What You Need to Know About Heart Disease

A young man at the pool asked me, “Why does blood get thicker with age?”

After telling him this wasn’t true, I asked where he got the idea.

“All the older men in the steam room are on blood thinners.”

Those men had an irregular heart rhythm called atrial fibrillation. Their doctors had prescribed anticoagulant medication to prevent blood clots in the heart from going to the brain and causing strokes.

This was an example of the common confusion about heart disease . . . and the general quality of health education in the community.

Every other organ of your body depends on the heart. It is both a muscular and electrical organ. The heart pumps blood to the lungs, and then it pumps oxygenated blood to all the tissues of the body.

The heart has its own built in pacemaker and its muscle tissue conducts the electrical signal to coordinate the contraction of the four chambers of the heart

Are you at risk for heart disease? Yes, we all are.

Two of the biggest risk factors for heart disease are beyond our control: age and genetics. The good news is that other risk factors are modifiable; these include high blood pressure, diabetes, high cholesterol, smoking and physical inactivity.

And even though having a sibling or parent with heart disease increases your personal risk, the knowledge of your family history can help you and your physician proactively reduce your risk, identify problems early and better manage any chronic condition.

There are four major types of heart disease: (1) coronary artery disease, (2) valvular heart disease, (3) arrhythmia and (4) heart failure.

The coronary arteries are the blood vessels that deliver oxygen-rich blood to the heart muscle. When one of these arteries are completely blocked, the area of the heart downstream is starved of blood – and dies. The result: a heart attack.

When a coronary artery is partially blocked, the area of heart muscle downstream receives less blood than it needs. The result is ischemia (decreased blood flow) and angina (chest pain). The symptoms include chest pain, fatigue and shortness of breath with activity.

Arrythmias are abnormalities in the rhythm of the heart beat or contractions. With tachycardia, the heart beats too fast; with bradycardia, it beats too slow. We can have premature or early beats and pauses or delayed beats. The symptoms of arrhythmias include chest pain, shortness of breath, palpitations or fainting spells. However, many patients have no symptoms at all.

Heart failure is a decline in the pumping ability of the heart. The symptoms include fatigue, shortness of breath on exertion and when lying flat, waking up at night short of breath, weight gain with fluid retention, and edema or swelling of the feet and legs.

The heart has four valves that allow the one-way flow of blood between the atria and ventricles (chambers of the heart) and through the aortic and pulmonary arteries. Valves can be narrowed (called stenosis) or leaky (called regurgitation).

To learn more about “What You Should Know About Heart Disease”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series. You’ll learn if you are at increased risk, practical tips to reduce your risks and how to maintain your best health in spite of heart disease.

I’ll be speaking on Wednesday, March 1^st at 7 p.m. at the Bonsor Community Centre at 6550 Bonsor Avenue in South Burnaby. Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

Your Heart: What Have You Done for It Lately?

We all play favourites.

We look at the attractive, we hang out with the most fun, and we take for granted the reliable and dependable in our lives that are always there day after day.

What is your favourite organ?

You may not choose two of the most important – your brain and heart, but the rest of you couldn’t survive without them.

With every beat, your heart keeps every cell of your body alive, pumping blood freshly oxygenated by your lungs. If your heart stopped pumping or an artery was blocked, you would suffer a stroke, blindness, organ failure or the loss of your legs.

So take a moment to think about your heart. What have you done for it lately?

You can increase your odds for a long and happy life by thinking about your heart as you should your most important relationships. Are you paying attention? Are you showing care each day? Are you working to make it great?

1. Listening (for Trouble)

Sometimes, it’s obvious when something is wrong – irregular heart beats with lightheadedness; pain or pressure on exertion in your chest, throat or arms.

Sometimes the signs are subtle and mistaken for normal aging – or being married a long time: fatigue or exhaustion, feeling out of shape and short of breath, calf pain while walking, and decreased sexual function.

Before considering vitamins, Viagra or marriage counseling, see your doctor.

2. How Do You Care for Your Heart?

The best predictor of your future health are (1) the health of your parents and (2) the habits you practice today.

If a parent or sibling had heart surgery, a heart attack or heart failure, you should ask your doctor to assess your personal risk factors, including high cholesterol, diabetes and high blood pressure.

Are you living a life that minimizes risks? Care for your heart by limiting salt, alcohol and a lazy, leisurely lifestyle. Don’t sacrifice long term health for short-term pleasure.

Enjoy the rewards of daily healthy living. Eat more fruits and vegetables and other foods that really make you feel good. If you can sit, stand. If you can stand, walk. If you can walk: run, swim or cycle.

Butt out, get outside and live.

3. Make a Good Thing Great

Why settle for good enough when you can get great?

You don’t know what you’ve got ‘til it’s gone, and you don’t know great ‘til you’ve got it.

Your heart is another muscle you can train. Unless you’ve already been a world-class athlete, none of us knows what we can achieve.

When you’re fit and strong, everyday life is easier. You’ll have plenty of energy to shop, clean, mow the lawn, get out and dance. Everyday tasks – climbing a flight of stairs, lifting and moving – become effortless and fast.

For those with heart disease or its risk factors, Healthy Heart programs in your community can safely move you to your fittest state.

Be the best you can be today.

To learn more about “What You Should Know About Heart Disease”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series. You’ll learn if you are at increased risk, practical tips to reduce your risks and how to maintain your best health in spite of heart disease.

I’ll be speaking on Wednesday, March 30th at 7 p.m. at the Alan Emmott Centre at 6650 Southoaks Crescent in South Burnaby. Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

Davidicus Wong is a family physician and his Healthwise columns appear regularly in the Vancouver Courier, Burnaby Now, Royal City Record and Richmond News newspapers. 

What do you know about heart failure?

What do you know about heart failure?

If you’re like most people, not enough.

In fact, it is believed that most people who have heart failure are not even aware of it. It is estimated that 30% of those who have heart failure but are not aware of it will go on to develop full blown symptoms requiring urgent medical care within the next three years.

The overall one-year mortality rate (risk of dying) for patients diagnosed with heart failure is 30%. The risk is higher with those with three or more other chronic health conditions (up to 50%) and higher still in the elderly (up to 61%).

But patients who are informed and engaged in self-management in partnership with their family physicians have much better outcomes – slower disease progression and fewer hospitalizations.

Your heart is a muscular organ that acts as a pump. The right side of the heart receives blood returning from the body through veins and pumps this oxygen-depleted blood to the lungs. Oxygen-rich blood then returns to the left side of the heart which delivers it to the rest of the body (including the brain) through the arteries.

Congestive heart failure (CHF) is due to the decline in the pumping ability of the heart. This results in shortness of breath when blood backs up into the lungs, edema (or fluid retention) particularly in the legs and feet when blood backs up into the extremities, and fatigue because less blood is getting to the brain, muscles and organs.

The most common causes of heart failure are high blood pressure and atherosclerosis (narrowing of the arteries). Because the effects of these chronic conditions accumulate over time, the onset of symptoms is often gradual, unrecognized or mistaken for normal aging or deconditioning.

Other causes for heart failure include irregular heart rhythms, smoking, obesity, thyroid disease and excessive alcohol. Less common causes include disease of the heart muscle following viral infections, as side effects of medications (including some types of chemotherapy) or due to metabolic conditions such as hemochromatosis (iron overload).

In addition to the symptoms of fatigue, fluid retention and shortness of breath with physical activity, another classical symptom is shortness of breath when lying flat. In patients with worsening heart failure, blood fills the lungs unless they are sitting upright.

Several classes of medications have been shown to improve both the survival and quality of life in heart failure. These include beta blockers and ACE inhibitors. The condition requires close medical follow-up and regular monitoring.

Individuals with heart failure can maintain their health with diligent self-care and lifestyle management, monitoring their weight to pick up on fluid retention that may indicate a sudden worsening of their condition; limiting salt, alcohol and fluid intake, and maintaining regular appropriate exercise.

To learn more about “What You Should Know About Heart Disease”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series. You’ll learn if you are at increased risk, practical tips to reduce your risks and how to maintain your best health in spite of heart disease.

I’ll be speaking on Wednesday, March 30th at 7 p.m. at the Alan Emmott Centre at 6650 Southoaks Crescent in South Burnaby. Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

Are you at risk for heart disease?

Are you at risk for heart disease?

The simple answer is yes. We all are.

As we age, so do our blood vessels. With advancing years, plaque accumulates within the arteries that supply the heart muscle (causing angina and heart attacks), our brains (causing dementia and strokes) and our extremities (causing peripheral vascular disease).

If we are lucky enough not to die from accidents, cancer or dementia, by the time we are in our 80s, we are likely to die from a heart attack or stroke.

But some of us are at much higher risk for premature heart disease.

Most of the causes are modifiable – meaning we can reduce our risks through healthy living or medications. We can’t change our age, but we can slow down the aging process. We can’t choose our parents, but knowing family history can empower us to be proactive – to identify and modify our risk factors.

When we think about cardiovascular (heart and blood vessel) risk. The first place to start is with family history. We consider first degree relatives (parents and siblings), multiple generations and the ages at which they were diagnosed.

In general, premature heart disease is an event (such as a heart attack) in a male under 55 or a female under 65. Increased family risk may also be indicated by heart disease in each generation (e.g. your father, his mother and maternal aunts and uncles).

Some people think of family history with a sense of fatalism.

One patient, whose father and paternal uncles all died in their 40s, expected to die soon after his 40^th birthday. It didn’t stop him from smoking.

But a strong family history is like a visit from Christmas Future. That might be your fate if you don’t make changes today. A family history of heart disease should encourage us to be proactive, identify the particular risk factors common in the family tree and treat them early.

Common hereditary conditions that predispose us to premature atherosclerosis (narrowing of the arteries) are high blood pressure, diabetes, high LDL cholesterol and low HDL cholesterol. All of these conditions can be identified early and when appropriately treated with healthy eating, appropriate monitoring and medications, we can reduce or eliminate the increased risk.

The more details you know about your family history the better. Some people only know that their parents had heart conditions. Heart disease might refer to several distinct conditions.

Angina refers to chest pain due to narrowed coronary arteries (These are the blood vessels that supply the muscle of the heart). If those arteries are narrowed, the individual may feel chest pain or pressure with exercise or stress, both of which raise the heart rate and make the heart muscle work harder. The pain is due to ischemia (insufficient blood flow).

A heart attack or a myocardial infarction is the result of a complete obstruction of a coronary artery. When no blood flows at all to an area of the heart muscle, the muscle dies and no longer functions. With a massive heart attack, an artery supplying a large area of cardiac muscle is blocked and the heart can no longer pump blood to the brain and the rest of the body.

Heart failure refers to a significant decline in the pumping function of the heart. When the heart is too weak to pump blood throughout the body, the individual feels short of breath and weak. When the pump is failing, blood backs up into the lungs and extremities, causing swelling of the feet and legs and chest congestion, especially when lying down.

Valvular heart disease refers to abnormalities of one or more of the valves (pulmonary, aortic, mitral or tricuspid) between the chambers of the heart. A valve can be narrowed (e.g. aortic stenosis) or leaky (e.g. mitral regurgitation). Valvular heart disease is associated with murmurs (sounds heard with the stethoscope due to turbulent blood flow). Patients may experience chest pain or shortness of breath.

To learn more about “What You Should Know About Heart Disease”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series. You’ll learn if you are at increased risk, practical tips to reduce your risks and how to maintain your best health in spite of heart disease.

I’ll be speaking on Wednesday, March 30th at 7 p.m. at the Alan Emmott Centre at 6650 Southoaks Crescent in South Burnaby. Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

Davidicus Wong is a family physician and his Healthwise columns appear regularly in the Burnaby Now, Vancouver Courier, Royal City Record and Richmond News.

The Value of Your Family History

Confederation Park, Burnaby

Though some illnesses are random and many caused by the way you live your life, your family history can reveal your predisposition to certain conditions.

Some people take this to the extreme. If a parent died at a young age, they don’t expect to live beyond that age . . . and they do nothing at all to change how they live. Some people have a false sense of security when their family history is good. Most women diagnosed with breast cancer have no family history. People can have strokes, diabetes, heart attacks and other cancers before others in their families.

Others don’t think about their family history at all, don’t do the screening tests they should or take proactive and preventive measures to remain healthy.

Those who don’t learn from their family history may be destined to repeat it.

Consider Scrooge in Dickens’ “A Christmas Carol.” The ghost of Christmas Future gave him a glimpse of his future if he kept on behaving the way he had. Yet he was able to avoid that bleak future and create a more positive one by adopting new attitudes and actions.

Few of us will awaken completely transformed after one night with three bad dreams, but how we live our lives day by day and work periodically with our physicians can foster our potential for longer, healthier lives.

There are a few basic things you should know about family history. Genetically your closest relations (assuming you do not have a twin or clone) are your first degree relatives who each share half of your genes. They include your parents, siblings and children.

A grandparent, grandchild, niece, nephew, aunt, uncle or half-sibling is a second degree relative who shares only a quarter of your genes.

Your first cousins, great grandparents and great-grandchildren are your third degree relatives. They each share only an eighth of your genes.

So obviously you are much more likely to share inherited health conditions with your first degree relatives. That is why doctors are most interested in the histories of your immediate family members.

However, if a condition has been diagnosed in multiple relatives across multiple generations, your odds of having the same condition are much greater. An example is colon cancer diagnosed in a maternal grandparent, maternal aunts or uncles, their children and your own mother.

Your risk is even greater if an inherited condition arises at a relatively young age. An example for a woman would be breast cancer diagnosed in her mother before menopause; for a man, prostate cancer in his father under age 50.

A family history of a sudden death, stroke or heart attack under the age of 50 strongly suggests a genetic factor you should know about.

Again having a family history of these conditions does not condemn you to suffer the same fate. They serve as an early warning to be more vigilant and to consult early and regularly with your physician. Early detection or intervention can change the course of a disease. Many are curable at earlier stages.

Next: Family history and your risks for cancer, strokes and heart disease.