Heart Health – the No. 1 Killer in America

What is Cardiovascular Disease?

Taking care of your heart health is essential so you can avoid developing cardiovascular diseases. Cardiovascular disease can refer to a number of conditions. These are the following [1]:

Heart Disease

Heart Attack

• Angioplasty: Special tubing with an attached deflated balloon is threaded up to the coronary arteries.
• Angioplasty, Laser: Similar to angioplasty except that the catheter has a laser tip that opens the blocked artery.
• Artificial heart valve surgery: Replaces an abnormal or diseased heart valve with a healthy one.
• Atherectomy: Similar to angioplasty except that the catheter has a rotating shaver on its tip to cut away plaque from the artery.
• Bypass surgery: Treats blocked heart arteries by creating new passages for blood to flow to your heart muscle.
• Cardiomyoplasty: An experimental procedure in which skeletal muscles are taken from a patient’s back or abdomen.
• Heart transplant: Removes a diseased heart and replaces it with a donated healthy human heart.
• Radiofrequency ablation: A catheter with an electrode at its tip is guided through the veins to the heart muscle to destroy carefully selected heart muscle cells in a very small area.
• Stent procedure: A stent is a wire mesh tube used to prop open an artery during angioplasty.
• Transmyocardial revascularization (TMR): A laser is used to drill a series of holes from the outside of the heart into the heart’s pumping chamber.

Stroke

Treatment

Heart Failure

Treatments

• Coronary bypass surgery. Blocked arteries can cause heart failure. To clear this, your doctor may recommend coronary artery bypass surgery. The procedure involves taking a healthy blood vessel from your leg, arm, or chest. The blood vessel is then connected below and above the blocked arteries Omit heart. This new pathway improves blood flow to your heart muscle.
• Heart valve repair or replacement. If a faulty heart valve causes your heart failure, the valve needs to be repaired or replaced. Surgeons can repair the valve by reconnecting valve flaps. It can also be by removing excess valve tissue so that the leaflet closes. Sometimes, fixing the valve includes tightening or replacing the ring around the valve.
• Implantable cardioverter-defibrillators (ICDs). An ICD is used to prevent complications of heart failure. It isn’t a treatment for heart failure itself, but it is like a pacemaker. It is implanted under the skin in your chest with wires leading through your veins and into your heart.
• The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if the heart stops. When the heart stops, this device will try to pace your heart or shock it back into normal rhythm. An ICD can also work as a pacemaker and speed your heart up if it is going too slow.
• Cardiac resynchronization therapy (CRT). Also called biventricular pacing. CRT is a treatment for heart failure in people whose lower heart chambers (ventricles) aren’t pumping in sync. A biventricular pacemaker sends electrical signals to the ventricles. It signals your ventricles to contract. This will trigger the ventricles to contract in a more coordinated way. It improves blood pumping out of your heart, and CRT may be used with an ICD.
• Ventricular assist devices (VADs). — also known as a mechanical circulatory support device. It is a device that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body. Although a VAD can be placed in one or both ventricles of your heart, it is most implanted in the left ventricle.
  • The doctor may recommend a VAD if you wait for a heart transplant. In some cases, VAD is used as a permanent treatment for people who have heart failure. But those who aren’t good candidates for a heart transplant are first in line.
• Heart transplant. Some people have severe heart failure, that surgery or medications don’t help. These people may need to have their hearts replaced with a healthy donor heart.

• Angiotensin-converting enzyme (ACE) inhibitors. These drugs relax blood vessels to lower blood pressure, improve blood flow and decrease the strain on the heart. Examples include enalapril (Vasotec, Epaned), lisinopril (Zestril, Qbrelis, Prinivil), and captopril.
• Angiotensin II receptor blockers. These drugs, which include losartan (Cozaar), valsartan (Diovan), and candesartan (Atacand), have many of the same benefits as ACE inhibitors. They may be an option for people who can’t tolerate ACE inhibitors.
• Beta-blockers. These drugs slow your heart rate and reduce blood pressure. Beta-blockers may reduce signs and symptoms of heart failure, improve heart function, and help you live longer. Examples include carvedilol (Coreg), metoprolol (Lopressor, Toprol-XL, Kapspargo Sprinkle), and bisoprolol.
• Diuretics. Often called water pills, diuretics make you urinate more frequently and keep fluid from collecting in your body. Diuretics, such as furosemide (Lasix), also decrease fluid in your lungs to breathe more easily.
  • Because diuretics make your body lose potassium and magnesium, your doctor may also prescribe supplements of these minerals. If you’re taking a diuretic, your doctor will likely monitor potassium and magnesium levels in your blood through regular blood tests.
• Aldosterone antagonists. These drugs include spironolactone (Aldactone, Carospir) and eplerenone (Inspra). They are potassium-sparing diuretics with additional properties that may help people with severe systolic heart failure live longer.
  • Diuretics like spironolactone and eplerenone can raise the potassium in your blood to dangerous levels. Talk to your doctor if this is a concern so you can modify your intake of food high in potassium.
• Positive inotropes. These medications may be given by IV to people with certain types of severe heart failure who are in the hospital. Positive inotropes can help the heart pump blood more effectively and maintain blood pressure. Long-term use of these drugs has been linked to an increased risk of death. Talk to your health care provider about the benefits and risks of these drugs.
  • Dobutamine and milrinone are the most common. 
• Digoxin (Lanoxin). This drug, also called digitalis, increases the strength of your heart muscle contractions. It also tends to slow the heartbeat. Digoxin reduces heart failure symptoms in systolic heart failure. It may be more likely to be given to someone with a heart rhythm problem, such as atrial fibrillation.
• Hydralazine and isosorbide dinitrate (BiDil). This drug combination helps relax blood vessels. It may be added to your treatment plan if you have severe heart failure symptoms and ACE inhibitors or beta-blockers haven’t allowed.
• Vericiguat (Verquvo). This newer medicine for chronic heart failure is taken once a day by mouth. It’s a type of drug called an oral soluble guanylate cyclase (sGC) stimulator. In studies, those with high-risk heart failure who took vericiguat had fewer hospital stays for heart failure and heart disease-related deaths than those who received an inactive pill (placebo).

Arrhythmia

Arrhythmia refers to an abnormal heart rhythm. There are various types of arrhythmias. The heart can beat too slow, too fast, or irregularly.

Bradycardia, or a heart rate that’s too slow, is when the heart rate is less than 60 beats per minute. Tachycardia, or a heart rate that’s too fast, refers to a heart rate of more than 100 beats per minute.

An arrhythmia can affect your heart health and how it works. With an irregular heartbeat, your heart may not be able to pump enough blood to meet your body’s needs.

Treatment

• Vagal maneuvers. If you have a very fast heartbeat due to supraventricular tachycardia, your doctor may recommend this therapy. Vagal maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow. For example, you may be able to stop an arrhythmia by holding your breath and straining, dunking your face in ice water, or coughing. Vagal maneuvers don’t work for all types of arrhythmias.
• Cardioversion. This method to reset the heart rhythm may be done with medications or as a procedure. Your doctor may recommend this treatment if you have a certain type of arrhythmia, such as atrial fibrillation.
  • During the cardioversion procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and can restore a normal rhythm.
• Catheter ablation. In this procedure, the doctor threads one or more catheters through the blood vessels to the heart. Electrodes at the catheter tips use heat or cold energy to create tiny scars in your heart to block abnormal electrical signals and restore a normal heartbeat.
• Pacemaker. If slow heartbeats (bradycardias) don’t have a cause that can be corrected. Doctors often treat them with a pacemaker because there aren’t any medications that can reliably speed up the heart.
  • A pacemaker is a small device that’s usually implanted near the collarbone. One or more electrode-tipped wires run from the pacemaker through the blood vessels to the inner heart. If the heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate the heart to beat at a steady rate.
• Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this device if you’re at high risk of developing a dangerously fast or irregular heartbeat in the lower heart chambers (ventricular tachycardia or ventricular fibrillation). If you have heart health issues, had a sudden cardiac arrest, or have certain heart conditions that increase your risk of sudden cardiac arrest, your doctor may also recommend an ICD.
  • An ICD is a battery-powered unit that’s implanted under the skin near the collarbone — similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm.
  • If the ICD detects an abnormal heart rhythm, it sends out low- or high-energy shocks to reset the heart to a normal rhythm. An ICD doesn’t prevent an irregular heart rhythm from occurring, but it treats it if it occurs.
• Maze procedure. In the maze procedure, a surgeon makes a series of incisions in the heart tissue in the upper half of your heart (atria) to create a pattern (or maze) of scar tissue. Because scar tissue doesn’t conduct electricity, it interferes with stray electrical impulses that cause some types of arrhythmia.
  • The maze procedure is usually reserved for people who don’t get better with other treatments or who are having open-heart surgery for other reasons.
• Coronary bypass surgery. If you have severe coronary artery disease in addition to heart arrhythmia, your doctor may perform coronary bypass surgery. This procedure may improve the blood flow to your heart. Because of this, your heart health may be compromised. 

Heart valve problems

Once your heart health goes down, problems arise. When heart valves don’t open enough to allow the blood to flow through as it should, a condition called stenosis results.

When the heart valves don’t close properly and allow blood to leak through, it’s called regurgitation. If the valve leaflets bulge or prolapse back into the upper chamber, it’s a condition called prolapse. 

Treatment

• Heart valve repair: Patch holes in a valve. Separate valve leaflets that have fused. Replace the cords that support the valve. Remove excess valve tissue so that the valve can close tightly.
  • Surgeons often tighten or reinforce the ring around a valve (annulus) by implanting an artificial ring. In some cases, doctors use less invasive procedures to repair certain valves using long, thin tubes (catheters). These procedures can involve clips, plugs, or other devices.

• Heart Valve Replacement: If the valve is not repaired, surgeons might remove the damaged valve and replace it with a mechanical valve. It can also be a valve made from cow, pig, or human heart tissue (biological or tissue valve).
  • If you had valve replacement with a mechanical valve, you’d need to take blood thinners to prevent blood clots for the rest of your life. Biological tissue valves break down over time and usually need to be replaced.
  • A minimally invasive procedure called transcatheter aortic valve replacement (TAVR) may be used to replace a damaged aortic valve. In this procedure, the doctor inserts a long, thin tube (catheter) into an artery in your leg or chest and guides it to the heart valve. A replacement valve is moved through this catheter to the correct position.

Types of Cardiac Medications for Your Heart’s Health

• Anticoagulant – is used to treat specific blood vessel, heart, and lung conditions.
• Antiplatelet agent – keeps blood clots from forming by preventing blood platelets from sticking together.
• Angiotensin-converting enzyme (ACE) inhibitor – expands blood vessels and decreases resistance by lowering levels of angiotensin II. Allows blood to flow more easily and makes the heart’s work easier or more efficient.
• Beta-blocker: Decreases the heart health rate and cardiac output, lowering blood pressure and making the heartbeat more slowly, with less force.
• Angiotensin II receptor blocker – rather than lowering levels of angiotensin II (as ACE inhibitors do), angiotensin II receptor blockers prevent this chemical from having any effects on the heart and blood vessels. This medication keeps blood pressure from rising.
• Combined alpha and beta-blocker: Combined alpha and beta-blockers are used as an IV drip for those patients experiencing a hypertensive crisis. They may be prescribed for outpatient high blood pressure use if the patient is at risk for heart failure.
• Angiotensin receptor neprilysin inhibitor: Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. By inhibiting neprilysin, those natural substances can have their usual effect. That improves artery opening and blood flow, reduces sodium (salt) retention, and decreases strain on the heart.
• Calcium channel blocker Interrupts the movement of calcium into the heart and blood vessel cells. May decrease the heart’s pumping strength and relax the blood vessels.
• Cholesterol-lowering medications: Various medications can lower blood cholesterol levels, but statins are the best first course of action. Other drugs may be recommended when statins prove ineffective or if a patient experiences severe side effects from statin therapy.
• Digitalis preparation: Increases the force of the heart’s contractions, which can be beneficial in heart failure and for irregular heartbeats.
• Diuretics: Cause the body to rid itself of excess fluids and sodium through urination. Help to relieve the heart’s workload. Diuretics also decrease fluid buildup in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through various methods.
• Vasodilator: Relaxes blood vessels and increases the supply of blood and oxygen to the heart while reducing its workload. Available as pills to be swallowed, chewable tablets, and a topical application (cream).

Fact Sheet – Heart Disease

Taking care of your heart health is essential. Remember that heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States [2].

• There are about 3 million deaths in the US.
• Cardiovascular disease alone accounts for almost 1/4th of the total deaths in the US. 
• One person dies every 36 seconds in the United States from cardiovascular disease.
• Heart disease cost the United States about $363 billion each year from 2016 to 2017. It includes the cost of heart health care services, medicines, and lost productivity due to death.

Coronary Artery Disease

• Coronary heart disease is the most common type of heart disease, killing 360,900 people in 2019.
  • About 18.2 million adults age 20 and older have CAD (about 6.7%).
  • About 2 in 10 deaths from CAD happen in adults less than 65 years old.

Heart Attacks

In the United States, a person suffers from a heart attack every 40 seconds.

• Every year, about 805,000 people in the United States have a heart attack. Of these,
  • 605,000 are a first heart attack
  • 200,000 happen to people who have already had a heart attack
  • About 1 in 5 heart attacks are silent—the damage is done, but the person is not aware of it.

Race of Ethnic Group	% of Deaths	Men, %	Women, %
American Indian or Alaska Native	18.3	19.4	17.0
Asian American or Pacific Islander	21.4	22.9	19.9
Black (Non-Hispanic)	23.5	23.9	23.1
White (Non-Hispanic)	23.7	24.9	22.5
Hispanic	20.3	20.6	19.9
All	23.4	24.4	22.3

Cardiovascular Disease Beyond Death

Cardiovascular disease isn’t something that just happens one day and death follows it the next. It is a chronic heart health condition that gets worse over time. Often times it can be managed and people can live active and great lives even when they have comorbidity.

Cardiovascular disease is not a death sentence but when it is not managed properly, it can be a problem[3]. According to heart.org, almost half of the US population has some type of cardiovascular disease. 

• • According to 2017 figures, 116.4 million people had hypertension, almost half of the US population at that time, and that is just hypertension alone.
  • Cardiovascular disease is such an issue that the AHA had to lower its guidelines for what hypertension is from 140/90 to 130/80 so that people can get treated sooner.

• 1 in 5 Americans reported having adequate aerobic exercise and muscle-strengthening activity to meet the physical activity guidelines.

• Estimates for 2035 are showing that more than 130 million people will have some form of cardiovascular disease and the total cost to the healthcare system would be $1.1 trillion. 

Activity Guidelines for Your Heart Health

Key Guidelines for Adults

• • Adults should move more and sit less throughout the day. Some physical activity is better than none. Those people who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits.

• For substantial heart health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic exercise. Preferably, aerobic activity should be spread throughout the week.

• Additional heart health benefits are gained by engaging in physical activity beyond 300 minutes (5 hours) of moderate-intensity physical activity a week.
• Adults should also do muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups two or more days a week. These activities provide additional heart health benefits.

Key Guidelines for Older Adults

The fundamental guidelines for adults also apply to older adults. In addition, the following vital guidelines are just for older adults [4]:

• • Older adults should do multicomponent physical activity as part of their weekly physical activity that includes balance training and aerobic and muscle-strengthening exercises.
  • Senior adults should determine their level of effort for physical activity relative to their fitness level.
  • Older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely.

Aging adults cannot do 150 minutes of moderate-intensity aerobic activity weekly because of chronic conditions. They should be as physically active as their abilities and needs allow. 

Diets Effects on Cardiovascular Disease

Trans Fats

Trans Fat in Our Diet

The FDA also does not require to list trans fats if the product contains <0.5g. So, if you think about it, some of the products can have 0.4g, and through your diet, the total can add up to well over the 2g recommendation. 

Common foods that have trans fats:

• Fast food
• Doughnuts
• baked goods 
• pie crusts
• Biscuits
• frozen pizza
• Cookies
• Crackers
• margarine and other spreads

To watch the full episode of Ep. 85, check out the whole video here 👇👇👇

TIME STAMPS:

0:00 Introduction
0:52 Sponsor Ads
2:01 Cup of Nurses Introduction
2:30 Episode Introduction
2:46 What is Cardiovascular Disease?
5:36 Heart Disease
9:50 What happens in the hospital when you get a heart attack?
26:00 What are the 2 types of stroke?
28:32 Treatments for Stroke
31:58 Heart Failure
32:20 When does heart failure happen?
34:48 Treatments for Heart Failure
48:00 Medications for Heart Failure
54:41 What is Arrhythmia?
55:03 Treatments for Arrhythmia
1:04:10 Heart Valve Problems
1:06:12 Treatments for Heart Valve Problems
1:07:01 Types of Cardiac Medications
1:11:58 Fact sheet – Heart Disease
1:14:49 Probability of Heart Attack Based on Ethnicity Group
1:17:47 Activity Guidelines for Adults
1:21:25 Diets Affecting Cardiovascular Disease