Category: Heart Attacks

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Heart Attacks Heart Health

Fearing a Heart Attack

The health anxiety surrounding a heart attack can be overwhelming. Every little pain or twinge makes you wonder if your heart is about to give out. The reality is that your heart is much more resilient than you might think. Fearing a heart attack is definitely worth discussing but often not as dangerous as you think.

Heart Attacks Aren’t Always Fatal

Having seen many patients in the urgent care and emergency room, they present with chest pains. I order an EKG and see they have a heart attack or perhaps had one recently.

Unfortunately, a little under 50% of adults might have a fatal heart attack, but symptoms are often quite telling.

They might have sudden fatigue or nausea or chest pains or shortness of breath with certain actions. But of course, there are cases where the plaque breaks off suddenly without previous underlying coronary artery stenosis.

The Fear of a Heart Attack

Fearing a heart attack – the fear itself – is often detrimental. And we fear it because we worry that if we don’t fear a heart attack, we may not do anything about it.

The hearty attacks which kill you won’t have any control over. At least not the heart attack (myocardial infarction) itself. But you can affect the chance of a heart attack by living a “heart healthy” life.

The anxiety and stress of fearing a heart attack have little value. It adds little to your decision matrix and keeps you in a negative loop.

Preventing a Heart Attack

It’s never too late to start working on your heart health. I’m not a fan of terms like a “heart-healthy” diet or lifestyle because they reduce the problem to a few individual actions.

The body and the mind are connected even if we wish they weren’t. The outlook and expectations you have feed back into your cellular health, down to the last cardiac myocyte.

To prevent a heart attack, the key factors are:

  1. stress
  2. sleep
  3. diet
  4. inflammation
  5. activity
  6. individual risks
  7. environment

Your individual risk might be the genetic factors predisposing you to your particular cardiovascular condition.

Your environment may not be conducive to your optimal heart health, etc.

When the Fear Comes

You’re sitting somewhere or coming back from the gym and feeling off. You feel something in your chest, and your heart rate goes up. You think you’re damaging your heart or having a heart attack causing you to sweat.

Everything spirals down quickly, and you fear the worst.

A deep breath at this point is the best medicine. Sit down, just be present. Feel what’s going on in the chest. Feel what’s going through your head.

Sit with it without trying to change it. They call this mindset a mindful approach to anxiety or stress, or any feeling. It works because you don’t try to take full control of the situation.

If your gut tells you that you should call 911, then that’s what you’ll do. If you feel it could be benign, you can decide to wait.

It feels good to have faith in your instincts and your body.

Categories
Heart Attacks Heart Health Prevention Treatment

Heart Health in Traditional Medicine

Traditional medicine, also called western medicine, is exalted for its evidence-based, scientific approach. It has proven capable of treating some of the most life-threatening and severe conditions. However, heart health in traditional medicine remains less advanced.

First Signs of Heart Disease

Most adults don’t necessarily know they have heart disease. And unfortunately, death is the first presenting symptom in a little less than half of those presenting for the first time.

That means 50% will have a fatal heart attack and not just a high cholesterol level or atherosclerosis seen on imaging.

We haven’t figured out a way to decrease that number fast enough. This means that heart health in traditional medicine can only help 50% of adults.

Traditional Medicine and Heart Disease

In traditional medicine, assuming you have good insurance, you can get excellent care to lower your cholesterol levels and blood pressure by using medications.

This requires regular visits for blood testing to make sure your liver and kidney can handle the medications. Refills cost money and time spent in the pharmacy.

These treatments don’t work for everyone. However, traditional medicine views all high-lipid and hypertensive patients similarly and treats them the same. This is one of the downsides of this practice model.

But if you need a stent or need to be resuscitated, western medicine is as good as it gets. We have incredible talent that can perform heart transplants and perform bypass grafting.

Heart Health is About Prevention

I can treat the high cholesterol with statins and perform a stent in the coronary artery, followed by a coronary artery bypass graft later in life. This is treating the symptom and not the condition.

Heart Health Coaching, which is what I do, focuses on lifestyle factors. It’s more about prevention and diving deep into potential causes for not-so-great metabolic health.

Heart Health and Pills

A pill can lower your blood pressure and decrease the chance of atherosclerosis plaque progression.

But it cannot prevent a heart attack or prevent you from getting fatty liver or diabetes from the factors which lead to high cholesterol or high blood pressure, to begin with.

Perhaps somewhere around 2-3% of individuals have genetic factors causing high cholesterol and high blood pressure. All methods other than pills will likely fail these individuals. For the rest of us, pills may not be as effective.

Prevention + Treatment

In the perfect world, everyone would have a Heart Health Coach and work to overcome hurdles toward ideal heart health.

If that fails and heart disease develops, they have the excellent skills of capable cardiologists, surgeons, and intensivists who can help restore their cardiovascular health.

Categories
Heart Attacks Heart Health Metabolic

Atherosclerosis and Inflammation

If you’re interested, you can read about how a coronary plaque ends up causing a blockage of the vessel and eventual ischemia. It’s often not what most people think. In this article, I will discuss the basics of how atherosclerosis and inflammation play a role in heart health.

Atherosclerosis

Plaque is the buildup inside an artery, leading to decreased blood flow and sometimes complete lack of blood flow – obstruction.

With obstruction comes ischemia – lack of oxygen to nearby tissue; not just muscle but the vessels themselves, the nerves, and connective tissue.

You need cholesterol to build up the plaque. With a total cholesterol value below 150, achieved naturally without medications, it’s rare to see someone develop much plaque in their arteries.

Another ingredient for plaque buildup is hardened vessels and increased pressures or turbulent flow of blood through those vessels. Hypertension can cause this; lack of exercise or inflammation can also contribute.

Unstable Plaque

Let’s lay the cards flat on the table – we don’t know much about inflammation. Astute clinicians can recognize inflammation when they see it. There are specific biomarkers that are helpful as well.

Inflammation adds to the problem of atherosclerotic and negatively affects heart health because it leads to unstable plaques.

A plaque is like a scab on a wound. If it’s the right time for it to come off, it’ll fall off without any bleeding. Rip it off prematurely, and you’ll get fresh blood.

That fresh blood will clot in the artery and create unstable plaque is prone to rupturing and exposing those raw surfaces. Suddenly you go from a tiny plaque to a massive clot that halts all blood flow in that artery.

Measuring Inflammation

There are several biomarkers that can tell us there is inflammation. But it’s not biomarkers alone I use in my practice.

Some people with inflammation in their bodies may never develop unstable plaque. And some with inflammation may not have much plaque, to begin with. But that might be the exception.

If someone has atherosclerosis, my goal is to increase their exercise capacity – both cardiovascular and anaerobic. Next, I want their systemic inflammation to be as low as possible.

Examples of inflammatory biomarkers:

  • CRP
  • ferritin
  • ESR
  • homocysteine
  • uric acid
  • triglycerides
  • HDL
  • platelets
  • neutrophils or leukocytes
  • insulin

Atherosclerosis and Inflammation

In regards to heart health, atherosclerosis isn’t a death sentence. Most of us will develop it, and less than half of us will suffer heart attacks or other complications because of it.

Preventing atherosclerosis is what I do in my program – that’s my main goal. But most of those who come to me already have atherosclerosis.

Plaque and inflammation have an essential relationship in heart health which I address with this second group. I want to decrease their total body inflammation to allow newly formed plaques or old plaques to stabilize.

Other Inflammatory Markers

No need to do these blood tests. Even without serology, we can tell if someone has inflammation.

The following are inflammatory markers I use based on signs and symptoms:

  • obesity
  • acne
  • rosacea
  • seborrheic dermatitis
  • joint pain
  • fatigue
  • sleep disturbance
  • agitation
  • sound sensitivity
  • GI changes
  • heavy menses
  • concentration issues

As you can imagine, these are rather subjective. Even if you have a little bit of all of this it doesn’t mean there is inflammation.

We use these data points as a guide. With them, we change our diet and lifestyle and reevaluate. If these markers decrease, then inflammation is likely.

Categories
Heart Attacks Heart Health Statins

Statins for Heart Disease Prevention

Statins are prescribed either for existing heart disease or to prevent heart disease. Preventing heart disease is referred to as a primary prevention strategy. Let’s discuss if statins for heart disease prevention are as effective as advertised and what other factors one should consider.

Statins to Prevent Heart Disease

Statins have gone through a lot of recommendation changes over the years. Some statins stand out more than others.

But there are still a lot of disagreements when it comes to using statins for the prevention of heart disease. This means using a statin for someone who is otherwise healthy but wants to prevent a heart attack.

In western medicine, it’s the standard of care to prescribe this medication to individuals with high cholesterol or diabetes, hoping it will prevent a heart attack.

The Actual Numbers

Think back to your high school class. Let’s say you had 150 people in that class. If everyone in that class took a statin to prevent a stroke, then only 1 out of 150 would benefit.

In other words, 150 people would have to be treated to prevent 1 stroke. And 100 would have to be treated to prevent 1 heart attack.

We refer to this as the NNT – the number needed to treat.

The Harm of Statins

Fortunately, statins are relatively safe medications. Yes, some people develop terrible side effects with them. Some even can develop diabetes or muscle or liver damage.

Obviously, we wouldn’t prescribe medication unless it was absolutely necessary. If only those who really needed this medication took it, the risk of statins would be far lower than its benefits.

But the actual harms of this medication – 1 in 50 would potentially develop diabetes, and 1 in 10 would develop muscle pains or damage.

Preventing Heart Disease

So what does work if not statins?

Controlling your blood pressure, eating a healthy diet, and maintaining a healthy activity level seems to decrease your risk of a heart attack.

Other factors like stress and cholesterol matter but are closely tied to your diet and activity levels.

The Individual Factor

As a physician, I don’t like talking about medication or an illness in general terms. Each person is unique, and all things matter. I learned this phrase from my functional nutrition course.

Each person is unique, so we must approach each person’s risk factors and decisions individually.

All things matter means that the patient’s individual abilities and lifestyle factors determine what intervention we choose or don’t choose.