Another name for BMT is Cardiopulmonary Exercise Test. This is an excellent way to determine what is causing a patient to be tired and short of breath. It can not only help diagnose heart failure and lung disease but can also help determine if the lack of exercise is playing a role.

12:46 P.M.
EmoryHealthcare: These questions have been great! We have time for just one more question today. Any remaining questions will be answered by Dr. Gupta in a post- chat Q& A blog on http://advancingyourhealth.org

12:48 P.M.
EmoryHealthcare: My mom has congestive Heart Failure and needs the best heart doctor.

12:49 P.M.
EmoryHealthcare: Emory Heart & Vascular Center has many excellent physicians who are board certified in Advanced Heart Failure & Transplant Cardiology. Our nurses at HealthConnection can help you find the best physician for your Mom. They can be reached at 404–778–7777.

12:50 P.M.
EmoryHealthcare: Are there any other questions?

12:52 P.M.
EmoryHealthcare: That’ s all the time we have for today. Thanks so much for joining us! As we mentioned, we’ll follow up with a blog post to answer any questions we didn’t get a chance to address today. Thank you!


Want to Learn More?

At Emory Healthcare’s Heart & Vascular Center, your health is our priority. Our program is consistently recognized by U.S. News & World Report as one of the top heart health centers in the nation.

or call 404-778-7777 to make an appointment.

 

 

Heart Disease and Emory Women’s Heart Center

According to the American Heart Association, heart disease is the number one killer of women and is more deadly than all forms of cancer combined. It is also preventable. The Emory Women’s Heart Center is a program dedicated to the screening, prevention and treatment of heart disease in women.

The number of women at risk is startling. “Believe it or not, a very small percentage of women fall into the low risk category for heart disease, and those people are mostly in their twenties,” says Stacy Jaskwhich, a nurse practitioner at Emory’s Johns Creek’s Women’s Heart Center. “When you consider family history, age, diet, activity levels and other existing conditions such as diabetes or rheumatoid arthritis, most women are at some level of risk.”

“Most heart disease is preventable, so we want to reach these women, ideally between the ages of 40-60, to evaluate their individual risks and educate them on risk reduction. Starting treatment early, when it’s necessary, will help save lives,” says Gina Lundberg, MD, clinical director of Emory Women’s Heart Center and assistant professor of medicine, Emory University School of Medicine. Dr. Lundberg founded Georgia’s first women’s cardiac prevention program in 1998. She also launched the Emory Saint Joseph’s Heart Center for Women in 2007.

The Emory Women’s Heart Center offers comprehensive cardiac risk assessments and education for women at risk for heart disease. If necessary, the Center can also assist with referrals. Screenings are beneficial to those who have a family history of heart disease or risk factors such as obesity, hypertension, smoking, and/or diabetes. The initial two hour screening includes a review of family history of heart disease and a comprehensive global risk assessment that includes age, blood pressure, total cholesterol level, HDL level, blood glucose, smoking history, pregnancy history, hypertension history, and individualized education based on your risk factors. Screenings can be self-referred and start at $75. Gift certificates are also available to purchase for loved ones.

Women often experience symptoms that are different than those experienced from men. For example, women may not experience chest pain. Because of this, women must understand that heart attack symptoms may be similar to those of panic disorders, muscle strain, indigestion or influenza.

Rapid intervention is most effective in beginning stages of a heart attack. Damage to heart muscle starts within 30 minutes of the onset of symptoms, and according to the Society of Chest Pain Centers (SCPC), 85% of heart damage occurs within the first two hours – sometimes irreversible. Call 911 as soon as the first symptoms of a heart attack appear.

Symptoms of a Heart Attack

  • Chest pain or discomfort: It may feel like a squeezing, pressure, heaviness, tightness or fullness.
  • Heaviness or pain in areas other than the chest: This symptom is more common in women. The pain or pressure can be gradual or sudden. It may come and go, gradually intensify, or awaken one from sleep. Areas that are common include the back, neck, jaw or arms.
  • Cold sweats: This symptom can occur without chest discomfort. If there is no obvious reason for sweating, such as exercise or hot flashes, consider contact your physician.
  • Fatigue: Some women may experience an inability to complete routine tasks. This can be due to extreme tiredness or a decrease in energy level.
  • Nausea: This can be mistaken for other problems, such as influenza, heartburn, or stomach ulcers.
  • Shortness of breath: This can occur with minimal activity or with activities that previously did not cause difficulty with breathing. This is especially important for people with diabetes, as they are less likely to experience chest pain.
  • Lightheadedness: This symptom may occur with activity or in conjunction with any of the other symptoms.

 

A Disease You’ve Probably Never Heard Of

fmd-smallHave you ever felt sick enough to visit a doctor, only to feel much improved soon after leaving your physician’s office? Receiving an accurate diagnosis often makes us reassured, even before receiving treatment.  However, patients with rare diseases sometimes wait several years before discovering what causes their symptoms. Fibromuscular Dysplasia, commonly known as FMD, is a vascular disease often resulting in a delayed diagnosis due to lack of awareness.

What is FMD?

FMD is a non-atherosclerotic, non-inflammatory vascular disease most often affecting the renal and carotid arteries. Although it predominantly affects middle-aged women, the disease can present in men, women, and children of all ages. FMD causes abnormal cell growth in artery walls, most often presenting as a “string of beads.” On an angiogram, you would see sections of bulging and narrowing in the affected arteries.

Common symptoms

Sometimes FMD is entirely asymptomatic and is only discovered incidentally. However, carotid FMD often presents with headache and pulsatile tinnitus (a “swooshing” sound in your ears). Renal FMD can cause hypertension due to the narrowing of the renal arteries. Aneurysm, stroke, and carotid or renal artery dissection are also possible.

How are patients diagnosed?

FMD is diagnosed by angiography. Noninvasive techniques such as duplex ultrasound, MRA, and CTA can provide an accurate image of the vessels, but catheter angiography remains the most reliable method for diagnosing FMD. Unfortunately, there is no cure for FMD and the cause is unknown.

What treatment options are available?

While there is no cure, FMD rarely progresses. Some patients only need to be monitored with surveillance of the affected arteries. Your doctor may prescribe medications such as anti-hypertensives or antiplatelet therapy in order to prevent complications. In cases of severe stenosis or events such as stroke and dissection, invasive procedures may be necessary.

What resources are available for patients with FMD?

Emory is one of 14 centers participating in the US registry for Fibromuscular Dysplasia. This registry has enrolled over 1400 patients, and has contributed valuable information to the continuing research on the disease. Not only do hospitals such as Emory provide excellent care from doctors familiar with FMD, but they also allow patients to contribute toward further research and become part of the FMD community. The registry does not require experimental therapies, and all patient data is kept anonymous. Patients only need to provide consent for their medical information to be used in the data analysis. If you have been diagnosed with Fibromuscular Dysplasia, consider enrolling in the registry at your next appointment with Emory Healthcare.

What should I do if I am diagnosed with FMD?

Though many patients experience a variety of symptoms and vascular events, there is a very low mortality associated with FMD. It is a manageable disease, and once diagnosed, most patients are able to better control their symptoms. It is important to make follow-up appointments and continue to monitor your health. The Fibromuscular Dysplasia Society of America is also a good resource for both patients and physicians. FMDSA not only funds the FMD registry, but also holds annual meetings and conferences, and provides information that is both helpful and accessible to patients.

For more information, contact:

Emory University Hospital Midtown: 404-686-4411

Or Theresa Sanders MN, RN: 404-686-3872

Or Bryan Wells, MD: 404-686-8203

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Emory Women’s Heart Center Wear Red Events

womensheartwearredHeart disease is the number one killer of women in the United States, but in many cases it’s preventable. That’s why Emory Healthcare would like to invite you to join us at one of our women’s heart health events in celebration and recognition of Heart Month in February, as well as Mother’s Day in May.

During these fun, educational events, participants will have an opportunity to meet Emory Women’s Heart Center physicians and staff and learn about how to prevent, detect and treat heart disease. You will also have the opportunity to purchase products and services from our vendors who will be on hand providing consultations, displaying jewelry, sharing healthy foods, etc.

To learn more, please call Emory HealthConnection℠ at 404-778-7777. The events are free! Parking will be available in hospitals’ main parking lots.

Emory Women’s Heart Center Wear Red Event Details

Friday, February 5, 2016
Emory Saint Joseph’s Hospital
Doctors Building Atrium
7:30 a.m. – 1 p.m.

Friday, February 19, 2016
Emory University Hospital
Hospital Auditorium
Open House from
7:30 a.m. – 1 p.m.

Friday, May 6, 2016
Emory University Hospital Midtown
Medical Office Tower Atrium
Open House from
7:30 a.m. – 1 p.m.

View more Wear Red Event information here

About the Emory Women’s Heart Center

Emory Women’s Heart Center is a unique program dedicated to screening, preventing and treating heart disease in women. The Center, led by nationally renowned cardiologist Gina Lundberg, MD provides comprehensive cardiac risk assessment and screenings for patients at risk for heart disease as well as full range of treatment options for women already diagnosed with heart disease care. Find out if you are at risk for heart disease by scheduling your comprehensive cardiac screening. Call 404-778-7777.

Women & Heart Disease Live Chat- February 23, 2016

women-hrt-disease260x200Heart disease kills 6 times more women than breast cancer each year, making it the number one killer of women.

Many people consider heart disease to be a predominantly male-oriented condition. However, heart disease is the number one killer in women and affects one out of every three in the United States, according to the American Heart Association. Heart disease occurs when fatty build-up in your coronary arteries, called plaque, prevents blood flow that’s needed to provide oxygen to your heart. When the blood flow that brings oxygen to the heart muscle is severely reduced, or completely cut off, a heart attack occurs.

The Emory Women’s Heart Center is dedicated to screening, diagnosing, treating and preventing heart disease in Atlanta’s women. We’re thankful the awareness about heart disease, and the unique challenges faced by women, continues to be on the rise. The most important weapon against heart disease is awareness. Women need to research their family history and take time to educate themselves on not only the risk factors and symptoms of heart disease, but preventive medicine as well.

How can you educate yourself? Join Emory Women’s Heart Center physician, M. Carolina C Gongora, M.D., on Tuesday, February 23 at 12pm EST for an online web chat on women and heart disease. She will be available to answer your questions such as: unique challenges women face specific to heart disease, what women can do to prevent heart disease, the importance of getting treatment right away and the research underway to combat heart disease in women. Register for this live chat.

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Sudden Cardiac Death in Young Athletes

football250x250Sudden death in young people, often due to hidden heart defects or overlooked heart abnormalities, is rare. Of the 360,000 sudden cardiac arrests that occur in the United States each year outside of hospitals, very few occur in young people and only some of those young people die of sudden cardiac arrest. When these tragic sudden cardiac deaths do occur, it’s often during physical activity, such as participating in an athletic event or strenuous exercise.

Causes

The causes of sudden cardiac death in young people vary, but most of the time deaths are due to heart abnormalities, such as unrecognized inherited heart disease (example, hypertrophic cardiomyopathy) and coronary artery abnormalities. Other causes include inherited heart rhythm disorders such as Long QT syndrome, Brugada syndrome, or other inherited cardiac “channelopathies”.

Additional etiologies include inflammation of the heart muscle (myocarditis), which can be caused by viruses and other illnesses. Sudden cardiac death can also occur as the result of a blunt blow to the chest, such as being hit by a baseball or hockey puck, at just the right time (commotion cordis). The blow to the chest can trigger ventricular fibrillation if the blow strikes at exactly the wrong time in the heart’s electrical cycle.

Don’t Ignore the Warning Signs

What can young athletes do to prevent a sudden cardiac event? In more than a third of these sudden cardiac deaths, there were warning signs that were not reported or taken seriously. In particular, symptoms that occur during exercise should always be taken seriously. Here are the typical warning signs:

  • Fainting during physical activity;
  • Dizziness or lightheadedness during physical activity;
  • Chest pains or tightness, at rest or during exertion;
  • Palpitations – skipping, irregular or extra beats during athletics;
  • Being unable to keep up with peers due to shortness of breath or noted loss of exercise tolerance

Preventing Sudden Cardiac Death

A proper evaluation should find most, but not all, conditions that would cause sudden cardiac death in the athlete. Some diseases are difficult to uncover while others can be diagnosed following a normal guideline-based screening evaluation.

The required physical exam includes measurement of blood pressure, a careful listening examination of the heart, and palpation of the peripheral pulses. If there is concern for a condition associated with a higher risk of sudden cardiac death, further evaluation guided by the sports cardiologist would continue and frank discussions regarding the appropriate “exercise-prescription” would take place. These discussions would include the risk profile for ongoing competitive athletics.

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About Dr. Jonathan Kim, MD

kim-jonathanDr. Kim is an Assistant Professor of Medicine at the Emory Heart and Vascular Center. He graduated from Vanderbilt University School of Medicine, Nashville, TN, and did his residency at Massachusetts General Hospital, Boston, MA. His specialties are Cardiology (Board certified since 2014) and Internal Medicine (Board certified since 2008) and his area of clinical expertise is sports cardiology. He has developed a new sports cardiology clinic at Emory-St. Joseph’s Hospital.

Types of Cardiovascular Disease

heart-word-cloud 9-4Cardiovascular disease is the leading cause of death for both men and women in the United States. But did you know there are more than 50 types of heart disease? Heart disease is actually an umbrella term that includes a number of conditions affecting the structures or function of the heart, some of which are genetic, and many of which are the result of lifestyle choices.

Types of Cardiovascular Disease:

Coronary Heart Disease (CHD) is the most common form of heart disease. It occurs when the arteries supplying blood to the heart narrow or harden, which is known as atherosclerosis. CHD is usually the cause of heart attack, stroke, and peripheral vascular disease. Major risk factors include: high blood pressure, high blood cholesterol, tobacco use, unhealthy diet, physical inactivity, diabetes, advancing age, inherited (genetic) disposition.

Heart Attack – Also called “myocardial infarction,” a heart attack happens when blood flow to the heart is severely reduced or cut off, due to the hardening and narrowing of the coronary arteries from the build-up of fat, cholesterol, and other substances, known together as “plaque.” A blood clot forms around the plaque, blocking blood flow. This results in permanent damage or death of part of the heart muscle. The most common symptoms of a heart attack are:

  • Chest pressure or pain
  • Shortness of breath
  • Pain or discomfort in the jaw, neck, back, arms or shoulder
  • Feeling weak, lightheaded, or nauseous

Arrhythmia – “Arrhythmia” means your heartbeat is irregular. It doesn’t necessarily mean your heart is beating too fast or too slow. It just means it’s out of its normal rhythm. When the heart doesn’t beat normally, it can’t pump blood effectively to the lungs, brain, and other organs, causing them to potentially shut down or become damaged. You could have an arrhythmia even if your heart is healthy, as it can be a side effect of medicines that you are taking or a manifestation of an abnormality elsewhere in your body.

Heart failure is a serious condition that commonly develops slowly over time, and is the leading cause of hospitalization in people older than 65. Heart failure is a bit of a misnomer, since it does not actually mean the heart has stopped working; rather, the heart pumps weaker than normal, causing blood to move through the body at a slower rate and increases pressures in the heart. The weakened heart muscle has to work overtime to keep up with the body’s demands, which can leave a person tired. Some of the symptoms of heart failure:

  • Shortness of breath
  • Difficulty breathing when lying down
  • Swelling in the legs, ankles, and feet
  • General fatigue and weakness

Congenital Heart Disease is a category of heart disease in which congenital heart defects are present at birth. Defects occur when the fetus is developing and may produce symptoms at birth or during childhood, while others aren’t discovered until a person is an adult. Some causes of congenital heart defects are:

  • Chromosomal abnormalities, such as Down syndrome
  • Maternal viral infection in the first trimester of pregnancy
  • Maternal drug or alcohol abuse during pregnancy, and certain medications such as Warfarin

Heart Muscle Disease (Cardiomyopathy) is a progressive disease that causes the heart to be abnormally enlarged, thickened and/or stiffened. Cardiomyopathy limits the heart’s ability to pump blood effectively, and often leads to heart conditions like arrhythmias or heart failure.

While there is a wide range of heart and vascular conditions associated with cardiovascular disease, the good news is that many types of heart disease can be prevented with healthy habits. You can reduce your risk of certain types of heart disease, such as heart attack, coronary artery disease and peripheral artery disease by doing the following:

  • Eating a low sodium diet
  • Eating more fresh fruit and vegetables while limiting foods high in saturated fat
  • Exercising at least 3 – 5 times a week for 30 minutes a day
  • Stop smoking!
  • Controlling your diabetes and high blood pressure

If you suspect you have heart condition, talk with a trained Emory Healthcare doctor, who can recommend or administer screening or diagnostic tests.

About Dr. Danny Eapen, MD

eapen-dannyDanny Eapen, MD  is an Assistant Professor at Emory University School of Medicine. Dr. Eapen specializes in preventive cardiology and adult heart disease. He pursued a degree in medicine from the University of Miami, Miami FL, and his internship and residency in Internal Medicine at Emory University School of Medicine. He also completed his research and general cardiology fellowship at Emory University.

The Role of Gender in Heart Disease

mom-daughter-gran (1)Every minute in the United States, someone’s wife, mother, daughter or sister dies from heart disease, stroke or another form of cardiovascular disease (CVD) Heart disease is the No. 1 killer of women, and is more deadly than all forms of cancer combined. Heart disease causes 1 in 3 women’s deaths each year, killing approximately one woman every minute.

An estimated 43 million women in the U.S. are affected by heart disease. While 1 in 31 American women dies from breast cancer each year, 1 in 3 dies of heart disease. (AHA Go Red statistics)

For years, heart disease was thought of as a “man’s disease,” but more women than men die of heart disease each year. Since 1984, more women than men have died each year from heart disease and the gap between men and women’s survival continues to widen. Despite increased awareness over the past decade, only 54% of women recognize that heart disease is their number 1 killer [2].

Risks

Heart disease is the No. 1 killer in women. Yet, only 1 in 5 American women believe that heart disease is her greatest health threat. Ninety percent of women have one or more risk factors for developing heart disease.

The largest risk factors of heart disease affect both men and women. The good news is that many of the major contributing factors can be controlled, including:

  • Hypertension (high blood pressure)
  • Tobacco use
  • Raised blood glucose (diabetes)
  • Physical inactivity
  • Unhealthy diet
  • Cholesterol/lipids
  • Overweight and obesity
  • Metabolic syndrome
  • Mental stress and depression
  • Pregnancy complications such as high blood pressure or diabetes during pregnancy

There are also other risk factors that are not modifiable such as age and family history. Although men and women share a lot of the same risks, your gender can play a role in heart disease. Some risks that vary by gender are the following:

  • Age – men tend to develop coronary artery disease earlier in life. However, after age 65 the risk of heart disease in women is almost the same as in men.
  • Women, especially younger women (<65 yrs), have worse outcome after a heart attack.
  • Diabetes is a particularly important risk factor for developing heart disease in women. The symptoms of heart disease in diabetic women can be very subtle. Women may have mild heartburn or breathlessness during physical exertion rather than chest pain that is considered typical in men or in people without diabetes.
  • Unhealthy behaviors – Men tend to engage in certain high-risk behaviors that can have adverse effects on the heart, such as tobacco use and alcohol consumption. 20.5% of adult men smoke cigarettes compared to 15.3% of women, putting men at a higher risk [3]. Similarly, studies have shown that high-volume drinking is consistently more prevalent among men than among women [4].

Symptoms

The most common symptoms of heart attack in women is some type of pressure, discomfort or pain, in the chest. However, sometimes, women may have a heart attack without chest pains. Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

  • Neck, jaw, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Right arm pain
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue

These symptoms can be more subtle, like pressure or tightness, than the crushing chest pain often associated with heart attacks in men. Women’s symptoms may be triggered by mental stress and may occur more often when women are resting, or even when they’re asleep.

About the Author

parashar-susmitaSusmita Parashar, MD, MPH, MS, FAHA, FACC is a Board certified cardiologist at the Emory Heart and Vascular Center and Associate Professor of Medicine (Cardiology) at Emory University School of Medicine. Dr. Parashar is an educator and cardiovascular outcomes researcher with emphasis on women and heart disease, preventive cardiology and heart disease in cancer patients. She has received several grants and awards from the National Institute of Health (NIH) and the American Heart Association (AHA) to conduct research on women and heart disease. Dr. Parashar was awarded the AHA Trudy Bush Fellowship for Cardiovascular Research in Women’s Health Award to recognize outstanding work in the area of women’s health and cardiovascular disease

 

Sources
[1] CDC.gov – Heart Disease Facts
American Heart Association – 2015 Heart Disease and Stroke Update, compiled by AHA, CDC, NIH and other governmental sources

[2] CDC.gov – Women and Heart Disease Fact Sheet. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm

[3] Center for Disease Control (CDC). “Current Cigarette Smoking Among Adults in the United States.” http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/

[4] Wisnack et al. “Gender and Alcohol Consumption: Patterns From the Multinational Genacis Project.”
Addiction. 2009 Sep; 104(9): 1487–1500. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844334/

[5] CDC.gov – Men and Heart Disease Fact Sheet. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm