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Heart Smart

Knowledge and prevention are key for preventing heart disease.

There are two ways to become a statistic when diagnosed with heart disease—either die from it or survive it. While some potentially fatal diseases can’t be prevented and occur without explanation, heart disease isn’t one of them.

Considering that one of every four deaths in the U.S. each year is from heart disease and that it’s the leading cause of death for both men and women, it may be time to consider taking preventive measures. Adopting a healthy lifestyle, reducing blood pressure and cholesterol, managing or eliminating diabetes, and stopping smoking could reduce heart attack, stroke, and all types of heart disease by 60 to 80 percent. Additionally, today’s rushed, high-stress lifestyle leaves little time to focus on a proper diet and exercise, and is now considered another primary reason for heart disease. While many patients will report their heart issues came on suddenly, that’s not usually the case.

Most people start to notice a decline in the function of their heart in their 30s and 40s if they aren’t taking good care of themselves and are often under high stress, and heart disease will typically catch up to most people in their 50s. High blood pressure and cholesterol don’t usually appear suddenly, but instead, build up through the years. Therefore, it’s important to make your annual check-ups, pay attention to warning symptoms, and adopt a healthy lifestyle early on–even if you are feeling well.

It’s important to make your annual check-ups, pay attention to warning symptoms, and adopt a healthy lifestyle early on–even if you are feeling well.

Diabetes, smoking, blood pressure, cholesterol, lifestyle changes, and family history of heart disease are often attributed to a failing heart. While cardiologists can’t do anything about a family history of heart disease, the rest can be addressed, making heart disease one of the most preventable diseases. Cardiologists say that stopping smoking or, of course, never starting the habit is one of the best methods of prevention. Next, get moving. Being active at least three times a week improves vascular tone and blood pressure also affects how fats and sugars are metabolized.

Dr. Eric Eichorn, an interventional cardiologist at Medical City Dallas and at Baylor Regional Medical Center in Plano, says, “I encourage my heart failure patients to lose weight. If their weak heart must carry an extra 50 to 80 pounds around with them every day, it puts additional stress on it. This means patients need to alter their lifestyle by diet and exercise. I also make sure they do not have any sleep-disordered breathing which could contribute to heart failure, risk of heart attack, and rhythm disturbances.”

For patients who present with symptoms of heart disease, Dr. Eichorn routinely checks them for lipid abnormalities which could impact the risk of future heart attacks and/or strokes. “When I first see new patients with heart failure, I make sure their standard medical therapy is maximized,” he says. “Often, I find room for improvement. Standard therapy includes a beta-blocker, an ACE (angiotensin receptor blocker), and an aldosterone antagonist. These therapies all have data supporting their use and increase the chance for survival in heart failure.”

Often, heart disease is related to an issue with the aortic valve. Aortic stenosis is the most common problem with the aortic valve, and the most common reason for valve-related heart surgery. Stenosis, or narrowing of the valve, occurs when calcium builds up on the valve and limits its ability to open when the heart contracts. The normal opening of the aortic valve is roughly the size of a half-dollar; severely narrowed valves have an opening the size of a dime. According to Dr. Todd M. Dewey, surgical director of both structural heart disease and cardiac transplantation at Medical City Dallas Hospital, initial symptoms are mild fatigue or shortness of breath with exertion. As the stenosis progresses and worsens, patients may develop fainting with rapid standing, lower extremity edema, chest pain, shortness of breath at rest, and ultimately death unless treated.

Says Dr. Dewey, “Typically, aortic stenosis is treated with open-heart surgery to completely replace the narrowed valve. The most common type of valves used to replace abnormal aortic valves are either bovine or porcine in origin. These types of valves do not require the use of blood thinners. In medical centers with extensive experience in aortic valve surgery, most patients are treated with a minimally invasive approach that decreases patient discomfort and promotes early return to activity. Percutaneous aortic valve replacement is being performed at the leading cardiac surgical centers around the world. This new technique does not require opening the chest, stopping the heart, or using the heart-lung machine to replace the aortic valve. The valve can be inserted through either an artery in the leg or a small incision between the ribs. This new valve is currently FDA approved for use in patients too old or sick for conventional surgery and likely to receive FDA approval in the near future for higher-risk patients with critical aortic stenosis.”

Most of the damage caused by heart disease can be reversed with a healthy lifestyle, medication, and possibly minimally invasive interventional procedures.

For the tiniest patients, there are no risk factors of heart disease other than being born with it.  Approximately one out of every 150 newborn babies are born with some form of congenital heart disease. “This is not to say that all of those babies require surgical therapy; most do not,” says Dr. Eric Mendeloff, founder of Medical City Children’s Hospital Congenital Heart Surgery Program. “Probably only about one in eight or one in 10 of those will require surgery in the first year of life, but nonetheless, there are a variety of abnormalities that can happen with the heart and it is more common that many people think.”

When to start screening for heart disease varies depending upon age and family history. Most cardiologists recommend initial screenings for heart disease in the 30s, particularly if there is a family history or for early symptoms. Stress tests or heart CT scans are often recommended first. And for those who do get diagnosed with heart disease, there’s plenty of reasons to expect a good outcome. Most of the damage caused by heart disease can be reversed with a healthy lifestyle, medication, and possibly minimally invasive interventional procedures. For proactive patients, heart disease—heart attack, coronary artery disease, heart valve disease, congestive heart failure, etc.–is no longer considered a death sentence as there is a myriad of options to treat these conditions.

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