Diagnosing Heart Problems

There are numerous tests available to diagnose problems affecting the heart. These range from noninvasive screenings to more involved procedures that may include the use of high-tech imaging equipment. If you are experiencing symptoms such as chest pain, shortness of breath, or irregular heartbeats, your physician may recommend diagnostic tests to assess the health of your heart.

“Common testing for exploring these symptoms includes electrocardiogram, echocardiogram, or a stress test,” says Joy Gelbman, MD, a cardiologist at the Weill Cornell Greenberg Center. Other tests that may be employed, depending on the patient’s signs and symptoms, include heart rhythm monitors, cardiac MRI tests, cardiac computerized tomography (CT) scans, and electrophysiology tests—for electrical issues such as irregular heart rhythms.

Signs, Symptoms and Family History

If you do not have heart disease symptoms but have a family history of heart disease, you are a likely candidate for a heart health evaluation. “Having a first-degree relative with early onset of cardiovascular disease, such as heart attack, arrhythmias, or sudden unexplained death, might warrant additional testing,” explains Dr. Gelbman. Even in the absence of symptoms or a family history of heart disease, your doctor might recommend further evaluation. “For example, testing might be warranted based on what is found on your physical exam, such as a heart murmur, elevated blood pressure, or swollen legs,” says Dr. Gelbman.

Guide to Common Heart Tests

Here is a guide to some common tests that are frequently ordered when your heart health is being evaluated:

Electrocardiogram (ECG). An ECG is a quick and painless test that checks your heart’s electrical system and heart rhythm. This test will be ordered if you have risk factors for an enlarged heart such as high blood pressure, or symptoms of heart disease such as chest pain, shortness of breath, palpitations, or an irregular heartbeat.

Echocardiogram. This exam uses sound waves to create detailed images of the heart in motion. An echocardiogram can help determine if a valve is narrowed or leaking. “An echocardiogram tells us if the heart is strong, or stiff, and if the valves are working normally,” explains Dr. Gelbman.

Stress tests. These tests involve walking on a treadmill or riding a stationary bike, while the heart is monitored. Exercise stress tests help reveal how the heart responds to physical activity and whether heart disease symptoms occur during exertion. For patients who are not physically fit enough to participate in an exercise stress test, there are alternatives. “We can administer an intravenous medication stress test that shows how blood flows through the heart, or a CT scan that looks at the coronary arteries and assess for blockages,” Dr. Gelbman explains.

Cardiac catheterization. This test can show blockages in the heart’s arteries. Under sedation, in a surgical setting, a long, thin flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on x-ray images taken during the test.

Consistent Follow-up

“It is important to have regular followup with your doctor since some cardiac risk markers such as high blood pressure, high cholesterol, and elevated blood sugar do not always cause symptoms,” says Dr. Gelbman. Many of the major risk factors for heart disease can be modified and controlled with lifestyle changes such as a heart-healthy diet and exercise.

Your doctor will decide which tests are important both to diagnose what you have and to rule out certain diseases. Diagnosis is the first critical step in planning a treatment strategy. “Your doctor will work with you to figure out if your symptoms are cardiac in nature,” says Dr. Gelbman, “and if they are, they will help to identify the appropriate treatment strategies.”

The post Diagnosing Heart Problems Is the First Step In Managing Disease appeared first on University Health News.

Cardiac Arrest vs. Heart Attack

Although some people may use the terms heart attack and cardiac arrest interchangeably, these conditions are not the same. Cardiac arrest occurs due to an electric malfunction in the heart. In contrast, a heart attack is akin to a plumbing problem and results from blockages in the coronary arteries. If those blockages aren’t opened, part of the heart normally nourished by that blood supply starts to die.

Symptoms of a heart attack can be mild and start slowly, or they can be intense and abrupt. The heart, however, keeps on beating. And that’s the key difference between these two conditions—during cardiac arrest, the heart stops beating suddenly and often without any warning. According to the American Heart Association (AHA), immediate action using CPR can double or even triple the chances of survival after cardiac arrest.

“During cardiac arrest, the electrical signals that direct your heart to pump blood unexpectedly malfunction. This causes a disruption in your heart’s ability to provide blood to your body. Suddenly, your entire body including your lungs and your brain, is devoid of all the oxygen and nutrients it needs to survive,” explains Marwah Shahid, MD, cardiology fellow at UCLA Medical Center. “If someone is in cardiac arrest outside of the hospital, it is very unlikely that they will survive without CPR. By doing CPR we are mimicking the function of the heart, which is pumping the nutrient-rich blood to our vital organs.”

Immediate Action Matters

Every second counts when the heart stops beating. With each passing minute, a person’s chance of survival goes down by about 10%. While calling 911 is, of course, a vital part of the protocol in an emergency, it can take a while for first responders to arrive on the scene. Therefore, the actions of bystanders can make the difference between life and death, as well as how much disability a person can incur if they do survive cardiac arrest. The longer a person is with limited or no blood flow to the brain, the greater and more widespread the risk of brain damage. That’s why immediate action to try to restart the heart is so very important.

Myths About CPR

There are several reasons why people might be reluctant to perform CPR, especially on a stranger. Below are the most common misunderstandings.

• Fear of being sued. Every state has Good Samaritan laws designed to protect bystanders who perform CPR or give other assistance to someone who is injured or otherwise in danger. The law applies to someone performing CPR, using a defibrillator/AED (automated external defibrillator), or simply giving chest compressions in an attempt to restart/restore a person’s normal heart rhythm. Defibrillators send an electric shock to the heart to try to restore its normal rhythm. AEDs are portable defibrillators installed in many public places. Though AEDs are not difficult to use (most have voice prompts), training is very helpful. You can learn how to use one in a CPR class.
• Mouth-to-mouth reluctance. Part of the classic CPR process includes giving mouth-to-mouth resuscitation, which can make people reluctant to do/learn CPR, especially after the COVID-19 pandemic. However, statistics show that about 70% of cardiac arrests occur at home, so chances are high that you will know the person needing CPR. Also know that hands-only (chest compression only) can still be effective in the first few minutes after cardiac arrest. Even if you haven’t taken a CPR class, doing chest compressions can help. Call 911 and while you are waiting for first responders, put your phone on speaker mode and the 911 operator can talk you through the process. Become acquainted with the process by viewing the AHA’s hands-only CPR video, which you can find online here: https://tinyurl.com/AHAhands-OnlyCPR.
• Doing more harm than good. Emergencies are stressful by nature. Nonmedical professionals might be quite nervous that they may not perform CPR correctly and therefore cause more harm than good. But according to Dr. Shahid, the most harmful thing you can do is doing nothing at all. “Almost 90% of people who have an out-of-hospital cardiac arrest will die, and immediate CPR can double or triple their chance of survival,” she stresses. “As a cardiology fellow at UCLA who has witnessed cardiac arrest countless times, the victims that are most likely to survive are those who had immediate CPR at the time of their cardiac arrest.”

Risk Factors for Cardiac Arrest

Cardiac arrests can happen to anyone: professional athletes, young children, and older adults. In most cases, physicians may not know what triggered the event. In adults, the most common causes are ventricular fibrillation or ventricular tachycardia, which are types of arrhythmias (abnormal electrical signals in the heart). To diagnose an arrhythmia, your doctor will ask you about any symptoms, lifestyle habits, and other risk factors of arrhythmias. Your doctor will also do a physical exam, which may include these steps:

• checking for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure

• taking your pulse to find out how fast your heart is beating

• assessing the rate and rhythm of your heartbeat

• listening to your heart for a heart murmur

• testing for signs of other diseases, such as thyroid disease, which could be causing arrhythmias.

Other risk factors for cardiac arrest include a blockage in one of the arteries of the heart and problems with the heart muscle.

More than half of cardiac arrests occur in people who didn’t know they had a heart problem. Cardiac arrest can sometimes be prevented by treating arrythmias and preventing the progression of heart disease with medications or advanced therapies. In younger people, an unfortunate but common cause of cardiac arrest is drug overdose. In children, the most common cause is choking. CPR and First Aid classes can provide you with the skills to act quickly and potentially save a life.

The post Save a Life; Learn CPR appeared first on University Health News.

As with most serious medical conditions, early intervention, including diagnosis, is key to a successful outcome.

Once you’re aware that you have CAD, you can take necessary steps to reduce the chance of having a heart attack or stroke. Whether you see a cardiologist, vascular specialist, or neurologist, it’s important to find a physician to help determine your cardiovascular risk so you can develop a treatment plan.

Depending on your symptoms (or lack thereof), your doctor may order tests to determine whether your discomfort is being caused by CAD and how many coronary arteries are affected by the disease. In addition to a physical exam, you’ll likely be scheduled for various diagnostic tests, which fall into two categories: non-invasive and invasive.

If your situation isn’t an emergency (e.g., you’re not suffering from a heart attack or stroke), a non-invasive test may be your first diagnostic step. As its name implies, non-invasive tests involve assessing your heart from the outside—by looking at blood pressure, for example, or conducting an electrocardiogram.

Those whose non-invasive test results are abnormal, whose conditions are more serious, or whose symptoms are worsening may need invasive testing. These exams are more expensive and require specialized equipment. They’re not generally used to screen for CAD, but to assess more high-risk situations (for example, when stenting or bypass surgery are being considered to relieve a severe blockage).

Non-Invasive Diagnostic Testing

There are four commonly used non-invasive tests to diagnose CAD: electrocardiography, stress tests, nuclear perfusion tests, and echocardiography.

Electrocardiography

Electrocardiography provides a snapshot of the electrical impulses that make up your heartbeat. The recording of your heart’s electrical activity is called an electrocardiogram (ECG, or EKG from the German elektrokardiogramm).

Changes from the normal, expected pattern can reveal evidence of past heart attacks, heart rhythm disturbances, an enlarged heart, and other problems. However, a normal ECG doesn’t necessarily mean you’re free from CAD.

Stress Tests

Chest discomfort that’s triggered by exertion is one sign you may have CAD. Having an ECG while your heart is being stressed (for example, while walking on a treadmill or riding a stationary bike) can reproduce this problem in a controlled setting. Evidence of CAD may appear on the ECG as you approach your exercise limit. By comparing your ECG before, during, and after exercise, your doctor will have a much better idea of the extent and severity of your CAD.

If you have stable angina, your ability to perform a stress test will be limited. Nevertheless, you may be asked to undergo stress tests periodically; any changes in your performance can provide clues as to whether your CAD is worsening. Stress tests also can determine whether medical therapy and lifestyle changes are improving your condition.

Nuclear Perfusion Tests

A stress test conducted after a radioactive isotope has been injected is called a nuclear perfusion (“blood flow”) test or scan. The radioisotope—usually thallium or technetium—is carried by the blood, accumulating in portions of the heart with adequate blood flow. When CAD blocks a coronary artery, the thallium or technetium can’t get through. This test helps reveal whether all parts of the heart muscle are receiving adequate blood flow.

The radiation emitted by these radioisotopes is gamma rays. A camera that sees only gamma rays is therefore used to take an image of the heart at rest and post exercise. This technique is called Single-Photon Emission Computed Tomography (SPECT)—“single-photon” because the radioisotope emits only one wavelength of gamma radiation. A camera collects these rays and a computer constructs an image from the emitted radiation.

Tomography is a method of reconstructing cross-sectional images (slices) of the heart to evaluate blood flow to the myocardium (heart muscle). Normal flow throughout the myocardium at rest and with exercise argues against the presence of severe CAD. However, normal flow at rest that decreases after exercise suggests a severe coronary artery narrowing. Decreased flow both at rest and during exertion tends to indicate scarring from a past heart attack.

An exercise nuclear perfusion scan can help identify patients with severe CAD, a group at high risk for heart attack. Those who show poor blood flow are then treated appropriately in hopes of preventing a heart attack. When a person can’t exercise, adenosine (Adenoscan), dipyridamole (Persantine), or regadenosoin (Lexiscan) are given through a vein to dilate, or open up, coronary arteries.

Heavily diseased vessels can’t dilate as much as healthy ones, selectively decreasing the delivery of the radioactive tracer to the heart muscle. Note: A typical nuclear stress test provides a radiation dose equivalent to 900 chest X-rays.

Echocardiography

An echocardiogram (“echo”) is a collection of moving pictures of the heart taken with high-frequency sound waves (ultrasound). Echocardiograms reveal the shape, size, position, and motion of cardiac structures, including the thickness of ventricle walls, the condition of heart valves, or the presence of abnormal openings between the chambers.

Echocardiography can provide two-dimensional (2-D) or three-dimensional (3-D) images. The more commonly used 2-D echo technology provides moving pictures of slices of the heart. These pictures are usually taken from the front of the heart through the chest wall in a technique known as transthoracic echocardiography (TTE).

Under certain circumstances, pictures may be taken from the back of the heart via the esophagus in a procedure called transesophageal echocardiography (TEE). During heart surgery, TEE often is used to assess the heart’s pumping function or to confirm whether a valve repair or replacement has been successful.

A sophisticated emerging technology known as 3-D echocardiography provides more information by reconstructing the heart on a computer screen. The 3-D image can be rotated to view the heart from different angles.

Stress echocardiography often is used as an indirect test for CAD. Patients either exercise on a treadmill or receive a drug called dobutamine that makes the heart beat faster and harder. If the walls of the heart don’t contract as well during stress as they do at rest, blockages may be limiting blood flow to the hard-working heart muscle.

Invasive Diagnostic Testing

Invasive diagnostic tests help confirm the presence of CAD, identify which coronary artery or arteries are obstructed, and determine whether stenting or bypass surgery is needed. They are performed in a cardiac catheterization laboratory, or cath lab. The gold-standard test for diagnosing severe CAD is selective coronary angiography, a method of taking x-ray movies of the beating heart and its arteries.

Angiography

To perform angiography, a thin, flexible tube called a catheter is inserted into a blood vessel in the groin, elbow, or wrist and advanced to the mouth of the coronary arteries. This procedure is called cardiac catheterization.

A liquid contrast material (“dye”) that blocks x-rays is injected through the catheter directly into the coronary arteries, enabling the internal contours of the arteries to be clearly seen. These images, called angiograms, are viewed in real time and digitally recorded. Coronary arteries that are narrowed or completely blocked by plaque can be immediately identified on the angiograms.

Coronary angiography is performed primarily on:

• Patients with stable or unstable angina, those with severe or worsening symptoms, and patients who have had a heart attack. Often, the condition of these patients has not improved with medical therapy, so they are being considered for stenting or coronary artery bypass surgery.
• Patients with symptoms that suggest CAD but whose diagnosis has not been confirmed by non-invasive diagnostic procedures.
• Patients who have undergone non-invasive testing with results that suggest the presence of severe lack of blood flow to the heart muscle (ischemia), even in the absence of angina. This condition, called silent myocardial ischemia, may be as dangerous as the CAD that causes angina.

Intravascular Ultrasound (IVUS)

Intravascular ultrasound (IVUS) uses a catheter tipped with a tiny ultrasound probe to take pictures inside the coronary arteries using high-frequency sound waves. IVUS provides a direct look at the size and composition of plaques. It’s particularly valuable for monitoring plaques as they change over time or when overlapping arteries cause a fuzzy image on an angiogram.

A tiny ultrasound transducer on the tip of the IVUS probe bounces sound waves off the walls of the coronary arteries and sends signals back to a computer, where they are immediately translated to images and displayed on a monitor. These images show the artery walls, the central channel (lumen) through which blood flows, and the presence or absence of plaque. Different types of plaque reflect sound waves in different ways, enabling the cardiologist to tell whether the plaque is mostly hard or soft.

It’s particularly valuable when coronary angiography is unable to determine whether a lesion is blocking the artery by 70 percent or more—the point at which treatment with angioplasty or bypass surgery may be required.

With this information, doctors are better able to choose the most appropriate treatment and size of stent to hold the artery open. After a stent has been inserted, IVUS may be used to ensure it is fully expanded. IVUS also is used in clinical trials to monitor the effects of cholesterol-lowering and anti-inflammatory medications on plaque.

Advances in Diagnostic Testing

New and innovative tests are being developed to examine the heart. Their goal: to assess the heart’s health in a less invasive and less expensive way. The following are showing great promise.

Computed Tomography Angiography (CTA)

An invaluable tool, computed tomography angiography (CTA) combines a CT scan with an injection of iodine-rich dye to help study arteries in the brain, lungs, kidneys, arms, and legs. Some leading cardiologists feel that CTA has the potential to become an accurate, non-invasive method of imaging the coronary arteries.

CTA is performed with high-powered scanners with dual-source technology, which produces images of the heart and coronary arteries in seconds. The speed of these scanners significantly reduces image blur generated by the fast motion of the beating heart.

CTA also can identify older, harder plaques by their calcium content, producing a calcium score. The higher the score, the more severe the CAD and the greater the risk of heart attack. The newest CT scanners also reveal plaques without calcium, which may be more vulnerable to rupture.

CTA is sometimes used in place of cardiac catheterization, but it’s still unclear whether this test is a better choice. In a large study of more than 10,000 patients with symptoms suggestive of CAD, CTA was no better than traditional stress testing for diagnosing CAD. However, CTA can be effective in evaluating the coronary arteries of patients with suspected dilated cardiomyopathy, a form of heart failure that isn’t caused by narrowing of the coronary arteries. In these patients, CTA can rule out CAD 99 percent of the time.

In 2010, several medical organizations issued joint guidelines for the use of cardiac CT. They deemed the use of cardiac CT appropriate for diagnosis and risk assessment in patients at low or intermediate risk, to gauge probability of CAD, or to evaluate the structure and function of the heart. Other appropriate uses include CT without contrast for calcium scoring in low- and intermediate-risk patients with a family history of premature CAD, for pre-electrophysiology testing, and before repeat CABG or valve surgery.

Inappropriate applications of cardiac CT include its use in high-risk patients when repeated testing is required (due to cumulative radiation exposure), for screening asymptomatic patients, and for preoperative risk assessment in patients with no history of heart conditions undergoing non-cardiac surgery.

Magnetic Resonance Imaging (MRI)

MRI is a safe, painless, non-invasive technology that uses magnetic fields and radio waves to see inside the body. Physicians have finally discovered a way to use MRI to identify the composition of plaque as well as to assess the area of tissue damage following a heart attack. Cardiac MRI is deemed a very useful technology and one especially suited to identifying living heart tissue after a heart attack.

An MRI also is excellent for defining the heart’s structure, including the size, location, and connections of the heart’s chambers and great vessels (aorta, vena cava, and their branches).

Positron Emission Tomography (PET) Scanning

A type of nuclear imaging, positron emission tomography (PET) can determine the difference between stunned (in shock) heart muscle and nonfunctional scar tissue. In PET scanning, a short-acting radioactive tracer called rubidium is injected into the bloodstream, and the patient is scanned with a nuclear camera.

Normal heart muscle absorbs the radioactive agent, but scar tissue and hibernating muscle do not. However, hibernating muscle will take up radioactively tagged sugar molecules in the area where rubidium wasn’t absorbed. If the scan shows the heart muscle is receiving normal blood flow, it’s likely that the patient’s discomfort stems from a source other than the heart.

When blood flow to heart tissue is stopped, healthy tissue dies and is replaced by scar tissue. However, a temporary blockage of blood flow can cause the heart muscle to go into shock. Although it appears dead, the muscle is only stunned in this instance.

Ever sat too long in one position only to struggle to get up, your leg refusing to move normally for a few minutes? You’ve likely impinged a nerve, causing this discomfort. This is similar to what happens with a stunned heart.

When stunned, the heart’s been deprived of oxygen, causing it to beat irregularly. Sometimes, when a trickle of blood is able to keep stunned heart muscle alive for a prolonged period of time, the muscle is said to be hibernating. This is of great interest to cardiologists, because hibernating heart tissue usually recovers when blood supply is restored.

Optical Coherence Tomography (OCT)

Optical coherence tomography (OCT) produces highly accurate images of the artery wall using reflection from light rays. Various tissue components reflect light differently, enabling all tissue layers to be clearly differentiated from each other. OCT can be used to determine the thickness of the fibrous cap, as well as contact between a stent and its vessel wall. However, blood flow to the artery must be temporarily stopped to conduct the test. Despite the outstanding image quality provided by OCT, it’s not widely used in the United States.

Fractional Flow Reserve

This invasive stress test involves threading a long, narrow tube, or catheter, through a blood vessel in the arm or leg and into the heart.

With the help of an x-ray machine and contrast dye that’s injected through the catheter, doctors can measure the pressures on both sides of a blockage to determine its functional significance. Doctors also can confirm the presence of CAD and other heart diseases.

This test has been extensively studied and is used to determine those who would benefit from a stent or CABG.

Blood Tests

C-reactive protein (CRP) is a marker of inflammation. Produced in the liver, its level rises when there’s inflammation in the body. Since inflammation is associated with the development of atherosclerosis and the rupture of vulnerable plaques (an occurrence that precipitates a heart attack), it’s important to measure this substance.

An easy way to do this is through an inexpensive test to measure CRP levels in the blood known as high-sensitivity CRP (hsCRP). This test is helpful in refining individual estimates of the risk of developing CAD and the risk of having a second heart attack. The higher the CRP level, the higher the risk.

Don’t panic if your levels are high. You can lower them through losing weight, exercising, quitting smoking, improving your diet, or taking aspirin and/or statins.

The post 3. CAD Diagnosis and Testing appeared first on University Health News.

Among the conditions are having a heart attack, diseases that affect the heart muscle, high blood pressure, diabetes, heart valve diseases, congenital heart disease, medications, lung conditions, being overweight, and alcohol or drug abuse, plus air pollution—not a disease but an environmental risk factor that has now been linked with heart failure. More than half of all Medicare patients with heart failure have four or more other non-cardiovascular risk factors. A family history of heart failure is also a risk factor. In fact, The Framingham Heart Study showed a 70 percent increased risk for heart failure in people who had a parent with heart failure.

Heart Attack

A heart attack happens when a chain of events culminates with a blood clot that cuts off most or all of the blood supply to the heart. When the flow of blood slows or stops, the area of heart muscle fed by that artery does not receive nourishment from oxygen-enriched blood. The more time that passes without treatment, the greater the damage to the heart.

Plaque: Hard vs. Soft

Fatty deposits (plaques) caused by atherosclerosis (hardening, narrowing of arteries) can interfere with blood flow in two ways. In one form, they grow slowly, becoming hard over time, gradually reducing the diameter of the artery. Patients with hard plaques experience chest pain (angina pectoris) when they exercise, exert themselves, or consume a big meal. How well you sleep can affect your risk of atherosclerosis (see “Poor Sleep Linked to Atherosclerosis”).

A second type of plaque is even more dangerous. This plaque has a soft, fatty (lipid) core covered by a fibrous cap. The cap may rupture, releasing a variety of substances into the bloodstream that cause the blood to clot. If the clot blocks the flow of blood, a sudden heart attack occurs. Blood flow has to be restored quickly to prevent part of the heart muscle from dying, causing scarring and permanent damage. Damaged areas of heart muscle cannot contract. As a result, the heart cannot squeeze as strongly as it did prior to the damage.

Angina: Stable vs. Unstable

Angina is a chest discomfort or pain that occurs when the muscle is not receiving enough blood. Stable angina disappears with rest and can be treated with medications to dilate and relax the arteries.

As the disease progresses, stable angina may become unpredictable and more frequent, and it may begin to occur at rest. This is called unstable angina, and it can be the precursor to a heart attack.

Unstable angina often is treated in the catheterization lab with balloon angioplasty and stenting, or by coronary artery bypass surgery. Even with treatment, however, a heart attack may occur. If it does, it may lead to a weakened heart muscle and heart failure.

Heart Muscle Problems

Up to half of all heart failure cases are caused by cardiomyopathies—diseases that primarily affect the heart muscle. Cardiomyopathies often occur without a known reason, but they also can be caused by various medical conditions, including infections (usually viral), metabolic disorders, endocrine disorders, and adverse reactions to medications. Cardiomyopathy may have an autoimmune or genetic component and can be associated with alcohol or drug abuse, pregnancy, and prior radiation or chemotherapy.

Patients who have heart failure due to cardiomyopathy may want to encourage their children to be screened. The chance they have not inherited an increased risk of heart failure is very good. However, if early signs of heart failure are found, medications and lifestyle changes can delay its development.

Studies now underway—specifically those focused on genetic mutations associated with cardiomyopathies—may allow earlier diagnosis and treatment. They may also describe preventive measures to delay or prevent the development of heart failure.

Types of Cardiomyopathies

In dilated cardiomyopathy, all chambers of the heart enlarge (dilate), and the ability of the left ventricle to contract is weakened. More blood than normal remains in the enlarged ventricle after a heartbeat, meaning that less blood is pumped out with each contraction.

In hypertrophic cardiomyopathy, the muscle mass and thickness of the left ventricle increase, which decreases the interior size of the ventricle.

In hypertrophic obstructive cardio­myopathy, the wall between the two ventricles becomes enlarged and obstructs blood flowing out of the left ventricle.

In non-obstructive hypertrophic cardiomyopathy, the thickened muscle does not obstruct blood flow and may contract vigorously, but it becomes stiff and is unable to relax normally. This causes improper filling between heartbeats: Less blood enters the ventricle, so less blood is pumped out. Improper filling causes blood to back up in the veins of the lungs, where it produces elevated blood pressure.

Restrictive cardiomyopathy is a different, uncommon form of the disease. It happens when the heart is stiff and cannot fill properly, even though its pumping strength may be normal. An insufficient amount of blood enters the heart, so too little is pumped out. This form may be caused by abnormal scarring (fibrosis), abnormal infiltration of the heart muscle with iron or protein, or an unknown reason.

Arrythmogenic right ventricular dysplasia is a rare, often inherited, form of cardiomyopathy in which the muscle tissue in the right ventricle dies and is replaced with fibrous scar tissue. This disrupts the normal conduction of electrical signals in the heart and can cause arrhythmias. It most commonly affects teenagers or young adults.

High Blood Pressure

Almost half of Americans have high blood pressure (HTN), and one in five adults don’t know they even have it, according to the Centers for Disease Control and Prevention. Taking medications as prescribed is a problem for many patients, and it’s estimated that nearly 30 percent of patients who have high blood pressure don’t control their condition with medications. There are many reasons why heart failure may occur, and high blood pressure is a major culprit.

An Inside View

When the heart pumps, pressure is created to expel blood by way of arteries and capillaries to nourish the entire body. Veins bring the blood back to the heart. In the first phase, called systolic pressure, blood is forced out of the heart and pressure is at its peak. In the second (diastolic) phase, the heart fills and pressure is at its lowest. These two pressures are represented in numbers—such as 130 over 80 (130/80). Systolic is the top number; diastolic, the lower figure.

Elevated blood pressure can create tiny tears in arteries. This enables substances in the blood, such as fat and cholesterol, to stick more easily to arterial walls. The substances cause arteriosclerosis, which forces the heart to work harder to circulate blood.

High blood pressure is common as we get older because blood vessels naturally thicken and stiffen over time. This age-related trend might lead some people to believe that it’s okay to skip medications and to stop taking regular readings.

Some of those with elevated blood pressure may feel perfectly fine. But high blood HTN is a silent predator that can strike without notice and result in serious, life-altering consequences.

New Guidelines. Based on American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, high blood pressure should be treated earlier with lifestyle changes and in some patients, with medication, at 130/80 rather than 140/90.

Newer guidelines—the first since 2003—lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition has resulted in nearly half of the U.S. adult population having high blood pressure.

In a person who has high blood pressure, there is more resistance to the flow of blood through the arteries, so the heart has to work harder to push blood through the body. It’s like adding weight to a barbell—adding more weight makes the barbell harder to lift.

About 75 percent of people with heart failure have a history of hypertension, and the lifetime risk of developing heart failure with a blood pressure higher than 160/90 is double that of blood pressure lower than 140/90 millimeter of mercury (mmHg).

Although up to 90 percent of people ages 80 and older have some degree of hypertension, it is not normal, and it greatly increases the risk of heart attack or stroke. Using medications to bring blood pressure down below 120/80 mmHg can reduce the risk of heart failure, even in the very elderly.

Controlling High Blood Pressure. Lifestyle modifications can lower blood pressure, in some cases as much as 20 points. Lifestyle changes should be the first course of action. Here are five specific suggestions:

• Lose weight if you are overweight.
• Stop smoking.
• Follow the DASH diet (Dietary Approaches to Stop Hypertension).
• Limit salt intake to 2,300 milligrams (mg) per day.
• Break a sweat with exercise at least 30 minutes a day most days of the week.

The next course of action is medications, which should be started if blood pressure readings are in the 140s. Work with your doctor in evaluating your tolerance to a new medication and reporting blood pressure changes, if any. Take your blood pressure daily, in the morning, and keep a written log.

In addition, HTN should be regularly monitored and managed by a physician. The length of time between follow-up appointments will be based on your current health and other medical conditions.

A primary care physician can initiate and manage therapy. However, if your blood pressure is difficult to treat or if other conditions complicate medication choices, you may be referred to a cardiologist.

Diabetes Connection

Diabetes has long been recognized as a risk factor for heart failure. Because heart failure tends to occur at an older age, when type 2 diabetes is the predominant type, the connection between type 2 diabetes and heart failure has been confirmed. Here are key takeaways from recent and relevant research:

• Men with type 2 diabetes have a 2.4-fold increased risk of developing heart failure, and women with type 2 diabetes have a five-fold increased risk, based on findings of the Framingham Heart Study. The presence of other risk factors, such as coronary artery disease or hypertension, further increases the risk.
• People with diabetes or prediabetes who are hospitalized with heart failure have an increased risk of dying in the hospital and require intensive glucose control to lower the risk. The study, published in Diabetes Care, May 2016, included more than 13,000 subjects in the Atherosclerosis Risk in Communities study.
• Type 1 diabetes quadruples the risk of heart failure, although the risk is still low among young adults. This study was the first time the role of type 1 diabetes was clearly defined. When type 1 diabetes is poorly controlled, the risk is even greater—10 times that of people without diabetes. The study was published in The Lancet Diabetes & Endocrinology, November 2015. A more recent study published in the journal Circulation in June 2018 also found that the risk of death from heart failure was higher in patients with type 1 diabetes than with type 2 diabetes.
• The drug Metformin, already used to treat type 2 diabetes, also may be effective in treating heart failure, according to a study published in the Journal of General Physiology (see “Diabetes Drug Metformin Could Help Heart Failure Patients”).
• Women with type 1 diabetes have a higher risk of heart failure than men with type 1 diabetes. The risk was especially high among women between the ages of 35 and 59. The study appeared in The Lancet Diabetes & Endocrinology, September 2015.
• Approximately 40 to 50 percent of heart failure patients have chronic kidney disease, a common complication of diabetes. The severity of renal dysfunction is associated with an increased risk of death, according to a study in Circulation, July 2016.

A study published in late 2018 revealed that a molecule called methylglyoxal builds up in heart muscle tissue and interferes with its ability to contract normally (see “Diabetic Cellular Changes May Cause Heart Failure”).

Heart Valve Disease

Your heart moves 83 or more gallons of blood through your body every hour. For that astounding amount to make its way through the heart and the rest of your body, every moving part has to work perfectly. But sometimes those parts don’t work perfectly, and the cause is often related to the heart’s four valves.

• Mitral and tricuspid valves control the flow of blood between the upper and lower chambers of the heart. They are the valves most likely to be affected by heart valve disease.
• The pulmonary valve controls the flow of blood from the heart to the lungs.
• The aortic valve controls the flow of blood between the heart and the aorta as it makes it way to blood vessels in the rest of the body.

10 Risk Factors

Ten may not be an absolute number, but it’s close. Whether you call them causes or risk factors, they include:

• Age (heart tissue may degenerate with age)
• High blood pressure
• Atherosclerosis
• Bacterial infection (of the inner lining of the heart muscle and heart valves)
• Heart disease or heart attack (that can damage muscles that control heart valves)
• Radiation therapy
• High cholesterol
• Diabetes
• Congenital heart disease
• Medications (for migraine headaches and some diet drugs)

Effects on Heart Valves

The Texas Heart Institute identifies two types of problems that can disrupt the flow of blood through the valves.

• Regurgitation (backflow) happens when a valve doesn’t close properly, causing blood to leak backward instead of moving forward. The heart compensates by working harder, which eventually leads to an enlarged heart that is less able to pump blood.
• Stenosis is a narrowing caused by the valves’ flap-like door not opening properly. The valves may become thickened, stiff, or fused and do not open fully, causing the heart to have to work harder to pump blood through the narrowed opening.

The National Heart, Lung, and Blood Institute adds a third problem called atresia, which happens if a heart valve does not have a clear opening through which blood can pass. Instead of an opening, there is a sheet of tissue that obstructs blood flow between chambers. Babies born with this condition may have a hole between the ventricles so that some blood can get through.

There are no medicines that can cure heart valve disease, but there are ways to relieve its symptoms through lifestyle choices such as not smoking, eating low-salt, low-fat foods, and taking prescribed medications. Valve surgery can repair or replace a defective valve.

Congenital Heart Defects

The ACC says there are at least 18 known distinct types of heart defects, with many more anatomic variations. They range from relatively minor issues to complex, life-threatening problems. Some heart defects do not need immediate attention, but others may require surgeries. For the first time, more adults are living with congenital heart disease than children.

Adult congenital heart disease normally takes one of two forms. The first is a defect with no symptoms early in life that becomes associated with symptoms later in life. The second is a complex defect repaired during childhood that requires further repair or new treatment in adulthood.

Because repaired congenital heart defects can still cause problems later on, patients with a defect repaired in childhood need regular cardiac care throughout their lives. Occasionally, an adult will experience symptoms of a more complicated defect for the first time as an adult.

In addition to heart failure, people with a congenital heart defect have an increased risk for other heart problems, including stroke, pulmonary hypertension, and arrhythmia.

Common Congenital Defects

The most common types of minor congenital heart defects diagnosed in an adult are septal defects, valve defects, and narrow blood vessels, according to the University of Ottawa Heart Institute.

• Holes in the Heart (Septal Defects). A septal defect can occur between the two pumping chambers (ventricles) of the heart, or between the two filling chambers. With either type, oxygenated blood coming from the lungs gets mixed with deoxygenated blood returning from the body. A serious complication of septal defects occurs when the direction of the mixing of blood causes the blood supply leaving the heart to contain less oxygen than normal.
• Heart Valve Defects. A valve in the heart may be unable to open completely or unable to close completely due to a defect, or the valve may be abnormally shaped.
• Narrow Blood Vessels. Blood vessels can be too narrow or they can be connected incorrectly, sending deoxygenated blood to the body or already oxygenated blood back to the lungs.

Cancer Drugs and Radiation

Some chemotherapy cancer drugs may be toxic to the heart muscle cells and increase the risk of heart failure. These include doxorubicin (Adriamycin), bevicizumab (Avastin), mitomycin (Mutamycin), mitoxantrone (Novantrone), sorafenib (Nexavar), sunitinib (Sutent), and trastuzumab (Herceptin). The angiotensin-receptor blocker candesartan (Atacand), a common heart medication, may help preserve the heart’s function in patients who have just begun taking chemotherapy drugs.

Treatment with radiation for lymphoma, and breast, lung, or esophageal cancer also can result in heart failure, particularly when radiation is given in conjunction with one of the above drugs or given to patients with other risk factors for developing heart failure. Patients who take these chemotherapy agents should be monitored regularly for signs of cardiac dysfunction.

Lung Conditions

In patients with heart failure, chronic obstructive pulmonary disease (COPD) is a consistent predictor of hospitalization and death. Research has shown that this is particularly true for women.The two conditions are connected, and shortness of breath is the hallmark symptom associated
with both.

In heart failure, fluid levels and blood can back up into both the heart and lungs, leading to shortness of breath.

COPD is a chronic, progressive condition that slowly damages the tissues of the lungs. The conditions that cause COPD, such as chronic bronchitis and emphysema, result in irritation and damage to airways or air sacs, making it difficult to breathe.

People with COPD are short of breath when they are physically active. When they exhale, the damage prevents oxygen from being fully released before the next breath is taken.

If you are having shortness of breath for whatever reason, see a physician to get a correct diagnosis and treatment. A study at the University of British Columbia found that permanent damage caused by COPD starts earlier than previously thought—even before patients begin to show symptoms (see “Permanent Damage Caused by COPD Starts Earlier Than Previously Thought”).

Obesity: It’s a Paradox

Obesity increases the risk of developing other risk factors for heart disease. It triggers inflammatory processes that can lead to atherosclerosis, and it can change the structure of the heart. Among its other negative effects are hypertension, elevated cholesterol, type 2 diabetes, metabolic syndrome, enlarged heart, increased stress on the heart, and the list goes on.

Then there’s the obesity paradox. While study after study has shown that obesity dramatically increases the risk of heart failure, a significant number of studies have shown that persons who are overweight or obese have lower mortality rates related to heart failure compared to people of normal weight. They are more likely to have heart failure, but less likely to die from it. It is a paradox that has perplexed the medical community
for decades.

The Paradox Debunked?

In 2018, the obesity paradox was challenged by a study of nearly 300,000 people published in the European Heart Journal. The research showed that the risk of heart and blood vessel problems, such as heart attacks, strokes, and high blood pressure, increases as body mass index rises beyond healthy levels. The cardiovascular disease risk also increases steadily the more fat a person carries around their waist (see “Excessive Waist Fat Is a Risk Factor for Cardiovascular Disease”).

The new evidence, according to the authors, refute previous conflicting findings. They add, “Any public misconception of a potential protective effect of fat on heart and stroke risks should be challenged.”

Air Pollution

The AHA is on record stating that exposure to air pollution contributes to cardiovascular illness, including heart failure and mortality. Short-term exposure can increase the risk of heart attack, stroke, arrhythmias, and heart failure in susceptible people.

The risk is greater from long-term exposure. Air pollution may play a role in high blood pressure, heart failure, and diabetes. A study published in 2018 found a correlation between living near a busy road, which exposed residents to a pollutant, and having enlarged hearts (see “Low-Level Air Pollution Correlated with Heart Enlargement in Adults”).

Other Causes

The following conditions also are associated with the risk of heart failure:

• Heart valve infection
• Inflammation of the heart muscle
• Untreated rapid heart rhythms
• Anemia
• Pregnancy
• Hyperthyroidism
• Emphysema
• Sleep apnea

A Heart Remodeled

The extra workload on the heart causes the heart muscle to thicken, a process that occurs naturally with any muscle that is exercised. Unlike a bicep in the upper arm, a thickened heart muscle is not good. As the heart walls become thicker, the heart demands more oxygen and it becomes more difficult for the muscle to relax. These conditions cause the body to release various hormones, peptides, and inflammatory substances.

These neurohormonal changes lead to a phenomenon called remodeling, in which the left ventricle (the heart’s main pumping chamber) becomes enlarged, and the individual heart muscle cells change size and shape. Having the walls of the heart stretch may be beneficial at first, but like an overstretched rubber band, they eventually become too stretched to contract adequately.

Remodeling triggers an increase in heart rate initially, which helps the heart pump out more blood. Because it raises the demand for oxygen in the heart muscle, it may lead to myocardial ischemia—an inability to deliver enough oxygen-rich blood to the heart muscle.

Reduced blood flow to the inner layer of the heart muscle further impairs heart function. The increased heart rate has the potential to directly damage heart muscle.

Unless an attempt to restore balance is made, the cycle continues. The heart tries to compensate, and in time these efforts cause increasing damage. Eventually, heart failure may progress to the point where the heart no longer can compensate for the stresses placed on it. Breathlessness and fatigue become so severe that hospitalization is necessary.

At this point, heart failure is said to be decompensated, or acute. It implies a rapid onset of symptoms. American Nurse Today describes acute decompensated heart failure as a condition in which cardiac output fails to meet the body’s metabolic needs. It requires immediate treatment because it impairs organs and jeopardizes their function.

What’s Next?

A person can have heart failure and not even know it until symptoms develop. Chapter 3 describes the symptoms and what they mean.

The post 2. Underlying Causes and Conditions appeared first on University Health News.

High blood pressure, also known as hypertension, is an all-too-common condition that can lead to a wide range of health problems. It’s one of the leading enlarged heart causes, as well as a major risk factor for some serious cardiovascular health complications.One of the most misleading things about high blood pressure is that it’s usually present without obvious symptoms, says Washington University cardiologist Lynne Seacord, MD.

“Many people fail to treat their high blood pressure because they can’t ‘feel’ that it’s high,” Dr. Seacord says. “Even when they’re told it’s high, they think, ‘Well, I don’t need to treat it because I feel fine.’ Yet, it is high and causing a lot of changes, including their risk of heart attack, stroke, and heart failure later in life.”

To avoid taking hypertension too lightly, it helps to understand what blood pressure itself is—and also what high blood pressure is.

What Does Blood Pressure Represent?

Blood constantly travels through the arteries and veins throughout your body. The arteries deliver oxygenated blood to your tissues and organs, while veins bring oxygen-depleted blood back to the heart.

The force of blood flow against the interior walls of the arteries is your blood pressure. The pressure rises and falls with every heartbeat. When your heart contracts and squeezes blood out through the aorta and pulmonary artery, the pressure is at its highest. When the heart relaxes and fills up with blood in between each heartbeat, the pressure is at its lowest.

That’s why you get two numbers on your blood pressure reading. The top number is the systolic pressure—the force of blood as it’s being pushed through your arteries. The bottom number is the diastolic pressure, the force the bloodstream exerts when the heart is at rest.

Know Your Numbers

So what is normal blood pressure, and what is high blood pressure?

According to the American Heart Association, a healthy or normal blood pressure is a systolic pressure of less than 120 mm Hg (millimeters of mercury) and a diastolic pressure of less than 80 mm Hg.

High blood pressure starts when your systolic pressure gets to 140 mm Hg or your diastolic is at least 90 mm Hg. In between—a systolic pressure of 120 to 139 mm Hg or a diastolic pressure of 80 to 89 mm Hg—is a condition known as prehypertension. It should be considered a red flag that your blood pressure needs attention.

Those standards underwent a revision in late 2017, when new hypertension guidelines issued by the American College of Cardiology (ACC) and American Heart Association (AHA) redefined the threshold for high blood pressure.
The new thresholds, as described in our post New Hypertension Guidelines: Rethinking Blood Pressure Standards, look like this:

• Normal: Less than 120 mmHg systolic and less than 80 mmHg diastolic
• Elevated: 120 to 129 mmHg systolic and less than 80 mmHg diastolic
• Hypertension Stage 1: 130 to 139 mmHg systolic or 80 to 89 mmHg diastolic
• Hypertension Stage 2: systolic pressure of 140 mmHg or higher or diastolic pressure of 90 mmHg or higher
• Hypertensive urgency: Systolic blood pressure greater than 180 mmHg and/or diastolic pressure greater than 120 mmHg
• Hypertensive emergency: Systolic blood pressure greater than 180 mmHg and/or diastolic pressure greater than 120 mmHg, plus target organ damage

It’s important to note that not all medical care providers have adopted the new standards. One thing is for sure, though: If your blood pressure reaches 180/110 mm Hg, that’s considered a hypertensive crisis and it requires emergency care.

Avoid High Blood Pressure Complications

Now that you understand high blood pressure from a numbers standpoint, consider what’s happening to your heart and blood vessels if you have hypertension.

When blood pressure is elevated for a long time, all that additional force against the arterial walls takes a toll. Arteries narrow and become less elastic—a condition called atherosclerosis, or hardening of the arteries. This situation is made worse as plaque made up of cholesterol, fats, and other substances builds up in the arteries.

Atherosclerosis in the arteries supplying your heart muscle with blood is called coronary artery disease (CAD), and can lead to a heart attack. If the narrowing occurs in the arteries supplying your brain with blood, the possible consequence is a stroke. In the legs, it’s called peripheral artery disease (PAD).

Hard-Working Heart: Health Issues

Hypertension also makes the heart work harder. Overwork leads to cardiomegaly, also known as an enlarged heart. Causes of cardiomegaly also include CAD, but the main culprit is high blood pressure. An enlarged heart doesn’t pump blood as effectively as it should throughout the body. This can lead to heart failure.

Research led by João Lima, MD, director of cardiovascular imaging at the Johns Hopkins School of Medicine’s Heart and Vascular Institute, found that pre-hypertension and even blood pressure at the high end of the normal range, can cause problems that can weaken the heart muscle and its pumping ability.

“Our results suggest the heart muscle may be more exquisitely sensitive to the effects of even subtle elevations in blood pressure than we thought,” Dr. Lima says.

Heart valve disease and kidney disease are other enlarged heart causes, but both those problems are made worse by high blood pressure.

High blood pressure is also associated with such issues as memory loss, erectile dysfunction, kidney damage, fluid in the lungs, and even vision problems.

What Is High Blood Pressure? Treatment Options

A regular exercise routine goes a long way in keeping your blood pressure under control.

As Dr. Seacord noted, just because you “feel fine” doesn’t mean the numbers of your blood pressure reading can be ignored. If you haven’t had your blood pressure checked lately, have it done soon. And if your doctor is telling you to manage your blood pressure, pay attention and follow his or her instructions carefully. (See our post “Blood Pressure Chart: Where Do Your Numbers Fit?.”

Many people need more than one medication to control blood pressure, so be prepared for a little trial and error to find out which combination is best for you. The good news is that if you can maintain a healthy weight, cut back on your sodium intake, and exercise most (if not all) days of the week, you may be able to keep the medications to a minimum. (See also “What Blood Pressure Is Too High?”)

High blood pressure can usually be brought back down to normal levels, but not on its own. Taking care of your blood pressure means taking care of more than just your heart and blood vessels. It means improving your overall health and quality of life.

The post What Is High Blood Pressure—and Why Do Your Numbers Matter? appeared first on University Health News.

Unfortunately, there often aren’t obvious enlarged heart symptoms when the condition is first developing. But some enlarged heart causes, including symptoms of heart attack, bear unmistakable signs.

Cardiomyopathy Types

There are actually several different types of cardiomyopathy. They include the following:

• Hypertrophic cardiomyopathy: An enlargement of the heart muscle without an obvious cause.
• Dilated cardiomyopathy: An enlargement and weakening of the ventricles, which can lead to heart failure, arrhythmias and blood clots.
• Restrictive cardiomyopathy: Reduced blood volume filling the ventricles, which become stiff but not thick.
• Arrhythmogenic right ventricular dysplasia: A rare but serious disease in which the right ventricle’s muscle is replaced with more fibrous and fatty tissue. It often leads to arrhythmias.

There are other types of cardiomyopathy, usually categorized under “unclassified cardiomyopathy.” Some people with mild cardiomyopathy may never experience any enlarged heart symptoms, while others develop very serious complications. Typically, the cause of your cardiomyopathy determines the severity of symptoms and the type of treatment that you’ll need.

There are two basic enlarged heart causes. It can either be inherited or acquired. Inherited, as you might surmise, means the condition is part of the genes passed on to you from your parents. Hypertrophic cardiomyopathy is often inherited, though it can develop in older adults.

Dilated cardiomyopathy is sometimes inherited, but is usually the result of coronary artery disease, high blood pressure, a heart attack, or other heart condition. A viral infection that causes inflammation of the heart can also lead to dilated cardiomyopathy. The condition in women is also sometimes related to complications during the last months of pregnancy.

Causes of an Enlarged Heart

The causes of restrictive cardiomyopathy range from connective tissue disorders, such as Marfan syndrome and cellulitis, to cancer treatments, such as chemotherapy and radiation. Other health problems, such as amyloidosis (a buildup of certain proteins in the heart and other organs), can also result in restrictive cardiomyopathy.

Arrhythmogenic right ventricular dysplasia is thought to be an inherited enlarged heart cause.

In the early stages of cardiomyopathy, you may not notice any enlarged heart symptoms. But as the condition develops, you may experience heart failure-like symptoms, such as shortness of breath, fatigue, and swelling in the legs and feet (and possibly in the neck and abdomen). Dizziness or lightheadedness may also occur, and arrhythmias may also develop over time.

See also these University Health News posts on heart health:

• “The Four Heart Problem Symptoms You Shouldn’t Ignore“
• “Fluttering, Pounding, Skipping a Beat. . . What Do Heart Palpitations Symptoms Mean?“
• “Mild Heart Attack Symptoms: What Do They Mean?“

Originally published in April 2016 and updated.

The post Cardiomyopathy: What Causes an Enlarged Heart? appeared first on University Health News.

“There is no bundle of tests that are right for everyone,” explains cardiologist Deena Goldwater, MD, PhD, Ronald Reagan UCLA Medical Center. “The tests ordered depend upon a patient’s symptoms.”

Symptoms and Common Heart Tests

Unexplained chest pain, shortness of breath, and irregular heartbeats are a few of the symptoms that would indicate the need for a specific heart test.

Electrocardiogram (EKG or ECG). This test checks the heart’s electrical system and heart rhythm. It shows how fast the heart is beating and whether its rhythm is steady or irregular. An EKG can show if the heart has been damaged by a previous heart attack, if there is a heart rhythm disturbance, an enlarged heart, or a valve problem. For this painless test, several adhesive electrodes are attached to a patient’s chest, upper arms and legs, and all that is connected to a machine. The heart’s electrical data are recorded on a graph, which shows electrical signals passing through the heart.

Stress Tests. The most common type of stress test involves walking on a treadmill or riding a stationary bike with ECG electrodes attached to the patient during the activity. The test is used to assess how healthy the heart is for exercise. It’s especially useful after a heart attack, or after a long period of being sedentary. A stress test can also help determine the cause of chest pain because chest discomfort from coronary artery disease (CAD) is usually triggered by exertion. Some heart patients may be asked to repeat stress tests to assess whether medications are working, or if CAD is getting better or worse.

Echocardiogram. This test is typically ordered when a doctor suspects there may be a problem with heart valves or chambers. An echocardiogram uses high-frequency ultrasound. A computer translates the ultrasound into a moving image on a monitor. To conduct the test, a technician spreads cool gel on a patient’s chest and gently presses a device against the skin, painlessly sending the ultrasound beam to the heart. The test reveals the shape, size, position and motion of cardiac structures, including the thickness of ventricle walls, the condition of heart valves, or the presence of abnormal openings between the chambers of the heart. This test can also be combined with a technology known as a Doppler echocardiogram, which reveals how blood flows through the chambers and valves of the heart. It is a useful test when blood flow problems are suspected.

Coronary angiogram. This invasive test requires a thin flexible tube to be inserted into a blood vessel in the groin, elbow, or wrist. The tube is directed to the coronary arteries. A contrast dye is used with an x-ray picture to detect blockages due to plaque. The test is typically for patients who have stable or unstable angina (chest pain caused by decreased blood supply to the heart), or have had a heart attack, and their condition is not getting better. It’s also for patients who are suspected to have CAD but non-invasive tests haven’t detected it.

Risk Assessments and Preventing CAD

A lipid profile is a blood test that reveals how much cholesterol is in the blood. The body needs some cholesterol, but if it’s too high, there’s risk for developing CAD. Lowering cholesterol, and heart attack risk from it, can often be achieved through lifestyle changes, such as losing weight, quitting smoking, exercising, and eating a heart-healthy diet.

Understanding your risk for a first-time cardiovascular event like a heart attack or a stroke is important. Dr. Goldwater recommends seeing your physician to calculate your 10-year and lifetime risk. The results of this screening test can inform recommendations on lifestyle modifications or medications.

The post Common Heart Tests appeared first on University Health News.

Cinnamon?In addition to antioxidant and antimicrobial activity, cinnamon is now hailed for its power to improve insulin sensitivity and reduce blood glucose levels. It’s also been shown to lower cholesterol and triglyceride blood levels. Unfortunately, the data have been inconsistent. Nevertheless, even small amounts of cinnamon may be effective. One study showed that the equivalent of just one-half teaspoon of cinnamon powder twice daily before meals lowered glucose and cholesterol levels. Another found that the equivalent of a teaspoon a day lowered fasting glucose in people with diabetes.

Curry Powder?The current flurry around curry centers on its primary ingredient, turmeric, which contains curcumin, a powerful polyphenol with antioxidant properties. Curcumin lends the spice its distinctive flavor and vivid yellow color.

In a study in Endocrinology in July, Columbia University researchers reported that curcumin reduced inflammation and lessened the chances that obese mice would develop type 2 diabetes. Furthermore, in the mice that did get the disease, curcumin still lessened insulin resistance, improved blood sugar levels, decreased body fat and increased muscle mass.

More exciting studies target heart disease and cancer. Canadian scientists gave curcumin to mice with enlarged hearts. Not only did it lower the incidence of heart failure (a common outcome of an enlarged heart), but it reversed the condition, restoring heart function. Curcumin also has the ability to stop tumor growth and promote tumor cell breakdown, particularly in colorectal cancer cells.

Earlier animal research suggests curcumin may help prevent rheumatoid arthritis, psoriasis and Crohn’s disease. Its extract blocks bone breakdown, reducing the risk for osteoporosis. Now, scientists are looking at curcumin and Alzheimer’s disease. In India?where people eat two to four grams (about one teaspoon) of turmeric daily?Alzheimer rates are one-quarter what they are in the U.S.

It’s a leap from mice to men, of course, but it’s an exciting new avenue of research. Currently, 10 studies are underway in humans. In the meantime, cotton up to curry in cooking.

Ginger?This Asian spice, which has been used as a medicinal herb for centuries, has a reputation for preventing and soothing the nausea associated with motion sickness, pregnancy and chemotherapy. Its most active and pungent compounds are called gingerols, touted as potential cancer and inflammation fighters but, so far, the preliminary evidence is sketchy.

Oregano?Aside from its supreme antioxidant abilities (oregano has up to 20 times the antioxidant activity of other herbs, and ounce-for-ounce beats out apples and oranges), oregano is a potent anti-inflammatory agent too. That’s what German and Swiss researchers found recently when they gave oregano’s active ingredient to mice with swollen paws. The swelling subsided in up to 70% of the mice.

Rosemary?Rosemary is a robust herb that adds oomph to dishes, but can it crack down on cancer? Scientists think so, at least a concentrated extract of the herb might. Some researchers believe oregano can block dangerous carcinogenic compounds called heterocyclic amines (HCA) from forming during cooking.

A Kansas State University food scientist, motivated by a study showing that marinades made with rosemary, thyme and other spices could cut HCA in grilled steak by 87%, tried rosemary extract alone. Bingo. The rosemary wiped out any trace of HCA in the cooked beef patties, and without a strong rosemary taste. Researchers credit phenols with protective antioxidant, anticarcinogenic and anti-inflammatory effects.

Saffron?This spice is what turns rice yellow in the Spanish dish paella. Both the petal and sought-after stamen of saffron have shown potent antidepressant effects in several studies. In fact, a few studies found that 30 milligrams of saffron was just as effective as commonly prescribed fluoxetine (Prozac, Sarafem) and imipramine (Tofranil) for treating mild-to-moderate depression. Other research suggests saffron has anticarcinogenic properties.

Sage and Thyme?Both sage oil and thyme oil are thought to help maintain and protect brain function. Early research on rats suggests thyme oil works as a brain antioxidant, protecting polyunsaturated fatty acids and omega-3 fatty acids from oxidation as the brain ages. Sage oil’s antioxidant powers may improve cognitive function in mild-to-moderate cases of dementia. In healthy adults, sage oil has been shown to improve mood and performance on simple tasks.

The Bottom Line. Ancient cultures have been using herbs and spices to prevent and treat illnesses for thousands of years, but only recently have Western scientists begun to substantiate some of these claims as well as discover new benefits.

Keep in mind, however, that much of the research has been in animals so far, and many studies use extracts, concentrates and supplements in amounts impossible to consume, fresh or dried. So researchers need to study these herbs and spices in humans in everyday amounts before recommendations can be made.

Nonetheless, it’s becoming clear that there are benefits to be had from enjoying a healthful and flavorful dose of herbs and spices in your food. Bon appetit!

The post Spice Up Your Cuisine To Help Protect Against Heart Disease, Cancer, Diabetes appeared first on University Health News.

The post A Toast To Better Health? The Heart May Say Yes, But The Head Hesitates appeared first on University Health News.