All entries tagged with “heart attack”
Study Proves Benefit of Neck Ultrasound in Predicting Risk of Heart Disease
Predicting and reducing a patient’s risk of having heart disease is the cornerstone of preventive cardiology. Doctors have many options on how to do this including tabulating risk factors like diabetes, smoking, high blood pressure, high cholesterol and family history. However, some patients will go on to develop heart disease with few or no risk factors. In fact, the majority of heart attacks occur in patients who would be deemed “low risk”. A recent study in the New England Journal of Medicine examined the ability of carotid ultrasound (an ultrasound study of the main artery in the neck) to predict an individual’s risk of developing heart disease. Nearly 3000 healthy patients with an average age of 58 underwent an ultrasound examination and then were followed for seven years. The ultrasounds were evaluated for the presence or absence of plaque as well as the thickness of the arterial wall (cIMT). Patients with even minimal plaque in the neck arteries were noted to have double the risk of heart disease compared to those who did not have plaque. A similar relationship was also found with patients who had thickening of the arterial wall which is a very early sign of plaque build up. Carotid ultrasound testing can be performed in a doctor’s office, is relatively inexpensive and involves no radiation. This study demonstrates that the findings of a carotid ultrasound gives doctors a powerful tool to predict, and thus reduce, a patient’s future risk of heart disease. 
Cardiac Rehab Slashes Risk of Dying by 50%
In the early days of cardiology, patients with heart disease were advised to rest for weeks to months after a heart attack. In the 1960s the prevailing theory was challenged and the modern concept of cardiac rehabilitation was begun. In the modern era, cardiac rehab is a 12 week structured exercise program that is put on by the hospitals. It is covered by most insurance plans within 1 year of the cardiac event. It focuses on aerobic exercise with close monitoring of the heart rate, blood pressure and symptoms to allow the cardiac the patient the opportunity to gradually increase exercise. It also places a heavy emphasis on education of the patients with regard to preventing future heart problems through lifestyle changes. A recent study out of the Mayo Clinic looked at over 2000 patients who had stents placed in blocked arteries. The patients were followed for an average of 6 years. Some of the patients enrolled in cardiac rehab (40%) and some did not. Over the follow up period, the patients who enrolled in cardiac rehab enjoyed a whopping 50% decrease in the risk of dying. This held true for men, women, old and young patients. The take home message from this study is clear- that patients should enroll in cardiac rehabilitation programs after having a stent placed. Unfortunately, the majority (60% in this study) of patients do not take advantage of this opportunity. The reasons for this are not clear but why miss out on a "free" 50% reduction in mortality?
Are You Healthy Enough to Exercise?
At first glance the question seems kind of ridiculous. You are exercising to get healthy so how could exercise itself NOT be healthy? The truth is that there is some risk of having a heart attack or dying associated with exercise - unfortunately we are reminded of this after every heavy snowfall when people unaccustomed to exercise lift shovels full of wet snow and suffer a heart attack or cardiac arrest. But it is also true that those who exercise regularly can dramatically reduce their lifetime risk of having heart disease. To reconcile these two statements it is necessary to understand that there is an initial "upfront" risk associated with exercise. Once a person successfully overcomes that initial risk and continues to exercise they will then reap the health benefits associated with regular exercise. So how do you know if you are at risk when starting out? The most important red flag is the presence of any of the following symptoms- chest pain or pressure, shortness of breath, palpitations, passing out, or discomfort in the neck, jaw or arm. People who have any of these symptoms should be thoroughly evaluated by their physician prior to starting any exercise program, most likely with a stress test. For people who have no symptoms but have risk factors for coronary artery disease (age over 50, diabetes, smoking, high cholesterol, family history, high blood pressure) it is reasonable to get evaluated with a stress test prior to beginning an exercise program. Other suggestions to keep exercise safe include; allowing 5-10 minutes of warm up and cool down, gradual increments in exercise intensity and duration and constant monitoring for any of the symptoms mentioned above.
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