Atrial Flutter

Atrial flutter is an abnormality in the beating of the heart. Such abnormalities in the rhythm or speed of the heartbeat are known as arrhythmias. Atrial flutter is closely related to another arrhythmia, called atrial fibrillation.

Normal Heartbeat
Each heartbeat is a very rapid series of 2 contractions:

The beating of the heart is controlled by electrical impulses.

Atrial flutter occurs when an abnormal conduction circuit develops inside the right atrium, allowing the atria to beat excessively fast, about 250-300 beats per minute.

Danger of Atrial Flutter
The main danger of atrial flutter is that the heart does not pump blood very well when it is beating too fast.

Atrial flutter can come and go; this is known as paroxysmal atrial flutter. An episode of atrial flutter usually lasts hours or days. Less often, atrial flutter is more or less permanent and is known as persistent atrial flutter.
With proper treatment, atrial flutter is rarely life threatening. Complications of atrial flutter can be devastating, but they usually can be prevented with proper treatment.
Atrial Flutter Causes
Atrial flutter may be caused by abnormalities or diseases of the heart itself, by a disease elsewhere in the body that affects the heart, or by consuming substances that change the way electrical impulses are transmitted through the heart. In a few people, no underlying cause is ever found.

Next Steps: Outlook
Atrial flutter increases your risk of having a stroke.

The other serious complication of atrial flutter is heart failure.

If you experience atrial flutter and are found to have no underlying heart disease, your outlook is generally quite good. If it occurs once without serious heart or lung disease, most likely you will never have it again. If you do have underlying heart disease, your atrial flutter may recur. Therefore, you should see a heart specialist (cardiologist).

 

Atrial Fibrillation

Atrial fibrillation is an irregular beating of the heart that starts in the atria (the upper two chambers of the heart) and travels to the ventricles (the lower two chambers of the heart).  This irregular rhythm is typically fast, but may be normal or slow.  The causes of atrial fibrillation include reactions to medications, high blood pressure, heart attack, hyperthyroidism, coronary artery disease, heart valve disease, and heart failure.  The longer the irregular rhythm is allowed to go on and not treated, the more difficult it is to correct.  A person may not even know that he has an irregular heart beat until a doctor diagnoses it.  Atrial fibrillation can be serious since it decreases efficient filling of the heart with blood.  Blood clot formation is possible which increases the risk of stroke.

Symptoms may include:
There may be no symptoms
Weakness, dizziness
Fatigue
Shortness of breath
Chest pain with increased activity
Feeling of irregular or fast heartbeat or pulse

What your doctor can do:
Diagnostic tests may include blood tests, an echocardiogram (non-invasive, painless test that uses sound waves to record heart valve activity) and an electrocardiogram (ECG or EKG, noninvasive, painless test that records electrical activity of the heart).
Medications for controlling the rhythm and medicine to thin the blood and prevent blood clots.  Some medications will require you to have periodic blood tests done to check that you are getting the correct dose.  It may take time to find the medication or combination of medications that work best for you.
Sometimes medication cannot help.  In these cases, a controlled electric shock may be given to attempt conversion to a regular rhythm.

What you can do:
Take medications as prescribed by your doctor.
DO NOT stop your medications without talking to your doctor first.  Contact your doctor about any side effects or adverse reactions
Keep follow-up appointments for lab tests and check-ups.

What you can expect:
Atrial fibrillation can usually be controlled through treatment.
Working closely with your doctor to determine the proper medications and doses is very important.
Possible complications if uncontrolled include stroke or heart attack.

Contact your doctor if you have symptoms of atrial fibrillation.  If you have any of the risk factors, such as another heart condition, it is important to keep a regular schedule of check-ups.

Ventricular Tachycardia

What is Ventricular Tachycardia?
Ventricular tachycardia (VT) is a pulse rate of about 160-240 beats/min (normal resting heart rate is 60-100 beats/minute), with at least three irregular heartbeats in a row. In VT, the irregular heartbeats start in the lower chambers of the heart – the ventricles.

VT may develop as a complication of a heart attack because scar tissue can form in the ventricle muscle within days, months, and or years after a heart attack. Additionally, it can occur in patients with cardiomyopathy, heart failure, heart surgery, myocarditis, and valvular heart disease.

Symptoms of Ventricular Tachycardia:

Signs indicative of ventricular tachycardia include loss of consciousness, normal or low blood pressure, or rapid pulse.

Diagnosing Ventricular Tachycardia:
Ventricular tachycardia can be seen using

Treating Ventricular Tachycardia:
An implantable cardioverter defibrillator (ICD) is recommended for treating chronic ventricular tachycardia. The ICD is implanted in the chest and connects to your heart with wires. The ICD senses when ventricular tachycardia is occurring and when it does, the ICD administers a shock to the heart to restore normal heart rhythm.

 

Updated February 25, 2009 - MJ

Ventricular Fibrillation

What is Ventricular Fibrillation?
Ventricular fibrillation is a type of potentially fatal arrhythmia that is characterized by rapid, uncontrolled contractions of the muscle fibers in the lower chambers of the heart, the ventricles. When this happens, the ventricles do not contract properly and blood cannot leave the heart, often leading to unconsciousness and cardiac arrest unless it is treated immediately.

Symptoms of Ventricular Fibrillation:

How Do I Treat Ventricular Fibrillation?
If a person having ventricular fibrillation collapses at home, call 911. While you wait for emergency assistance, make sure the person’s head and neck are in line with the rest of his/her body to facilitate breathing. Start CPR with mouth-to-mouth breathing and chest compressions. Ventricular fibrillation is also treated by giving a quick electric shock to the heart using an external defibrillator; this shock restores the normal rhythm of the heartbeat.

An implantable cardioverter defibrillator (ICD) is recommended for individuals who have survived a ventricular fibrillation attack or those who are at risk of future attacks.

 

Updated February 25, 2009 - MJ

Ventricular Tachycardia

Advanced Lipid Panel (VAP)

What is a Lipid Panel? What Does it Measure?

What is Advanced Lipid Testing?

VAP ® (Vertical Auto Profile)

Why a VAP Test?

Components of the VAP Test:
The VAP test measures the following lipids:

 

How do I get a VAP Test?

 

Updated January 30, 2009 – MJ

 

 

Hyperlipidemia

HYPERLIPIDEMIA

How do I control my lipid levels?

Updated January 30, 2009 - MJ

Lipoprotein (a)

Lipoprotein (a) (Lp(a)):
Lipoproteins circulate in the blood and contain cholesterol and fat. Lipoprotein (a) is a lipoprotein molecule similar to LDL cholesterol. Both Lipoprotein (a) and LDL are rich in cholesterol and contribute to atherosclerosis, or hardening and narrowing of the arteries.  These changes in the arteries can lead to heart attack, angina, and stroke.

Signs and Symptoms of Elevated Lipoprotein (a):
There are no specific signs or symptoms of elevated lipoprotein (a), although special blood tests can determine lipoprotein (a) levels.

Treatment Options to Lower Elevated Lipoprotein (a) Levels:
High Lipoprotein (a) levels are hard to treat, although they may somewhat be treated by giving niacin or fibrate drugs. When a high lipoprotein (a) levels discovered in a patient, attention toward other, more treatable heart disease risk factors should be increased. Such risk factors include high LDL cholesterol levels, smoking, and leading a sedentary lifestyle.

 

Updated March 5, 2009 - MJ

Atherosclerosis

What is Atherosclerosis?
Atherosclerosis is a disease in which fat deposits on the walls of your arteries, making them narrow and reducing blood flow. Severely restricted blood flow can lead to chest pain, although atherosclerosis symptoms do not appear until complications arise. Atherosclerosis is the most common type of arteriosclerosis, which describes several diseases in which the wall of an artery becomes less elastic. In the United States and in many other developed countries, atherosclerosis is the leading cause of illness and death. It affects arteries of the brain, heart, kidneys, other organs of the body, and legs.

What Causes Atherosclerosis?
The causes of atherosclerosis are multi-factorial, but the most common cause is repeated injury to an artery’s walls. This includes physical stresses from blood flow (particularly in hypertensive individuals) and inflammatory stresses that involve the immune system, such as chemical abnormalities of the bloodstream.

What are the Risk Factors?
Tobacco use: The risk of developing coronary artery disease is directly related to the amount of tobacco smoked in a day. Smoking increases the carbon monoxide levels in the blood, which can increase the risk of arterial wall injury. Tobacco causes already-narrowed arteries to constrict even more, decreasing blood flow to the body. Lastly, tobacco increases blood’s clotting tendency, increasing the risk of various other cardiovascular diseases.

Hyperlipidemia: A high level of HDL (good) cholesterol decreases the risk of atherosclerosis, whereas a low level increases the risk. The desired level of total cholesterol is 140-200 mg/dL. When an individual’s total cholesterol level approaches 300 mg/dL, the risk of heart attack more than doubles. By maintaining low LDL (bad) and high HDL (good) cholesterol levels, you can decrease your risk of atherosclerosis and thereby decrease your heart attack and stroke risk too.

Hypertension: High blood pressure is a risk factor for heart attack and stroke, both of which are caused by atherosclerosis.

Diabetes: Most individuals with Type I Diabetes tend to develop diseases affecting small arteries – those in the eyes, nerves, and kidneys, which contributes to vision loss, nerve damage, and kidney failure. Most people with Type II Diabetes tend to develop atherosclerosis at an earlier age and in large arteries. The risk of developing atherosclerosis increases two- to six-fold among diabetic individuals; there is an even higher risk among diabetic women.

Obesity: Obesity (especially abdominal obesity) increases the risk of coronary artery disease, which is atherosclerosis that occurs in the coronary arteries that supply blood to the heart muscle. Abdominal obesity increases the risk of atherosclerosis risk factors.  

Physical inactivity: Physical inactivity increases the risk of developing coronary artery disease. Regular physical activity helps to reduce this risk and the risk of other atherosclerosis risk factors.

Diet: Fruit/vegetable consumption can decrease coronary artery disease risk.

How does Atherosclerosis Develop?
Atherosclerosis begins when the injured wall of the artery sends out chemical signals that cause white blood cells (monocytes and T cells) to attach to the artery wall and enter it. In the wall, the white blood cells are transformed into foam cells that collect cholesterol and other fatty materials. With time, the foam cells accumulate and form patchy deposits (called plaque), which line the artery walls.

Plaque usually forms where arteries branch, although they may form in medium and large-sized arteries as well. As the plaque grows, some thicken the artery’s wall and bulge into the artery’s channel, which is dangerous because it can reduce blood flow to the rest of your body. Some plaques do not block the artery but may split open; this can trigger a blood clot that can block the artery, possibly causing a heart attack or stroke. Sometimes, pieces of the plaque or blood clots may break off, travel through the bloodstream, and block an artery elsewhere in the body.

What are the Symptoms of Atherosclerosis?
Symptoms usually depend on where in the body the affected artery is located and the severity of the blockage – whether it is narrowed or suddenly blocked. The first symptom may be pain or cramps, which may occur when the blood flow cannot keep up with the body’s oxygen demands.

How is Atherosclerosis Diagnosed?
Tests can look for the location and extent of blockage in people who are experiencing symptoms. Often, people with atherosclerotic arteries in one organ have atherosclerotic arteries in other arteries. Therefore, when doctors find an atherosclerotic blockage in one artery, they may look for blockages in other arteries too.

As part of a prevention strategy, some doctors recommend tests that look for atherosclerotic blockages in people who are not experiencing symptoms as all. These tests include an electron beam CT scan and an MRI, which detect hardened (calcified) plaque in the coronary arteries.

 

 

Updated February 5, 2009 - MJ

 

Reducing Your Risk of Coronary Heart Disease
It’s the Type of Fat – Not the Amount of Fat

Although many people believe that reducing their intake of dietary fat will lower their risk of coronary heart disease (CHD), recent studies show that the type of fat—not the amount of fat—consumed influences cardiovascular risk.(1) Despite a decrease in total fat consumption in the United States, there has not been a decline in total caloric intake; additionally, the prevalence of type 2 diabetes and obesity has increased, suggesting that there is another dietary factor influencing cardiovascular risk.1 This factor is the type of fat consumed; different types of fats have different effects on health.

Challenging the Low-Fat Diet
Results of a prospective cohort study assessing dietary choices of 80,082 women with no cardiovascular disease at baseline showed that each 5% energy intake from saturated fat was associated with a 17% increase in the risk of coronary disease.2 The study concluded that replacing saturated and trans fats with unhydrogenated, monounsaturated, and polyunsaturated fats is more effective at preventing CHD than is following a low-fat diet.(2) This is because low-fat, high-carbohydrate diets raise HDL cholesterol levels and raise fasting triglyceride levels, which increases cardiovascular risk.2

Why is Saturated Fat Bad?
Saturated fatty acids increase total cholesterol and LDL cholesterol levels; elevated lipid levels are a risk factor for cardiovascular disease.1 In the Nurses’ Health Study, there was an increase in cardiovascular disease risk with each intake of saturated fatty acids.1 Both saturated and trans fat intake are associated with higher LDL levels and lower HDL levels, which increase cardiovascular disease risk. Additionally, trans fat consumption increases lipoprotein(a) levels, which are also associated with cardiovascular disease.

What is Monounsaturated Fat?
Both monounsaturated and polyunsaturated fats are liquid at room temperature. Polyunsaturated fats help your body to rid itself of newly synthesized cholesterol, keeping blood cholesterol levels low. Both fats keep your blood cholesterol levels low when substituted in place of saturated fats.

Studies have shown an inverse relationship between consumption of monounsaturated fats and total mortality.1 In fact, mortality rate of cardiovascular heart disease is very low in traditional Mediterranean populations that consume olive oil (a monounsaturated fatty acid source) as their primary source of fat.1 In metabolic studies, substituting carbohydrates with monounsaturated fats raises HDL levels without affecting the LDL levels. This may also improve glucose tolerance and insulin sensitivity among diabetic patients.

Now What?
In your diet, you should replace saturated and trans fats with monounsaturated and polyunsaturated fats. This will lower your lipid profile as well as your risk of CHD. Also, you should exercise at least 20 minutes a day, most days of the week, to ensure optimal cardiovascular health. In fact, a combination of diet and lifestyle changes is associated with decreased progression of atherosclerosis. The Lifestyle Heart Study assigned 28 MI patients to an intervention consisting of a low-fat, vegetarian diet, exercise, and yoga.1 The other 20 individuals were assigned to usual care group.1 After one year, the blood cholesterol was lowered by 19% in the intervention group, compared with the control group.1 This shows the benefits of both a healthy diet and exercise.

Dietary Sources of Trans Fats: Stick margarine, commercially baked products, deep-fried foods, partially hydrogenated vegetable oils (cookies, crackers, French fries, donuts)

Dietary Sources of Saturated Fats: some plant oils (palm, palm kernel, and coconut oils), foods from animals (whole milk, ice cream, lard, meats).

Dietary Sources of Polyunsaturated Fats: nuts (walnuts, almonds, peanuts, and other nuts), certain plant oils (safflower, sesame, soy, and others)

Dietary Sources of Monounsaturated Fats: certain plant oils (olive, canola, peanut), avocados

 

Updated February 12, 2009 - MJ

 

Coumadin (also called Warfarin)

What is it?

Coumadin is a prescribed medication that decreases the clotting ability of blood. This helps to keep blood flowing smoothly by preventing clots from forming in the blood vessels and heart.

 

Why do I need it?

Coumadin is prescribed to patients to prevent blood clots from forming or growing larger in the blood vessels. Coumadin is required in patients who have:

• A prosthetic heart valve

• Atrial fibrillation (irregular heart rhythm)

• Clotting disorders (i.e. antiphospholipid syndrome)

• Had previous stroke or heart attack

• Had a clot which has travelled to the lung (pulmonary embolism) or leg (deep vein thrombosis)

• Recent surgeries (hip/knee replacement)

• An existing clot to prevent it from growing larger

 

 

What tests do I need?

The two tests that are required to determine the clotting time are:

• Prothrombin time (Protime, PT) – test that measures the time it takes for the clotting mechanism to progress. This is specifically sensitive to clotting factors that are affected by Coumadin.

• International normalized ratio (INR) - expresses the PT in a standardized way to ensure that results taken from different laboratories can be reliably compared.

These are taken every 1-4 weeks and can alter the dosage of Coumadin you are taking based on the periodic blood tests to maintain the clotting time within a target range. 

After taking Coumadin the general effect occurs within 24 hours, but the peak effect may be after 3-4 days.  After a single dose of Coumadin the action can last up to 2-5 days. The effects may be more pronounced as the daily doses overlap. Coumadin is completely absorbed after oral administration with a peak concentration within the first 4 hours. It is excreted mostly in urine and the effects of a single dose of Coumadin can wear off in approximately 1 week.

 

 

How should I use it?

• Coumadin should be taken Exactly as directed.

• Take the dose once a day, around the same time every day.

• If you forget to take your daily dose at the same time as normally, take the dose as soon as possible on the same day. In case you miss the dose that day, wait until the following day to take the regularly prescribed dose for that next day. DO NOT TAKE A DOUBLE DOSE.

• If you forget to take your dose for 2 or more days in a row, call Dr. Jamnadas. He may need to change your dose.

• Dosage ranges from 1-10 mg as scored tablets, making it easier to cut in half. Your dosage will be adjusted according to the results of your blood tests which are taken every 1-4 weeks.

• Can be taken with or without food.

• Refill your prescription 1 week before your supply ends to avoid missing a dose.

• Continue taking your Coumadin as long as Dr. Jamnadas prescribes it.

 

 

Where can I store this?

Keep this medication in the container provided, keeping it tightly closed.
Keep it stored at room temperature and away from excess heat, cold, moisture, and light. Do not store in the bathroom.
Keep out of reach of children.

 

 

What precautions should I know?

If you are taking these medications, they may interfere with Coumadin:

• Amidarone or Digoxin (antiarrhythmic drug)

• Antibiotics: Cephalosporins, Ciprofloxacin, Erythromycin, Sulfamethoxazole-Trimethoprim etc.

• Anti-inflammatory: Ibuprofen (Advil or Motrin), Naproxen (Aleve or Naprosyn) Acetaminophen (Tylenol)

• Antifungal: Fluconazole

• Anticoagulants: Heparin, Plavix, or Aspirin

• Medications for: cancer, cholesterol, colds and allergies, depression, mental illness, diabetes, heartburn or peptic ulcers, gout, seizures, tuberculosis, thyroid problems, birth control.

• Herbal or botanical products

 

If you initiate, stop, or start, or change doses of any of these medications it will affect your PT and INR.

.
Do not take two or more medications containing Warfarin.

 

 

You are at higher risk of bleeding if you are taking Coumadin and:

 

• Are 65 years of age or older

• Have history of peptic ulcers

• Have high blood pressure

• Have history of stroke

• Have a serious heart disease

• Have a low blood count or cancer

• Have had trauma or surgery

• Have renal disorders

 

 

Let us know if you:

• Are pregnant or think you might be pregnant or plan on being pregnant while taking Coumadin.

• Are Breast-feeding

• Have any bleeding tendencies

• Are diabetic

• Are having surgery including dental or medical surgery

• Are consuming large amounts of alcohol

• Use an indwelling catheter

• Are receiving an immunization such as the flu shot

• Are unwilling to take the medication or non-complaint

• Wish to start a new medication including over the counter medications such as cold medicine or pain reliever.

 

 

What side effects can it cause?

Coumadin therapy may cause:

 

 

What dietary instructions should I follow?

Follow a normal and healthy diet. Certain foods and beverages can affect the efficiency of Coumadin. It is important to pay attention to what you eat while taking this medication. Vitamin K can reduce the efficiency of Coumadin. Do not restrict the amount of vitamin K intake; just be consistent with the amount normally taken. Eating small amounts of foods that are rich in vitamin K should not cause any problems. Avoid eating or drinking large amounts of:

 

• Green leafy vegetables including: collard and mustard greens, kale, parsley, Brussels sprouts, spinach, cabbage, and green tea.
• Vegetable oils
• Soybean or canola
• Cranberry  and grapefruit juice

 

Let Dr. Jamnadas or Dr. Kelly know if you are planning on eating more or less vegetables or decide to follow a special meal plan to lose weight.

 

 

Recommendations:

Prevent falls: Falling can increase the risk of bleeding. Try preventing falls in the house by removing loose rugs and electrical cords that can lead to slipping and falling. Ensure adequate lighting in your home, especially in stairways and entrances. Avoid walking on wet floors or any slippery surface or in unfamiliar areas.

Reduce the risk of bleeding: Since there is a tendency of bleeding, some simple changes can decrease the risk by

Dental procedures: including simple extraction of 3 teeth, gingival surgery, crown and bridge procedures, dental scaling, and surgical removal of teeth. It is NOT necessary to change your dose of Coumadin if your INR is below 4. The risks of discontinuing Coumadin, even for a short period of time, may cause irreversible changes due to a dislodged clot (thromboembolism) causing stroke or heart attack. Most dental procedures can be managed using routine local measures to control bleeding. The effects of minor bleeding are reversible. Consider the benefits and risks before discontinuing Coumadin.

Exercise: avoid any activity or contact sport that may cause serious injury.

Avoid excessive alcohol consumption: Alcohol can affect your ability to handle Coumadin. Drinking alcohol can increase the risk of injury and therefore bleeding.

Identification bracelet: Carry an identification bracelet stating that you take Coumadin. On the bracelet list your name, medical problems, medications and dosages, doctor’s name and telephone number.

Carry a list of medications: It is important to keep a written list of the medications you are taking weather it is prescribed or not prescribed (over the counter) and any other vitamins, minerals, or dietary supplements.

 

Updated January 31st, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

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Pacemakers

What is a pacemaker?
A pacemaker is another type of implantable cardiac device that monitors the heart to treat bradycardia (slow, irregular, or interrupted heartbeat). This is for patients without heart failure, who only suffer from bradycardia. The pacemaker sends out small, undetectable electrical signals to the heart to correct bradycardia and help restore the heart to a normal rate. Pacemakers only send out the pulses when your heart needs them – the rest of the time, they are waiting and watching.

How do I know I need a pacemaker?
You need a pacemaker when your heart’s electrical conduction system malfunctions, causing your heart to beat too slowly. Sometimes, a slow heart rhythm may be discovered during a routine checkup visit, without your even knowing about it. Symptoms of bradycardia include lightheadedness, shortness of breath, fatigue, weakness, or fainting. Your doctor may prescribe you an electrocardiogram (ECG) to provide a graphic representation of your heart’s rhythm. Alternatively, your doctor may recommend a Holter monitor to record your heart’s rhythm over 24 hours.

You might need a standard pacemaker if:

Where in the body are pacemakers implanted? How do they work?
The pulse generator component of the pacemaker is implanted in the upper chest, just below the skin near the collarbone. The pulse generator contains the battery and electronic circuitry that directs the battery to send electrical pulses through the leads, thereby stimulating the heart to beat at a normal rhythm. Leads are inserted through a vein and connect the pulse generator to the heart. These leads monitor your own heart rhythm and transmit this information to the generator, which adapts its responses to your heart’s specific needs. An external tabletop computer called a programmer allows your doctor to change your pacemaker settings without invasive surgery.

How long to pacemakers last?
Pacemakers last anywhere from 2 to 10 or more years; on average, they last about 6 years.

How big are pacemakers? Can I feel them “tick” inside me?
Today’s pacemakers are very small – many times less than 2 inches wide and a quarter-inch thick. Initially, after pacemaker is implanted in the body, you will be aware of it. However, this feeling will lessen with time; a pacemaker does not make sounds, so neither you nor anybody around you will hear it.

Can I still live an active lifestyle after pacemaker implantation?
Yes, typically, pacemaker patients can continue leading active lifestyles; you should be able to participate in most of the activities you participated in prior to receiving a pacemaker. However, your doctor may advise you about your limits.

Do I have to stay away from things like magnets, microwaves, and strobe lights?
Pacemakers cannot be damaged by using household appliances such as microwaves, electric blankets, and most power tools. Using electric arc welders or working on automobile ignition systems should not damage pacemakers, but there is the possibility that they may briefly interfere with proper pacemaker operation. Some medical equipment may interfere with pacemaker functioning. If you feel rapid, irregular heartbeats when operating or standing near any of this equipment, you should turn the equipment off or walk away from it, and this will allow for normal pacemaker operation.

Can I still use cell phones?
Cell phones send electromagnetic signals, and this may interfere with proper pacemaker operation. Therefore, it is recommended that you do not carry your phone in a breast pocket over the pacemaker and that you do not hold your cell phone to the ear closest to your pacemaker.

Will pacemakers interfere with airport security devices?
No. Pacemaker recipients can travel without restrictions.

How do I know if I need a new pacemaker?
A pacemaker will give ample warning if its battery is low; in fact, most pacemaker systems will continue functioning normally for 3 to 6 months after the battery is signaling a low level.

 

 

Updated January 29, 2009 - MJ

 

Biventricular Pacemakers

What the normal heart does:

• In the normal heart, the heart’s lower chambers (ventricles), pump simultaneously and in sync with the upper chambers (atria)
• When a person has heart failure, oftentimes the right and left ventricles do not pump together, and as a result, the left ventricle is not able to pump enough blood to the body.
• This leads to an increase in heart failure symptoms, including shortness of breath, swelling in the ankles or legs, weight gain, fatigue, irregular or rapid heartbeat, and increased urination.

What does the biventricular pacemaker do?

How is a biventricular pacemaker different from traditional pacemakers?

You need a biventricular pacemaker if you…

 

 

 

Updated January 29, 2009 - MJ

 

ICDs

Implantable Cardiac Devices: are miniaturized, batter-powered devices that help keep your heart rhythm normal. Today’s implantable devices treat abnormal heart rhythms and treat other heart problems such as heart failure.

Types of Implantable Cardiac Devices:
Implantable Cardioverter Defibrillators (ICDs): monitor the heart rate to treat tachycardia (fast heart beats), which can lead to cardiac arrest. If left untreated, cardiac arrest can lead to death within minutes.  Therefore, ICDs are very important in maintaining your heart’s normal rhythm.

How do ICDs work?
ICDs deliver small, painless electrical signals called defibrillation to the heart, and this startles the heart back to a normal rhythm. Defibrillation must be done quickly, as it there is a greater risk of sudden cardiac arrest with each minute that goes by.

Where in the body are ICDs implanted? How do they work?
An ICD is implanted beneath your skin similar to how a pacemaker is. The ICD monitors your heart’s rhythm and responds immediately and automatically if it senses an abnormal rhythm. ICDs send small painless electrical signals to your heart to treat dangerously fast heart rates by helping to restore the heart to a normal rate

You might need an ICD if:

Updated January 29, 2009 - MJ

Biventricular ICD

What the normal heart does:

What does a biventricular ICD do?

You need a biventricular ICD if…

Updated January 28, 2009 - MJ

 

Stress Test

What Is Cardiac Stress Test?

A Cardiac Stress Test is a diagnostic procedure to record the heart's electrical activity while it is under the stress of increased physical demand. This is also known as an exercise tolerance test.

Parts of the Body Involved:

Chest, Arms and Legs

Reasons for Procedure:

A cardiac stress test is used to assess the heart muscle's response to the need for additional oxygen, which occurs during increased physical activity.

What to Expect

Prior to Procedure

Your doctor will likely do the following:

In the time leading up to your procedure:

During Procedure

Continuous ECG and intermittent blood pressure monitoring

Anesthesia: None

Description of the Procedure

The technician checks your blood pressure, attaches electrocardiogram electrodes (small adhesive patches with wires that connect to an ECG machine) to your chest and arms, and performs a resting ECG.
The cardiac stress test is done either on a treadmill (most common) or on a stationary bike. You slowly start walking or riding. At 2- or 3-minute intervals, the technician increases the speed and elevation or resistance in order to make the exercise more strenuous. The technician closely monitors the ECG and your symptoms to assess the status or your heart. Try to exercise until you are exhausted or you have reached the target heart rate.

 

 

 

Updated January 30, 2009 - MJ

 

 

NUCLEAR STRESS TEST

 

What is a nuclear stress test?

A nuclear stress test measures the blood flow to your heart both at rest and during stress on the heart during exercise. This test provides images of the amount of blood flow in all sections of the heart, which can show areas of low blood flow and damaged tissue.

 

Why do I need a nuclear stress test?

If the doctor suspects you have Coronary Artery Disease or if you are experiencing symptoms of chest pain or sudden loss of breath.
To asses the amount of blockage within the vessels of the heart.
A nuclear stress test may be advised to you even if you have already been diagnosed with coronary artery disease to asses the effectiveness of the treatment you are on.
To look at the size and shape of your heart. It may be enlarged in patients whose hearts are working harder than normal.
To measure the Ejection Fraction this shows how well your heart pumps with each beat.
An accurate stress test Decreases the use of unnecessary stenting.

 

How to prepare for the nuclear stress test:

 

Continue your medications up to the day of the procedure. On the day of the test,

Stop these drugs:

 

Ask your doctor how much insulin you should take the day of the test. Your doctor may recommend you to only take half of the usual morning dose and to eat a light meal 4 hours before the test. Do NOT take your diabetes medication and skip a meal before the test.

 

 

What to expect during the test:

• First, a nuclear medicine technologist will place an i.v. into your arm or hand. You may be injected with an isotope called Cardiolite that allows us to pick up your blood flow on camera.

• After this is injected, you will wait about 30 minutes before the first set of “Resting” images are taken.

• You will be asked to lie under a gamma camera with both arms above your head for 15-20 minutes. This camera will capture the images of the blood flow through your heart at rest.

• Next, the technician will place electrodes on your chest, arms, and legs. These electrodes connect to wires on an electrocardiogram (EKG) machine. The EKG records the electrical activity of the heart.

• If a pharmacological stress test has been ordered for you, you will then be injected with a pharmacological medication known as Lexiscan. This medication increases the blood flow to the heart to simulate exercise. This does NOT increase your heart rate, only dilates the vessels as if you were exercising.

• If an exercise nuclear test has been ordered for you then you will slowly begin walking on the treadmill. As the test progresses, the speed and incline on the treadmill increases. Your blood pressure and EKG will be monitored throughout the test.

 

The length of the test depends on your physical fitness and symptoms. The goal is to have your heart working hard for about 5- 15 minutes in order to thoroughly monitor its function. Exercise is continued until you reach your target heart rate. During the test you may develop symptoms or signs of:

 

 

You may stop the test at any time if uncomfortable. Symptoms typically disappear once you rest.
Finally, after a 30-60 minute breakfast or lunch break you will be asked to again lie under the camera with both arms above your head for 15-20 minutes. The camera will capture the “exercise” images of the blood flow through your heart. This set of images will be compared to the resting images.
The entire test will take about 3-4 hours.
Once your nuclear stress test is complete, you may return to your normal activities, eating habits, and medications.

 

Risks:

Nuclear stress tests are generally safe and complications are very rare. Although with any medical procedure, it does carry a small risk of complication. These complications include:

Results:

Dr. Jamnadas or Dr. Kelly will review the results of your nuclear stress test before your next office visit, not the same day as the test.
The results of the test will compare the images of the heart at rest and during exercise.

 

Interpretations of the results: 

In patients with mild to moderate blockage blood flow is not restricted. Usually only coronary blockages of >70% restrict blood flow and will usually show up on a nuclear stress test.
A nuclear stress test showing mild to moderate blockages usually do not show up on a nuclear stress test and do Not need stenting or bypass. This can be cured by lifestyle and preventative changes.

 

 

 

 

 

 

Updated January 31, 2012- JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Echocardiogram

An echocardiogram, also known as echocardiogram Doppler, is used for many purposes.

Test Preparation

There is no special preparation for this test.  It is performed in the echocardiogram department. 

Test Procedure

You need to remove any jewelry and clothing above the waist, and you will be given proper covering during the procedure.  Ultrasound gel is applied to the skin around your heart, and a probe is passed over the heart while you are laying audio back, and on the left side.  This instrument will send sound waves into the heart and pick up the reflections on the video monitor. You will be able to see your heart pumping.  The valves are clearly demonstrated, together with the flow of blood within the heart.  You will hear noises of the Doppler, and at times, you may be asked to hold her breath.  The entire procedure will take approximately 30 minutes.

The results of the echocardiogram will be given to you during the office visit.

 

Updated January 30, 2009 - MJ

Blood Pressure Monitoring

Devices for Blood Pressure Monitoring
Blood pressure readings taken outside a clinic setting by a patient or by ambulatory monitoring devices have become increasingly prominent in the management of patients with hypertension.

Why Should I Self-Monitor My Blood Pressure?
Self-monitoring can be an accurate method to evaluate a patient's usual blood pressure and to evaluate the effect of antihypertensive medication. Self-measured blood pressure readings may be more reliable because of the greater number of readings that can be obtained during a certain time period.
The circumstances at the time of measurement may influence the height of the blood pressure. If readings are taken too soon after a meal or exercise, they may be lower than at other times, while if they are taken after smoking a cigarette or drinking coffee, they may be increased.

What are the Benefits of Self-Monitoring?
The benefit of self-monitoring is twofold: first, a large number of readings are taken, and second, they are taken outside the environment of the doctor's office. Thus self-monitoring gives a better prediction of the risk associated with high blood pressure than do doctor's readings. In addition, it is the only way of assessing the diurnal rhythm of blood pressure, which is characterized by higher pressures during the day and lower pressure at night.
Self-monitoring is recommended for the majority of patients with hypertension. Exceptions would include persons who are markedly obese or those with irregular heart rhythms. Four potential benefits of home monitoring are:

Patients should check the accuracy their blood pressure monitoring devices in their physician's office before home use and then once a year thereafter to ensure accuracy.

Patients should be instructed to take readings both in the morning and in the evening, on work and non-work days. The frequency of readings should be determined by the patient's clinical situation. The frequency of readings depends on the situation: for initial evaluation, it may be appropriate to take them several days per week, but when the patient's condition is diagnosed, stable readings can be taken less frequently.

There is no universally agreed on upper limit of normal home blood pressure level, but a reasonable figure would be 135/85 mm Hg. Blood pressure recorded at work may be somewhat higher.

Ambulatory Blood Pressure Monitoring (ABPM)

Ambulatory blood pressure monitoring (ABPM) is a technique for measuring blood pressure over a period of 24 hours while people go about their normal daily activities. The patient wears a small monitor, which takes readings automatically every 15 to 30 minutes, and stores them in its memory. The ABPM provides accurate and reliable information and can give your doctor a more accurate picture of your blood pressure than occasional visits and readings taken at the doctor’s office.

Will I Be Able to Lead a Normal Life When Wearing a Blood Pressure Monitor?

Wearing a monitor does not interfere with daily activities. The monitors are lightweight, comfortable, and quiet. A trained professional in your physician's office will program the device to automatically measure your blood pressure throughout the day and night. You will have an inflatable cuff worn on one arm and a recording device about the size of a Walkman worn at the waist. Most people find them very comfortable to wear.

Other Monitoring Devices

There is a wide selection of digital blood pressure monitors that are available to you, and some do not require 24 hour monitoring. Such devices are used at the patient's discretion and convenience. Omron makes top-quality blood pressure monitors, which include the wrist blood pressure monitor and digital read-out blood pressure monitoring machines such as the manual inflation monitor and the automatic inflation monitor.

What Else Do I Have to Do?
Your doctor may ask you to keep a record of things like the time you wake up, go to sleep, eat, experience strong emotions or stress, take medication, exercise, or have other experiences that can affect your blood pressure. This information will help your doctor with the blood pressure monitoring process.

To learn more about blood pressure managment, click here.

To learn more about the components of blood and blood pressure, click here.

Updated February 2, 2009 - MJ

Hypertension (High Blood Pressure)

 

What is high blood pressure?

High blood pressure is also known as hypertension. In this condition, the force of the blood pressing against your artery walls is high. High blood pressure is important to control because it can lead to serious health problems including heart attack, stroke, and heart failure. Hypertension can be asymptomatic and therefore dangerous. High blood pressure is easily detected and should be routinely monitored.

 

What are the causes of high blood pressure?

There are 2 types of hypertension, each having different causes:

      Accounts for 85% of cases and influenced by diet, lifestyle, or family history of high blood pressure.

Accounts for 15% of cases as a sudden cause of high blood pressure due to involvement of other organs or medications including:

 

 

Risk factors affecting high blood pressure

• Sex- Men are more likely to develop hypertension. Women are more likely to develop high blood pressure after menopause.
• Old age
• Race- more common amongst African Americans than Caucasians.
• Family history of high blood pressure
• Smoking
• Alcohol
• Being overweight or obese
• Lack of physical activity
• Too much salt in your diet
• Stress
• Chronic conditions may increase the risk of high blood pressure including high cholesterol levels, diabetes, adrenal and thyroid disorders, and sleep apnea.

 

Symptoms of high blood pressure:

Some people may have NO signs or symptoms and can be surprised when diagnosed.

Symptoms include:

 

How do I know if I have high blood pressure?

Blood pressure is recorded at your routine doctor’s visit. If you are not diagnosed with hypertension, check your blood pressure at least twice a year. For patients already diagnosed with high blood pressure should check their blood pressure more frequently. Blood pressure does not only have to be recorded at your doctor’s appointment. You can check at any local grocery store or at home if you have your own blood pressure monitor. Take your blood pressure when you are calm and relaxed. Home blood pressure monitors are a great way to get accurate readings while you are at rest. 24 hour blood pressure recording is better than office recordings.

The correct method to check blood pressure is to place the cuff over your Left arm about 2cms above the elbow. Not too tight or too loose, you should be able to pass 2 fingers in the cuff.

Once you have recorded your blood pressure you will be left with 2 numbers. The top number, Systolic pressure is the pressure in the arteries during contraction of the heart when arteries are being filled with blood.  The bottom number is the Diastolic pressure which measures the pressure within the arteries during the relaxation of the heart resulting in a lower value than the top number.  Normal blood pressure ranges up to 120/80, but blood pressure can rise and fall with exercise, rest, or emotions.

 

	Systolic Pressure	Diastolic Pressure
Normal	<120	<80
Prehypertension	>120-139	80-89
Essential (primary) Hypertension	140-159	90-99
Secondary Hypertension	>160	>100

 

 

What happens if my blood pressure is not controlled?

You are at risk of having:

How can I prevent this?

• Check your blood pressure routinely.
• Diet modification: cut back on salty and buttery foods. Be sure to eat plenty of fruits, vegetables, and foods rich in potassium.
• Certain supplements can help lower cholesterol including Cod liver oil, Coenzyme Q10, and Omega 3 fatty acids.
• Follow a diet. Try using the “No Whites Diet”, “DASH diet”, or the “Paleolithic diet”. Ask Dr. Jamnadas about which diet plan is best for you.
• Maintain a healthy weight with a body mass index <25. This will minimize the pressure in your arteries.
• Get a comprehensive nutritional evaluation. Certain elements and vitamin deficiencies can cause high blood pressure. I.e. Vitamin D deficiency affects an enzyme produced by your kidneys that affects blood pressure.
• A full endocrine evaluation may be recommended to rule out secondary causes of hypertension.
• Be more physically active. Try going for a walk, jog, bike ride, or swim.
• Quit smoking
• Limit alcohol: if you choose to drink alcohol, limit it to no more than 2 drinks a day.
• Keep stress levels to a minimum.

 

Treatment of high blood pressure:

Diet modification, weight loss, and active lifestyle all help in lowering blood pressure.
Medical treatment varies in each patient.
Dr. Jamnadas will prescribe a single low dose medication to lower the blood pressure first. If not controlled with just one, a combination of 2 or more medications may be advised for best results.
The category of medication Dr. Jamnadas prescribes depends on the stage of high blood pressure and whether you have other medical problems.

Blood pressure lowing drugs include:

• Diuretics- sometimes referred to as “water pills”. These reduce sodium and water to lower blood volume.

• Beta Blockers- act by lowering the heart rate to decrease the work load of the heart and help dilate the blood vessels.

 

• ACE Inhibitors- lower blood pressure by preventing some of your natural chemicals to be made that constrict blood vessels and promote dilatation.

•  Angiotensin II Receptor Blockers (ARBs) - block the action of the natural chemicals that narrow blood vessels.

 

• Calcium Channel Blockers- relax the muscles within the blood vessels by selectively blocking excess calcium and slow the heart rate. This increases the oxygen supply to the heart, increases blood flow, lowers resistance within the vessel, and prevents coronary artery spasm.

• Vasodilators- directly act on the muscles within the walls of the blood vessels, promoting dilatation and decreases blood pressure.

 

Once your blood pressure is under control, Dr. Jamnadas may have you take a daily aspirin to reduce your risk of cardiovascular disorders.

*RESPeRATE: Resperate is a portable FDA approved device that lowers your blood pressure by altering your breathing patterns. This uses chest sensors to measure breathing to synchronize you to a breathing pattern with longer expirations. This is recommended to be used for 15 minutes a day, 3- 4 days a week. A reduction in stress levels will be noticed.  This device is available for purchase in our office.

 

Don’t Forget!

Schedule routine visits to Dr. Jamnadas to monitor your blood pressure.

Take your medications regularly, exactly as prescribed.

If you are having any side effects or the costs of medications are posing problems please do NOT discontinue your medications on your own. Ask Dr. Jamnadas about other options.

Ensure good nutrition and get regular exercise.

Quit smoking

Manage stress: stay positive, optimistic, and most of all calm.

 

 
*The single most important parameter to treat in your life is your blood pressure*

 

Updated January 31st, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

 

White Coat Syndrome

What is White Coat Syndrome?
White Coat Syndrome (WCS) refers to the situation when a person’s blood pressure, as measured in a physician’s office, is consistently higher than when measured at home or at work. Studies suggest that nearly 10% to 20% of patients experience WCS. Although the cause of WCS is unclear, some people suggest it is a conditioning phenomenon. That is, patients feel anxious during their early visits to the doctor’s office, and this anxiety is subconsciously repeated in later visits. Cardiovascular risk is increased in patients with WCS but not as much as that of true hypertensive patients.

How is White Coat Syndrome Diagnosed?
White Coat Syndrome is best diagnosed by wearing a 24-hour ambulatory blood pressure monitor. This periodically measures and records your blood pressure over a 24-hour time period, enabling you to obtain blood pressure readings outside the physician’s office. Before using one, make sure your physician checks the blood pressure monitor to ensure it is working accurately.

Is there a Test for White Coat Syndrome?
Yes. The best way to diagnose WCS is through a 24-hour ambulatory blood pressure monitoring devices, which are provided by CVI.

What are the Blood Pressure Monitoring Devices Available to Me?

 

Updated February 2, 2009 - MJ

Content 1

Content 2

Glycemic Index

What is the Glycemic Index?
The glycemic index (GI) is measure of the ability of foods (specifically carbohydrates in food) to raise your blood sugar (glucose) levels after being eaten. The GI scale ranks carbohydrates from 0 to 100, with 0 as the slowest absorption and 100 as the fastest absorption into the bloodstream. Foods with high GIs (greater than 70) are quickly digested and absorbed, resulting in a rapid increase in blood sugar and, consequently, insulin levels. Foods with low GI (less than 55) are slowly digested and absorbed, meaning they gradually increase blood sugar and insulin levels.

The Glycemic Index and Your Health
Because low-GI foods are absorbed slowly, they provide weight control benefits by making you feel satiated, thereby controlling your appetite and delaying hunger. Additionally, low-GI diets reduce insulin levels and insulin resistance, decreasing the risk of developing diabetes. This is supported by studies from the Harvard School of Public Health, which found a link between the risk of diseases and the GI of people’s overall diets; the lower the GI of the diet, the lower the risk for diabetes and coronary heart disease. Following a low GI diet is especially important for diabetic (Diabetes Type 1 and 2) patients because a low GI diet improves glucose and lipid levels and decreases cardiovascular disease risk.

Figure 1: This graph depicts the changes in blood glucose levels induced by high and low GI foods. Foods with a high GI cause a significantly sharper rise in glucose and insulin levels when compared with low GI foods.

Research suggests that the glycemic index of foods is related to HDL-cholesterol concentrations – in clinical studies, patients following high-GI diets had the lowest HDL levels. High GI diets are associated with higher fasting triglyceride levels, increasing cardiac risk, especially among overweight individuals. In contrast, patients following a low-GI diet had a decreased incidence of diabetes mellitus.

In order to decrease your risk of chronic diseases such as diabetes and cardiovascular disease, you should follow a low-GI diet of fruits, vegetables, and whole grains. Following a low-GI diet not only reduces your cardiovascular risk, but it also improves your lipid panel and helps you to maintain a healthy weight by making you feel satiated after eating. A list of foods and their GI values is presented below. You should make changes to your diet that include more low-GI foods and exclude high GI and sugary foods.

Glycemic Index of Foods
Glycemic Index and Average Carbohydrate Concentration per 100g

Updated January 29, 2009 - MJ

Definitions of Claims on Food Labels

The following definitions of nutrition labels will help you to understand exactly what is in the foods you buy:

Free - the product contains no or only a trivial amount of one or more of the following:

Low - this means a large quantity of the food can be eaten without exceeding the Recommended
Dietary Value for the nutrient

Updated January 29, 2009 - MJ

Diabetes and Eating Healthy

If you have Diabetes, you do not need a special diet. You simply need to follow the same healthy eating plan that is recommended for everyone. The following information can help you plan delicious and nutritious meals to keep you healthy.

Eat small meals and snacks throughout the day
Consume regular meals and snacks so that your food intake is spread throughout the day; this will help control your blood sugars. It is important to start each day with a healthy breakfast. Do not skip meals. If you take tablets or insulin, regular meals and snacks can help you to avoid symptoms of low blood sugar.

Reduce your sugar intake by choosing low sugar foods and drinks
It is not necessary to avoid sugar completely. Aim to eat less sugary foods and drinks, such as candy bars, ice cream, cookies, sweet sodas, and fruit juices. These foods can make your sugar levels rise quickly, especially if eaten in large quantities. Try to choose low sugar foods and sugar free drinks when possible.

Eliminate fast foods & junk foods
Fast foods and junk foods are full of fat and calories and usually offer little or no nutritional value. A simple change in habits can help you eliminate these foods from your diet. If you are in the habit of driving through a fast food restaurant pick up window to grab a quick burger and fries, start taking your lunch to work or school. For snacks, avoid vending machines, which usually only offer foods high in fat and calories. Instead, have sliced carrots, an apple or low fat yogurt. Unfortunately, convenience often means sacrificing nutrition.

Include a helping of starchy food at each meal
Starchy foods are breads, cereals, rice, potatoes and pasta. Try to base your meals around these foods, as they will help to keep your blood sugar levels steady. Include high fiber varieties where possible.

Eat more fruits and vegetables
They are an important part of a healthy diet because of their vitamin and mineral content. Additionally, they are important in regulating bowel function because they increase the fiber content of your diet. For a snack or dessert, start having a piece of fruit and enjoy all varieties of vegetables, salads and fruits. They can be fresh, frozen, tinned, or present in natural juice. Unsweetened fruit juice should be kept to one small glass per day before or with a meal.

Reduce fried and fatty foods

Updated January 29, 2009 - MJ

Nutrition and Heart Disease

The Basics

Vitamin and mineral supplements combined with an unrefined diet high in fruits and vegetables, some omega-3 oils, no hydrogenated fats, and a good lifestyle are the basics for a healthy heart. Include weight control, not smoking, some exercise, and the ability to manage stress, and you will improve your general health and prevent or help control heart disease.

A Healthy Diet

Science shows that a varied diet of relatively unrefined foods with many fruits, vegetables, brown rice and whole grains is the basics of a healthy diet. Unfortunately, these foods are becoming scarce in many Western diets. When the food industry processes these foods, at least 75% of the minerals, vitamins, fiber, and antioxidant nutrients is lost, and this contributes to the development of chronic diseases.
Most of the world's heart and cardiology organizations suggest reducing saturated (solid) fat and cholesterol intake while increasing polyunsaturated fat consumption. Although less fat is generally good, the only clear benefits of fat substitutions are those with omega-3. Polyunsaturates without omega-3 (all the high omega-6 linoleic oils: corn, sunflower, safflower or cottonseed) can in fact cause harm, especially if they are partially hydrogenated (shortening and 90% of margarines). Virgin olive oil has no omega-3 but it's the healthy unprocessed oil for daily use. Butter is better than margarine except possibly unhydrogenated canola and soy based types.
Reduce sugar, white flour, white rice, ordinary white noodles and foods that are deep fried, have shortening and anything "hydrogenated".
Potassium (found in bananas, celery, potatoes, fruits & veggies) and magnesium (whole grains, nuts, greens) can help prevent heart attacks. Sweating and most diuretics flush out these spark plugs for the heart. It is recommended that you drink at least eight 8oz. glasses of water every day.

Vitamin & Mineral Supplements

Foods low in these "minor" nutrients can cause initially hidden illness, like heart disease, cancer, Alzheimer's, and arthritis. These are the slow-building diseases that drug-based medicine has not been able to prevent or effectively control.
Even when in great health, there's excellent reason for taking a good multi-vitamin plus foods and supplements so that your total daily intake reaches about 1 gram of vitamin C, 1.5 g calcium, 3/4 g magnesium, 200-400 IU vitamin E and 200 mcg selenium. It is also the easiest life-style change you can make.
Us a single multivitamin with most B's near the 25 mg level, B3 at 100 mg, folic acid at 400 mcg and B12 at 100 mcg. Separately take 200 IU natural (type d) or 400 IU synthetic vitamin E (type dl), about 1 gram vitamin C (not Ester-C) and take 200 mcg selenium.
It is important to get about 1½ g calcium, ¾ g magnesium (most people will need to supplement) and 4-800 IU vitamin D to make the calcium build bone.
Only take iron if you are in your child bearing years or have another reason. Go easy on the copper (1 - 2 mg max.) but do include 15 mg zinc. These plus the selenium and the D can be found in the same single multi. If you have a cholesterol problem, try to avoid the statin drugs by taking the niacin route (vitamin B3, about 3x1 g/day) and always consult a doctor. Generic niacin is 10-20 times cheaper, effective and unique in its action on blood fats, lowering all that's bad, raising all that's good, and more.
If you have a (congestive) heart condition or take a statin drug, consider at least 60 mg coenzyme Q10 (CoQ10).

Exercise

Everyone knows that regular physical activity has a direct link to weight loss, lowering cholesterol levels, fighting obesity, controlling heart disease and helps maintain general good health. Make it a part of your daily routine.
There is an excellent chance that with long-term use of these foods, supplements, omega-3's along with regular exercise, you will significantly reduce your risk of sudden heart death.

 

The Paleolithic Diet

INTRODUCTION:
Although we are living in the 21st century, our human genome is greater than 10,000 years old. The way we metabolize our food is largely determined by our genetic machinery. Yet today, we live in a mechanized urban setting, lead sedentary lifestyles, and eat highly processed and synthetic diets that our genome is not accustomed to. It therefore comes as no surprise, that cardiovascular disease is the number-one cause of death and accounts for 41% of all fatalities. It should also come as no surprise that metabolic syndrome is present in over 40% of middle-aged American adults and that the lifetime probability of hypertension is greater than 90%. This cardiovascular disease pandemic will continue until we realize that our bodies were not designed for this lifestyle and diet. The genes we are born with will remain unchanged; therefore, our diet and lifestyle need to change. 

When our forefathers transitioned to an agricultural grain based diet, a gradual deterioration in health care began. Our ancestors consumed lean meats, fruits, and vegetables as opposed to cereals.  The grain-based diet resulted in shorter life spans, higher childhood mortality, and a higher incidence of osteoporosis, rickets, and various other mineral and vitamin deficiency diseases.  Further adaptation to Western lifestyles have lead to obesity, diabetes, atherosclerosis, and other degenerative diseases.

DIET:
There is so much controversy and confusion in recent times about the type of diet that we should follow. The Ornish diet consists of 80% carbohydrates with minimal consumption of animal fat or protein. The Atkins diet is high in protein and high in saturated fats and avoids almost all carbohydrates.  Each diet has its benefits and disadvantages.

Over 150 studies about diet and cardiovascular health have demonstrated that the following may reduce cardiovascular events:

Our ancestors consumed only natural and unprocessed food from the environment that provided them with a diet of protein, fiber, vitamins, minerals, antioxidants, and other beneficial phytochemicals. Our ancestors’ diet had three times more fiber, twice as much polyunsaturated and monounsaturated fats, four times more omega-3 fatty acids, and 70% less saturated fat. Furthermore, their sodium intake was 1/5 of what it is today, and their diet did not contain refined grains and sugar. It is evident that the epidemic of cardiovascular diseases is at least in part due to the striking discrepancies between the diet we are designed to eat and what we eat today.

CALORIES:
In this modern world, calorie-dense foods are abundant and inexpensive; therefore, most people are dying of caloric excess, which manifests itself as hypertension, cardiovascular disease, metabolic syndrome, and obesity. We also expend much less energy than our ancestors did. A diet that is high in carbohydrates and low in fat will have a much lower satiety index than the diet that has adequate quantities of proteins and fats.  Therefore, diets containing moderate amounts of beneficial fats and proteins, low glycemic index carbohydrates, and a regular exercise regimen are the most effective ways to maintain an ideal body weight and reduce cardiovascular disease risk. 

GLYCEMIC INDEX OF CARBOHYDRATE CONCENTRATIONS PER 100g

	Carbohydrate  Concentrn	Glycemic Index
Aubergines	4	10
Brocolli	4	10
Cabbage	4	10
Garlic	28	10
Green Vegetables	4	10
Lettuce	4	10
Mushrooms	4	10
Onions	5	10
Red Peppers	4	10
Tomatoes	4	10
Walnuts	5	15
Apricots (fresh)	10	20
Fructose	100	20
Grapefruit	10	20
Peanuts	9	20
Soya (cooked)	15	20
Cherries	17	22
Dark Chocolate (<70% cocoa solids)	32	22
Lentils – Green	17	22
Peas – Split	22	22
Plums	10	22
All Bran	46	30
Apple	12	30
Beans – French	3	30
Beans – Haricot	17	30
Chick Peas (cooked)	22	30
Fruit Preserve (w/out sugar or grape juice)	37	30
Lentils – Brown	17	30
Milk (semi-skimmed0	5	30
Peach	9	30
Apricots (dried)	63	35
Carrots (raw)	7	35
Chinese Vermicelli (mungo bean)	15	35
Fig (fresh)	12	35
Ice Cream (made w/ alginates)	25	35
Maize/Corn on the cob (traditional variety)	21	35
Orange	9	35
Pear	12	35
Peas - Dried (cooked)	7	35
Quinoa (cooked)	7	35
Yogurt (full-milk)	4.5	35
Yogurt (skimmed)	5.3	35
Apple Juice (fresh)	17	40
Black Bread (German)	45	40
Flour T200 (unrefined) - Bread	45	40
Flour T200 (unrefined) - Pasta	17	40
Grapes	16	40
Kidney Beans	11	40
Orange Juice (freshly pressed)	10	40
Peas (Fresh Petis Pois)	10	40
Rye (wholegrain, cooked)	49	40
Boulgour (wholegrain, cooked)	25	45
Bran Bread	40	45
Flour T1550 (unrefined) - Pasta	19	45
Spaghetti (hardgrain, cook al dente)	25	45
Buckwheat (black wheat flour0	65	50
Crepe/Pancake (made w/ buckwheat)	25	50
Flour T150 (unrefined) - wholemeal bread	47	50
Kiwi	12	50
Rice (Basmati)	23	50
Rice (Brown)	23	50
Sorbet	30	50
Sweet Potato	20	50
Petite Beurre Biscuit	75	55
Shortbread Biscuit (Flour B)	68	55
White Pasta (normal cooking)	23	55
Rice (long grain, white)	23	60
Banana	20	65
Brown Flour T85 (brown bread)	50	65
Jam (traditional)	70	65
Melon	6	65
Orange Juice (industrial)	11	65
Potatoes (boiled in their skins)	14	65
Raisins	66	65
Semolina (refined)	25	65
Cereals (sugared)	80	70
Chocolate Bars (ex. Mars Bar)	60	70
Cola Drinks	11	70
Cornflour	88	70
Flour T65 - country style bread	53	70
Maize/Corn on the cob (modern variety)	22	70
Noodles, Ravioli	23	70
Potato (peeled and boiled)	20	70
Rice (pre-cooked and non-stick)	24	70
Sugar	100	70
Turnip	3	70
Pumpkin	7	75
Watermelon	7	75
Broad Beans (cooked)	7	80
Crackers	60	80
Potato Crisps	49	80
Tapioca	94	80
Carrots (cooked)	6	85
Corn Flakes	85	85
Flour T55 – Baguettes	58	85
Popcorn (no sugar)	63	85
Rice Cake	24	85
Honey	80	90
Mashed potato	14	90
Rice (pre-cooked)	24	90
Potato (chips)	33	95
Puffed Rice	85	95
Beer	5	110

Glycemic Index and Average Carbohydrate Concentration per 100g

	Carbohydrate  Concentration	Glycemic  Index
All Bran	46	30
Apple	12	30
Apple Juice (fresh)	17	40
Apricots (dried)	63	35
Apricots (fresh)	10	20
Aubergines	4	10
Banana	20	65
Beans – French	3	30
Beans – Haricot	17	30
Beer	5	110
Black Bread (German)	45	40
Boulgour (wholegrain, cooked)	25	45
Bran Bread	40	45
Broad Beans (cooked)	7	80
Brocolli	4	10
Brown Flour T85 (Brown Bread)	50	65
Buckwheat (black wheat flour)	65	50
Cabbage	4	10
Carrots (cooked)	6	85
Carrots (raw)	7	35
Cereals (sugared)	80	70
Cherries	17	22
Chick Peas (cooked)	22	30
Chinese Vermicelli (mungo bean)	15	35
Chocolate Bars (ex. Mars Bar)	60	70
Cola Drinks	11	70
Corn Flakes	85	85
Cornflour	88	70
Crackers	60	80
Crepe/Pancake (made w/ buckwheat)	25	50
Dark Chocolate (<70% cocoa solids)	32	22
Fig (fresh)	12	35
Flour T150 (unrefined) - Pasta	19	45
Flour T150 (unrefined) - Wholemeal Bread	47	50
Flour T200 (unrefined) - Bread	45	40
Flour T200 (unrefined) - Pasta	17	40
Flour T55 – Baguettes	58	85
Flour T65 - country style bread	53	70
Fructose	100	20
Fruit Preserve (w/out sugar or grape juice)	37	30
Garlic	28	10
Grapefruit	10	20
Grapes	16	40
Green Vegetables	4	10
Honey	80	90
Ice Cream (made w/ alginates)	25	35
Jam (traditional)	70	65
Kidney Beans	11	40
Kiwi	12	50
Lentils – Brown	17	30
Lentils – Green	17	22
Lettuce	4	10
Maize/Corn on the cob (modern variety)	22	70
Maize/Corn on the cob (traditional variety)	21	35
Mashed Potatoes	14	90
Melon	6	65
Milk (semi-skimmed)	5	30
Mushrooms	4	10
Noodles, Ravioli	23	70
Onions	5	10
Orange	9	35
Orange Juice (freshly pressed)	10	40
Orange Juice (industrial)	11	65
Peach	9	30
Peanuts	9	20
Pear	12	35
Peas (Fresh Petis Pois)	10	40
Peas - dried (cooked)	7	35
Peas – split	22	22
Petite Beurre Biscuit	75	55
Plums	10	22
Popcorn (no sugar)	63	85
Potato (chips)	33	95
Potato (peeled and boiled)	20	70
Potato Crisps	49	80
Potatoes (boiled in their skins)	14	65
Puffed Rice	85	95
Pumpkin	7	75
Quinoa (cooked)	18	35
Raisins	66	65
Red Peppers	4	10
Rice (Basmati)	23	50
Rice (Brown)	23	50
Rice (long grain, white)	23	60
Rice (pre-cooked and non-stick)	24	70
Rice (pre-cooked)	24	90
Rice Cake	24	85
Rye (wholemeal bread)	49	40
Semolina (refined)	25	65
Shortbread Biscuit (Flour B)	68	55
Sorbet	30	50
Soya (cooked)	15	20
Spaghetti (hardgrain, cooked al dente)	25	45
Sugar (saccharose)	100	70
Sweet Potato	20	50
Tapioca	94	80
Tomatoes	4	10
Turnip	3	70
Walnuts	5	15
Watermelon	7	75
White Pasta (normal cooking)	23	55
Yogurt (full-milk)	4.5	35
Yogurt (skimmed)	5.3	35

 

	Glycemic Index (GI) by Glycemic Load (GL)
	Low GI	Medium GI	High GI
	All Bran Cereal	Beats	White Flour
	Apples	Cantalope	Whole Wheat Flour
	Carrots	Pineapple	Popcorn
	Chana Dal
	Chick Peas	Succrose	Watermelon
	Grapes	Sugar
	Green Peas	Banana
Low GL	Kidney Beans	Mangos
	Oranges
	Peaches
	Peanuts
	Pears
	Pinto Beans
	Strawberries
	Red Lentils
	Sweet Corn
	Low GI	Medium GI	High GI
	Apple Juice	Life Cereal	Cheerios
	Buckwheat	New Potatoes	Shredded Wheat
	Fettucinni	Sweet Potatoes
Medium GL	Navy Beans	Fried Rice
	Orange Juice
	Parboiled Rice
	Sourdough Wheat Bread
	Low GI	Medium GI	High GI
	Linguini	White Rice	Baked Russet Potatoes
High GL	Maccaroni	Couscous	Corn Flakes
	Spaghetti
	GI:  Low - 1-55	GL:  Low - 1-10
	Medium - 56-69	Medium - 11-19
	High - >70	High - >20

TRANS-FATTY ACIDS:
These are found in commercially prepared foods and are synthesized when hydrogen is applied to edible oils under high pressures and temperatures in the presence of a catalyst.  Hydrogenation of oils is done by the food industry to prolong the shelf life of commercially baked goods such as cookies, crackers, doughnuts, croissants, and snacks.  It is also found in shortening, margarines, and deep-fried foods. These hydrogenated fats lower HDL levels, increase LDL levels, and increase the risk of cardiovascular disease.  Some studies indicate that replacing trans-fatty acids with the same amount of natural, unsaturated fatty acids will result in a 50% reduction in risk of coronary heart disease.

OMEGA-3 FATTY ACIDS:
The sea algae and the grasses and leaves on land are rich in omega-3 fatty acids.  Therefore, fish and larger grazing animals have a high content of omega-3 fatty acids.  However, today, the meats from domesticated animals are very low in omega-3 fatty acids because they are generally grain- or corn-fed rather than grass-fed. Compared to the European Mediterranean diet, the American dietary intake of omega-3 is extremely low.  Patients on a Mediterranean diet rich in omega-3 fats, unsaturated fats, fruits, vegetables, legumes, and nuts experienced 50 to 70% reductions in risk of cardiovascular events in long-term follow-up.  In the GISSI prevention study, survivors of myocardial infarction were given 1g a of omega-3 supplements daily and experienced a 45% reduction in sudden cardiac death and a 20% decrease in all cause mortality during a 3 ½-year follow-up.  Increased fats in the form of omega-3 fatty acids either from plant sources such as flaxseed oil or fish oils will reduce cardiovascular risks anywhere from 32% to 50%.

MONOUNSATURATED FATS:
Our ancestors had a diet where one half of the total fat is composed of monounsaturated fats. Monounsaturated fats reduce cardiovascular risks when substituted for the high glycemic index carbohydrates and sugars. Nuts are a valuable source of monounsaturated fats and have been shown to be cardio-protective in multiple studies. The calories in nuts are typically 80% from fat, but most of the fat is healthy monounsaturated and polyunsaturated fatty acids.  Epidemiological studies showed that nut consumption, five times a week at least, is associated with a 50% reduction in the risk of myocardial infarction, compared to the risk for people who rarely or never eat nuts.  Nut consumption also reduces the risk of developing diabetes, lowers LDL, and provides a plant based protein together with vitamin E, folic acid, magnesium, copper, zinc, and selenium.  Nuts have a high satiety index and therefore, often prevent over-eating.  Oleic acid is the major monounsaturated fat in our diets and is found in meats, nuts, avocados, dark chocolate, and olive oil.  Replacing saturated fat with monounsaturated fats results in a 30% reduction in risk.

VEGETARIANISM:
Our ancestors were omnivorous.  Modern vegetarian diets rely heavily on processed carbohydrates such as white rice, potatoes, white flour, and sugars.  Therefore, they are not recommended.  The South Asian paradox refers to the high prevalence of coronary artery disease despite low levels of LDL cholesterol and low prevalence of obesity in urban vegetarians from India who consume a diet that is high in refined carbohydrates.  High glycemic index (GI) diets lower HDL cholesterol and predispose people to metabolic syndrome and cardiovascular disease. In fact, high-GI diets are one of the most atherogenic features of our modern eating pattern. Overall, a vegetarian diet composed of low GI foods is cardio-protective.  However, our current vegetarian diets are very rich in refined flour and grains; as a result; their GI values are extremely high.  Consuming foods in the natural state retains more nutritional value and keeps the GI of the food low.

Our ancestors derived 45% of their calories from animal foods. However, the meats had less than 4% fat by weight and contained relatively high levels of monounsaturated and omega-3 fatty acids, compared to the grain-fed domestic meats of today that contain 20% to 35% fat - much of it in the form of saturated fats. It is highly likely that it is the high levels of saturated fats typically found in the meat of modern domesticated animals which is most atherogenic. There are many other compelling reasons for not consuming large amounts of currently available meats in the United States.  The leading source of saturated fats and cholesterol in the American diet is meat, poultry, and dairy products.  These are directly linked with atherogenesis, or accumulation of plaque on the innermost layer of the artery walls. There is no cholesterol found in grains, legumes, fruits, vegetables, nuts, and seeds.

BEVERAGES:
Our ancestors only drank water.  Soda drinks are the predominant beverage consumed in America today. Over 50 million cans of soda are sold every day in the United States of America. These are calorie dense, nutritionally empty drinks which increase the risk of obesity and insulin resistance.  Between 1990 and 1995, the consumption of soda among children and adolescents increased by 41%. The average consumption of soda among teenage males between 13 and 18 years is 3 or more cans of soda pop a day. Ten percent of teenage males drink 7 or more cans a day.  The average teenage girl drinks two cans of soda pop a day, and 10% of all teenagers drink more than 5 cans a day.  The Center for Science in the Public Interest is asking for more water fountains, soda-free schools, and health education campaigns in schools. Soda consumption is linked to obesity, tooth decay, caffeine dependence, and bone weakening. A team of Harvard researchers presented the first evidence linking soft drink consumption to childhood obesity in The Lancet. Recent human studies also demonstrate that girls consuming soda pop are more prone to have brittle bones. Recent animal studies using rats also demonstrated the same findings. Phosphorus encourages calcium loss and weakening of the bones.  Soda consumption increases the likelihood of bone fractures in female teenagers fivefold. 

Tea is high in natural antioxidants, which are beneficial. An inverse relationship between tea consumption and cardiovascular disease has been observed.

SUMMARY:
The most practical solution for reducing the incidence of chronic degenerative diseases such as atherosclerosis is to realign our current maladaptive diet and lifestyle to simulate what our bodies were initially made to consume. Our food sources today are different from the food sources that were available to our ancestors; for example, today’s meat is totally different from the meat that was available to our ancestors. Our vegetarian diets have become so refined and have such high glycemic indices that it is essential that we make radical changes to our eating habits and follow a more natural, healthy diet.

It is therefore my strong recommendation that the ideal diet currently available to the public is predominantly a vegetarian diet, closely related to the Mediterranean diet.  It should be rich in fruits, vegetables, and whole grains, and very low in meats and dairy products. The ideal diet should also be sugar-free. The best drink is water, and the next-best would be tea.

ARGUMENTS AGAINST MEAT CONSUMPTION
Cholesterol: The leading sources of saturated fats and cholesterol in the American diet is meat, poultry, and dairy products. Vegetables do not contain cholesterol. The body is able to make its own cholesterol, so it is important to limit your dietary cholesterol intake so that your cholesterol levels remain in the normal range. Cholesterol is directly responsible for heart disease, which is the most common cause of death in the United States, with $135 billion spent annually to treat it.

Cancer:  Among men who consume meats, dairy products, and eggs on a daily basis, the risk of fatal prostate cancer 3.5 times greater than the risk for men who consume meat sparingly. The risk of breast cancer among women who eat meat daily is 3.5 times higher than the risk for women who eat meat once a week. There is a 3.2 times greater risk of breast cancer among women who eat butter and cheese two to four times a week compared to women who eat butter and cheese once a week.  Nearly 40% of all cancers in the United States are related to diet.

Health:  Approximately 68% of all diseases are diet-related. The following conditions can be commonly prevented or improved with a low-fat diet that is free from animal products: arthritis, breast cancer, asthma, colon cancer, diabetes, constipation, gallstones, diverticulosis, heart disease, hypertension, impotence, hypoglycemia, renal disease, obesity, peptic ulcers, osteoporosis, prostate cancer, food poisoning, and stroke.

 Protein:  Many feel that a vegetarian diet will not provide enough protein in their diets.  According to the World Health Organization, only 4.5% of the calories need to come from protein.  According to the food and nutrition Board of the United States Department of Agriculture, only 6% of the protein calories are needed.  The national research Council states that only 8% of the calories need to be derived from protein.  The following vegetables have high percentages of calories as protein:  Broccoli 47%; zucchini 28%; wheat:  17%; brown rice 8%; lettuce is 34%; tomatoes 18%; potatoes 11%.

Antibiotic: About 55% of all the total antibiotic production in the United States is fed to livestock and finds its way into our foods.  Staphylococcal resistance to penicillin increased from 13% in 1960 to 291% in 1988.  A major contributor to the rise of antibiotic resistance is the breeding of antibiotic resistant bacteria in farms due to routine feeding of antibiotics to livestock.

Food Safety:  One-third of all inspected chickens are infected with salmonella. Surprisingly, 75% of federal poultry inspectors said that they would not eat chicken.

The Environment:  One-third of US cropland is permanently removed from production due to excess soil erosion directly related to animal husbandry. One pound of feedlot steak requires the loss of 55 pounds of topsoil.  Every second, US livestock produces 250,000 pounds of excrement. Water pollution created by US Agriculture with the runoff of topsoil, pesticides, and manure is greater than all municipal and industrial sources combined. Fifty percent of all the wells and surface streams in the United States are contaminated by agricultural pollutants. Approximately 200 years ago, America’s top soil was 21 inches deep; now, it is only 6 inches deep.  It takes 500 years to the paste one inch of topsoil. Nearly 85% of the topsoil loss is directly related to cattle farming. One acre of land can produce 20,000 pounds of potatoes or 165 pounds of beef. A startling arithmetic is as follows: the livestock population in the United States consumes enough grain and soybeans to feed the entire human population of the United States five times over.  Cycling our grain through livestock, we receive only 10% of the available calories.

Over one-half of the water in our country is used to grow feed and fodder for livestock.  If cattle farmers in California reduced their water consumption by just 6% it would be equivalent to a 75% reduction in domestic use.

The Natural Resources:  One-third of all the raw materials, including base products, for farming, forestry, and mining (including fossil fuels) consumed in the United States is devoted solely to the production of livestock. It requires 78 calories of fossil fuel to produce one calorie of protein from beef. It requires only two calories of fossil fuel to produce one calorie of protein from soybeans.  The livestock production accounts for more than half of all water consumption for all purposes in the United States.  Approximately 64% of all United States cropland is used for producing livestock feed. Only 2% of the United States cropland is used to produce fruits and vegetables.

One acre of prime land can produce 5000 pounds of cherries, 20000 pounds of apples, 40000 pounds of potatoes, 60000 pounds of celery, 10000 pounds of green beans, 30000 pounds of carrots, and 50000 pounds of tomatoes. Yet, one acre of prime land only produces 250 pounds of beef.

World Hunger:  It is ironic that 70% of the grain production in the United States is actually consumed by livestock. Yet, 38,000 children die every day because of malnutrition and starvation. Livestock consumes 50% of the world grain harvest. If we could reduce our intake of meat by a fraction, there would be so much land, water, and energy freed up from growing livestock that we could probably feed millions of people.

For more information, read John Robbins: “Diet for a New America                                              David Pimentel,” Energy and Land Constrains in Food Protein production,” Science
Newsweek, The Browning of America Feb 22, 1981

WHAT ABOUT MILK?
Milk contains a sugar called lactose. At least 20% of the population does not produce the enzyme, lactase, needed to digest lactose. Furthermore, milk products are very fatty and create tremendous amounts of mucus, which can line the intestinal tract and decrease absorption of other nutrients. To test for lactose intolerance, one can do a simple experiment and consume lots of milk. If you notice postnasal drip and excess of phlegm in your throat, it is a clear indication of the effects of milk.  The same applies to cheese as well. Milk also contains growth hormones that are designed to increase the weight of the calf from 90 pounds and birth to 1000 pounds within two years. Large quantities of growth hormones have been detected in milk. The principal protein in cow’s milk is casein. However, casein is not the protein that humans need. Much of the casein remains undigested in humans, and may be responsible for much of the allergies known today.

Americans consume more milk products than any other country in the world; yet, there is a very high incidence of osteopenia among Americans. Consuming milk products can actually cause osteoporosis.  The incidence of osteoporosis is lowest in countries with smallest amounts of milk products are consumed.

The adult cow does not drink milk, then why should humans?  We are the only adult mammals that drink the milk of another species.

WHAT WE SHOULD EAT TODAY

 

Albert CM, Gaziano JM, Willett WC, Manson JE, Nut consumption and decreased risk of sudden cardiac death in the Physicians’ Health Study.  Arch Intern Med.  2002;162:1382-1387.
Atkins RC.  Dr. Atkins; The New Diet Revolution.  New York, NY:  Avon Books; 1998.
Cohen MN.  Health and the Rise of Civilization.  New Haven, Conn;  Yale University Press; 1989:118-119.
Cordain L.  The nutritional characteristics of a contemporary diet based upon Paleolithic food groups.  J Am Neutraceut Assoc.  2002;5:15-24.
De Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N.  Mediterranean diet, traditional risk factos, and the rate of cardiovascular complications of myocardial infarction:  final report of the Lyon Diet Heart Study.  Circulation.  1999;99:779-785.
Foot DK, Lewis RP, Pearson TA, Beller GA.  Demographics and cardiology, 1950-2050.  J Am Coll Cardiol.  2000;35(5, suppl B):66B-80B.
Ford ES, Giles WH, Dietz WH.  Prevalence of the metabolic syndrome among US adults:  finding from the third National Health and Nutrition Examination Survey.  JAMA. 2002;287:356-359.
Ford ER, Liu S.  Glycemic index and serum high-density lipoprotein cholesterol concentration among US adults.  Arch Intern Med.  2001;161:572-576.
GISSI-Prevenzione Investigators (Guppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocarico).  Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction; results of the GISSI-Prevenzione trial [published correction appears in Lancet.  2001;357:642].  Lancet.  1999;354:447-455.
Hu FB, Willett WC.  Optimal diets for prevention of coronary heart disease.  JAMA.2002;288:2569-2578.
Joshipura KJ, Hu FB, Mason JE, et al.  The effect of fruit and vegetable intake on risk for coronary heart disease.  Ann Intern Med..  2001;134:1106-1114.
Kris-Etherton PM, Harris WS, Appel LJ, American Heart Association, Nutrition Committee.  Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease [published correction appears in Circulation.  2003;107:512].  Circulation.2002;106:2747-2757.
Lemaitre RN, King IB, Mozaffarian D, Kuller LH, Tracy RP, Siscovick DS.  N-3 Polyunsaturated fatty acids, fatal ischemic heart disease, and nonfatal myocardial infarction in older adults:  the Cardiovascular Health Study.  Am J Clin Nutr. 2003;77:319-325.
Lugwig DS. The glycemic index:  physiological mechanisms relating to obesity, diabetes, and cardiovascular disease.  JAMA.  2002;287:2414-2423.
Marchiloi R, Barzi F, Bomba E, et al, GISSI-Prevenzione Investigators.  Early protection against sudden dealth by n-3 polyunsaturated fatty acids after myocardial infarction:  time-course analysis of the results of the Guppo Italiano per lo Sudio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione.  Circulation.  2002;105:1987-1903.
Ornish D.  Dr. Dean Ornish;s Program for Reversing Heart Disease:  The OnlySystem Scientfically Proven to Reverse Heart Disease Without Drugs or Surgery.  New York, NY:  Random House; 1990.
Reddy ST, Wang CY, Sakhaee K, Brinkley L, Pak CY.  Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism.  Am J Kidney Dis.  2002;40:265-274.
Sacks FM, Katan M.  Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease.  Am J Med.  2002;113(suppl 9B):13S-24S.
Singh RB, Dubnov G, Niaz MA, et al.  Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study):  a randomized single-blind trial.  Lancet.  2002;360:1455-1461.
Vasan RS, Beiser A, Seshadri S, et al.  Residual lifetime risk for developing hypertension in middle-aged women and men; the Framingham Heart Study.  JAMA.  2002;287:1003-1010.

 

Updated February 4, 2009 - MJ

 

 

 

 

Vitamin D and Cardiovascular Disease

What Do Foods Rich in Vitamin D Do?

What is the Major Source of Vitamin D?
Most Vitamin D is produced in your body through the sun’s ultraviolet light, which reacts with the 7-dehydrocholesterol precursors on your skin. This reaction converts the precursors to Vitamin D3. In the liver, Vitamin D3 undergoes 25-hydroxylation to form 25(OH)D.1 The best level of 25(OH)D is suggested to be 30ng/ml or above.1

Few foods contain Vitamin D, but some that do include the following: fish (salmon, mackerel, tuna), and fish liver oils are among the best sources of Vitamin D. Beef liver, cheese, and egg yolks contain small amounts of Vitamin D.2

In the American diet, fortified foods provide the most Vitamin D; this includes the U.S. milk supply, fortified with 100 IU/cup of vitamin D.2

Symptoms of Vitamin D Deficiency

How Can I Test for Vitamin D Deficiency?
The SpectraCell Analysis Test is an evidence based test that measures the levels of select vitamins (including Vitamin D), minerals (including calcium), antioxidants, and other micronutrients in your white blood cells. This test is important because nutrient status is a very important component of your health. Every micronutrient plays an important role in optimal functioning of your cells. The SpectraCell Analysis Test will identify any micronutrient deficiencies you may have; identifying and correcting deficiencies is essential in maintaining optimal health.

The SpectraCell Analysis Test is available Monday through Friday from 8:30am-3:30pm

Vitamin D and Cardiovascular Disease
Studies have shown that low 25(OH)D levels are associated with cardiovascular heart disease and congestive heart failure.1

Vitamin D and Hypertension
Results from cross-sectional studies show an inverse relationship between Vitamin D levels and blood pressure – the higher the Vitamin D levels, the lower the blood pressure.1 Other studies show that high blood pressures were associated with higher levels of parathyroid hormone (PTH), a hormone that increases blood calcium concentration by removing calcium from your bones.1

Vitamin D and Diabetes
Insulin is secreted by cells in the pancreas called beta cells. According to a meta-analysis, Vitamin D appears to influence the response of insulin to elevated glucose levels; Vitamin D may also regulate extracellular calcium to ensure that there is normal calcium influx through the cell membranes and intracellularly. This is important because insulin release by beta cells is dependent on calcium.3 Furthermore, calcium is needed in insulin-mediated intracellular processes in tissues that are insulin-responsive, such as adipose tissue and skeletal muscle.3 Therefore, changes in the concentration of calcium in the cell may lead to insulin resistance because of impaired signaling in the cell. Insulin resistance, in turn, can lead to diabetes.

Vitamin D and Obesity
Vitamin D deficiency has been linked to obesity.1 A recent study found that obese individuals have lower levels of 25(OH)D and higher PTH levels than do non-obese individuals. Vitamin D is fat soluble and therefore is stored in adipose tissue.4 Results from the study found identical concentrations of Vitamin D among obese and non-obese patients after exposure to UV-B irradiation.4 However, the increase in blood Vitamin D concentration was less in obese patients than in non-obese patients.4 This suggests that obesity does not affect the capacity of the skin to produce Vitamin D, but obesity may alter the release of Vitamin D from the skin to the bloodstream because the excess adipose tissue hinders Vitamin D’s release into the bloodstream.4
 
Calcium and Metabolic Syndrome
A research study using data from the Women’s Health Study found an inverse relationship between calcium intake and prevalence of metabolic syndrome. This study did not find a relationship between Vitamin D intake and metabolic syndrome, but the effects of Vitamin D are dependent on the presence/absence of other nutrients such as calcium. Therefore, low serum calcium levels influence Vitamin D action, and this affects your health.

Updated February 16, 2009 - MJ

"No Whites" Diet

The purpose of Dr. Jamnadas’ “No Whites” Diet is to lose weight. This is a fairly simple diet and is easy to follow as well.

The plan consists of:

If you are still hungry, have more of the main entrée (the proteins):

Make sure you include:

Following this plan will provide you with a healthy and safe way to lose weight. You are on your way to a healthier new you!

 

 

Updated February 26, 2009 - MJ

The TV Method: Exercise Made Fun and Easy

Exercise is an important component in maintaining optimal cardiovascular health; yet many people feel that time conflicts prevent them from exercising. However, the TV Method, an innovative and fun exercise regimen, will allow you to gain the health benefits of exercise while you watch your favorite television programs.

In a Nutshell:
If you have a treadmill, elliptical, or cycling machine at home, place it near the television. Find a show to watch on television and exercise while the program is running.

Workout Schedule:
Week 1: Pick a 30-minute television program to watch. Exercise during the program. Take a break during the commercials. This is a 22 minute workout.

Week 2: Pick another 30-minute television program. Exercise throughout the duration of the program and also during the first commercial break. Take a break during the second set of commercials. This is a 25 minute workout.

Week 3: Pick another 30-minute television program. Exercise throughout the duration of the program, including both commercial breaks. This is a 30 minute workout.

Week 4: Pick a 1-hour television program to watch. Exercise during the program and take a break during the commercials.

Week 5: Pick a 1-hour television program to watch. Exercise during the program and every other commercial break.

Week 6: Pick a 1-hour television program to watch. Exercise throughout the entire duration of the program.

	Week 1	Week 2	Week 3	Week 4	Week 5	Week 6
Exercise	Only during program	During program + first commercial break	During program + both commercial breaks	Only during the program	During program + every other commercial break	During program + all commercial breaks
Rest	Every commercial break	Second commercial break	None	Every commercial break	Alternating commercial breaks	None

The Importance of Physical Fitness

Over the past 25 years, the United States has experienced a steady decline in the number of deaths from cardiovascular disease (CVD), primarily in mortality caused by coronary heart disease and stroke. Still, coronary heart disease is the leading cause of death while stroke is third. Lifestyle improvements and better control of the risk factors for heart disease and stroke have been major contributors to this decline.

There are many risk factors associated with coronary heart disease and stroke. Modifiable risk factors include smoking, high blood pressure, blood lipid levels, obesity, diabetes, and physical inactivity. National trends observed with smoking, high blood pressure, and high blood cholesterol have improved, but obesity and physical inactivity have not. Advanced technologies have taken the place of physical activity in many daily tasks. As a result, many Americans are physical inactive.

Physical activity protects against the development of CVD and also improves other CVD risk factors, including high blood pressure, blood lipid levels, insulin resistance, and obesity. Physical activity is also important in the treatment and management of those with hypertension, stable angina, prior myocardial infarction, peripheral vascular disease, or heart failure. Physical activity, therefore, is important for cardiac rehabilitation.

Advantages to an Active Lifestyle
Physical inactivity among the U.S. population is now widespread. About one in four adults (more women than men) currently lead sedentary lifestyles with no leisure time physical activity. An additional one-third of adults are insufficiently active to achieve health benefits. The prevalence of inactivity varies by gender, age, ethnicity, health status, and geographic region, but it is common to all demographic groups.

Girls become less active than boys as they grow older. Children become far less active as they move through adolescence, and as a result, obesity is increasing among children. It is related to an energy imbalance (i.e., calories consumed in excess of calorie expended.) Data indicate that obese children and adolescents have an increased risk of becoming obese adults, and obesity in adulthood is related to coronary artery disease, hypertension, and diabetes. Thus, the prevention of childhood obesity has the potential of preventing CVD in adults.
There is evidence that increased physical activity leads to weight loss and that combining physical activity with reducing food intake can help maintain a healthy body weight.

Middle-aged and older men and women who engage in regular physical activity have significantly higher high-density lipoprotein (HDL) cholesterol levels than do those who are sedentary. When exercise training has extended to at least 12 weeks, the HDL cholesterol levels are even more improved.

What Type, Intensity, and Quantity of Exercise Are Best?
You don't need a structured or vigorous exercise program to reduce CVD risk factors and gain many other health benefits. Most benefits of physical activity can be gained by performing moderately intense activities.

Everyone should maintain regular physical activity at a level appropriate to his or her abilities and interests. Both children and adults should have at least 30 minutes or more of moderate-intensity physical activity most days of the week. However, physical activity must be performed regularly to maintain positive effects. Intermittent or shorter bouts of activity (at least 10 minutes), including tasks of daily living, also have similar cardiovascular and health benefits if performed at a level of moderate intensity (such as brisk walking, cycling, vacuuming, and yard work) for a total of 30 minutes daily. People who currently meet the recommended minimal standards may gain additional health and fitness benefits from increasing their activity. Higher intensity or longer duration activity could be performed approximately three times weekly and achieve cardiovascular benefits, but low-intensity or shorter duration activities should be performed more often to achieve cardiovascular benefits.

People who are not currently active should gradually build up to the recommended goal of 30 minutes of moderate activity daily by adding a few minutes each day until reaching their personal goal to reduce the risk of injury.
Developing muscular strength and joint flexibility is also important for an overall activity program to improve one's ability to perform tasks and to reduce the potential for injury. Resistance training may contribute to better balance, coordination, and agility that may help prevent falls in the elderly.

Physical activity carries risks as well as benefits. The most common adverse effects of activity relate to musculoskeletal injury and are usually mild and self-limited. The risk of injury increases with increased intensity, frequency, and duration of activity and also depends on the type of activity. Exercising in moderation can reduce these injuries.

Because the risks of physical activity are very low compared with the health benefits, most adults do not need medical consultation before starting a moderate-intensity physical activity program. However, those with known CVD and men over age 40 and women over age 50 with multiple cardiovascular risk factors should have a medical evaluation prior to initiating such a program.

Updated January 29, 2009 MJ

Nature's Superfoods

Food’s Influence on Your Health:

• Nearly half of all cardiovascular disease and hypertension cases can be attributed to diet
• An estimated 300,000 to 800,000 preventable deaths per year in the United States are nutrition related. This number includes deaths from atherosclerotic diseases, diabetes, and some cancers

Fruits, vegetables, and other natural foods are loaded with phytonutrients

What are Phytonutrients?

3 Types of Phytonutrients:

Micronutrients in Fruits/Vegetables are Age-Defying

BEANS
Nutrients:

Nutritional Benefits of Beans
Lower cholesterol levels:
Frequent consumption of beans is associated with lower cholesterol levels. Cholesterol is found only in animal foods, so if you substitute animal protein with plant protein, and if you limit your intake of saturated fat and partially hydrogenated oils, you will be on track to lowering your cholesterol

Combat cardiovascular disease:
Beans are just as effective at keeping low blood cholesterol levels are oat bran is. Combine the two with a regular exercise regimen, and you have a great remedy for reducing your cardiovascular risk.

Reduce obesity:
Beans have a low Glycemic Index (GI), meaning that when you eat beans, they are slowly absorbed through the blood stream. Consequently, you feel satiated after eating, and this prevents overeating.

Reduce blood sugar:
Beans are high in fiber and have a low GI, so they help maintain a steady blood sugar level and provide slow-burning energy for your body.

Reduce cancer risk:
Beans contain phytoestrogens called lignins that have estrogen-like properties that help reduce estrogen levels and reduce the risk of cancers (mainly breast cancer and prostate cancer) that are related to estrogen levels.

How Do I Incorporate Beans Into My Diet?

BLUEBERRIES
Nutrients:

Nutritional Benefits of Blueberries:
Antioxidant Boost:
Blueberries contain more antioxidants than do any other fruit/vegetable. One serving of blueberries (1/2 cup) contains as many antioxidants as do five servings of carrots, apples, broccoli, and squash. Antioxidants are important because they can reduce your risk of cancer, cardiovascular disease, and diabetes.

Anthocyanin:
This is an antioxidant in the flavonoid family that gives blueberries their strong blue color and their powerful antioxidant properties. Anthocyanin helps to neutralize cellular free-radical damage. 

Reduce Effects of Age-Related Conditions:
Animal studies have shown that blueberries help to reduce effects of Alzheimer’s disease and dementia.

Quercetin:
This is another antioxidant in the flavonoid family that has anti-inflammatory properties.

The Brain:
The nutrients in blueberries have an affinity for the areas in the brain that control movement. Studies assessing motor skills showed that people who ate 1 cup of blueberries daily performed 5-6% better on motor skills tests, compared with the control group.

Digestive Health:
Blueberries are rich in pectin, a soluble fiber that works to relieve diarrhea and constipation. The tannins in blueberries reduce inflammation in the digestive system. Blueberries also reduce the ability of the E.coli bacterium to adhere to the mucosal linings of the bladder and urethra. This reduces the risk of urinary tract infections.

How Do I Incorporate Blueberries Into My Diet?

BROCCOLI
Nutrients:

Nutritional Benefits of Broccoli
Prevention of Birth Defects:
Broccoli is loaded with folate and Vitamin B, which helps prevent birth defects, such as spina bifida.

Cardiovascular Disease Prevention:
The folate in broccoli helps remove homocysteine from the circulatory system. This is important because high levels of homocysteine are linked with cardiovascular disease. Broccoli is also one of the few vegetables that have a high level of coenzyme Q10, which is a fat-soluble antioxidant linked to energy production in the body. In patients with cardiovascular disease, coenzyme Q10 serves a cardio-protective function.

Cancer Prevention:
Researchers at Johns Hopkins University discovered a compound in broccoli that prevented tumor development by 60% and reduced the size of developed tumors by 75%. Another study showed that eating two servings of cruciferous vegetables (mainly cabbage, broccoli, and Brussels sprouts) a day results in as much as a 50% reduction in the risk for certain types of cancers. Furthermore, ½ cup of broccoli daily protects from numerous cancers, including colon, lung, stomach, and rectal cancers.

Bone Health:
Broccoli, along with other cruciferous vegetables, help build your bones because it is loaded with calcium and Vitamin C, which increases calcium absorption to your bones.

How Do I Incorporate Broccoli Into My Diet?

OATS
Nutrients:

Nutritional Benefits of Oats:
Lowers Cholesterol Levels:
Oats contain beta glucan, a soluble fiber that is responsible for lowered cholesterol levels. Since oats are low on the GI, they help maintain a steady blood glucose level; this is especially important for diabetics.

Improved Cardiovascular Health:
Consumption of whole grains is associated with lowered overall mortality rates, lowered cholesterol levels, and stabilized blood sugar levels. Additionally, whole grain consumption is linked to a reduction in stroke risk.

Phytochemicals:
The germ and bran of oats have lots of phytonutrients, including ferulic acid and caffeic acid. Ferulic acid may be beneficial in preventing colon cancer; additionally, it has been found to be a strong antioxidant to protect against oxidative damage to the cell. Lastly, it inhibits the formation of cancer-promoting compounds in the body.

Flaxseeds:
Flaxseeds are the best plant source of omega-3 fatty acids, as well as fiber, protein, iron, and magnesium. Flaxseeds also contain lignins, which help to protect against breast cancer. Flaxseeds are usually found in stores as ground (flaxseed meal) or in whole seed form. They must be ground before eating because the nutrients are more easily absorbed when ground.

Wheat Germ:
This is the embryo of the wheat berry, and it is loaded with nutrition, and it is a good source of omega-3 fatty acids.

Whole Grains:
This relates to the Glycemic Index (GI), a ranking scale of carbohydrates and how quickly they are absorbed into the body. The lower the GI, the slower the absorption into the bloodstream is. As a result, you feel satiated (full) when you eat low-GI foods, and this prevents overeating and helps to maintain your ideal weight. Whole grains decrease the risk of coronary heart disease, stroke, diabetes, hypertension, obesity, and some cancers.

There are 3 parts to a whole grain:

How Do I Incorporate Whole Grains Into My Diet?

ORANGES
Nutrients:

Nutritional Benefits of Oranges:
Citrus Flavonoids:
These are a class of polyphenols found in fruits’ tissue, juice, pulp, and skin and contain the health-promoting power of citrus foods. Citrus flavonoids (especially hesperidin in oranges) are antioxidant and antimutagenic, meaning that they prevent mutations in cells.

Improved Cardiovascular Health:
Hesperidin is a flavonoid that enhances Vitamin C’s effect of neutralizing free radicals in the body. In fact, orange pulp contains ten times the amount of Vitamin C that is found in the juice. Oranges also contain folate, which is one of the B Vitamins. Dietary folate is also important in maintaining normal DNA in the cell and preventing colon and cervical cancers. Folate is important in maintaining low levels of homocysteine in the blood, and this is important because high homocysteine levels increase the risk of cardiovascular disease. The risk of heart attack and stroke is inversely related to the amount of folate consumed.

Reduced Cancer Risk:
Limonene is a phytonutrient found in the oil of the peel of citrus foods, and this stimulates antioxidant detoxification, meaning limonene stops cancer even before it develops. Additionally, limonene reduces protein activity that may trigger abnormal cell growth. Citrus also contains Vitamin C, and this protects against nitrosamines, which may trigger cancers of the colon, mouth, and stomach

Stabilized Blood Sugar Levels:
Citrus contains pectin, which slows the absorption of glucose, helping to maintain steady glucose and insulin levels. This is important for diabetic individuals, because regular citrus consumption helps stabilize blood sugar levels.

How Do I Incorporate Oranges Into My Diet?

PUMPKIN
Nutrients:

Nutritional Benefit:
Prevent Progression of Atherosclerosis:
Alpha- and Beta-carotene are major fighters against chronic disease because they have strong antioxidant and anti-inflammatory properties. Beta-carotene prevents oxidation of cholesterol, and this is important because it is oxidized cholesterol that builds up in blood vessels and contributes to the risk of heart attacks. Beta-carotene consumption may also reduce colon cancer risk because it protects cells of the colon from cancer-causing chemicals.

Protection From Cardiovascular Disease:
The cumulative effects of carotenoids, potassium, magnesium, and folate offer protection against cardiovascular disease and decrease the risk of cardiovascular events.

Slowed Biological Aging:
Alpha-carotene consumption is inversely related to biological aging. Alpha-carotene also protects against cataracts and various cancers.

How Do I Incorporate Pumpkin Into My Diet?

WILD SALMON
Nutrients:

Nutritional Benefits of Wild Salmon
Excellent Source of Omega-3 Fatty Acids:
There are four types of dietary fats: saturated, trans, monounsaturated, and polyunsaturated.

Omega-3 Fatty Acids:

SOY
Nutrients:

Nutritional Benefits of Soy
Non-Meat Protein:
Soy is loaded with protein – a half-cup of tofu has 18 to 20 grams of protein, 258mg calcium, and 13mg of iron. Furthermore, soy has a good balance of various fats and does not contain any cholesterol, making it ideal an ideal source of protein and fiber. Additionally, soy provides the highest-quality protein of any plant food, provides all nine essential amino acids, and is a great source of omega-3 fatty acids. In comparison with other plant-based sources of protein, tofu is low in calories and high in protein.

Cancer Prevention:
Soy contains isoflavones, two of which are genistein and daidzein, which act as antioxidants and weak estrogens in the body that compete with natural estrogens to prevent hormone-dependent cancers such as breast cancer and prostate cancers.

Lignins:
These bind with carcinogens in the colon and facilitate their swift exit from the body, reducing negative effects

Protease Inhibitors:
These block the activity of cancer-causing enzymes called proteases. This reduces the risk of cancers.

Oil:
Soy provides oil that is cholesterol free and offers a good ratio of fatty acids, including omega-3 fatty acids.

How Do I Incorporate Soy Into My Diet?

SPINACH
Nutrients:

Nutritional Benefits of Spinach:
Lowered homocysteine levels:
Betaine is a derivative of choline, which is an essential fat. Betaine lowers homocysteine levels in the blood, and this is important because high levels of homocysteine increase cardiovascular risk.

Protection From Age-related Macular Degeneration (AMD)
Spinach helps elevate macular pigment levels, and this lowers the risk of AMD. Free-radical damage from long-term exposure to light and UV radiation may play a role in causing macular degeneration. Lutein and zeaxanthin are two powerful carotenoids that can reduce AMD risk. Lutein and zeaxanthin also prevent other eye problems, such as cataract problems. Orange bell peppers are also very rich in lutein and zeaxanthin.

Vitamin K
Spinach is a rich source of Vitamin K, which is needed for production of six of the proteins needed for proper blood coagulation. Additionally, just one cup of spinach daily helps to reduce the risk of hip fracture in women.

Combat Cardiovascular Disease
The carotenoids in spinach protect the artery walls from damage. Spinach contains Vitamin C and beta-carotene, and these two nutrients work to prevent oxidized cholesterol from accumulating in the walls of your blood vessels. Spinach also has a lot of folate, which helps repair damaged DNA in cells, thereby aiding in cancer prevention.

Cancer Prevention:
Various flavonoid compounds in spinach work together to prevent cancer development. Glutathione and alpha lipoic acid are both found in spinach, and glutathione protects our DNA by repairing damaged DNA and promoting healthy cell replication. Alpha lipoic acid boosts glutathione levels and stabilizes blood sugar levels.

Improved Immune System:
Lutein is another antioxidant in spinach and enhances the immune system, warding off many cancers. Usually, the darker the greens, the more bioactive phytonutrients they contain and the more powerful they are against cancer and other diseases.

How Do I Incorporate Spinach Into My Diet?

TEA
Nutrients:

Nutritional Benefits of Tea
Cancer Protection:
Caffeine from tea has anti-mutagenic properties, which may offer protection against cancer. Caffeine may also offer protection against the development of Parkinson’s disease. Other evidence suggests that tea consumption decreases the risk of bladder, breast, colorectal, esophageal, lung, prostate, and stomach cancers. Researchers demonstrated that catechins in tea prevent cell mutations and deactivate carcinogens. They also inhibit the growth of blood vessels that tumors need to grow. Although one cup of tea may offer health benefits, it may take up to four cups a day to achieve a significant decrease in cancer risk.

Cardiovascular Protection:
A study from Harvard showed a 44% reduced risk of heart attack and a 40% decrease in death from coronary artery disease in people who drank at least one cup of tea daily. Other evidence shows that tea consumption is associated with a decreased risk of heart disease and stroke. Tea consumption is inversely related to homocysteine levels, which is important because high homocysteine levels are correlated with increased cardiovascular risk. Tea also maintains plaque-free blood vessels, which reduces coronary artery disease.

Dental Health:
Tea consumption reduces the risk of developing cavities and gum disease; one study found that tea consumption may reduce cavity formation by up to 75% because the fluoride content of tea inhibits cavity formation. Additionally, tea inhibits bacteria from sticking to tooth surfaces, and this inhibits the rate of acid production of oral bacteria.

Improved Bone-Mineral Density:
Studies focusing on hip fracture risk discovered that tea consumption for 10+ years has benefits to bone-mineral density. This may be due to the flavonoids in tea, which have phytoestrogen activity that benefits bone health.

How Do I Incorporate Tea Into My Diet?

TOMATOES
Nutrients:

Nutritional Benefits of Tomatoes:
Very Powerful Antioxidants:
Lycopene is a pigment that contributes to the red color of tomatoes and is a very strong antioxidant that is very efficient at quenching free radicals. Lycopene is also involved in the antioxidant defense network and helps raise the SPF of the skin, thereby protecting your skin from the sun’s damaging rays. Lycopene absorption depends on the presence of a bit of dietary fat, so tomatoes are often served with olive oil or cheese.

Cancer Protection:
Tomatoes have been shown to protect against cancer, specifically prostate cancer. Lycopene blocks the destructive effects of free radicals in the body and interferes with the growth factors that stimulate cancer cells to grow and proliferate.
One study found that tomato sauce consumption is the most reliable indicator of reduced risk for prostate cancer. This suggests that tomato sauce and paste may be more effective than raw tomatoes at reducing cancer risk; processed tomato products and cooked tomatoes contain 2-8 times the available lycopene of raw tomatoes. Processing tomatoes does reduce the Vitamin C levels, but it elevates total antioxidant activity, providing enhanced benefits.

Cardiovascular Protection:
Lycopene and other vitamins such as Vitamin C and beta-carotene, work to neutralize free radicals in the body that damage cells. This reduces the progression of atherosclerosis because it reduces the potential for inflammation. Tomatoes have high levels of potassium, niacin, vitamin B6, and folate, all of which are very heart-healthy nutrients. Potassium-rich foods help to achieve optimal blood pressure, and niacin lowers elevated blood cholesterol levels. The combination of folate and Vitamin B6 reduce homocysteine levels in the blood; this is important because high homocysteine levels increase cardiovascular disease risk.

How Do I Incorporate Tomatoes Into My Diet?

TURKEY (SKINLESS BREAST)
Nutrients:

Nutritional Benefits of Turkey
Low-Fat Protein:
Turkey breast is very low in saturated fat, so it closely approximates the lean sources of animal protein during Paleolithic times. The problem with commonly available meats, specifically red meat, in the United States is that they are very high in saturated fat and omega-6 fatty acids, which is not the type of fat we do need. Free-range and free-roam cattle are a better alternative to meat raised in feedlots because free-roaming cattle consume more omega-3 fats. Grass-fed meats contain omega-3 fats and Vitamin E.

Cardiovascular Health:
Turkey is a good source of niacin, Vitamin B6, and Vitamin B12. These vitamins are important for energy production because niacin is associated with lowered risk of heart attack and heart attack-associated mortality. Vitamins B6 and B12 help to keep homocysteine levels low, which is important because high homocysteine levels are associated with cardiovascular risk.

Immune Health:
Turkey is rich in zinc, and the zinc found in turkey is more bio-available than zinc found in non-meat sources. Zinc promotes wound healing and normal cell division. Turkey also has a lot of selenium, which is involved in a myriad of body functions, including thyroid hormone metabolism, antioxidant defense systems, and immune function. Evidence suggests that an inverse relationship exists between selenium intake and cancer risk.

How Do I Incorporate Turkey Into My Diet?

WALNUTS
Nutrients:

Nutritional Benefits of Walnuts:
Low Glycemic Index (GI)
Nuts have a low GI, so when you eat them, you feel satiated (full). This prevents overeating and helps you maintain a healthy weight. People who eat nuts in a balanced diet tend to be thinner than those who do not.

Cardiovascular Health:
Nut consumption is associated with a decreased risk of coronary artery disease. People who eat nuts five or more times a week had a 15-51% reduction in coronary heart disease risk, according to recent studies. This is mainly attributable to omega-3 fatty acids found in nuts; omega-3 fats thin the blood and help blood to freely flow throughout the body, preventing clot formation and preventing blood cells from sticking to vessel walls. Omega-3 fats also reduce hypertension, decrease cardiovascular disease risk and macular degeneration as well.

Blood Vessel Flexibility:
Arginine is an essential amino acid that is found in walnuts, and this helps keep the interior of blood vessels smooth and flexible to increase blood flow. This reduces blood pressure to relieve hypertension.

Decreased Diabetes Risk:
Harvard researchers studied 83,000 women and found that those who ate a handful of nuts or two tablespoons of peanut butter at least five times a week were more than 20% less likely to develop type II diabetes. The fiber and magnesium found in nuts maintain balanced insulin and glucose levels.

Fiber and Vitamin E:
Nuts are a rich source of dietary fiber and Vitamin E, which have strong anti-inflammatory properties, contributing to heart health

How Do I Incorporate Nuts Into My Diet?

YOGURT
Nutrients:

Nutritional Benefits of Yogurt:
Prebiotics and Probiotics:
Prebiotics are non-digestible food ingredients that affect the gut by stimulating the growth or activity of beneficial bacteria in the colon. Probiotics are live microorganisms that can benefit your health when taken in small amounts.

Gastrointestinal Health:
A healthy digestive system is essential to good health, and probiotics help to preserve intestinal health. Probiotics absorb mutagens that cause cancer, and evidence suggests that they are effective in fighting colon and breast cancer. They stimulate the immune system by promoting immunoglobulin production and lower cancer risk by decreasing inflammation and preventing growth of cancer-causing intestinal microflora. Probiotics regulate the body’s inflammatory response, which relieves symptoms of inflammatory bowel disease (IBD).

 

Fish Oils and Cardiovascular Health

Fish Oil
Fish oils are very healthy because they are loaded with omega-3 polyunsaturated fats.1 Omega-3 fatty acids are essential fats that your body cannot make but that are essential for your health.   Omega-3 fatty acids reduce your risk of coronary artery disease by increasing your HDL levels and reducing your blood pressure. Omega-3 fats have two forms: plant derived (ALA) and marine species derived (EPA/DHA) . These fats also stabilize your heartbeat, thereby preventing arrhythmias.2

Fish Oil and Heart Attacks
Studies of fish oils show that they decrease the risk of heart attacks. In the Chicago Western Electric Study, the eating patterns of 2107 individuals were followed for 20 years, and their vital statuses were also measured.3 End points of the study were death from myocardial infarction (MI) and death from coronary heart disease (CHD). The vital status of the participants was measured for the next 15 years; the end points of the study were death from myocardial infarction (MI), coronary heart disease (CHD), or death from cardiovascular disease.3 Results showed that age-adjusted mortality rates from MI, CHD, and cardiovascular disease were lowest among men who had the highest consumption of fish, showing an inverse association between fish consumption and 30-year risk of fatal myocardial infarction.3

Fish Oil and Lipid Levels
Fish oil has been found to reduce cholesterol synthesis; it may also reduce cholesterol absorption in humans. Evidence suggests that fish oil down-regulates the LDL receptor in hepatic cells.4 This is important because abnormalities in LDL are often associated with abnormal LDL binding to its receptors. 4 By disrupting such binding, LDL cholesterol levels are lowered. Similarly, fish oils help to increase HDL levels, although very high intake of fish oils may depress HDL levels.

Fish Oil and Coronary Artery Disease
Fish oils have also been shown to decrease the risk of coronary heart disease (CHD). One prospective cohort study examined the relationship between omega-3 consumption and (CHD) risk in women. Data was collected from female nurses in the Nurses’ Health Study who had no cardiovascular disease at baseline in 1980. These women completed questionnaires about their dietary habits through 1994, and outcome measures were nonfatal heart attack and death from CHD.5 After 16 years of follow-up, there was an inverse relationship between omega-3 consumption and risk of CHD.5 The inverse association between omega-3 fatty acid consumption and risk of CHD was stronger than the association between omega-3 fatty consumption and nonfatal myocardial infarction.5 This relationship was independent of established cardiovascular risk factors and dietary habits, such as fiber intake and ratio of polyunsaturated to saturated fats.5

Fish Oil and Hypertension
Omega-3 fatty acids found in fish oils lower your blood pressure because these fats improve the elasticity of your blood vessels.1 At CVI, we have a non-invasive test called the CVProfilor® that measures changes in the elasticity of your blood vessels. If you want to monitor the effects of fish oil on the health of your blood vessels, CVProfilor® is an easy and non-invasive way to do so.

Current Recommendations from the American Heart Association 
The American Heart Association (AHA) recommends eating fish at least twice weekly. Lean fish are a great source of protein, and fatty fish such as salmon, lake trout, sardines, herring, albacore tuna, and mackerel have high levels of two types of omega-3 fatty acids – eicosapentaenoic acid (EPA) and decosahexaenoic acid (DHA).6 The AHA  recommends that individuals without coronary heart disease (CHD) should eat a variety of fish, preferably oily fish.6 Fish oil supplements should only be considered by those who already have heart disease or high triglyceride levels, and those with CHD should consume 1g/day of EPA and DHA, preferably from fish, but supplements are acceptable too and should be considered in consultation with a physician.6

 

Updated February 12, 2009 - MJ

 

SpectraCell Analysis Test

What Does the SpectraCell Analysis Test Measure?
The SpectraCell Analysis Test assesses the function of a range of vitamins, minerals, antioxidants, and other micronutrients in your blood cells. The SpectraCell test is currently the gold standard in evaluating nutritional status, and this technology is known as Functional Intracellular Analysis, or FIA™.

Why is the SpectraCell Test Important?
This preventive, diagnostic test is important because nutrient status is a very important component of your health. Every micronutrient plays an important role in optimal functioning of your cells. The SpectraCell Analysis Test will identify any micronutrient deficiencies you may have; correcting such deficiencies is essential in maintaining optimal health. This test, therefore, allows clinicians to develop appropriate interventions for patients wanting to maintain optimal health.

What Influences My Micronutrient Requirements?
There are many things influencing each individual’s micronutrient requirements. These include the following: biochemical individuality, absorption, chronic conditions, age, and lifestyle. Even people with healthy habits can have micronutrient deficiencies.

Who Benefits from This Test?
Everybody. You may be deficient in a micronutrient and not even know about it. Nearly 50% of patients taking a multivitamin are functionally deficiency in at least one essential nutrient that is vital to long-term health.

How Does the Test Work?
You will have your blood drawn (no need for fasting) and sent to the SpectraCell laboratory in California. The lymphocyte cells are isolated from the blood sample, grown in patented culture media, and stimulated to grow in a control media that has optimal amounts of specific micronutrients. As each micronutrient is removed from the culture media, your lymphocytes must use their own internal mechanisms (storage reserves or metabolic processes) to grow. If the cells grow in the absence of the micronutrient in the culture media, you are not deficient in that micronutrient. However, if the cells do not grow optimally, you are deficient in that micronutrient.

What Specific Micronutrients Does This Test Measure?
Vitamins: D, E, B1, B2, B3, B6, B12, Biotin, Folate, Pantothenate
Minerals: Calcium, Magnesium, Selenium, Zinc
Antioxidants: Coenzyme Q10, Glutathione, Cysteine, Total Antioxidant Function
Amino Acids: Asparagine, Carnitine, Glutamine, Serine

Does My Insurance Plan Pay For This Test?
Most insurance carriers cover the SpectraCell tests.

Call 407-894-4880 to make your appointment. Space is limited, so sign up today!

Updated February 16, 2009 - MJ

Abdominal Aortic Aneurysm

What is an abdominal aortic aneurysm (AAA)?

Abdominal aortic aneurysm (AAA) involves an abnormal widening or stretching of the abdominal portion of the aorta, usually due to a weak or damaged area in the wall of the artery. The exact cause is unknown, but risks include atherosclerosis and hypertension. Some causes of an abdominal aortic aneurysm are injury, infection, or congenital weakening of the connective tissue component of the artery wall.
Abdominal aortic aneurysm can affect anybody, but it is most often seen in men over 40 years of age. AAA occurs less frequently in white women and African Americans of both sexes. A common complication is "ruptured" aortic aneurysm. This is a medical emergency where the aneurysm breaks open, resulting in profuse bleeding. Ruptured aneurysm occurs in approximately 5 out of 10,000 people. Aortic dissection occurs when the lining of the artery tears and blood leaks into the wall of the artery. An aneurysm that dissects is at even greater risk of rupture.

Symptoms:

Aneurysm may develop slowly over many years and often have no symptoms. If the aneurysm expands rapidly, tears open (ruptured aneurysm), or blood leaks along the wall of the vessel the above symptoms may develop suddenly.

Signs and Tests:

Listening to the abdomen with a stethoscope shows a "blowing" murmur over the aorta or a "whooshing" sound. Physical examination of the abdomen is performed. If a rupture is suspected, physical examination for signs of blood loss and an evaluation of lower extremity pulses and circulation are performed.

Treatment:

If the aneurysm is small and there are no symptoms (for example, if the aneurysm is found during a routine physical examination), periodic evaluation to watch for changes may be recommended. Symptomatic aneurysms may require treatment to prevent complications. Antihypertensive medications may be prescribed to reduce blood pressure. Other medications may include analgesics to relieve pain. Surgical repair or replacement of the section of aorta is often recommended. The goal of treatment is timely surgical intervention before complications develop. The risk of complications increases as the size of the aneurysm increases. Because surgery for abdominal aortic aneurysm is risky, the surgeon may wait for the aneurysm to expand to a certain size before operating (that is, when the risk of complications exceeds the risk of surgery).

Expectations:

The probable outcome is good when an aneurysm is monitored carefully and if surgical repair is performed before the aorta ruptures. Aortic rupture is life threatening. Less than 50% of all people with a ruptured abdominal aortic aneurysm survive.

Complications:

Prevention

You should go to the emergency room or call the local emergency number if you develop severe abdominal pain or other symptoms that are suggestive of an abdominal aortic aneurysm. Immediate medical attention is crucial.

Updated January 29, 2009 - MJ

 

Aortic Dissection

What is aortic dissection?
Aortic dissection involves bleeding into and along the wall of the aorta (the major artery from the heart), most often because of a tear or damage to the inner wall of the artery. Most often, this occurs in the chest portion of the aorta but can also occur in the abdominal portion.
The exact cause is unknown, but risks include atherosclerosis and hypertension. Traumatic injury is a major cause of aortic dissection, especially blunt trauma to the chest as with the steering wheel of a car during an accident. It may also be associated with other injury, infection, congenital weakness of the aorta, collagen disorders such as Marfan's syndrome, pseudoxanthoma, elastoma, Ehlers-Danlos syndrome, relapsing polychondritis, or abdominal aortic aneurysm. Pregnancy, valve disorders (including aortic insufficiency) may also be associated with aortic dissection.
Aortic dissection occurs in approximately 2 out of 10,000 people. It can affect anybody, but it is most common in men over 40 years of age.
Prevention:
Adequate treatment and control of atherosclerosis and hypertension may reduce risk although many cases are not preventable. Use safety precautions to reduce the risk of injury.
Symptoms (some may begin suddenly):

Signs and Tests:
Listening with a stethoscope at the chest and abdomen may reveal a "blowing" murmur over the aorta, a heart murmur, or other abnormality. There may be decreased pulses in the upper extremities. There may be signs of hypovolemia (a decrease in the volume of circulating blood) or signs resembling acute myocardial infarction (MI). There may also be signs of shock but with normal blood pressure.
Aortic dissection or aortic aneurysm may be revealed on:

Treatment:
The goal of treatment is preventing of complications. Hospitalization is usually required. Antihypertensives may be prescribed to reduce blood pressure . These may be given through a vein. Analgesics may be needed for pain. Cardiac medications such as beta-blockers may reduce some of the symptoms.
Surgical repair or replacement of the section of aorta is curative.
Prognosis:
Aortic dissection may be life threatening. The disorder is curable with surgical repair if it is performed before aortic rupture. Less than half of the patients with ruptured aorta survive.
Complications:

It is imperative that you seek medical attention immediately if you develop severe abdominal pain or other symptoms that are suggestive of an abdominal aortic aneurysm.

Updated January 29, 2009 - MJ

 

Aortic Stenosis

What is aortic stenosis?
When aortic valve stenosis occurs, the aortic valve, located between the aorta and left ventricle of the heart, is narrower than normal size. When the degree of narrowing becomes significant enough to impede the flow of blood from the left ventricle to the arteries, heart problems develop. These problems include blackouts (fainting), congestive heart failure with edema or shortness of breath, or angina pectoris (chest pain). The worst complication is sudden death and arrhythmia.

Aortic stenosis is caused by many disorders. The most common cause of aortic stenosis is age related calcification of the valve. This usually occurs in patients in their 80s but can occur sooner. One cause is rheumatic fever, which may occur with strep throat and scarlet fever. Other causes include congenital abnormalities such as Bicuspid aortic valve. This may present as a murmur at a young age and cause problems in the 40s. There may be a history of other valve diseases and coronary artery disease.

Aortic stenosis is three times more common among men than women. Symptoms usually do not appear until middle age or older. Occassionally a murmur is heard by a health provider.

Prevention:
Notify your health care provider about any history of heart valve disease before treatment for any condition. Also, any dental work, including cleaning, and any invasive procedure, can introduce bacteria into the bloodstream, which can infect a weakened valve. This is the reason why you may be asked to take antibiotics prior to dental work.

Follow your provider's treatment recommended for conditions that may cause valve disease. Treat strep infections promptly to prevent rheumatic fever. Notify the provider if there is a family history of congenital heart diseases.

Symptoms (some may not show until late in the course of the disease):
·     Breathlessness, swelling of the feet, effort intolerance
·     Sensation of feeling the heart beat
·     Cough
·     Chest pain, angina-type
-Under the sternum, may radiate
-Crushing, squeezing, pressure, tightness
-Increased with exercise, relieved with rest
·     Decreased urine output
·     Dizziness or blackouts

Signs and Tests:
Examination shows a palpable chest thrill or heave (vibration or movement felt by holding the hand over the heart). There is almost always a heart murmur, click, or other abnormal sounds on auscultation (examination of the chest with a stethoscope). There may be faint pulses or changes in the quality of the pulse in the neck and blood pressure may be low.

Aortic stenosis and/or enlargement of the left ventricle may be revealed on:
·     A left coronary angiography
·     An echocardiogram
·     A Doppler ultrasonography
·     A chest X-ray

An ECG may show left-ventricle enlargement or arrhythmias (unusual pattern of heart beats) such as ventricular tachycardia or sinus bradycardia.

This disease may also alter the results of the following:
·     A chest MRI
·     An aortic angiography

Treatment:
If there are no symptoms, or if symptoms are mild, only observation may be required. If symptoms are mild to severe, hospitalization may be required. Medications may include diuretics, digoxin, and other medications to control heart failure. Symptomatic people may be advised to avoid strenuous physical activity. People with symptoms of aortic difficulty breathing, chest pain, and syncope should have a physical exam every 6 to 12 months, an ECG performed every 1 to 3 years, and an echocardiogram done annually.

Surgical repair or replacement of the valve is the preferred treatment for symptomatic aortic stenosis.The surgical options are a tissue valve or a metal valve.The latter is probably more durable but requires lifelong use of Coumadin, a blood thinner, which prevents blood clots from forming on the metal valve. This prevents strokes too. Of course, coumadin is not to be taken lightly and has potential dangers that should be discussed with the doctor.

Expectations:
Aortic stenosis is curable with surgical repair, although there may be a continued risk for arrhythmias. The person may be symptom-free until complications develop. Without surgery, probable outcome is poor if there are signs of angina or heart failure.

Complications: Complications of aortic stenosis include:
·     Left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve
·     Angina
·     Left-sided heart failure
·     Sudden death from arrhythmias
·     Endocarditis

If the degree of stenosis of the valve is severe, a definitive cardiac catheterization is needed. During this procedure, the exact degree of narrowing, possible leaking and coronary anatomy is determined. Based on the results, surgery can be planned.

The surgery required is open heart surgery. The patients usually stay in the hospital for 7 days and then spend the next 4 to 6 weeks recovering from the surgery.The overall risk varies between 5 and 10%.

 

Updated January 29, 2009 - MJ

Deep Vein Thrombosis

What is deep venous thrombosis?
Deep venous thrombosis (DVT) affects mainly the veins in the lower leg and the thigh. It involves the formation of a clot (thrombus) in the larger veins of the area. This thrombus may interfere with circulation of the area, and it may break off and travel through the blood stream (embolize). The embolus thus created can lodge in the brain, lungs, heart, or other area, causing severe damage to that organ.

Risks include prolonged sitting, bedrest, or immobilization; recent surgery or trauma, especially hip surgery, gynecological surgery, heart surgery, or fractures; childbirth within the last 6 months; obesity; and the use of medications such as estrogen and birth control pills. Risks also include a history of polycythemia vera, malignant tumor, changes in the levels of blood clotting factors making the blood more likely to clot, disseminated intravascular coagulation (DIC), and dysfibrinogenia.

Deep venous thrombosis occurs in approximately 2 out of 1,000 people. The condition is most commonly seen in adults over age 60.

Prevention:
Anticoagulants may be prescribed as a preventive measure for high-risk people. Minimize immobility of the legs.

Symptoms:

Signs and Tests:
An examination may reveal a red, swollen, tender area of the leg. The Homans sign is positive, there is sharp pain when the foot is flexed upward.
The presence of deep venous thrombosis may be seen on:

Treatment:
The clot itself usually will resolve through the natural healing processes. Treatment is also aimed at relieving symptoms and preventing the clot from traveling to the lungs, heart, brain, or other areas. Treatment usually requires hospitalization, at least initially.

Anticoagulants or antiplatelet medications are prescribed to prevent further clotting. Analgesics may be needed to control pain. Thrombolytics (clot dissolving medications) are rarely needed.

Bedrest may be recommended until the symptoms are relieved. The leg may be elevated to reduce swelling. Avoid prolonged sitting. Warm, moist heat to the area may help relieve pain.

After returning home, the patient may continue oral anticoagulants or antiplatelet medications for a prolonged period of time. Warm compresses may also be continued. Continue to avoid prolonged sitting or standing in one position.

Expectations:
Most DVT's disappear without difficulty. Complications may be life threatening.
Complications:

It is recommended that you call your health care provider if symptoms suggestive of DVT occur. With proper attention and care, a person with DVT can still live a long and productive life.

Updated January 29, 2009 - MJ

EECP (Enhanced External Counter Pulsations)

 

What is EECP?

EECP is a non-invasive, FDA approved, outpatient therapy for patients having coronary artery disease with persistent symptoms of angina or heart failure who have already had the standard treatments for revascularization or those who are not eligible for surgical intervention. EECP stimulates the formation of collaterals to help create a natural bypass around narrowed or blocked arteries to improve coronary perfusion. This increases the amount of oxygen rich blood to the heart and reduces the symptoms of chest pain, shortness of breath, and fatigue.

 

 

Who needs EECP?

• Patients with coronary artery disease who do not require surgical intervention.

 

 

 

What are the benefits of EECP?

• Lowers the requirement of medications.

 

 

How does EECP work?

EECP affects the dynamics of cardiovascular blood flow. A series of inflatable cuffs sequenced from the calves, thighs, and hips rapidly inflate and deflate.

The timing of the inflation will be during the exact resting phase of each of your heartbeats. This timed compression in the lower extremities pushes the arterial blood backwards into the aorta and increases the coronary perfusion pressure causing stress in the coronary arteries facilitating the development of collaterals.

EECP also increases the venous return during the sequential compression of the lower extremities with a “milking” effect at the same time as the arteries, which further increases cardiac output.

 

 

Since collaterals take time to develop, EECP is given for about 1 hour a day, for 7 weeks, with a total of 35 sessions. 80% of patients usually notice improvement of symptoms with this therapy.

Patients may be ordered a nuclear stress test after the course of therapy is complete to confirm the improvement of coronary blood flow.

 

Can anybody with chest pain try this?

Patients who do not qualify for EECP include patients with:

• Uncontrolled congestive heart failure

• Uncontrolled arrhythmia

• Severe pulmonary or systemic hypertension

• Mild to moderate aortic insufficiency

• Significant coagulopathy- patients on heparin or warfarin

• Severe peripheral vascular disease

• Thromboplebitis- Inflammation in the veins due to a clot

 

 

What are the risks of EECP?

EECP is a non-invasive procedure and risks are very low. Although risks are rare, patients may feel discomfort or minor pain in their legs or back. Other effects may include bruising, blistering, or skin abrasions from the inflatable cuffs.

 

Dr. Jamnadas has been performing EECP on patients since 1994 and has the largest EECP experience in Central Florida. EECP is FDA-approved and covered by most insurance companies.

 

 

Updated January 31st, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

 

 

 

Pulmonary Hypertension

What is Pulmonary Hypertension?

Pulmonary hypertension is caused by certain forms of congenital heart disease, lung disease and blood clots in the lung arteries. It is also associated with collagen vascular disease, portal hypertension (usually caused by liver disease), diet, drugs, HIV infection, and some other rare diseases. In some cases, no cause can be identified, and these cases are called primary pulmonary hypertension (PPH).
Life expectancy depends on many variables. Without knowing the specifics of each case, it is impossible to even guess. Patients with severe forms of pulmonary hypertension have a shortened life expectancy, but recently developed treatments can often help these patients.

Treatment

Today there is treatment to help almost every PH patient. Doctors might begin by trying to lower lung pressures with medicine. Then a transplant is considered. Always discuss your treatment with your health care provider. Be sure to ask questions if you do not understand something, and ask for information on options, risks, possible side effects, drug interactions and dosages. Learn as much as you can about PH and treatment options so you can make educated decisions.
When PH is caused by a blood clot (or clots) in a pulmonary artery, a surgical procedure called a pulmonary thromboendartectomy may restore almost normal blood flow to the lungs. Most clots form in a leg, break off, and travel to a lung. If they do not dissolve (most do), and if they lodge in the lung, they age and become almost like scar tissue. When the clot grows into the wall of the vessel, it may take a decade or longer before the overloaded vasculature that remains becomes damaged from the extra load it is carrying, and PH symptoms may appear. Not all chronic clots cause PH.
Just as a lack of oxygen can cause PH, PH sometimes causes reduced oxygen in the bloodstream. Low levels of bloodstream oxygen make PH worse, so often PH patients need supplemental oxygen. Oxygen is available in several forms. It can be delivered to your home in waist-high tanks, from which you can refill smaller, portable tanks; you can rent an oxygen concentrator, which is rather noisy and must be cleaned frequently; or you can use the more convenient Oxylite portable system (where available) that has a smaller, lighter container than a regular tank, and that saves oxygen by delivering it in pulses. Oxygen can be inhaled through a facemask, or the more preferred cannula (nose prongs).
If you are using street drugs, especially cocaine and methamphetamine, you must seek treatment and quit. Consider joining a support group.

Is Pulmonary Hypertension Hereditary?

Approximately 6-10% of cases of primary pulmonary hypertension are hereditary. Therefore whenever a patient is diagnosed with PH all first order relatives (siblings, children and parents) should be screened for the disease. The best screening test is an echocardiogram. Many women with PH cannot become pregnant, but if they do, the maternal mortality is in excess of 50%.

Daily Living & Wellness

Plan to do the tasks that require the most energy when your energy level is highest, usually in the mornings. Take time to rest, plan sit-down jobs for those in-between energy and no-energy times. Avoid doing jobs that you know will be stressful or too tiring for you. You have to know your own limitations, and then make the necessary decision about what is right and good for you. What we want to do and what we can do can be two very different things.

 

Updated February 2, 2009 - MJ

 

CVProfilor®: A Non-Invasive Way to Determine Cardiovascular Disease Risk

Background:
There are various genetic and environmental factors influencing the development of cardiovascular disease; these factors include diet, smoking, inactivity, elevated lipid levels, elevated blood pressure, and oxidative stress, which increase cardiovascular risk by causing a dysfunction of the endothelial lining of small arteries and arterioles in the body. This change in blood vessels can be detected as a reduction in blood vessel elasticity, relative to elasticity values for normal and healthy individuals of the same age and gender.

Why Is Artery Elasticity Important?

(2) C1-large artery elasticity: A reduction in large artery (femoral, brachial, carotid, etc) elasticity relative to the arterial elasticity values for a normal, healthy individual of the same age and gender.

What Does the CVProfilor® Do?
The CVProfilor® non-invasively detects changes in your vascular tone through collection and analysis of your blood pressure waveforms. Checking your vascular tone is important because loss of arterial elasticity is correlated with early vascular complications that are indicative of an increased risk for cardiovascular disease. Using CVProfilor®, you can detect early signs of underlying vascular disease that would otherwise go unnoticed in a regular doctor’s visit. CVProfilor® is helpful in detecting early signs of elevated blood pressure and atherosclerosis, which only occur in the presence of endothelial dysfunction. The CVProfilor® is the only device that provides an assessment of small and large artery elasticity, enabling early detection of beginning stages of vascular disease.

How important is C2-small artery elasticity?

Treatment options for patients with decreased C2-small artery elasticity:

Abnormal C2-small artery elasticity and normal C1-large artery elasticity:

Abnormal C2-small artery elasticity and abnormal C1-large artery elasticity:

Do I Need to Fast for the CVProfilor®?
There are many factors that influence arterial elasticity, such as time of day, food, smoking, caffeine, and alcohol. Individually, these factors will not change the diagnostic category of the elasticity readings. However, cumulatively, their impact can be greater. If you are being assessed for changes in your artery elasticity over time, it is important and recommended that you follow a fasting protocol.

 

Updated February 4, 2009 - MJ

 

Stroke

What is a Stroke?

Similar to a heart attack that cuts off the blood flow to the heart, stroke is a brain attack that cuts off blood flow to the brain, the body's most vital organ. When an artery in, or leading to, the brain becomes clogged or ruptured, blood cannot reach brain cells. Deprived of the blood's essential oxygen and nutrients, these cells die. As a result, functions that were normally controlled by these cells become impaired, causing, for example, paralysis or loss of speech or vision. Stroke is the third leading cause of death in the United States (second for women) and the number one cause of adult disability. About 80% of strokes are caused by blood clots that obstruct circulation. A thrombotic stroke occurs when blood flow is blocked by a clot formed in an artery in the head. An embolic stroke occurs when a small clot forms elsewhere in the body (e.g., the heart) and gets stuck in an artery leading to the brain. The other 20% of strokes are hemorrhagic strokes that occur when an artery in the brain ruptures. This cuts off blood to some cells and damages others from the pressure of the bleeding. These types of strokes are more lethal, with a death rate of about 50%.

A Medical Emergency

During stroke, brain cells in the infarct, the immediate area where stroke occurs, die quickly. When this happens, a chain reaction endangers cells in the surrounding area of tissues in the penumbra. Every minute following stroke affects the ability of damaged brain cells to recover. Proper diagnosis and prompt medical attention improve the chances for survival and successful recovery. Additionally, strokes may lead to other medical complications, like cardiac arrhythmias, that need to be treated quickly. Therefore, recognition of stroke symptoms - by the patient and emergency medical personnel - is critical.

Risk factors

Everyone is at risk for stroke. However, certain conditions increase the risk, such as:

Symptoms

Generally, people recognize the symptoms of a heart attack and obtain immediate medical assistance. Stroke symptoms, however, are more subtle and often overlooked. Recognizing these symptoms is very important to getting the quick diagnosis and treatment that can save lives. The most common symptoms are:

Depression after a stroke

It is normal for a stroke victim to feel sad over the problems caused by a stroke. Some people, however, experience severe depression, which should be treated as soon as possible. If a stroke survivor has symptoms of depression, professional help is needed immediately. Symptoms include:

Be aware of the symptoms that may accompany a stroke and if symptoms occur, seek professional care. If you or a family member has had a stroke, work with your healthcare professional to maximize recovery. To learn more about hypertension and stroke, click here

Preventing Stroke
It is now believed that stroke is as preventable as heart attack. In addition to primary prevention tactics such as quitting smoking, drinking only in moderation, and exercising, there are medical interventions that can decrease your risk of stroke if you are in a high-risk group. Recent studies show that if you have conditions known as atrial fibrillation or carotid artery disease, there are interventions that can dramatically lower your risk of stroke.

Updated January 29, 2009

 

Mitral Regurgitation

Mitral regurgitation is a disorder in which the mitral heart valve does not close properly, causing blood to leak into the left atrium when the left ventricle contracts. Mitral regurgitation affects approximately 5 out of 10,000 people.

Causes and Risk Factors

Regurgitation is caused by disorders that weaken or damages the valve. Inadequate closure of the mitral valve causes blood to backflow to the left atrium, decreasing the blood flow to the rest of the body. This causes the heart to pump harder to try to compensate for the decreased blood flow. Mitral regurgitation may also be the result of dysfunction or injury to the valve following a heart attack or infective endocarditis, which may result in rupture of the valve, papillary muscle, or chordae tendineae (the structures that anchor the valve cusps). Such a rupture results in the valve leaflet protruding into the atrium, leaving an opening for the backflow of blood.
Risk factors include an individual or family history of the above disorders.

Prevention

Prompt treatment of causative disorders reduces the risk of mitral regurgitation. As with mitral stenosis and mitral valve prolapse, you should advise your physician or dentist of any history of heart valve disease before receiving treatment to prevent a bacterial infection.

Symptoms

There may be an abrupt onset of symptoms.

Signs and tests

Palpation may show a vibration over the heart. A stethoscope may reveal a distinctive murmur in the heart. If fluid backs up into the lungs, there may be signs of congestion of the pulmonary (lung) veins. Blood pressure is usually normal. Billowing of the mitral valve and/or regurgitation of blood may show on an echocardiogram or a coronary angiography.
A chest X-ray may also show fluid in the lungs or prominent pulmonary veins. Swan-Ganz left heart catheterization pressure readings will record a marked elevation of left atrial pressure. An ECG usually shows a normal sinus rhythm, but may show arrhythmias such as atrial fibrillation. Other tests may include a chest MRI scan, radionucleotide scans, or a CT scan of the chest.

Treatment

Hospitalization may be required for diagnosis and treatment of severe symptoms. Emergency surgery is often necessary if acute regurgitation is a result of endocarditis, MI, or ruptured cordae.
Antibiotics may be prescribed if there is a bacterial infection. Antiarrhythmics may be needed to control irregular rhythms. Vasodilators reduce the workload of the heart. Digitalis may be used to strengthen heartbeat, and diuretics to remove excess fluid such as fluid in the lungs. Anticoagulants or antiplatelet medications may be used to prevent clot formation if atrial fibrillation is present. When blood pressure cannot be maintained, in emergency situations, the intra-aortic balloon pump (IABP) reduces backflow by lowering resistance in the aorta.

Expectations

The outcome varies and depends on the severity of the acute regurgitation. It can sometimes be controlled with medications, but surgery is often necessary as it may become a chronic condition.

Complications

Updated January 29, 2009 - MJ

Mitral Valve Prolapse

The most common heart valve abnormality is called mitral valve prolapse (MVP), which mostly affects women between the ages of 20 and 40. MVP can go undetected for years, as symptoms usually do not appear until adolescence or even adulthood. This is a condition of the mitral valve, a two-flapped heart valve between the left atrium and left ventricle. In MVP, one or both of the valve flaps are too large, and the valve does not close evenly with each heartbeat. Because of this imperfect closing, the valve itself slightly balloons back into the left atrium, sometimes causing what is known as a "click". With the flap there may sometimes be a slight backward leaking of blood (regurgitation) as well, resulting in a heart murmur.
It seems that MVP is an inherited disorder, although the exact genes are not known. Generally, MVP has no impact on normal activities; if proper precautions are taken, MVP will not affect life expectancy.

What are the Symptoms of MVP?

Generally, a stressful situation (childbirth, change in job situation or marital status, viral illness) brings on symptoms that ordinarily would not be present. Some 60% of those with MVP never show symptoms. Some symptoms include:

MVP can be detected during a routine check-up with a simple stethoscope. After the ventricle begins to contract, a clicking sound can be heard, the sound of the abnormal valve fighting the pressure of the left ventricle. The diagnosis can be confirmed with a cardiac echo or echocardiogram, which can also determine the level of severity of the prolapse and the degree of regurgitation. Most patients can be monitored simply, with a follow-up checkup every few years.

Common Risks and Problems Associated with MVP

Many MVP patients never experience any symptoms. However, rare complications include chest pain and irregular heart beat, both of which can be treated with medication, usually a beta-blocker. Another rare complication involves formation of blood clots on the valve, making an MVP patient vulnerable to strokes; this problem requires treatment with medication.
The most common and serious MVP-related problem, endocarditis, involves bacterial infection of the mitral valve. Although it can be fatal if left untreated, endocarditis can be easily prevented. MVP patients are most commonly vulnerable to introduction of bacteria into the bloodstream when they are undergoing certain medical procedures, particularly dental work or minor surgery. To avoid this, patients should inform their doctor or dentist that they have MVP, and be given preventative treatment before the procedure.

When is Surgery Recommended?

Although most MVP patients do very well with treatments and preventive measures, there is sometimes need for surgery to either repair or replace the mitral valve. This occurs only among patients who experience severe mitral regurgitation, which can result in progressive heart enlargement, and ultimately, heart failure. Surgeons are more likely to perform corrective surgery rather than replace the valve with an artificial one, mainly because the introduction of an artificial valve requires lifelong use of blood thinners to prevent clotting.

Updated January 29, 2009 - MJ

Mitral Stenosis

Mitral Stenosis is a heart valve disorder characterized by narrowing or obstruction of the mitral valve; this prevents the valve from opening properly. Also known as mitral valve obstruction, this disorder affects about 2 out of 10,000 people. Symptoms usually develop between the ages of 20 and 50.

Causes & Risk Factors

Mitral stenosis most commonly occurs in people who have had rheumatic fever, but it can be caused by any disorder that causes narrowing of the mitral valve. Congenital mitral stenosis alone is rare. It more commonly occurs with complex groups of cardiac abnormalities.
Narrowing of the mitral valve obstructs blood flow from the left atrium to the left ventricle. This can reduce the amount of blood that flows to the body. The atrium enlarges as pressure builds up in it, and blood may backflow into the lungs resulting, in fluid in the lung tissue.
Symptoms may begin with an episode of atrial fibrillation, or may be triggered by pregnancy or other stress on the body such as respiratory infection, stroke, endocarditis, and other cardiac disorders.

Prevention

Although mitral stenosis cannot be prevented, complications are preventable. Alert your physician or dentist of any history of heart valve disease before receiving treatment to prevent a bacterial infection.

Symptoms

There are often no symptoms, or symptoms may appear or worsen with exercise or increase in heart rate.
Symptoms include:

Signs and tests

A stethoscope examination reveals a distinctive murmur, snap, or other abnormal sounds. This means a rumbling sound is heard over the point of the heart during the resting phase of the heartbeat, and this sound becomes more pronounced just before the heart contraction begins. Examination may also reveal irregular heartbeat or lung congestion. Blood pressure is usually normal. There may be vibration or a tapping on palpation over the heart making it difficult to distinguish from a heart tumor.
Narrowing or obstruction of the valve, or enlargement of the atrium may show on an echocardiogram, Doppler ultrasound, chest X-ray, ECG or coronary angiography.

Treatment

No treatment may be necessary if symptoms are absent or mild. Hospitalization may be required for diagnosis and for treatment of more severe symptoms. Medications include diuretics, digoxin, or antiarrhythmics. Anticoagulants may be used to prevent blood clots. Heart valve surgery or replacement of the valve may be necessary. Balloon valvuloplasty may be considered instead of surgery.

Expectations

The disorder may be mild or without symptoms. It may be more severe and eventually disabling. Complications may be severe or life threatening. Mitral stenosis is usually controllable with treatment, and improved with surgery.

Complications

Updated January 29, 2009 - MJ

Bacterial Endocarditis Guidelines

What is Bacterial Endocarditis?
Bacterial Endocarditis, also known as Infective Endocarditis, is an infection of the heart’s valves or inner lining (endocardium). Bacterial Endocarditis is mostly seen in individuals who have a damaged, diseased, or artificial heart valve.

Causes: Bacterial endocarditis is caused by bacteria and, under very rare circumstances, fungi. Bacteria enter the bloodstream through various ways including dental and surgical procedures and settle on the inside of the heart, usually on the heart valves.

Risk: The risk of bacterial endocarditis is increased in individuals who have heart problems that affect blood flow because it is more likely that bacteria will attach to heart tissue. The risk of endocarditis is even greater in individuals with the following heart conditions:

If you have any of the above heart conditions, you may need to take antibiotics before certain dental or surgical procedures because antibiotics lower your risk of developing endocarditis. If you are at risk of developing endocarditis, maintaining good oral hygiene is essential for prevention.

What are the Latest Recommendations for Bacterial Endocarditis?
The American Heart Association (AHA) no longer recommends infectious endocarditis prophylaxis based on an increased risk of acquiring IE. If prophylaxis is effective, it is should be given only to patients who are at highest risk of an adverse outcome from bacterial endocarditis and who would gain the most from bacterial endocarditis prevention.

Recommended Regimens:
General Principles:

Recommendations for Patients Undergoing Cardiac Surgery

Regimens for Dental Procedures:

Regimens for Respiratory Tract Procedures

Recommendations for GI or GU Tract Procedures

 

Updated February 3, 2009 - MJ

Cardiac Catherization and Angiography

Overview:  A cardiac catherization is a test to check the condition of your coronary arteries, heart pump function, and valve function.  It is used most commonly to check blood flow inside the coronary arteries to rule out any obstruction created by calcium deposits, plaque and fat deposits that may have built up from atherosclerosis.  Blockages in the arteries can lead to heart attacks, chest pain (angina) and weakened heart muscle function leading to Congestive Heart Failure (CHF). 

If the coronary arteries are blocked, we can insert a balloon through the blockage to improve blood flow; this is called percutaneous coronary intervention (PCI).  Listed below are techniques commonly used to open blocked arteries.

Coronary stent placement:  A small expandable tube is inserted into the artery to hold it open.  The stent is left in place, and over the next few months, the inner lining of the artery (endothelium) gradually grows over the stent so the stent is no longer exposed to blood.  If this growth is excessive, it can obstruct the lumen.  This is known as re-stenosis.  Most of the stents used today are drug coated and are called drug-eluting stents.  This reduces the chance of restenosis within the stent by inhibiting excessive endothelial growth over the stent.  The chance of restenosis within a drug coated stent is less than four percent (4%).  Following a stent placement you will be required to continue Plavix® (Clopidogrel bisulfate), which reduces platelet stickiness and thereby reduces the chance of thrombosis and heart attack

Balloon angioplasty (PTCA):  In this procedure, a balloon is inserted inside the artery and dilated within the narrowed segment of the artery in order to improve blood flow.

 

Aspiration Thrombectomy:  Here a specialized catheter is used to extract blood clots within the artery.  This is usually the case when a patient presents with an active heart attack.

During a cardiac catheterization, contrast material is injected into the pumping chamber of your heart to assess the strength of contractions; this is known as the ejection fraction (EF).  The normal ejection fraction is between 55-65%.  During the test, pressure readings are performed to assess valvular function.  Valves can be leaky (regurgitant) or narrowed (stenotic). An accurate determination of valvular function is important prior to decisions to replace or repair valves.

HOW TO PREPARE

1. You will be asked to have blood tests to check kidney function and blood count during the week prior to the procedure.  Make sure that your bloodwork is done.

2. Do not eat or drink anything from midnight the night before the procedure.  The test is usually scheduled in the morning on an empty stomach.  However, you should take your medications as usual with a sip of water.  If you are on
Coumadin® (Warfarin), be sure to inform the doctor since Coumadin® should be
discontinued 5 days prior to the procedure.

3. If you are allergic to Iodine or if you have had a reaction to contrast in the past, you need to inform the doctor so that you can be pre-medicated with Prednisone to avoid a reaction to the dye used in the procedure.

4. Report to the hospital Cardiac Catheterization lab at the designated time. 

5. Remove nail polish, necklaces, rings, bracelets and any other jewelry before the test.

6. Make arrangements for someone to take you home after the test.  If you have had a diagnostic cardiac catheterization you will be discharged approximately 2   hours after the test.  If any interventions, such as stent placement, was performed then you will be required to stay overnight at the hospital after the procedure and will be discharged at around 10:30 am the next morning.

7. Please refrain from use of erectile dysfunction medications (Viagra®, Cialis®,
Levitra®) 4 days prior to the procedure.  Nitrate medications may be used during
the procedure and there is the risk of severe hypotension (low blood pressure)
occurring if erectile dysfunction drugs are in the body.

THE PROCEDURE
The cardiac catheterization and intervention is performed in the cardiac catheterization laboratory of the hospital by Dr. Jamnadas.  He is assisted by specialized cardiovascular technologists.  You will be asked to lay flat on a table under an X-ray machine.  This machine allows the doctor to visualize the contrast in your coronary arteries.  The EKG electrodes will be attached, a pulse oximeter clipped to your finger to measure oxygen levels, and an intravenous access (IV) will be established in one of your arms.  A sedative will be administered through the IV line so you are comfortable; the majority of patients do not remember many details of the procedure.

A small area in the groin is anesthetized, and then a special needle is inserted into the femoral artery.  Occasionally the doctor uses the brachial artery in the right elbow.  Once the femoral artery is cannulated with an introducer catheter, a special hollow catheter is pushed into the aorta. Under X-ray guidance, the tip of the catheter is placed into position in the coronary artery.  Contrast is injected, and the image is recorded.  The X-ray machine may move to many different positions and angles so that the doctor may clearly see all portions of your coronary arteries.  The inside of the artery has no sensation, so the procedure is painless.

In the event that a severe narrowing or blockage is identified, the doctor may proceed with the intervention.  During the intervention a larger catheter is used and a fine wire is passed into the artery beyond the narrowing in the artery.  The stent is placed over this wire and then inflated after careful positioning guided by the X-ray images.  During the procedure you may be given blood thinners and maintenance IV fluids.

Following the procedure, Dr. Jamnadas closes the puncture site in the artery with a special collagen plug called Angioseal®.  You will be asked to keep your leg straight and rest in bed for 2 hours.  After that, the nurse will allow you to move around freely.  If a diagnostic procedure was performed, you will be able to leave the hospital in 2 hours; but if an intervention was done, you will have to stay overnight in the hospital. You should drink plenty of fluids for several hours after the test in order to flush the contrast material out of your body and prevent dehydration.  If you have any pain in the groin, you should inform the nurse or call the doctor.  Some soreness and bruising at the insertion site is to be expected and disappears within a week.  Call the doctor if your leg becomes cold, painful, or numb.  Also call if you develop a fever, redness, and/or swelling at the insertion site.

RISKS
Complications are very rare; for cardiac catheterizations, the risk is less than 1 in 10,000 procedures.  For coronary intervention, the risk is less than 1%. Risks and complications are more likely to be seen in critically ill and elderly patients and include:
1. Heart attack:  This may be due to dislodgement of a blood clot causing
obstruction to a small branch artery.

2. Stroke:  A small plaque or blood clot can dislodge from the aorta and
end up in the brain resulting in a stroke.  It usually occurs in patients who have
extensive atherosclerosis of the aorta.

3. Arrhythmias:  This is rare and usually corrects itself after the procedure.

4. Kidney failure:  The contrast material can cause kidney failure in patients who
are dehydrated and have preexisting kidney disease or diabetes.  It is usually
transient but requires monitoring in the hospital for a few days longer.

5. Need for immediate open heart surgery:  This is very rare and can occur if
there is a puncture of the heart or a tear in its blood vessels at the time of stent
placement.

6. Allergic reaction: An allergic reaction to contrast material usually involves hives and itching and very rarely anaphalactic shock.

7. Bleeding:  This can occur at the catheter insertion site resulting in a hematoma, which    usually goes away in a few days.

RESULTS
Dr. Jamnadas will usually discuss the results within an hour after the procedure is completed. 

PLAN
In addition to the above stated information, you will be placed on a medication and prevention program.  Please take your medications EXACTLY as instructed.  Please also ask about the Cardiovascular Interventions generic drug program available.  When you leave the hospital you will be given a medication prescription and a follow up office appointment at CVI will be made.  Be sure you have your follow up appointment, if you do not have one, call the office to make one.  You are strongly encouraged to participate in:

1.)  Cardiac Rehabilitation program:  This program will help reduce future risk of cardiac events by nearly 25%.  Dr. Jamnadas encourages everyone to join the cardiac rehabilitation program. 

2.)  Lipid Management Program:  This program monitors your medications and diet to help manage your cholesterol.

3.)  Blood Pressure Control: Blood pressure control can reduce stroke and future cardiac events.

4.)  Diabetic control: Controlling blood sugar is important for your health

5.)  Weight loss:  Attaining and maintaining ideal body weight helps limit many diseases.  Please ask Dr. Jamnadas for treatment options.

6.)  Stress management:  No program is complete without risk and stress management.

 

Updated February 26, 2009 - MJ

 

 

Coronary Bypass Surgery

What is coronary artery bypass surgery?
Coronary artery bypass surgery is often the best solution for patients suffering from severe coronary artery disease (CAD). Atherosclerosis is the result of fat build-up on the inner walls of the arteries that nourish the heart and results in reduced blood flow to the heart. These build-ups can narrow the arteries and thus restrict the normal flow of oxygen-rich blood, or can block the flow of blood altogether. If your doctor has recommended coronary bypass surgery to "detour" your blocked artery, the following information can help answer your questions about this procedure.

Symptoms
In its early stages, CAD has no obvious symptoms. As Atherosclerosis worsens, it may cause one or more of the following:

How is coronary bypass done?
During coronary bypass surgery, surgeons take a blood vessel from another part of the body and construct a detour around the blocked part of the coronary artery. The breastbone is broken and opened to gain access to the heart; however, the heart itself is not opened. There are two common procedures:

Either way, blood can then use this new path to once again flow freely to the heart.

What is minimally invasive bypass surgery?
This is a new technique that is being evaluated as an alternative to traditional coronary artery bypass surgery. It involves the use of special tools to perform a coronary artery bypass procedure without breaking the breastbone and without the use of a heart-lung machine. Benefits to this procedure are less pain and shorter hospitalization. This is a new technique that many medical centers do not yet perform. Your doctor will help you decide which treatment is best for you.

What to Expect
Prior to your surgery, you will have a full medical and cardiac evaluation that usually includes cardiac catheterization (an examination of the inside of your heart), a coronary angiogram ventriculogram (an x-ray picture of the pumping action of the lower left part of your heart). The procedure is performed under general anesthesia.

After the coronary bypass surgery, you will recover in the intensive care unit of the hospital and be monitored closely for 2 - 3 days. You will have several tubes to help you breathe, empty your bladder, and provide medications. Once your condition is stable and the tubes are removed, you will be moved to a regular hospital room for 7 - 10 days. You will then receive physical, respiratory, and occupational therapy. Bypass surgery is a major surgical procedure, so it is important that you speak with your doctor in advance to weight the benefits and risks of this procedure.

After-Surgery Care
Your recovery time at home will be approximately one to two months. You will have follow-up visits during that time to monitor your progress and the success of the surgery; your doctor will place you on a specialized post-operative rehabilitation and prevention program. It is imperative that you follow your physician's instructions about reducing your risk of the progress of further Atherosclerosis by stopping smoking (if you smoke), reduce your consumption of high fat and cholesterol foods, follow your doctor's recommended exercise program, and learn how to control your blood pressure. Sexual activities may be resumed 3-4 weeks after surgery. You should be somewhat careful in protecting the area around the leg from which the vein was removed; this may take a few months to return to normal.

Most people who have sedentary office jobs can return to work in four to six weeks. Those who have physically demanding jobs will need to wait longer. In some cases, they may need to find other employment with less physical activity.

Hope for the future
By providing your heart with life-giving oxygen, coronary artery bypass surgery can help ensure a longer healthier life.

 

 

 

Aortic Stenosis

What is aortic stenosis?
When aortic valve stenosis occurs, the aortic valve, located between the aorta and left ventricle of the heart, is narrower than normal size. When the degree of narrowing becomes significant enough to impede the flow of blood from the left ventricle to the arteries, heart problems develop. These problems include blackouts (fainting), congestive heart failure with edema or shortness of breath, or angina pectoris (chest pain). The worst complication is sudden death and arrhythmia.

Aortic stenosis is caused by many disorders. The most common cause of aortic stenosis is age related calcification of the valve. This usually occurs in patients in their 80s but can occur sooner. One cause is rheumatic fever, which may occur with strep throat and scarlet fever. Other causes include congenital abnormalities such as Bicuspid aortic valve. This may present as a murmur at a young age and cause problems in the 40s. There may be a history of other valve diseases and coronary artery disease.

Aortic stenosis is three times more common among men than women. Symptoms usually do not appear until middle age or older.
Occassionally a murmur is heard by a health provider.

Prevention:
Notify your health care provider about any history of heart valve disease before treatment for any condition. Also, any dental work, including cleaning, and any invasive procedure, can introduce bacteria into the bloodstream, which can infect a weakened valve. This is the reason why you may be asked to take antibiotics prior to dental work.

Follow your provider's treatment recommended for conditions that may cause valve disease. Treat strep infections promptly to prevent rheumatic fever. Notify the provider if there is a family history of congenital heart diseases.

Symptoms (some may not show until late in the course of the disease):
·     Breathlessness, swelling of the feet, effort intolerance
·     Sensation of feeling the heart beat
·     Cough
·     Chest pain, angina-type
-Under the sternum, may radiate
-Crushing, squeezing, pressure, tightness
-Increased with exercise, relieved with rest
·     Decreased urine output
·     Dizziness or blackouts

Signs and Tests:
Examination shows a palpable chest thrill or heave (vibration or movement felt by holding the hand over the heart). There is almost always a heart murmur, click, or other abnormal sounds on auscultation (examination of the chest with a stethoscope). There may be faint pulses or changes in the quality of the pulse in the neck and blood pressure may be low.

Aortic stenosis and/or enlargement of the left ventricle may be revealed on:
·     A left coronary angiography
·     An echocardiogram
·     A Doppler ultrasonography
·     A chest X-ray

An ECG may show left-ventricle enlargement or arrhythmias (unusual pattern of heart beats) such as ventricular tachycardia or sinus bradycardia.
This disease may also alter the results of the following:
·     A chest MRI
·     An aortic angiography

Treatment:
If there are no symptoms, or if symptoms are mild, only observation may be required. If symptoms are mild to severe, hospitalization may be required. Medications may include diuretics, digoxin, and other medications to control heart failure. Symptomatic people may be advised to avoid strenuous physical activity. People with symptoms of aortic difficulty breathing, chest pain, and syncope should have a physical exam every 6 to 12 months, an ECG performed every 1 to 3 years, and an echocardiogram done annually.

Surgical repair or replacement of the valve is the preferred treatment for symptomatic aortic stenosis.The surgical options are a tissue valve or a metal valve.The latter is probably more durable but requires lifelong use of Coumadin, a blood thinner, which prevents blood clots from forming on the metal valve. This prevents strokes too. Of course, coumadin is not to be taken lightly and has potential dangers that should be discussed with the doctor.

Expectations:
Aortic stenosis is curable with surgical repair, although there may be a continued risk for arrhythmias. The person may be symptom-free until complications develop. Without surgery, probable outcome is poor if there are signs of angina or heart failure.

Complications: Complications of aortic stenosis include:
·     Left ventricular hypertrophy (enlargement) caused by the extra work of pushing blood through the narrowed valve
·     Angina
·     Left-sided heart failure
·     Sudden death from arrhythmias
·     Endocarditis

If the degree of stenosis of the valve is severe, a definitive cardiac catheterization is needed. During this procedure, the exact degree of narrowing, possible leaking and coronary anatomy is determined. Based on the results, surgery can be planned.

The surgery required is open heart surgery. The patients usually stay in the hospital for 7 days and then spend the next 4 to 6 weeks recovering from the surgery.The overall risk varies between 5 and 10%.

                                                  

Updated January 29, 2009 - MJ

Deep Venous Thrombosis

What is deep venous thrombosis?
Deep venous thrombosis (DVT) affects mainly the veins in the lower leg and the thigh. It involves the formation of a clot (thrombus) in the larger veins of the area. This thrombus may interfere with circulation of the area, and it may break off and travel through the blood stream (embolize). The embolus thus created can lodge in the brain, lungs, heart, or other area, causing severe damage to that organ.

Risks include prolonged sitting, bedrest, or immobilization; recent surgery or trauma, especially hip surgery, gynecological surgery, heart surgery, or fractures; childbirth within the last 6 months; obesity; and the use of medications such as estrogen and birth control pills. Risks also include a history of polycythemia vera, malignant tumor, changes in the levels of blood clotting factors making the blood more likely to clot, disseminated intravascular coagulation (DIC), and dysfibrinogenia.

Deep venous thrombosis occurs in approximately 2 out of 1,000 people. The condition is most commonly seen in adults over age 60.

Prevention:
Anticoagulants may be prescribed as a preventive measure for high-risk people. Minimize immobility of the legs.

Symptoms:

Signs and Tests:
An examination may reveal a red, swollen, tender area of the leg. The Homans sign is positive, there is sharp pain when the foot is flexed upward.
The presence of deep venous thrombosis may be seen on:

Treatment:
The clot itself usually will resolve through the natural healing processes. Treatment is also aimed at relieving symptoms and preventing the clot from traveling to the lungs, heart, brain, or other areas. Treatment usually requires hospitalization, at least initially.

Anticoagulants or antiplatelet medications are prescribed to prevent further clotting. Analgesics may be needed to control pain. Thrombolytics (clot dissolving medications) are rarely needed.

Bedrest may be recommended until the symptoms are relieved. The leg may be elevated to reduce swelling. Avoid prolonged sitting. Warm, moist heat to the area may help relieve pain.

After returning home, the patient may continue oral anticoagulants or antiplatelet medications for a prolonged period of time. Warm compresses may also be continued. Continue to avoid prolonged sitting or standing in one position.

Expectations:
Most DVT's disappear without difficulty. Complications may be life threatening.
Complications:

It is recommended that you call your health care provider if symptoms suggestive of DVT occur. With proper attention and care, a person with DVT can still live a long and productive life.

Updated January 29, 2009 - MJ

EECP

What is EECP®?
EECP® is a new treatment for individuals with ongoing chest pain (known as chronic angina) who have already had coronary artery bypass surgery or angioplasty and do not qualify for further surgical intervention. A benefit of EECP® is that it is a non-invasive treatment that provides the same benefits as coronary artery bypass surgery and angioplasty. This new treatment has clinically been proven to be as effective as coronary artery bypass surgery and coronary stent placement in its ability to eradicate angina pectoris. EECP® is often used to treat heart failures as well. EECP® improves exercise tolerance and reduces the frequency of angina pectoris, shortness of breath, fatigue, and tiredness. 

Dr. Jamnadas has been performing EECP® on patients since 1994 and has the largest EECP® experience in Central Florida. EECP® is FDA-approved and covered by most insurance companies.

How does it work?
EECP® creates coronary artery collaterals, which are new coronary blood vessels that grow to feed the heart muscle, thereby enabling blood to bypass blockages in coronary blood vessels. Most patients have an inherent ability to form collaterals, but they grow slowly. EECP® however, accelerates the rate of collateral branching. This is similar to the small shoots growing from roots of a plant; the shoots absorb water for the plant. Similarly, small collaterals supply blood and oxygen for the heart muscle.

How is EECP® performed?
A series of inflatable cuffs are wrapped around the legs and hips and then rapidly inflated and deflated. The high pressures generated by the cuffs will send a column of blood into the inferior vena cava and into the aorta, thereby into the coronary arteries and veins feeding the heart muscle. Blood is forced to the heart muscle with each heartbeat, and this stimulates the growth of new blood vessels. Within 7 to 10 days, most patients notice a marked improvement.

Since the collaterals take time to develop, you will need one hour of treatment on a daily basis, for a total of 35 sessions.  By the end of EECP® therapy, more than 90% of patients notice a marked improvement in their exercise tolerance and a decrease in the amount of angina pectoris they experience.

Who needs EECP®?

Is EECP® uncomfortable? What are the risks?
Only 1% of patients have had to discontinue EECP® because of discomfort or intolerance. The majority of patients become accustomed to EECP® within one or two sessions. They usually spend their one hour session reading a book, listening to music, or watching a video. For patients who experience muscle discomfort, a mild analgesic such as Tylenol taken in the morning may be helpful.

Other centers where EECP® is routinely performed:

 

 

Updated February 3, 2009 - MJ

Pulmonary Hypertension

What is Pulmonary Hypertension?

Pulmonary hypertension is caused by certain forms of congenital heart disease, lung disease and blood clots in the lung arteries. It is also associated with collagen vascular disease, portal hypertension (usually caused by liver disease), diet, drugs, HIV infection, and some other rare diseases. In some cases, no cause can be identified, and these cases are called primary pulmonary hypertension (PPH).

Life expectancy depends on many variables. Without knowing the specifics of each case, it is impossible to even guess. Patients with severe forms of pulmonary hypertension have a shortened life expectancy, but recently developed treatments can often help these patients.

Treatment

Today there is treatment to help almost every PH patient. Doctors might begin by trying to lower lung pressures with medicine. Then a transplant is considered. Always discuss your treatment with your health care provider. Be sure to ask questions if you do not understand something, and ask for information on options, risks, possible side effects, drug interactions and dosages. Learn as much as you can about PH and treatment options so you can make educated decisions.

When PH is caused by a blood clot (or clots) in a pulmonary artery, a surgical procedure called a pulmonary thromboendartectomy may restore almost normal blood flow to the lungs. Most clots form in a leg, break off, and travel to a lung. If they do not dissolve (most do), and if they lodge in the lung, they age and become almost like scar tissue. When the clot grows into the wall of the vessel, it may take a decade or longer before the overloaded vasculature that remains becomes damaged from the extra load it is carrying, and PH symptoms may appear. Not all chronic clots cause PH.

Just as a lack of oxygen can cause PH, PH sometimes causes reduced oxygen in the bloodstream. Low levels of bloodstream oxygen make PH worse, so often PH patients need supplemental oxygen. Oxygen is available in several forms. It can be delivered to your home in waist-high tanks, from which you can refill smaller, portable tanks; you can rent an oxygen concentrator, which is rather noisy and must be cleaned frequently; or you can use the more convenient Oxylite portable system (where available) that has a smaller, lighter container than a regular tank, and that saves oxygen by delivering it in pulses. Oxygen can be inhaled through a facemask, or the more preferred cannula (nose prongs).

If you are using street drugs, especially cocaine and methamphetamine, you must seek treatment and quit. Consider joining a support group.

Is Pulmonary Hypertension Hereditary?

Approximately 6-10% of cases of primary pulmonary hypertension are hereditary. Therefore whenever a patient is diagnosed with PH all first order relatives (siblings, children and parents) should be screened for the disease. The best screening test is an echocardiogram. Many women with PH cannot become pregnant, but if they do, the maternal mortality is in excess of 50%.

Daily Living & Wellness

Plan to do the tasks that require the most energy when your energy level is highest, usually in the mornings. Take time to rest, plan sit-down jobs for those in-between energy and no-energy times. Avoid doing jobs that you know will be stressful or too tiring for you. You have to know your own limitations, and then make the necessary decision about what is right and good for you. What we want to do and what we can do can be two very different things.

 

Updated February 2, 2009 - MJ

CVProfilor®: A Non-Invasive Way to Determine Cardiovascular Disease Risk

Background:
There are various genetic and environmental factors influencing the development of cardiovascular disease; these factors include diet, smoking, inactivity, elevated lipid levels, elevated blood pressure, and oxidative stress, which increase cardiovascular risk by causing a dysfunction of the endothelial lining of small arteries and arterioles in the body. This change in blood vessels can be detected as a reduction in blood vessel elasticity, relative to elasticity values for normal and healthy individuals of the same age and gender.

Why Is Artery Elasticity Important?

(2) C1-large artery elasticity: A reduction in large artery (femoral, brachial, carotid, etc) elasticity relative to the arterial elasticity values for a normal, healthy individual of the same age and gender.

What Does the CVProfilor® Do?
The CVProfilor® non-invasively detects changes in your vascular tone through collection and analysis of your blood pressure waveforms. Checking your vascular tone is important because loss of arterial elasticity is correlated with early vascular complications that are indicative of an increased risk for cardiovascular disease. Using CVProfilor®, you can detect early signs of underlying vascular disease that would otherwise go unnoticed in a regular doctor’s visit. CVProfilor® is helpful in detecting early signs of elevated blood pressure and atherosclerosis, which only occur in the presence of endothelial dysfunction. The CVProfilor® is the only device that provides an assessment of small and large artery elasticity, enabling early detection of beginning stages of vascular disease.

How important is C2-small artery elasticity?

Treatment options for patients with decreased C2-small artery elasticity:

Abnormal C2-small artery elasticity and normal C1-large artery elasticity:

Abnormal C2-small artery elasticity and abnormal C1-large artery elasticity:

Do I Need to Fast for the CVProfilor®?
There are many factors that influence arterial elasticity, such as time of day, food, smoking, caffeine, and alcohol. Individually, these factors will not change the diagnostic category of the elasticity readings. However, cumulatively, their impact can be greater. If you are being assessed for changes in your artery elasticity over time, it is important and recommended that you follow a fasting protocol.

 

Updated February 4, 2009 - MJ