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Deaths from Heart Disease Decline in US

By vadkins on January 25, 2008 in

USA Today reported this week that the number of people dying from heart disease in the US has fallen:

Heart disease deaths in the USA have fallen below the American Heart Association’s prevention goal for 2010, and deaths from strokes are nearing their own record low, the AHA said Tuesday.

…New government data show that heart disease death rates dropped 25.8% between 1999 and 2005, from 195 to 144 deaths for every 100,000 people, surpassing the AHA’s 25% target reduction. Stroke deaths dropped 24.4%, from 61 to 47 deaths per 100,000.

That adds up to roughly 160,000 lives saved in 2005, Jones says. If the trend holds, the AHA projects that as many as 240,000 lives may be saved this year.

It sounds like the recent advances in cardiology that helped save Jim, are working for many people:

Ridker says improved methods of preventing and treating cardiovascular disease have paid off. "Not only have they reduced the number of events, but when events occur, we’re more likely to survive them," he says.

Donations to the American Heart Association can be made here. They sure have made good use of their funds, and helped save lives.

vadkins

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Broccoli Can Reduce Risk of Heart Attack

By vadkins on January 25, 2008 in

The London Telegraph reports that broccoli may help your heart health:

But the brassica family of vegetables, including cauliflower, broccoli, cabbage and Brussels sprouts, provide antioxidants that prevent the build-up of free radicals.

Broccoli in particular contains sulforaphane, which triggers production of proteins that are part of the body’s cardiovascular defence system.

While researchers have long believed antioxidant substances have health benefits, many studies have failed to show an effect.

The new study, published in the Journal of Agricultural and Food Chemistry, shows a specific mechanism in tests on animals.

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Heart Attack – The Discharge Summary

By vadkins on January 22, 2008 in

In previous posts I detailed most of what was written in Jim’s Boston Medical Center Discharge Summary. Here’s the rest of the information from that summary:

  • Change from admission: improved
  • Major procedures: cardiac catheterization / LAD Vision (brand of stent) (bms) PCI, 1/10/2008
  • Significant Studies / Labs: LDL 109
  • Primary Diagnoses: Acute Coronary Syndrome; Secondary Diagnoses: NSTEMI, Dyslipedemia
  • Clinical Status at Discharge: weight- 225 lb., condition-stable, vital signs normal

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Heart Attack – Specific Discharge Instructions from the Boston Medical Center

By vadkins on January 22, 2008 in

As stated in the post below, Jim was released from the Cardiac Unit of the Boston Medical Center on Friday, 1/11/2008. In addition to the discharge instructions detailed in the post below, he was also told:

  1. No heavy lifting for one week (no more than 10 pounds
  2. No strenuous activities for one week
  3. Diet: Cardiac (low fat, low cholesterol, low sodium)
  4. Treatments: See your medication list
  5. Pain Management: No issues
  6. Medications: Medication Instruction Sheet attached, discharge medication reconciliation completed, discharge calendar given to patient
  7. Special Instructions/Safety Measures: Watch groin for signs of infection. If you suspect infection, contact your regular doctor. If heavy bleeding from groin occurs, report directly to any emergency room
  8. Please follow-up with primary care physician in Florida
  9. Vital Signs: Stable

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Heart Attack – Discharge Instructions from Boston Medical Center

By vadkins on January 22, 2008 in

My husband was released from the Cardiac Unit of the Boston Medical Center on Friday, 1/11/2008. As I detailed on this blog, my husband had had a heart attack (Acute Cardiac Syndrome), and had undergone a heart catheterization, angioplasty and a stent was placed in one of his cardiac arteries. These procedures were successful. Jim’s discharge instructions were:

  1. Catheterization Site Care:
    Keep the catheterization site clean, dry and open to the air
    Inspect the catheterization site frequently for the first several days to determine promptly if problems arise. While it is extremely unlikely that you will develop any problems, the following signs and symptoms should be reported immediately to your physician-bleeding, pain or swelling at the site of the catheterization that has increased beyond what was present at the time of discharge, drainage (bloody or yellow), increased redness around the puncture site that does not disappear.
    Fever or chills (temperature greater than 101 degrees)
    (Please note: bruising and discoloration of the skin around the catheterization site may be present at the time of discharge or may appear several days later. In absence of any of the above symptoms, this is of no significance and will disappear over time. Likewise, a small painless "bump" over the catheterization site will be present for several weeks following catheterization and part of the natural healing process.
  2. Activity:
    No heavy lifting (greater than 10 lbs.) or any type of strenuous activity (chopping wood, mowing lawn-etc.) for at least 48 hours after cardiac catheterization or one week following PTCA/Artherectomy. Walking may be resumed as tolerated
    No heavy lifting (greater than 10 lbs.) or any type of strenuous activity (chopping wood, mowing lawn) for 48 hours after cardiac catheterization or 1 week following PTCA/Atherectomy. Walking may be resumed as tolerated
    Do not sit for prolonged periods of time for the first 24-48 hours. When you do, please sit in a semi-reclined position on a couch or in a reclining chair
    Sexual activity may be resumed 24-48 hours after discharge from the hospital for routing cardiac catheterization or PTCA unless otherwise instructed by your cardiologist because of related clinical issues (i.e., recent heart attack)
    You may resume driving a car the day following discharge from the hospital unless other wise instructed by your cardiologist
  3. Medications:
    Per verbal instructions when discharged, along with medication teaching sheets and schedule
  4. Urinary Catheter:
    If you had a urinary catheter in your bladder during your hospitalization, you need to drink 4-12 oz. glasses of water each day for the next 48 hours after the catheter was removed. Call your primary physician if you develop: fever or shills with temperature greater that 101 degrees, burning, frequency and/or urgency with urination
  5. Follow Up Care:
    Call your primary cardiologist within two days of discharge to schedule a follow-up appointment. Most cardiologists will want to see you within 7-10 days following discharge. A follow-up stress test following PTCA or Coronary Artherectomy will usually be scheduled by your primary cardiologist within 2-6 weeks following discharge

vadkins

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Heart Attack – Mediterranean Diet Lowers Risk

By vadkins on January 18, 2008 in

When Jim was in the Boston Medical Center last week to be treated for his heart attack, we were given many handouts filled with great information listing ways that we can improve our lifestyles to decrease the risk of another heart attack. I remember reading in one of the handouts that a Mediterranean diet lowers the risk of heart attack. I can’t seem to find the sheet now, so here is a link to Mediterranean Diet information at the American Heart Association website. Here are the characteristics of a Mediterranean diet:

People who follow the average Mediterranean diet eat less saturated fat than the average American diet. The Mediterranean-style diet is close to the dietary guidelines of the American Heart Association, but doesn’t follow those guidelines exactly. A Mediterranean diet contains a relatively high percentage of calories from fat.

The AHA website also says:

The incidence of heart disease in Mediterranean countries is lower than in the United States. Death rates are lower, too. But this may not be entirely due to the diet. Lifestyle factors (such as more physical activity and extended social support systems) may also play a part.

Before advising people to follow a Mediterranean diet, we need more studies to find out whether the diet itself or other lifestyle factors account for the lower deaths from heart disease. See the Lyon Diet Heart Study entry in this Guide for more information.

vadkins

  • high consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
  • olive oil is an important monounsaturated fat source
  • dairy products, fish and poultry are consumed in low to moderate amounts, and little red meat is eaten
  • eggs are consumed zero to four times a week
  • wine is consumed in low to moderate amounts
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    Heart Attack – The Cardiac Diet and The Cardiac-Diabetic Diet

    By vadkins on January 18, 2008 in

    The Boston Medical Center gave Jim 2 handouts-The Cardiac Diet and The Cardiac-Diabetic Diet. Jim was told that he needs to follow the cardiac diet, and that it wouldn’t hurt him to follow the cardiac-diabetic diet. Jim is not diabetic, and now that he’s a heart patient, he definitely does not want to EVER become diabetic.

    • The Cardiac Diet is designed for patients who have a history of or who are at risk for heart disease. The purpose of this diet is to help control and/or lower cholesterol and blood pressure. Following a cardiac diet can help prevent further complications of heart disease:

    Grains, Cereals, Pastas: Allowed-whole grain breads, cereals, bagels, English muffins, pasta, rice, tortillas, homemade pancakes, homemade biscuits, salt-free crackers, pretzels, popcorn, graham crackers, fat-free potato chips (1 oz. per day)
    Avoid-packaged mixes (seasoned rice, pancakes, waffles, muffins, potatoes, instant dinners), commercially prepared cakes, donuts, pies, salted chips, pretzels, popcorn

    Vegetables: Allowed-all fresh, plain-frozen, and sodium-free canned vegetables, low-sodium salsa, salt-free/low-sodium vegetable juice, tomato sauce
    Avoid-sauerkraut, vegetables cooked in meat fat, cream, cheese, butter sauces, pickled vegetables, regular canned vegetables, regular vegetable juice

    Milk Foods: Allowed-skim or 1% milk, low-fat or fat-free yogurt, sour cream, cottage cheese, ricotta cheese, cream cheese, low-fat cheese, low-fat soymilk
    Avoid-2% or whole milk, yogurt, chocolate milk, cocoa, coffee drinks made with whole milk, cheese made from whole milk or cream, cream, half-half, sour cream, frozen topping, whipping cream, buttermilk

    Meats and Meat Substitutes    : Allowed-Skinless chicken and turkey (white meat), lean pork, beef, and lamb (round, loin, sirloin, tenderloin, rump), venison, trim off any visible fat, dried beans and peas, low-fat tofu, fish (canned tuna, salmon, shellfish), egg whites, egg yolk (5 per week), liver (3 oz. per week), peanut butter
    Avoid-organ meats, poultry skin, marbled meat, cured meats, lunch meats, sausages, pepperoni, salami, corned beef, frozen dinners (pizza, TV dinners), restaurant style Chinese, Mexican, Italian, fried foods

    Oils and Fats: Allowed-avocado, canola, olive, peanut, safflower, sunflower, soy oil, low-fat or fat-free mayonnaise and salad dressings, tub margarine, nuts (almonds, cashews, mixed peanuts, pecans-unsalted, no salt added-limit 15 nuts per day)
    Avoid-coconut, palm, hydrogenated oil, butter, lard, bacon, sour cream, gravy, cheese/cream sauces, shortening, regular mayonnaise, creamy salad dressings, tartar sauce, margarine with partially hydrogenated oil

    Miscellaneous: Allowed-salt-free broth, soups, pudding from skim or 1% milk, popsicles, sorbet, sherbet, ice milk, low-fat frozen yogurt, homemade desserts with recommended oils and margarines, decaffeinated coffee, tea
    Avoid-regular, frozen, instant soups, salted, deep-fried snack foods, store-bought desserts

    Condiments and Seasonings: Allowed-jelly, jam, honey, Mrs. Dash, fresh & dried herbs, spices, pepper, lemon juice, horseradish, ketchup, mustard, light soy sauce (limit to 2 tablespoons per day)
    Avoid-baking powder, soda, monosodium glutamate (MSG), meat tenderizer, spice blends and seasoning mixes containing salt, chili sauce, soy sauce, BBQ sauce, steak sauce, Worcestershire sauce, cooking wine, sherry, relish, olives, bouillon cubes

    Guidelines for a Cardiac Diet:

    • Lower total fat intake, in particular saturated fat and trans fat
      Saturated fat is usually solid at room temperature (lard, butter) and raises cholesterol in the body
      Trans fat has the same effect as saturated fat in the body. This fat is usually found in store-bought crackers, cookies, pies and chips. Check the food label for hydrogenated or partially hydrogenated
    • Lower cholesterol intake
      Cholesterol is only found in foods that come from animals (meat, milk, cheese, butter). Eat more fruits, vegetables and whole grains since these foods do not have cholesterol
    • Avoid adding salt to food and eating foods high in salt
      Foods that are processed, instant, or from fast food restaurants are typically higher in salt. The more fresh foods you can eat, the better
    • Control body weight, or lose weight if you are overweight
      Lowering fat intake is only part of the weight loss plan. You also need to be as physically active as possible and control portion sizes of foods

    Read The Cardiac-Diabetic Diet below the jump.

    vadkins

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    Heart Attack – Medications to Go Home With

    By vadkins on January 18, 2008 in

    Jim was released from the hospital on Friday morning (1/11/08). He was given these medicines to take for the rest of his life (except for the Plavix which he’ll take for 1 year):

    • Aspirin ec tbec 325 mg (1 tab by mouth daily)
    • Plavix tabs 75 mg (1 by mouth once daily)-the Plavix is taken for 1 year, so that the stent in Jim’s heart doesn’t form clots-after 1 year the stent will be coated with Jim’s own tissues so the Plavix can be discontinued at that time
    • Atenolol tabs 25 mg (1 by mouth once daily)-this is a beta blocker
    • Lisinopril 5 mg tabs (1 tab by mouth once daily)-this is to lower blood pressure-Jim doesn’t have high blood pressure, but he needs to keep his blood pressure lower than the general population now that he’s had a heart attack
    • Zocor tabs 40 mg (simvastatin)-1 by mouth once daily-to lower cholesterol
    • Nitroglycerin subl 0.4 mg-1 under your tongue every 5 minutes times 3-nitroglycerin is to be taken as needed, for angina

    After we returned home to Florida Jim’s cardiologist did change 2 of these medications, but more on that later.

    vadkins

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    Heart Attack – What the Doctors Told Us

    By vadkins on January 18, 2008 in

    I wanted to be sure to write a post with just a list of everything I can remember that the hospital doctors and physician assistants told us. So, relying on my very imperfect memory, and in no particular order, here goes:

    • Now that Jim has had a heart attack, he will always have a cardiologist
    • Jim will always carry nitroglycerin with him for the rest of his life-if he feels pain in his chest he will put one nitro pill under his tongue and sit down, wait  5 minutes to see if the pain goes away-if not, then Jim will put another pill under his tongue, if that doesn’t help then he is to call 911 immediately
    • DO NOT EAT ANY TRANS FATS!!
    • For some reason, we don’t know, the plaque in Jim’s cardiac artery cracked so that a blood clot formed there-causing the heart attack
    • Jim needs to reduce greatly his intake of saturated fats-that means no red meat, lunch meats in order to reduce his cholesterol (especially LDLs)…
    • Doctors are saying now that people should take a baby aspirin before going on long flights, to prevent the formation of clots
    • Jim needs to reduce his LDLs (bad cholesterol) to below 70 (the general population needs an LDL level below 100)
    • Jim needs to eat a low salt, low cholesterol and low sugar diet
    • Being both a heart patient and diabetic is very dangerous (Jim isn’t diabetic)
    • Jim doesn’t have any risk factors for a heart attack
    • Jim needs to reduce his waist size to less than 40", the waist dimension is more important than body weight (for a woman, the waist size needs to be less than 35")
    • Jim will always take a full dose (325 mg) of aspirin every day for the rest of his life
    • Jim will always carry with him nitroglycerin
    • Nitroglycerin doesn’t do well in hot or damp conditions, and has a very finite shelf life
    • If Jim had taken a stress test the day before the heart attack, it would have most likely been normal
    • Moderation is the key where diet and exercise is concerned
    • Jim needs to lower the salt in his diet
    • Because he has had a heart attack, Jim will need to meet more stringent standards for heart attack risks than the general population (low salt, low sugar, low fat, low cholesterol)
    • Jim will need to begin cardiac rehab when he returns home to Florida
    • Jim needs to do 20 minutes of aerobic exercise 3-4 times/week

    vadkins

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    Heart Attack – The Hospital Stay

    By vadkins on January 18, 2008 in

    Jim’s heart attack (ACS) occurred on the morning of Tuesday, 1/8/2008. The cardiologists at Boston Medical Center fixed his heart by doing a catheterization, angioplasty, and inserting a stent on Wednesday, 1/9/2008. Jim was released from the hospital on the morning of Friday, 1/11/2008.

    After the heart procedure, it was vitally important that Jim not move his right leg for at least 8 hours. That’s because the catheters were inserted into the femoral artery and the vein in his right leg. Then at the end of the heart procedure, a collagen plug was inserted into his artery so that he didn’t bleed. Immobilizing the leg is essential for the healing of the catheter insertion site:

    The incision will be closed with applied pressure, suture device or a plug. A plug is a material which works with your body’s natural healing processes to form a clot in the artery. You will need to lie flat and keep the leg straight for two to six hours to prevent bleeding (less time if a plug was used). Your head cannot be raised more than 30 degrees (2 pillows high). Do not try to sit or stand. A sterile dressing will be placed on the groin area to protect it from infection. The nurse will check your bandage regularly, but call your nurse if you think you are bleeding (have a wet, warm sensation) or if your toes begin to tingle or feel numb.

    Jim’s insertion site became very bruised and purple, which I understand, often happens.

    After 8 PM on the day of the heart procedure, Jim was allowed to stand up, finally. What a relief. He found that he could walk around OK, and overall, he felt well.

    Here’s what the Discharge Summary says about Jim, post-procedure:

    He had developed a hematoma around the venous sheath, probably secondary to the Integrelin infusion which was subsequently dc’d. He had an uneventful recovery and hospital course. He was seen by Physical Therapy for cardiac rehab teaching and discharged home 1/11/08. He was on no meds at home, but was discharged on the medical regimen listed above. Patient was instructed to contact his primary care physician upon return to Florida and arrange for follow-up and referral to a cardiologist.

    vadkins

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