Heart & Vascular Health

Keep your heart healthy for the years ahead.

Heart and vascular (blood vessel) diseases are the leading causes of disability and death for adults in the US. It’s important to understand what you can do to reduce your risk of developing these conditions, or to help stay as healthy as possible if you already have a cardiovascular condition.

Below you’ll find information about common diseases of the heart and vascular system, including overviews, risk factors, management, and commonly prescribed medications.

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Table of Contents:
  1. High Cholesterol
  2. High Blood Pressure
  3. Coronary Artery Disease
  4. Atrial Fibrillation
  5. Stroke
  6. Peripheral Artery Disease
  7. Heart Failure


High Cholesterol (Hypercholesterolemia)

Cholesterol is a kind of fat that you need to perform many bodily functions, like building cells. Your body makes cholesterol, and it also comes from certain foods, like meat and dairy products. When the total level of cholesterol in your blood is too high—200mg/dl or greater—your risk of cardiovascular diseases like heart attacks and strokes increases. In the US, roughly 38% of adults have high cholesterol. Many may not know they have this problem because high cholesterol, itself, doesn’t have any symptoms.

There are several types of fats, including HDL (good) and LDL (bad) cholesterol and triglycerides. High LDL or triglyceride levels and low HDL levels can create thick deposits (plaque) on the walls of your arteries, making them stiff and narrow (atherosclerosis). When plaque breaks off from the artery wall, a clot forms around it that can completely block or reduce blood and oxygen flow to the heart (heart attack) or brain (stroke).

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A fasting blood test (usually no food or drink for 8-12 hours before) is used to measure the levels of LDL, HDL, and triglycerides in your blood. Your “total cholesterol” is calculated from these levels. Speak with your doctor to find out how often you should have your cholesterol checked and how long you should fast before getting your blood test.
  • Behaviors you can influence
    • Inactive lifestyle, including lots of sitting
    • Smoking
    • Diet high in saturated fats (fatty dairy and meats) and trans fats (baked goods, snacks)
    • Alcohol (more than 1 drink for women and 2 drinks for men daily)

  • Medical conditions
    • Diabetes
    • Obesity

  •  Uncontrollable risk factors
    • Family History—Familial hypercholesterolemia (FH) is a condition where people have very low HDL cholesterol and very high LDL cholesterol starting at a young age that will require medications or other treatments in addition to lifestyle changes to manage.
    • Age: Risk increases with age

Lifestyle changes are always the first step in preventing or managing high cholesterol. These include:

  • Limiting your alcohol intake: No more than 2 drinks for men or 1 drink for women daily.
  • Quit smoking: Your doctor can provide resources or support to help you quit.
  • Managing your weight and being physical activity. Your doctor can support you in identifying a healthy weight goal and an exercise routine that works for you.
  • Limiting foods high in saturated fats and trans fats. Trans fats are found in baked goods and many snack foods. Saturated fats are found in foods that contain animal products like fatty meats or dairy products. Limiting does not mean cutting out of your diet completely, moderation is key!

Make sure to take any medications as your doctor has prescribed to get the most benefit from them. Create a follow-up plan so your doctor can determine if the medication is working. Below is information on some commonly prescribed cholesterol-lowering medication classes.

  • Statins: The most common cholesterol-lowering medications are HMG CoA reductase inhibitors, also known as “statins.” Statins decrease the body’s production of cholesterol and increase the removal of cholesterol by the liver. They’re most effective at lowering LDL and can also help lower triglycerides and increase HDL. Generic statin names end in -vastatin, including atorvastatin (Lipitor®), pravastatin (Pravachol®), rosuvastatin (Crestor®) and simvastatin (Zocor®).
  • Cholesterol absorption inhibitors: Ezetimibe (Zetia®) is a non-statin medication that lowers cholesterol by blocking the absorption of cholesterol in the intestines. It can be used alone or in combination with other cholesterol lowering agents such as statins.
  • Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: Alirocumab (Praluent®) and evolocumab (Repatha®) are injectable cholesterol-lowering agents that bind to and inactivate a protein on cells found in the liver to lower LDL (bad) cholesterol. They have been shown to reduce cardiovascular events such as heart attack or stroke.
  • Fibrates: Fibrates may be prescribed if you have high triglyceride levels. Examples of fibrates include fenofibrate (Antara®, Lofibra®, Tricor®) and gemfibrozil (Lopid®).


For additional information: High Cholesterol (healthwise.net)

High Blood Pressure (Hypertension)

Hypertension is when the force of blood pushing against the blood vessel walls is consistently too high. Nearly half of US adults have high blood pressure (above 130/80). It is considered a silent killer as often high blood pressure, itself, will lack any symptoms, but it can significantly raise the risk for heart attacks, strokes, and many other conditions.

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Doctors determine if you have high blood pressure by taking a reading of the pressure using an inflated arm cuff with a pressure meter. A blood pressure reading of 130/80 or greater is considered high.
  • Behaviors you can influence
    • Inactive lifestyle, including lots of sitting
    • Tobacco use
    • Diet high in salt (sodium)
    • Alcohol (more than 1 drink for women and 2 drinks for men daily)
    • Stress

  • Medical conditions
    • Kidney Disease-hypertension can be caused from or cause kidney disease
    • Obesity

  • Uncontrollable risk factors
    • Family history
    • Age: Risk increases with age
    • Gender: Under age 64, men are more likely to have high blood pressure than women
    • Race: Hypertension is more common in African Americans

There are many things you can do to help manage your blood pressure. Making changes to your lifestyle is the first step and include:

  • Cutting back on your salt intake: the American Heart Association recommends no more than 2300mg/day, ideally 1500mg/day. Discuss with your doctor how much salt you should limit to.

Please note: Sodium restriction not only encompasses table salt but also the salt that is a part of your food. It’s important to read nutritional labels to help you make informed decisions about what you are putting your body. Not all foods are equal, and moderation is key!

  • Quitting smoking: Your doctor can provide resources or support to help you quit.
  • Limiting your alcohol intake: No more than 2 drinks for men or 1 drink for women daily.
  • Reducing stress
  • Staying physically active: Talk to your doctor about what level of activity is appropriate for you.
  • Monitoring your blood pressure at home is another great idea: A trend of blood pressure readings can be more informative than a one-time spot check in the office.

Make sure to take any medications as your doctor has prescribed to get the most benefit from them. Create a follow-up plan so your doctor can determine if the medication is working. Let your doctor know if you experience any new symptoms.

Below is information on some commonly prescribed blood pressure lowering medication classes.

  • Diuretics: Also known as “water pills”, diuretics help lower blood pressure by increasing urination to get rid of excess water and salt (sodium). Some examples of diuretics include chlorthalidone, hydrochlorothiazide, furosemide (Lasix®), and spironolactone.
  • Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs): ACE inhibitors and ARBs work similarly to widen the blood vessels and decrease the work the heart has to do. They can also help prevent and slow progression of kidney disease. Generic ACE inhibitors names usually end in -pril (e.g., enalapril, captopril, and lisinopril) while generic ARBs usually end in -sartan (e.g., candesartan, losartan, and valsartan).
  • Calcium channel blockers: Calcium channel blockers work on the smooth muscle of the heart and arteries to open blood vessels which reduces heart rate and lowers blood pressure. Some examples of calcium channel blockers include amlodipine, felodipine, and diltiazem.
  • Beta-blockers: Beta-blockers lower blood pressure by decreasing heart rate and cardiac output. Generic beta blockers usually end in -olol (e.g., atenolol, metoprolol tartrate, metoprolol succinate extended-release, and propranolol).

Coronary Artery Disease (Angina, Heart Attacks)

Heart disease is the leading cause of deaths in the US, and coronary artery disease (CAD)—a narrowing of the major blood vessels in the heart—is the most common form of heart disease. CAD includes conditions like angina and heart attacks (myocardial infarctions).

A heart attack happens when plaque—a buildup of fat and cholesterol on the artery walls— breaks off and a clot forms around it. This causes severe narrowing or complete blockage of blood flow/oxygen to a portion of the heart, causing tissue in that area to be damaged or die.

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Symptoms of a heart attack include:

  • Pain or discomfort in chest: Some describe it as heaviness or ‘heartburn like’ and it can be intermittent or constant.
  • Shortness of breath
  • Pain in left arm/shoulder, jaw, neck, or back
  • Lightheadedness
  • Nausea, vomiting
  • In women, symptoms may also include pressure/pain in lower chest or upper abdomen, upper back pressure, dizziness, fainting, extreme fatigue

**After having a heart attack, some people report they thought their increased fatigue or shortness of breath with doing their normal activities was just them ‘getting older.’

If you are experiencing heart attack symptoms, seek help immediately. Call 911; an emergency medical services team can begin treatment on route and are trained to perform cardiopulmonary resuscitation if your heart stops. Never drive yourself to the hospital if you are experiencing symptoms of a heart attack for the safety of yourself and others on the road.

These are common tests/procedures used to determine if a heart attack has taken place:

  • Electrocardiogram (EKG): A picture of the electrical activity of your heart, it can sometimes show evidence of a heart attack or other heart conditions.
  • Cardiac enzyme tests (creatinine kinase and troponin): Blood tests that confirm a heart attack has occurred.
  • Stress test: A test where you are hooked up to a monitor and either walk on a treadmill or given medications to create an exercise-like effect on your body to see if there is reduction in blood flow to the arteries of your heart.
  • Cardiac catheterization: A cardiac catheterization is when a hollow tube is inserted into a large blood vessel, often in the groin or wrist, that leads to your heart. It can determine if there is disease of the heart muscles, valves, or arteries.
  • Behaviors you can influence
    • Inactive lifestyle, including lots of sitting
    • Smoking
    • Diet high in salt (sodium) and/or too many trans or saturated fats
    • Alcohol (more than 1 drink for women and 2 drinks for men daily)
    • Stress

  •  Medical conditions
    • High cholesterol (hypercholesterolemia)
    • High blood pressure (hypertension)
    • Obesity
    • Diabetes

  • Uncontrollable risk factors
    • Age: Risk increases with age
    • Gender: Men are at higher risk of having a heart attack than women; but post-menopausal women have a higher risk of death from heart attacks than men.
    • Family history of heart disease
COMMON TREATMENTS/PROCEDURES

Your test results will determine your treatment plan. Here are some of the most common procedures performed:

  • Angioplasty: During a cardiac catheterization, a tiny balloon is inflated at the blockage to help widen the area and improve blood flow.
  • Stent Procedure: During angioplasty, a wire mesh tube known as a stent is placed at the blockage site to prop open the artery and reestablish blood flow.
  • Bypass surgery: Open heart surgery where a healthy artery or vein is taken from another area of your body to help create a new pathway for blood flow in your heart.
    For everyone, lifestyle changes are applicable.

 

LIFESTYLE CHANGES

These lifestyle modifications can help reduce the risk of coronary artery:

  • Stay physically active: Talk to your doctor about what level of activity is appropriate for you 
  • Limit alcohol: No more than 2 drink for men and 1 drink for women daily 
  • Strive for a healthy weight: Discuss with your doctor what a healthy weight goal is for you 
  • Follow a heart-healthy diet
    •  Limit your saturated and trans fats (baked good, snack foods, dairy and fatty meats). Moderation is key!
    • Limit your salt (sodium). The American Heart Association recommends no more than 2300mg/day and an ideal limit of 1500mg/day. This includes table salt and the sodium contained in many prepackaged and/or prepared foods. Read nutritional labels to identify foods high in sodium.
    • Eat a diet with lean meats and lots of fruits and vegetables.

  • Consider attending cardiac rehab: This is a program generally offered to people after having a heart attack where health care professionals provide support, counseling, education, and monitoring during exercise.
  • Manage high blood pressure and high cholesterol
  • Attend doctors’ appointments and take medications as prescribed
  • Quit smoking: Your doctor can provide resources or support to help you quit.
  • Reduce stress levels

Make sure to take any medications as your doctor has prescribed to get the most benefit from them. Create a follow-up plan so your doctor can determine if the medication is working. Let your doctor know if you experience any new symptoms.

Below is information on some commonly prescribed medication classes to help reduce the risk of heart attack.

  • Anti-platelet agents: Anti-platelet agents such as aspirin, clopidogrel, and prasugrel help prevent blood clots from forming in your arteries. They are recommended for patients who have had a heart attack. For some patients, particularly those who have had a stent placed or angioplasty, dual anti-platelet therapy (DAPT) is recommended for a period of time. DAPT is when aspirin is combined with another antiplatelet drug.
  • Beta-blockers: Beta-blockers decrease heart rate and cardiac output and have been shown to help prevent future heart attacks. Generic beta blockers usually end in -olol (e.g., atenolol, metoprolol tartrate, metoprolol succinate extended-release, and propranolol).
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): ACE inhibitors and ARBs work similarly to widen the blood vessels and decrease the work the heart has to do. They can also help prevent and slow progression of kidney disease. Generic ACE inhibitors names usually end in -pril (e.g., enalapril, captopril, and lisinopril) while generic ARBs usually end in -sartan (e.g., candesartan, losartan, and valsartan).
  • Statins: The most common cholesterol-lowering medications are HMG CoA reductase inhibitors, also known as “statins.” Statins decrease the body’s production of cholesterol and increase the removal of cholesterol by the liver. They’re most effective at lowering LDL and can also help lower triglycerides and increase HDL. Generic statin names end in -vastatin, including atorvastatin (Lipitor®), pravastatin (Pravachol®), rosuvastatin (Crestor®) and simvastatin (Zocor®).
  • Nitrates: Nitroglycerin sublingual tablets or spray are intended for you to keep on hand in case you experience chest pain (angina). Nitroglycerin widens your blood vessels to increase the supply of blood and oxygen to your heart. It also decreases the workload of your heart which can help reduce the chest pain. If you are experiencing symptoms of a heart attack, seek help immediately.

 

For additional information: Coronary Artery Disease (healthwise.net)

 

Atrial Fibrillation (AFib)

Atrial fibrillation (AFib) is a type of irregular heartbeat (arrhythmia) where the upper chambers of the heart (atrials) quiver instead of beating effectively. This can cause blood clots, stroke, and heart conditions. The irregularity can be constant or intermittent in nature.

Approximately 12 million people in the United States have AFib; this diagnosis comes with a five-fold increase of having a stroke.

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Some people experience no symptoms when their heart is in an AFib rhythm, and it will only be detected through a physical examination or an electrocardiogram (EKG). For those who do experience symptoms, they can be:

  • Fast and irregular heartbeat or a fluttering sensation in the chest
  • Dizziness
  • Shortness of breath
  • Fatigue or weakness
  • Chest pain
  • Behaviors you can influence
    • Smoking
    • Moderate to heavy alcohol consumption

  • Health conditions
    • High blood pressure
    • Obesity
    • Diabetes
    • Heart failure or ischemic heart disease
    • Hyperthyroidism
    • Chronic kidney disease
    • Enlarged chambers on the left side of the heart

  • Uncontrollable risk factors
    • Age: Risk increases with age
LIFESTYLE CHANGES

These lifestyle modifications can help reduce the risk of complications from AFib like strokes and cardiac complications:

  • Stay physically active: Talk to your doctor about what level of activity is appropriate for you.
  • Follow a heart-healthy diet
    • Limit your saturated and trans fats (baked good, snack foods, dairy and fatty meats). Moderation is key!
    • Limit your salt (sodium). The American Heart Association recommends no more than 2300mg/day and an ideal limit of 1500mg/day. This includes table salt and the sodium contained in many prepackaged and/or prepared foods. Read nutritional labels to identify foods high in sodium.
    • Eat a diet with lean meats and lots of fruits and vegetables.
  • Quit smoking: Your doctor can provide resources or support to help you quit.
  • Avoid excessive alcohol: No more than 2 drinks for men and 1 drink for women per day.
  • Avoid excessive caffeine
  • Strive for a healthy weight: Discuss with your doctor what a healthy weight goal is for you.

The goal of managing AFib is to prevent blood clots and have the heart rate stay in a normal range. This is often achieved through medication management.

 

OTHER INTERVENTIONS

Some other interventions for atrial fibrillation if medications are not reducing symptoms or risk are:

  • Cardioversion: While you are under anesthesia, an electrical shock is applied to the heart through patches on the chest to achieve a normal heart rhythm.
  • Catheter ablation: A hollow tube is inserted into a large blood vessel, often in the groin or wrist, that leads to your heart. Once there, through heat or cold energy, a tiny scar is made in the heart in the area where the Afib is originating to establish a normal heart rhythm.

Make sure to take any medications as your doctor has prescribed to get the most benefit from them. Create a follow-up plan so your doctor can determine if the medication is working. Let your doctor know if you experience any new symptoms.

Below is information on some commonly prescribed medication classes for aFib.

  • Heart-rate-controlling medications: The following medications may be prescribed to help slow your heart rate which can help you feel better.

– Beta-blockers: Generic beta blockers usually end in -olol (e.g., atenolol, metoprolol tartrate, metoprolol succinate extended-release, and propranolol).

– Calcium channel blockers: Some examples of calcium channel blockers include amlodipine, felodipine, and diltiazem.

– Digitalis preparations: Digoxin is in this class of medications.

  • Heart-rhythm-controlling medications: The following medications may be prescribed once your heart rate is under control in order to help restore your heart rhythm back to normal.

– Sodium channel blockers: Some examples include flecainide and quinidine which slow the heart’s ability to conduct electricity which helps the heart's rhythm.

– Potassium channel blockers: Some examples include amiodarone, dofetilide, and sotalol. These medications slow down the electrical signals to help the heart’s rhythm.

  • Anti-coagulants: Anti-coagulants such as apixaban (Eliquis®), rivaroxaban (Xarelto®), and warfarin (Coumadin®) help prevent blood clots from forming in your arteries which could lead to stroke. Aspirin may also be used, though infrequently.

 

For additional information: Atrial Fibrillation (healthwise.net)

Stroke (Cerebrovascular Disease)

A stroke is when a part of the brain becomes damaged or dies as a result of a blood clot blocking the blood supply to the brain(ischemic stroke) or a blood vessel in the brain bursting (hemorrhagic stroke). Strokes are the fifth-leading cause of death in the United States and the leading cause of disability.

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Time is brain! If you are experiencing symptoms of a stroke you need to get help immediately; your treatment options decrease the longer you wait.

Use the acronym FAST to help you detect a stroke.

F=Face drooping: If asked to smile, is the smile uneven?
A=Arm weakness: Does one arm drift downward if both arms are raised?
S=Speech difficulty: Is speech slurred or garbled?
T=Time to call 911 if symptoms are present!

Sudden onset of numbness, confusion, trouble with vision or hearing, dizziness, loss of balance, or a severe headache may also be signs of a stroke.

A stroke is diagnosed through a combination of physical examination, medical history, and imaging. Often people will have an MRI (magnetic resonance imaging) or a CAT/CT scan as part of their work up. The type of stroke identified will determine the course of treatment.

Most strokes (87%) are ischemic (caused by blockage of blood flow). Patients with ischemic strokes will have a combination of lifestyle modifications suggested and medication management. At times, people qualify for treatment with tissue plasminogen activator (TPA); this medication is given intravenous(iv) and can dissolve the clot. Another procedure sometimes used when a large vessel is blocked is mechanical removal of the clot. In this procedure, a catheter (a hollow tube) is inserted into a large blood vessel, often in the groin, going to the site of the clot and removing it.

Both TPA administration and mechanical removal of the clot can only occur within a specific timeframe from the onset of symptoms, so make sure you seek care immediately!

  • Behaviors you can influence
    • Inactive lifestyle, including lots of sitting
    • Smoking
    • Diet high in salt (sodium) and/or too many trans or saturated fats

  • Medical conditions
    • Obesity
    • High cholesterol (hypercholesterolemia)
    • Diabetes
    • High blood pressure (hypertension)
    • Atrial fibrillation
    • Sickle cell disease, peripheral artery disease, carotid artery disease and heart disease
REHABILITATION

After a stroke, some patients will require rehabilitation. Depending on severity, rehabilitation may consist of staying at a facility, home health care, or going to an outpatient office. Rehabilitation can help with such things as balance, coordination, strengthening, memory, and speech. It can take time to see results, so be patient.

 

LIFESTYLE CHANGES

Lifestyle changes that can help prevent further events are:

  • Stay physically active: Talk to your doctor about what level of activity is appropriate for you.
  • Follow a heart-healthy diet
    • Limit your saturated and trans fats (baked good, snack foods, dairy and fatty meats). Moderation is key!
    • Limit your salt (sodium). The American Heart Association recommends no more than 2300mg/day and an ideal limit of 1500mg/day. This includes table salt and the sodium contained in many prepackaged and/or prepared foods. Read nutritional labels to identify foods high in sodium.
    • Eat a diet with lean meats and lots of fruits and vegetables.
    • Limit added sugar.
    • Manage your high blood pressure (hypertension) and high cholesterol (hypercholesterolemia).
  • Quit smoking: Your doctor can provide resources or support to help you quit.
  • Avoid excessive alcohol: No more than 2 drinks for men and 1 drink for women per day.
  • Strive for a healthy weight: Discuss with your doctor what a healthy weight goal is for you.
  • Attend doctor’s appointment and take medications as prescribed

Make sure to take any medications as prescribed by your doctor to get the most benefit from them. Create a follow-up plan so your doctor can determine if the medication is working. Let your doctor know if you experience any new symptoms.

Below is information on some commonly prescribed medication classes.

  • Antithrombotics (Anti-platelet/anti-coagulant medicines): Anti-platelet agents such as aspirin, clopidogrel, and dipyridamole and anti-coagulants such as apixaban (Eliquis®), rivaroxaban (Xarelto®), and warfarin (Coumadin®) help prevent blood clots from forming in your arteries which could lead to stroke.
  • Medications for high blood pressure: Having high blood pressure increases your risk of stroke. Below is information on some commonly prescribed blood-pressure-lowering medication classes.

– Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs): ACE inhibitors and ARBs work similarly to widen the blood vessels and decrease the work the heart has to do. They can also help prevent and slow progression of kidney disease. Generic ACE inhibitors names usually end in -pril (e.g., enalapril, captopril, and lisinopril) while generic ARBs usually end in -sartan (e.g., candesartan, losartan, and valsartan).

– Diuretics: Also known as “water pills”, diuretics help lower blood pressure by increasing urination to get rid of excess water and salt (sodium). Some examples of diuretics include chlorthalidone, hydrochlorothiazide, furosemide (Lasix®), and spironolactone.

– Calcium channel blockers: Calcium channel blockers work on the smooth muscle of the heart and arteries to widen blood vessels which reduces heart rate and lowers blood pressure. Some examples of calcium channel blockers include amlodipine, felodipine, and diltiazem.

  • Medications for high cholesterol: Having high cholesterol increases your risk of stroke. Below is information on some commonly prescribed cholesterol-lowering medication classes.

– Statins: The most common cholesterol-lowering medications are HMG CoA reductase inhibitors, also known as “statins.” Statins decrease the body’s production of cholesterol and increase the removal of cholesterol by the liver. They’re most effective at lowering LDL and can also help lower triglycerides and increase HDL. Generic statin names end in -vastatin, including atorvastatin (Lipitor®), pravastatin (Pravachol®), rosuvastatin (Crestor®) and simvastatin (Zocor®).

– Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: Alirocumab (Praluent®) and evolocumab (Repatha®) are injectable cholesterol-lowering agents that bind to and inactivate a protein on cells found in the liver to lower LDL (bad) cholesterol. They have been shown to reduce cardiovascular events such as heart attack or stroke.

 

For additional information: Stroke (healthwise.net)

Peripheral Artery Disease (PAD)

Peripheral artery disease is narrowing of the peripheral arteries caused by atherosclerosis. Atherosclerosis (sometimes called “hardening of the arteries”) is when cholesterol buildup (plaque) on the walls of the arteries cause narrowing or a total blockage of the blood flow. Peripheral artery disease most commonly affects the legs and feet. If left untreated, poor blood/oxygen flow can result in tissue getting infected or dying which can lead to disability—due to the need for amputation—or even death. Additionally, a diagnosis of PAD is a risk factor for a stroke or coronary artery disease.

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The most common symptom of PAD is “claudication”—pain in one or both legs with physical activity that resolves with rest. This cramping or aching pain can range from buttocks to calf.

Unfortunately, 40% of people don’t experience this pain with PAD and it can go undetected until it’s in a more severe state.

Other symptoms that could be present below the narrowed artery are:

  • Muscle weakness
  • Hair loss, shiny smooth skin, or coolness to touch
  • Decreased or absence of a pulse in your foot
  • Sores on your legs or feet
Diagnosing begins with reviewing medical history and a physical examination. Your primary care provider may refer you to a vascular surgeon. One of the most common and noninvasive tests to determine the presence of PAD is an ankle brachial index (ABI) that compares the blood pressures in your arms to the blood pressure in your legs. Imaging like ultrasound, magnetic resonance angiography or computed tomographic angiography may also be performed to pinpoint the diseased area.
  • Behaviors you can influence
    • Inactive lifestyle, including lots of sitting
    • Smoking

  • Medical conditions
    • Diabetes
    • High cholesterol (hypercholesterolemia)
    • High blood pressure (hypertension)

  • Uncontrollable risk factors
    • Increasing age
    • Family history of PAD, stroke, and/or cardiovascular disease
LIFESTYLE CHANGES

Here are some of the lifestyle modifications to help manage and prevent PAD:

  • Stay physically active: Talk to your doctor about what level of activity is appropriate for you.
  • Follow a heart-healthy diet
    • Limit your saturated and trans fats (baked good, snack foods, dairy and fatty meats). Moderation is key!
    • Limit your salt (sodium). The American Heart Association recommends no more than 2300mg/day and an ideal limit of 1500mg/day. This includes table salt and the sodium contained in many prepackaged and/or prepared foods. Read nutritional labels to identify foods high in sodium.
    • Eat a diet with lean meats and lots of fruits and vegetables.
    • Limit added sugar
  • Manage your high blood pressure (hypertension) and high cholesterol (hypercholesterolemia)
  • Quit smoking: Your doctor can provide resources or support to help you quit.
  • Attend doctor’s appointment and take medications as prescribed

 

PROCEDURES

Depending on severity, you may require a procedure in addition to lifestyle modifications and medication management.

Some of those procedures are:

  • Angioplasty or stent placement: A hollow tube (catheter) is inserted into a large blood vessel, often in the groin, and goes to the site of blockage. From there, a tiny balloon is inflated at the blockage to help widen the area and improve blood flow (angioplasty). In addition, a wire mesh tube known as a stent is sometimes placed at the blockage to prop open the artery and reestablish blood flow.
  • Atherectomy: A catheter goes to the blocked artery and a sharp blade on the end of the catheter removes the plaque.
  • Bypass surgery: A healthy artery or vein is taken from another part of the body to create a new pathway for blood flow around the narrowed or blocked artery.

Make sure to take any medications as prescribed by your doctor to get the most benefit from them. Create a follow-up plan so your doctor can determine if the medication is working. Let your doctor know if you experience any new symptoms. Below is information on some commonly prescribed medication classes.

  • Anti-platelet agents: Anti-platelet agents such as aspirin and clopidogrel help prevent blood clots from forming in your arteries. Cilostazol helps reduce the symptoms of claudication which can improve walking distance.
  • Medications for high blood pressure: Having high blood pressure increases your risk of PAD and complications such as stroke. Below is information on a commonly prescribed blood pressure lowering medication class used for PAD.

– Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs): ACE inhibitors and ARBs work similarly to widen the blood vessels and decrease the work the heart has to do. They can also help prevent and slow progression of kidney disease. Generic ACE inhibitors names usually end in -pril (e.g., enalapril, captopril, and lisinopril) while generic ARBs usually end in -sartan (e.g., candesartan, losartan, and valsartan).

  • Medications for high cholesterol: Having high cholesterol increases your risk of PAD and complications such as stroke. Below is information on a commonly prescribed cholesterol lowering medication class.

– Statins: The most common cholesterol-lowering medications are HMG CoA reductase inhibitors, also known as “statins.” Statins decrease the body’s production of cholesterol and increase the removal of cholesterol by the liver. They’re most effective at lowering LDL and can also help lower triglycerides and increase HDL. Generic statin names end in -vastatin, including atorvastatin (Lipitor®), pravastatin (Pravachol®), rosuvastatin (Crestor®) and simvastatin (Zocor®).

 

For additional information: Peripheral Arterial Disease of the Legs (healthwise.net)

 

Heart Failure

Heart failure is a chronic progressive disease where the muscles in the heart can’t keep up with the workload of pumping enough oxygen- and nutrient-rich blood to the rest of the body. For a period of time, the heart will enlarge or beat faster to try to make up for this but, eventually, these mechanisms fall short. It is estimated that 6.2 million adults in the United States have heart failure.

A common measurement associated with heart failure is an ejection fraction (EF). The EF reports what percentage of blood is being pumped out of the left ventricle to the rest of the body with each heartbeat. A normal EF is 60% —reflecting that 60% of the total amount of blood in the left ventricle is being pushed out of the heart with each beat. An EF under 40% may indicate heart failure or cardiomyopathy (a disease of the heart muscle making it hard to pump blood, sometimes a precursor to heart failure).

Think of the heart in terms of plumbing—when the heart pumps less blood out to the body, it causes blood (fluid) to back up, first into the lungs and eventually into the rest of your body. This can be seen as swelling in your feet, legs, and stomach.

 

Symptoms of heart failure include:

  • Shortness of breath with activity: For some people, just crossing a room or shaving can bring on this symptom.
  • Difficulty breathing when lying down: Requiring more pillows at night is a red flag that you should let your doctor know about .
  • Weight gain and/or swelling in your legs, feet, or stomach.
  • Fatigue
  • Cough or wheezing

Some of the more common tests used to diagnose heart failure are as follows:

  • Physical examination: This includes medical history, current symptoms, weight and listening to heart and lungs.
  • Lab work including a BNP (brain natriuretic peptide): BNP is a hormone primarily produced in the left ventricle of the heart when the heart is working too hard to pump blood.
  • Chest X-ray: Can show if there is congestion in the lungs or an enlarged heart.
  • Echocardiography (Echo): Can show how thick the walls of the heart are and how efficiently the heart is pumping (ejection fraction/EF).
  • Behaviors you can influence
    • Smoking
    • Having too much salt (sodium) or too many trans or saturated fats in your diet
    • Inactive lifestyle, including lots of sitting
    • Too much alcohol consumption

  • Medical Conditions
    • High blood pressure (hypertension)
    • Obesity
    • Heart valve disease
    • Coronary artery disease
    • Diabetes
    • Sleep apnea
    • Other heart conditions
LIFESTYLE CHANGES

These lifestyle modifications can help reduce the risk of complications from heart failure:

  • Daily weights: Do in the morning after urinating and before eating. To ensure day-to-day accuracy, take your weight undressed or with the same amount of clothes on every day. The American Heart Association recommends reporting a 2-3 lbs. gain in 24 hours or a 5 lbs. gain a week. Discuss with your doctor what parameters are right for you and make sure to write your weight down daily.
  • Salt (Sodium) restriction: Water follows salt so, if you are eating foods with a high salt content, you may experience more fluid retention. Your salt intake includes the table salt you use plus the salt in packaged, processed foods. The American Heart Association recommends no more than 2300 mg/day and an ideal limit of 1500mg/day. Discuss with your doctor how much salt (sodium) you should have in your diet.
  • Monitor your symptoms: Please use this Heart Failure Self Check Plan to support you in knowing when you are doing well, need to check in with your provider, or need emergency care.
  • Fluid Restriction: Ask your provider if you should limit your daily fluids to reduce extra strain on the heart. If you are placed on a fluid restriction by your provider, you need to account for all fluids (such as popsicles, soup, or milk in cereal), not just those that you drink.
  • Manage high blood pressure (hypertension)
  • Quit smoking: Your doctor can provide you with resources or support to help you quit.
  • Drink alcohol in moderation: No more than 1 drink for women and 1-2 drinks for men daily.
  • Manage stress
  • Stay physically active: Talk to your doctor about what level of activity is right for you.
  • Eat a heart healthy diet: Limit saturated and trans fats (baked good, snack foods, dairy and fatty meats), limit added sugar and eat lots of fruits, vegetables, and lean meats.
  • Take your medications as prescribed and attend your doctor’s appointments

Make sure to take any medications as your doctor has prescribed to get the most benefit from them. Create a follow up plan so your doctor can determine if the medication is working. B

Below is information on some commonly prescribed medication classes used to treat heart failure.

  • Diuretics: Also known as “water pills”, diuretics help reduce symptoms like swelling (edema) or difficulty breathing by increasing urination to get rid of excess water and salt (sodium). Some examples of diuretics used for heart failure include furosemide (Lasix®), bumetanide (Bumex®), torsemide, and spironolactone.
  • Beta-blockers: Beta-blockers lower blood pressure by decreasing heart rate and cardiac output. The most commonly prescribed beta-blockers for heart failure include bisoprolol, carvedilol, and metoprolol succinate extended-release.
  • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): ACE inhibitors and ARBs work similarly to widen the blood vessels and decrease the work the heart has to do. They can also help prevent and slow progression of kidney disease. Generic ACE inhibitors names usually end in -pril (e.g., enalapril, captopril, and lisinopril) while generic ARBs usually end in -sartan (e.g., candesartan, losartan, and valsartan).
  • Angiotensin-receptor neprilysin Inhibitors (ARNIs): Sacubitril/valsartan (Entresto®) is a newer drug combination that helps improve blood flow, decrease strain on the heart, and decrease retention of salt (sodium).
  • SGLT-2 inhibitors: SGLT-2 inhibitors, such as Jardiance® and Farxiga® ,were initially marketed for treatment of type II diabetes and have been shown to reduce the risk of cardiovascular death and hospitalization in adults with heart failure and reduced ejection fraction.

 

For additional information: Heart Failure (healthwise.net)

MARTIN'S POINT CARE MANAGEMENT

The treatment and management of heart disease begins with making healthy lifestyle choices.

If you’d like to learn more about a newly diagnosed heart condition or a chronic condition that you’ve had for a while, Martin’s Point has a team of nurse care managers here to help. This service is offered at no cost to you. A nurse care manager helps you learn about your chronic conditions and build skills to proactively manage your health. They review medications, help coordinate your care, and find helpful community resources.

If you would like to speak with a care manager, please call us at 1-877-659-2403.


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CHRONIC DISEASES & YOUR MENTAL HEALTH

Chronic disease is any disease that restricts your daily life and/or requires medical attention for at least one year.

Coronary artery disease, peripheral artery disease, atrial fibrillation, cerebrovascular disease, and diabetes are just some examples of chronic diseases.

For many, having a chronic disease can cause major upheaval in one’s previous routine. Some people are prescribed new medications, need to eat differently and/or perform routine monitoring at home. Some may have more medical appointments or expenses. Some may worry about experiencing another heart attack, stroke, or return of symptoms. Due to the nature of chronic diseases, mental health issues like anxiety or depression can occur.

If you are experiencing symptoms of depression or anxiety, please speak to your health care provider. These conditions are common, and your doctor will know how to best support you. Untreated, conditions like anxiety and depression can worsen and can also become a barrier to managing your chronic disease.