Sept. 29 is World Heart Day, a day for us to take a moment and consider our own heart health. While your health care provider can detect many heart conditions during a physical examination, many cases also rely on the information patients share with us. In this sense, patients are partners in helping reduce their risk of significant heart disease.
To illustrate this, picture an automobile engine. Modern engines have many components including mechanical, electrical and even plumbing. When an engine isn’t performing as it should, a skilled mechanic can recognize when isn’t producing enough power or that it isn’t firing on all cylinders. However, it’s difficult for a mechanic to recognize upon initial inspection when a fuel line is becoming clogged but hasn’t yet caused a problem.
The heart is much like the “engine” of the body. It circulates blood required by other organs so you can breathe, move and think. Just like taking your car to a mechanic can help diagnose a problem accurately and quickly, a little preventive maintenance can also go a long way in keeping our heart working well for years to come.
Lifestyle factors are important for many health outcomes, especially when it comes to heart health. Many of my patients tell me that addressing lifestyle factors has been particularly difficult during the COVID-19 pandemic because of increased stress and decreased access to fitness centers. Here are a few considerations for overcoming these challenges.
First, there are many ways to reduce stress. My personal favorites include listening to music or talking with a friend. Another is taking the time to prepare a healthy meal. This can lower stress levels while addressing another big component of heart health: diet.
Exercise is also important. My recommendation to patients is 150 minutes of cardiovascular exercise per week. This could be walking through the neighborhood while wearing a mask, using a pedal exerciser in the living room, or using an elliptical machine at a fitness center (when available). Finding a form of physical activity that works for you will improve conditioning and keep one’s weight in check, a separate but considerable risk factor.
Another lifestyle change is stopping or avoiding smoking. Research indicates that this is one of the best things anyone can do to promote cardiovascular health. The data on this is clear and compelling: tobacco use is a major risk for many types of heart disease.
Identifying and modifying risk
Medical science has made significant advances in diagnostic and therapeutic techniques for cardiovascular disease in recent decades. It has also helped us better predict who is at risk. One tool your health care provider may use is a risk calculator, which considers age, gender, blood pressure readings, cholesterol readings, smoking status, and other factors to generate a quantifiable risk.
The calculators are not perfect, but they are still powerful, predictive tools. As a patient, you can assist your provider by providing additional information that the calculator does not consider, like if there is a history of heart disease in your family.
Knowing your potential for developing heart disease can help you can better address the risk and modify any contributing behaviors or factors. Your health care provider can help you identify these lifestyle factors and determine specific goals. Most medical visits include a blood pressure reading, which is tracked over time to establish patterns that may require intervention. Another example is blood sugar, which is often tracked with basic blood work or more closely for patients with a diagnosis of diabetes.
Recommendations from the American College of Cardiology and the American Heart Association have evolved in the past decade on monitoring cholesterol. If you aren’t sure whether you’ve had a test before, ask your health care provider. One of the newer recommendations is that medication for lowering cholesterol should be considered for those at high risk, not just those with high cholesterol numbers. The class of recommended medications has been shown to lower rates of cardiovascular events, even for people with “normal” cholesterol levels, so patients with overall high risk should talk with their health care provider to determine if medication is appropriate.
The signals your heart sends when a problem is developing are not always obvious. In certain situations, additional testing may be required such as a cardiac stress test. You may have seen a version of this test on TV or in a movie (where a patient has adhesive EKG leads on their torso while walking on a treadmill as the speed gradually increases).
This test is generally meant for patients who have experienced chest discomfort symptoms and their health care providers are trying to discover whether the symptoms were due to coronary artery blockage or something else. In the absence of symptoms like chest discomfort, or when we are confident that symptoms are or are not cardiac in nature, we would consider other testing or treatment options. Even if a “medical-grade” stress test is not warranted, you can get some of the same information (without the EKG leads) from gauging your response to moderate exercise. Someone who can go for a brisk 10-minute walk without symptoms is unlikely to have a blockage that would warrant the risk of an invasive medical procedure.
Knowing what to watch for is critical to recognizing risk and responding appropriately. Chest pain is sometimes described as pressure, tightness or feeling like “an elephant is sitting on my chest.” Chest discomfort that comes on with exertion and resolves with rest is more suspicious. Pain that is sharp or lasts less than 10-20 seconds may be attributable to something else. Discomfort due to cardiovascular disease is sometimes associated with nausea or excessive sweating. Cardiac chest pain will often radiate to the left neck, shoulder or jaw.
This summer I received a call informing me that a family member had suffered serious symptoms while on the golf course. Listening to the story, I became concerned his symptoms could have come from his heart and was shocked to hear that rather than seeking immediate medical attention, he was still out on the golf course. I implored the other members of the golfing party to take him to urgent care for a few quick tests to assess the situation. Ultimately, this family member had a good outcome, despite his heart being the source of the issue. It highlights the importance of both recognizing symptoms and seeking timely medical attention.
We recommend avoiding delays to seeking care when it comes to chest pain. Delays can negatively impact outcomes. If you have an episode of chest discomfort, inform your health care provider. In an urgent situation when a real-time discussion is needed, a triage line can be helpful. This may be listed on your insurance card or available from your primary care clinic. Having this number available in advance helps ensure a more seamless experience when symptoms arise.
While it’s true these are unprecedently stressful times, we can’t let it take a toll on our hearts or our overall health. In addition to knowing more about the risks and talking with your health care provider, a little preventative care can go a long way towards keeping the heart-healthy.
Peter Barkett, MD, practices internal medicine at Kaiser Permanente Silverdale. He lives in Bremerton.
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