Atrial Flutter

 

What is it?

Atrial flutter is a relatively common abnormal heart rhythm where the atria beat quickly, but evenly. This is similar to atrial fibrillation, but the atria beat quickly and unevenly.

Atrial flutter and fibrillation always have some degree of atrial-ventricular (AV) block with a 2:1 pattern meaning the rate of the ventricles is usually 150 beats per minute while the atria beat at 300 beats per minute. In other words, every other atrial beat reaches the ventricle.

Both of these arrhythmias impair blood flow out of the heart (cardiac output) and promote clot (thrombus) formation.

 

 

How does a normal heart beat?

Heart muscle cells are activated by electrical impulses that cause them to contract regularly and in sync. This contraction produces a heartbeat, allowing blood to be pumped out to the entire body.

Electrical impulses originate from specialized cells called the sinoatrial (SA) node, which is the hearts natural pacemaker.

The SA node is located in the upper right chamber of the heart, the right atrium.  From the SA node, the impulse spreads across the upper chambers of the heart to reach the atrial ventricular (AV) node located between the atria and lower ventricles. After leaving the AV node, impulses spread across the pumping chambers of the heart, the ventricles.

As impulses are spread along the heart, the cardiac muscle cells are stimulated to contract, producing a heartbeat.

 

 

How does atrial flutter occur?

Sometimes the electrical impulses ‘short circuit’ and travel across the heart in an abnormal way. Abnormal electrical pathways produce irregular heartbeats and rhythms known as arrhythmias.

Arrhythmias occur when other areas of the heart, other than the SA node, begin sending out their own impulses and take over the pacemaker function of the SA node. The sites that take over could be from any area of the atria, AV node, or ventricles.

The rapid fluttering of the atria does not allow the complete filling of the ventricles, that pumps blood out to the entire body. Symptoms of atrial flutter such as lightheadedness or dizziness may be felt.

Also, some amount of blood remains in the chamber that leads to clot formation.

 

 

 

How is it classified?

Atrial flutter is classified into two types:

 

Most patients with atrial flutter will have only one of these. Rarely a patient may present with both types, although they can only occur one at a time.

 

 

What are the causes?

Atrial flutter can be due to abnormalities or diseases of the heart, or by diseases elsewhere in the body affecting the heart. Atrial flutter may occur after open heart surgery or substance abuse.

Heart abnormalities and diseases include:

 

Diseases elsewhere in the body affecting the heart:

 

Substance abuse:

 

Surgery

 

 

Who is at risk?

The following are at risk of developing atrial flutter:

 

 

What are the symptoms?

Some patients may be unaware of their heart beating abnormally.

Although characteristic symptoms include:

 

 

What are the complications?

The complications of atrial flutter include:

 

 

When should I seek medical care?

If you experience symptoms of atrial flutter, call your physician.

If you have already been diagnosed and being treated for atrial flutter, seek medical help at the hospital as soon as possible if you have the following symptoms:

 

 

 
How is it diagnosed?

The diagnosis of atrial flutter will be based on your history, physical examination, and certain tests.

 

 

1. Patient history

 

Most patients will give a history of characteristic symptoms like palpitations, dizziness, fatigue, shortness of breath, etc.

 

2. Physical Examination

You will be examined for signs of atrial flutter including:

 

 

3. Tests

 

Certain tests can be performed to determine the cause and severity of your condition including:

 

 

How is it treated?

Atrial flutter treatment goals include restoring the heart to normal rhythm, regulating heart rate, preventing blood clot formation, and treating the underlying cause.

This is done by the use of medications and procedures.

 

 

Medications

 

Some medications are used to slow an irregularly fast heart beat. These decrease the heart rate by slowing the conduction of impulses through the AV node.

These drugs include:

 

Medications are used to reduce the frequency and duration of atrial flutter and prevent future episodes.

These include:

 

Medications are used to prevent the formation of blood clots.

These drugs include:

 

 

Procedures

 

• Cardioversion- atrial flutter is sensitive to a low electrical energy direct-current (DC) or medical cardioversion (using an antiarrhythmic drug). DC cardioversion converts atrial flutter into a normal sinus rhythm with high a success rate. Cardioversion may be delayed until starting treatment with an anticoagulant. This medication is usually given for 3-4 weeks, allowing pre-existing clots to resolve. A transesophageal echocardiogram (TEE) is an alternative way of delaying cardioversion, if no blood clots are present, cardioversion may be started. A mild anesthetic is first given, pads are applied over the chest, and then the heart will be shocked into the correct rhythm.

• Catheter radiofrequency ablation- is a hospital procedure done to destroy areas on the heart that are causing irregular heart rhythms. A thin flexible tube is inserted into a blood vessel to access the heart. Heat is applied to the tip of the catheter to permanently destroy small areas of abnormal heart tissue. The damaged tissue is no longer capable of generating electrical impulses. A pacemaker may be placed after this procedure

• Pacemaker or ICD- a small implantable device used to regulate the heart rate and rhythm. Therefore, the heart contracts in a regular way. An ICD shocks the heart out of the dangerous rhythm.

 

 

What is the prognosis?

Atrial flutter can be controlled with treatment.

With treatment, many patients do well.

 

 

How can I prevent this?

Atrial flutter can not always be prevented, but there are ways of reducing the risk of developing atrial flutter.

Leading a healthy lifestyle may reduce the chance of coronary artery disease, which can cause atrial flutter.

Some ways you can do this is by:

 

 

Updated March 20th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Atrial Fibrillation

 

What is it?

Atrial fibrillation is a relatively common abnormal heart rhythm where the atria beat quickly, irregularly, and unevenly. 

Atrial fibrillation always has some degree of atrial-ventricular (AV) block with a 2:1 pattern meaning the rate of the ventricles is usually 150 beats per minute while the atria beat at 300 beats per minute. In other words, every other atrial beat reaches the ventricle.

This arrhythmia impairs blood flow out of the heart (cardiac output) and promotes clot (thrombus) formation.

 

 

How does a normal heart beat?

Heart muscle cells are activated by electrical impulses that cause them to contract regularly and in sync. This contraction produces a heartbeat, allowing blood to be pumped out to the entire body.

Electrical impulses originate from specialized cells called the sinoatrial (SA) node, which is the hearts natural pacemaker.

The SA node is located in the upper right chamber of the heart, the right atrium.  From the SA node, the impulse spreads across the upper chambers of the heart to reach the atrial ventricular (AV) node located between the atria and lower ventricles. After leaving the AV node, impulses spread across the pumping chambers of the heart, the ventricles.

As impulses are spread along the heart, the cardiac muscle cells are stimulated to contract, producing a heartbeat.

 

 

How does atrial fibrillation occur?

In atrial fibrillation, chaotic electrical signals travel across the heart in an abnormal way. Abnormal electrical pathways produce irregular heartbeats and rhythms known as arrhythmias.

Arrhythmias occur when other areas of the heart, other than the SA node, begin sending out their own impulses and take over the pacemaker function of the SA node. The sites that take over could be from any area of the atria, AV node, or ventricles.

The rapid fibrillation of the atria does not allow the complete filling of the ventricles, that pumps blood out to the entire body. Symptoms of atrial fibrillation such as lightheadedness or dizziness may be felt.

Also, some amount of blood remains in the chamber that leads to clot formation.

 

 

 

 

What are the types?

Atrial fibrillation can occur in different patterns.

These include:

 

 

What are the causes?

Atrial fibrillation can be due to abnormalities or diseases of the heart, or by diseases elsewhere in the body affecting the heart. Atrial fibrillation may occur after open heart surgery or substance abuse.

Heart abnormalities and diseases include:

 

Diseases elsewhere in the body affecting the heart:

 

Substance abuse:

 

Surgery

 

Medications

 

 

Who is at risk?

The following are at risk of developing atrial fibrillation:

 

 

What are the symptoms?

Some patients may be unaware of their heart beating abnormally.

Although characteristic symptoms include:

 

 

What are the complications?

The complications of atrial fibrillation include:

 

 

When should I seek medical care?

If you experience symptoms of atrial fibrillation, call your physician.

If you have already been diagnosed and being treated for atrial fibrillation, seek medical help at the hospital as soon as possible if you have the following symptoms:

 

 

How is it diagnosed?

The diagnosis of atrial fibrillation will be based on your history, physical examination, and certain tests.

 

 

1. Patient history

 

Most patients will give a history of characteristic symptoms like palpitations, dizziness, fatigue, shortness of breath, etc.

 

 

2. Physical Examination

 

You will be examined for signs of atrial fibrillation including:

 

 

3. Tests

 

Certain tests can be performed to determine the cause and severity of your condition including:

• Chest X-ray- a simple test performed in our office showing the size and shape of the heart. Also reveals the presence of fluid in the lungs.

• Echocardiogram (ECHO) - a noninvasive test performed in our office to determine the size and function of the heart’s chambers and the structure and function of the heart valves.

• 24-Hour Holter monitor- records the electrical events of the heart during your normal daily activities. This is useful in detecting evidence of arrhythmias.

 

 

How is it treated?

Atrial fibrillation treatment goals include restoring the heart to normal rhythm, regulating heart rate, preventing blood clot formation, and treating the underlying cause.

This is done by the use of medications and procedures.

 

 

1. Medications

 

Some medications are used to slow an irregularly fast heart beat. These decrease the heart rate by slowing the conduction of impulses through the AV node.

These drugs include:

 

Medications are used to reduce the frequency and duration of atrial fibrillation and prevent future episodes.

These include:

 

Medications are used to prevent the formation of blood clots.

These drugs include:

 

2. Procedures

 

• Cardioversion- atrial fibrillation is sensitive to a low electrical energy direct-current (DC) or medical cardioversion (using an antiarrhythmic drug). DC cardioversion converts atrial fibrillation into a normal sinus rhythm with high a success rate. Cardioversion may be delayed until starting treatment with an anticoagulant. This medication is usually given for 3-4 weeks, allowing preexisting clots to resolve. A transesophageal echocardiogram (TEE) is an alternative way of delaying cardioversion, if no blood clots are present, cardioversion may be started.  A mild anesthetic is first given, pads are applied over the chest, and then the heart will be shocked into the correct rhythm.

 

• Catheter radiofrequency ablation- is a hospital procedure done to destroy areas on the heart that are causing irregular heart rhythms. A thin flexible tube is inserted into a blood vessel to access the heart. Heat is applied to the tip of the catheter to permanently destroy small areas of abnormal heart tissue. The damaged tissue is no longer capable of generating electrical impulses. A pacemaker may be placed after this procedure

• Pacemaker or ICD- a small implantable device used to regulate the heart rate and rhythm. Therefore, the heart contracts in a regular way. An ICD shocks the heart out of the dangerous rhythm.

 

 

What is the prognosis?     

                                      
Atrial fibrillation can be controlled with treatment.

With treatment, many patients do well.

However, atrial fibrillation tends to return and get worse. It may come back even with treatment.

 

 

How can I prevent this?

Atrial fibrillation can not always be prevented, but there are ways of reducing the risk of developing atrial fibrillation.

Leading a healthy lifestyle may reduce the chance of coronary artery disease, which can cause atrial fibrillation.

Some ways you can do this is by:

 

 

Updated March 22nd, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Ventricular Tachycardia

 

What is it?

Ventricular tachycardia is an abnormal heart rhythm where the ventricles beat quickly, but evenly. This is similar to ventricular fibrillation, but the ventricles beat quickly and unevenly. The term tachycardia refers to a fast heart rate.

Ventricular tachycardia 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.

In ventricular tachycardia abnormal electrical signals originate in the ventricles, instead of the normal pathway from the atria down to the ventricles. If left untreated, ventricular tachycardia may lead to a dangerous and life-threatening ventricular fibrillation.

Both of these arrhythmias impair blood flow out of the heart (cardiac output) and are both medical emergencies.

 

 

How does a normal heart beat?

Heart muscle cells are activated by electrical impulses that cause them to contract regularly and in sync. This contraction produces a heartbeat, allowing blood to be pumped out to the entire body.

Electrical impulses originate from specialized cells called the sinoatrial (SA) node, which is the hearts natural pacemaker. The SA node is located in the upper right chamber of the heart, the right atrium.  From the SA node, the impulse spreads across the upper chambers of the heart to reach the atrial ventricular (AV) node located between the atria and lower ventricles. After leaving the AV node, impulses spread across the pumping chambers of the heart, the ventricles. As impulses are spread along the heart, the cardiac muscle cells are stimulated to contract, producing a heartbeat.

 

 

 

How does ventricular tachycardia occur?

Sometimes the electrical impulses ‘short circuit’ and travel across the heart in an abnormal way. Abnormal electrical pathways produce irregular heartbeats and rhythms known as arrhythmias. Arrhythmias occur when other areas of the heart, other than the SA node, begin sending out their own impulses and take over the pacemaker function of the SA node. The sites that take over could be from any area of the atria, AV node, or ventricles, in this case the ventricles.

The rapid rate does not allow the complete filling of the ventricles to pump blood out to the entire body. Symptoms of ventricular tachycardia such as lightheadedness or dizziness may be felt.

 

 

How is it classified?

Ventricular tachycardia can be classified in several ways.

 

 

What are the causes?

Ventricular tachycardia can be due to abnormalities or diseases of the heart, or by diseases elsewhere in the body affecting the heart. Ventricular tachycardia may occur after open heart surgery, substance abuse, or medications.

 

Heart abnormalities and diseases include:

 

Diseases elsewhere in the body affecting the heart:

 

Substance abuse:

 

Surgery

 

Medications

 

 

Who is at risk?

The following are at risk of developing ventricular tachycardia:

 

 

What are the symptoms?

Symptoms of ventricular tachycardia occur because the heart rate is beating so fast, blood pressure falls; therefore the heart can not pump enough oxygen rich blood to the body causing symptoms.

Some patients may be unaware of their heart beating abnormally. Although characteristic symptoms include:

 

 

What are the complications?

The complications of ventricular tachycardia include:

 

 

When should I seek medical care?

If you experience symptoms of ventricular tachycardia, call your physician.

If you faint, have difficulty in breathing, or have chest pain lasting more than a few minutes, call emergency care or call 911. These are urgent symptoms of a potentially fatal ventricular tachycardia and must seek emergency care immediately to avoid the risk of cardiac arrest and death.

 

 

How is it diagnosed?

The diagnosis of ventricular tachycardia will be based on your history, physical examination, and certain tests.

 

1. Patient history

 

Most patients will give a history of characteristic symptoms like palpitations, dizziness, fatigue, shortness of breath, etc.

 

 

2. Physical Examination

 

You will be examined for signs of ventricular tachycardia including:

 

3. Tests

 

Certain tests can be performed to determine the cause and severity of your condition including:

 

 

 

How is it treated?

The treatment goals for tachycardias are to slow a fast heart rate when it occurs, prevent future episodes, minimize complications, and treat the underlying cause.

 

 

1. Stop a fast heart rate:

 

A fast heart rate may terminate spontaneously, or you may be able to slow your heart rate using simple physical methods.

Medications and procedures may be required in addition to these methods.

 

 

2. Preventing episodes tachycardia:

 

• Catheter ablation: is a hospital procedure done to destroy areas on the heart that are causing irregular heart rhythms. A thin flexible tube is inserted into a blood vessel to access the heart. Heat is applied to the tip of the catheter to permanently destroy small areas of abnormal heart tissue. The damaged tissue is no longer capable of generating electrical impulses. A pacemaker may be placed after this procedure

• Medications: anti-arrhythmic medications may prevent tachycardia, when taken regularly. These medications include: calcium channel blockers such as diltiazem and verapamil or beta blockers such as metoprolol and esmolol or anti-arrhythmic such as lidocaine and amidarone.

• Pacemaker or ICD- a small implantable device used to regulate the heart rate and rhythm. Therefore, the heart contracts in a regular way. An ICD shocks the heart out of the dangerous rhythm.

 

3. Treating the underlying disease:

 

Treatment of an underlying condition attributing to tachycardia such as some form of heart disease or hyperthyroidism may prevent or minimize tachycardic episodes.

 

 

How can I prevent this?

Ventricular tachycardia can not always be prevented, but there are ways of reducing the risk of developing ventricular tachycardia.

Leading a healthy lifestyle may reduce the chance of coronary artery disease, which can cause ventricular tachycardia.

Some ways you can do this is by:

 

Updated April 2, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Ventricular Fibrillation

 

What is it?

Ventricular fibrillation is an abnormal heart rhythm that occurs when the heart beats so rapidly and irregularly that the heart muscle quivers and does not beat at all.

In ventricular fibrillation the ventricles produce many abnormal circuits, instead of following the normal electrical pathway from the atria down to the ventricles. This usually occurs due to damaged heart muscle.

The ventricles beat very quickly and irregularly, so blood is not pumped out of the heart to vital organs of the body.  If the heart is not able to pump at all (cardiac arrest), death may occur if emergency treatment is not given to return the heart rhythm to normal.

 

 

How does a normal heart beat?

Heart muscle cells are activated by electrical impulses that cause them to contract regularly and in sync. This contraction produces a heartbeat, allowing blood to be pumped out to the entire body.

Electrical impulses originate from specialized cells called the sinoatrial (SA) node, which is the hearts natural pacemaker. The SA node is located in the upper right chamber of the heart, the right atrium.  From the SA node, the impulse spreads across the upper chambers of the heart to reach the atrial ventricular (AV) node located between the atria and lower ventricles. After leaving the AV node, impulses spread across the pumping chambers of the heart, the ventricles. As impulses are spread along the heart, the cardiac muscle cells are stimulated to contract, producing a heartbeat.

 

 

How does ventricular fibrillation occur?

In ventricular fibrillation electrical impulses can become chaotic after the heart muscle has been damaged. Damage usually occurs after a first heart attack or due to problems from a scar in the heart muscle from a previous heart attack. Electrical activity is not passed through these scarred areas. The ventricles begin sending out their own rapid and chaotic impulses and take over the pacemaker function of the SA node.

Ventricular fibrillation may also develop if ventricular tachycardia is left untreated.

Rapid, chaotic electrical impulses cause the ventricles to quiver instead of pumping the blood out of the heart. This causes low blood pressure and no blood supply to the vital organs of the body including the brain. Most people lose consciousness within seconds and require immediate cardiopulmonary resuscitation (CPR).

The survival rate in ventricular fibrillation is better if CRP is initiated immediately until the heart can be shocked back into rhythm with the use of a defibrillator. If these measures are not taken immediately, death can occur within minutes.

 

 

 

What are the causes?

Ventricular fibrillation is usually caused after damage to the heart muscle from a previous heart attack.

Ventricular fibrillation can occur whenever the heart does not receive enough oxygen or due to abnormalities or diseases of the heart, or by diseases elsewhere in the body affecting the heart. Ventricular tachycardia may occur after open heart surgery, substance abuse, or medications.

 

Heart abnormalities and diseases include:

 

Diseases elsewhere in the body affecting the heart:

 

Substance abuse:

 

Surgery

 

Medications

 

 

Who is at risk?

Several factors may increase the risk of ventricular fibrillation.

These include:

 

 

What are the symptoms?

An episode of ventricular fibrillation presents with unconsciousness or sudden collapse. This is due to a lack of oxygen rich blood to the brain and other vital organs.

The following symptoms may occur within 1 hour before the collapse:

 

 

When should I seek medical care?

If you experience symptoms of ventricular fibrillation, seek emergency care immediately.

If you faint, have difficulty in breathing, or have chest pain lasting more than a few minutes, call emergency care or call 911. These are urgent symptoms of a life-threatening ventricular fibrillation and must seek emergency care immediately to avoid the risk of cardiac arrest and death.

Steps to follow:

 

 

What are the complications?

The most common complication of ventricular fibrillation is sudden death. This occurs within 1 hour of symptoms.

Complications in those who survive include:

 

 

How is it diagnosed?

Ventricular fibrillation is a medical emergency and is not typically diagnosed before hand unless an episode of collapse occurs within the doctor’s office.

Your physician will know if you are in ventricular fibrillation based on history, physical examination, and tests.

 

 

1. History

 

The patient will give history of sudden loss of consciousness or collapse.
History of warning symptoms of fibrillation may be given such as chest pain, dizziness, nausea, fast heart rate, or difficulty in breathing.

 

 

2. Physical Examination

 

After collapse:

 

Before collapse:

 

 

3. Tests

 

Certain tests can be performed to determine the cause and severity of your condition including:

 

• Chest X-ray- a simple test performed in our office showing the size and shape of the heart. Also reveals the presence of fluid in the lungs.

• Echocardiogram (ECHO) - a noninvasive test performed in our office to determine the size and function of the heart’s chambers and the structure and function of the heart valves.

 

 

How is it treated?

Ventricular fibrillation is a medical emergency and must be treated immediately.

The goal of treatment is to restore blood flow as quickly as possible to prevent damage to vital organs.

Once blood flow is restored, treatment is given to prevent future episodes.

- Call for emergency help immediately.

- CPR can be preformed by anyone trained in CPR including a family member until medical personnel arrive.

- As per new regulations, chest compressions must be initiated first rather then giving rescue breaths. Count 30 chest compressions that must be given hard and fast over the chest. Allow the chest to rise completely between compressions.

After 30 chest compressions are given, mouth-to-mouth breathing must be given with 2 rescue breaths with the person’s neck in an extended position to allow airflow through the airways.

Repeat chest compressions and rescue breaths until help arrives.

 

A shock may be given by medical personnel or may be given through a public-use defibrillator. A public defibrillator can be located in public places including airports, schools, malls, and community centers. A public defibrillator is called an Automated External Defibrillator (AED).

Once a person collapses and CPR is initiated, an AED must be retrieved. Turn the device on by pushing the power button. In the AED kit, two pads will be provided that must be matched up accordingly to the areas over the chest to the pictures given on the pads. The device will detect if the heart is to be shocked or not. If the heart requires a shock, stand clear and press the “Shock” button. CPR must be resumed until help arrives or until the person begins to move.

It is important to take a CPR class especially in those with family members who are at risk.

 

 

 

Treatment to prevent future episodes

If structural damage has occurred in the heart after ventricular fibrillation episode, medications or a medical procedure may be recommended to reduce the risk of a future episode.

 

 

1. Medications

 

Various anti-arrhythmic drugs may be used in the long term treatment of ventricular fibrillation.

Different classes of medications may be used including beta blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and anti-arrhythmics (amiodarone).

Since there is a stagnation of blood in the heart during fibrillation, blood clots commonly develop in the heart. Medications are used to prevent the formation of blood clots.

These drugs include:

 

 

2. Implantable cardioverter-defibrillator (ICD)

 

After fibrillation has been stabilized, an ICD implantation may be recommended.

This is a small implantable device used to detect abnormal heart rhythms and shock the heart out of the dangerous rhythm.

 

3. Catheter ablation:

 

is a hospital procedure done to destroy areas on the heart that are causing irregular heart rhythms.

A thin flexible tube is inserted into a blood vessel to access the heart. Heat is applied to the tip of the catheter to permanently destroy small areas of abnormal heart tissue.

The damaged tissue is no longer capable of generating electrical impulses.

 

 

What is the prognosis?

With early detection and effective CPR given before a defibrillator is given, up to 25% of victims are able to leave the hospital without neurological damage.

If ventricular fibrillation occurs within the hospital with a heart attack, defibrillation has a 95% success rate.

If shock and heart failure occur, even with defibrillation only 30% of those shocked will return to a normal heart rate.

The survival rate for a person who has an attack of ventricular fibrillation outside the hospital ranges between 2-25%.

 

 

How can I prevent this?

Ventricular fibrillation can not always be prevented, but there are ways of reducing the risk of developing ventricular fibrillation. Leading a healthy lifestyle may reduce the chance of coronary artery disease, which can cause ventricular tachycardia and fibrillation.

Some ways you can reduce the risk is by:

 

 

Updated April 4th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Ventricular Tachycardia

Advanced Lipid Profile

 

What is it?

An advance lipid profile is a test used for the identification of additional risk factors of coronary artery disease that may not be detected on a standard lipid profile, despite a normal result.

Early detection of elevated lipid levels can easily be reversed with diet modification and medications. An advanced lipid profile is a successful tool in the detection and management of high cholesterol that can cause serious heart problems.

Early risk factor identification and modification can drastically reduce the morbidity and mortality of heart disease. 

 

 

Why do I need it?

An advanced lipid profile is usually recommended at your initial visit to our clinic in addition to a standard lipid profile and is intermittently checked throughout treatment.

Standard cholesterol tests may not completely represent the risk for heart attack and strokes. This test is especially useful in patients with diabetes, insulin resistance, or cardiovascular disease who continue to have progression of cardiovascular disease even when their LDL (Lousy cholesterol) and total cholesterol is at their target goal.

This test helps determine the most accurate target number which is best for you, based on your risk factors.

 

 

What is it?

An advanced lipid profile measures a variety of markers for cholesterol.

The two tests commonly done are:

Other tests include:

 

 

Apolipoprotein B (ApoB) and LDL particle number (LDL-P)

Since cholesterol can not dissolve in blood, it needs to attach to a lipoprotein to transport cholesterol in blood. HDL particles are known as Apo A and the particles causing atherosclerosis (fatty plaque build up in arteries) are known as Apo B. The majority of circulating Apo B particles is LDL-P.

If there is an increased amount of triglycerides and cholesterol in the blood, an increased amount of Apo B will be driven into the walls of the arteries. A type of white blood cell known as a macrophage comes to the area of Apo B deposition and ingests this foreign material. This process is the hallmark of atherosclerosis.

LDL-P is the most significant predictor of cardiovascular morbidity and mortality. This gives the most accurate number of Apo B particles in circulation; therefore assess the true risk factor for atherosclerosis.

A standard lipid profile shows the overall outlook of cholesterol, it may even be normal, but an advanced lipid profile measures the most accurate LDL levels that can lead to atherosclerosis.

This shows the accurate target number that is required for the management of your cholesterol.

Your physician may advise a combination of diet and drug therapy to prevent the onset and progression of cardiovascular disease.

 

Apolipoprotein A1 (ApoA1)

HDL particles (Healthy cholesterol) are known as Apolipoprotein A1. Apo A1 helps to clear out cholesterol from your arteries.

High levels of Apo A is associated with decreased risk of cardiovascular disease.

 

HDL particle number (HDL-P)

An increased amount of HDL-P decreases the risk of cardiovascular disease. 

To further increase HDL, diet modification, exercise, and medications can be tried.

 

Small dense LDL (sdLDL)

Small dense LDL can produce more damage to the arterial wall than just regular LDL.

An LDL level in a standard lipid panel may be normal, but the sdLDL in an advanced lipid will assess your risk.

To lower your risk, diet, and exercise can help reduce sdLDL.

 

 

HDL-2

HDL-2 is the best type of HDL which removes cholesterol build up in the arteries.

An increased amount of HDL-2 decreases the risk of cardiovascular disease.

 

 

Lipoprotein (a) Mass (Lp (a))

Lipoprotein A is a genetic marker for cardiovascular disease.

An increased level of Lp (a) can increase the risk of cardiovascular risk at an early age.

 

 

Lipoprotein-associated phospholipase (Lp-PLA2)

Lp-PLA2 is a specific marker for vascular inflammation which can make fatty plaque build up within the artery prone to rupture.

Elevated Lp-PLA2 is a powerful predictor of heart attack and stroke.

 

 

Apolipoprotein E (Apo E) Genotype

Apolipoprotein E is a genetic marker for those who are more prone to high cholesterol levels.

Apo E comes in different forms including Apo E2, Apo E3, and Apo E4.

Apo E2 and Apo E3 patients respond well to statin drugs.

Fish oil is known to benefit Apo E2 and Apo E3 patients.

Apo E4 patients typically do not respond well to statin drugs, but respond well with diet modification.

Elevated Apo E levels increase the risk of cardiovascular disease, especially in Apo E4 patients.

This is also useful in the prediction of a patient’s responsiveness to cardiac-related environmental factors, diet, and drug therapy.

 

 

Omega 3 fatty acid

Omega 3 fatty acids reduce the risk of cardiovascular disease.

A good source of omega 3 fatty acids come from oily fish and fish oils.

 

 

Omega 6 fatty acid

Omega 6 fatty acid reduces the risk of cardiovascular disease.

Oily fish and fish oil are a good source of omega 6 fatty acid.

 

 

Results:

The results of your test will return within 7 days.

Your test results will be discussed with you during your next scheduled visit. Diet or drug therapy may be advised or altered.

Your test results will be reflected in a chart form similar to the one below.

Your test result may fall under a optimal range, intermediate risk range, or high risk range.

 

	Optimal Range	Intermediate Risk Range	High Risk Range
Apo B (mg/dL)	<60	60 - 79	≥ 80
LDL-P (nmol/L)	< 1000	1000 - 1299	≥ 1300
Apo A1 (mg/dL)	≥ 151	130 - 150	< 130
HDL-P (µmol/L)	≥ 35	28 - 34	<28
sdLDL (mg/dL)	< 20	21 - 30	≥ 31
HDL-2 (mg/dL)	≥ 17	13 - 16	≤ 12
Lp (a) Mass (mg/dL)	< 30		≥ 30
Lp-PLA2 (ng/mL)	< 200	200 - 234	≥ 235
Apo E Genotype	2/2 – 2/3	2/3	3/4 – 4/4

 

 

 

 

 

 

Updated March 6th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

 

Lipoprotein (a)

 

What is it?

Lipoprotein (a), also called Lp (a), is a modified form of LDL cholesterol bound to the protein apolipoprotein.

Elevated levels of lipoprotein (a) may promote atherosclerosis which is a risk factor for coronary artery disease.

There is a fundamental relationship of lipoprotein (a) excess with the risk of heart attack.

 

How am I at risk of a heart attack?

Lp (a) is a modified LDL (lousy cholesterol) in which a large protein, apolipoprotein (a) is bound to apolipoprotein B. Apolipoprotein (a) is a specific marker of Lp (a).The apolipoprotein (a) chain has five domains. One of the domains is similar to a fibrin-binding domain of plasminogen that dissolves clots. Because of the similar structure with plasminogen, Lp (a) interferes with the protein that dissolves clots.  

Lp (a) also binds to a type of white blood cell that promotes the formation of fatty cells in the arterial walls called foam cells. Lp (a) deposits cholesterol into atherosclerotic plaques that narrow blood vessels in the heart.  Inflammation begins within these plaques and leads to a thickening of the arterial wall. This further narrows the blood vessels depriving the heart muscle and body tissue of oxygen rich blood.

Therefore, plaque formation, inflammation and altered plasminogen activity increase the risk of heart attack.

Both genetic and environmental factors including age, sex, race, and ethnic background influence the risk of coronary artery disease.

 

 

What diseases can occur with high Lp (a) levels?

High Lp (a) levels in blood increases the risk for:

 

 

Who should be screened?

Patients with a moderate or high risk of cardiovascular disease are recommended to have their Lp (a) levels checked.

Any patient with the following risk factors should be screened.

There are no signs or symptoms of elevated lipoprotein (a), although Lp (a) levels are assessed by performing a simple blood test for an advanced lipid profile.  

Even those who are not at risk are recommended to have an advanced lipid profile done at least once to assess accurate lipid levels.

 

 

How is it treated?

High Lp (a) levels are hard to treat, yet some medications are available to lower these levels.

The medications available to lower elevated Lp (a) levels are:

 

Niacin 1-3 grams daily can reduce lipoprotein (a) levels by 20-30%.

Atorvastatin, aspirin, coenzyme Q10, L-carnitine, gingko biloba may be beneficial as well.

When elevated Lp (a) levels are discovered in a patient, attention towards other more easily treatable risk factors should be increased. These include high LDL cholesterol levels, smoking, and leading a sedentary lifestyle.

Lipoprotein (a) levels:

 

 

Updated April 18, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Atherosclerosis

 

What is it?

Atherosclerosis is the build up of fat and cholesterol filled plaques inside the artery walls, which can restrict blood flow.

These plaques have the potential to rupture leading to the development of a clot. A clot may restrict blood flow further or dislodge and obstruct another vessel.

Atherosclerosis increases the risk of cardiovascular disease including heart attack and stroke.

Atherosclerosis can affect any artery in the body and is a preventable and treatable condition.

 

 

How does it occur?

At a young age, fat can start to deposit within the blood vessel walls. Fat build up over the years can cause injury to the blood vessel walls.

Not only fat, but a number of other substances in blood including inflammatory cells, cellular waste products, proteins, and calcium begins sticking to the inside of vessel wall. All of these substances collectively form what is called Plaque.

 

Many of the plaque deposits have a soft inner center and hard exterior. If the hard outer surface breaks or tears, the soft inner center will become exposed to our body’s platelets.

The platelets will come to the area of breakage and form a clot around the plaque. This further narrows the artery and restricts blood flow.

A clot may dislodge and permit blood flow again, but the dislodging of a clot can also be dangerous.

 

What are the symptoms?

Atherosclerosis can affect any artery in the body. When this condition affects the vessels of the heart it is known as coronary artery disease. Atherosclerosis affecting all other arteries excluding the coronary arteries, it is known as peripheral vascular disease.

Peripheral vascular disease can affect the arteries of the neck, arms, kidneys, legs, etc. Symptoms depend on the part of the body that is affected although; more than one area can be affected.

Coronary artery disease: Symptoms may include chest pain (angina), shortness of breath, dizziness, palpitations, sweating, extreme weakness, fast heart beat, or nausea.

Peripheral vascular disease:

 

 

What are the causes of atherosclerosis?

• Smoking

• High blood pressure

• High cholesterol

• Diabetes

 

 

What are the risk factors?

 

Non-modifiable risk factors:

 

• Age: Old age

• Sex: Men have a greater risk of atherosclerosis than women. The risk increases in woman after menopause due to less hormone production of estrogen

• Race: African Americans have more severe high blood pressure than Caucasians

• Family history of medical diseases associated with cardiovascular disease

 

Modifiable risk factors:

• Smoking

• Excessive alcohol consumption

• High blood pressure

• High blood cholesterol levels

• Uncontrolled diabetes (HbA1c >7.0)

• Sedentary lifestyle- lack of physical activity is associated with atherosclerosis

• Obesity

• Obstructive sleep apnea

• Chronic inflammation- even having the flu can be a risk because it is a form of inflammation. C-reactive protein is a marker of inflammation and high levels of this can show an increased risk of atherosclerosis.

• Stress

• Homocysteine – is an amino acid in the body that helps make protein and maintain tissue. Elevated levels of this can increase the risk of atherosclerosis
  .

• Fibrinogen- is a protein in the body that aids in blood clotting. An increase in this can increase platelet clumping leading to the formation of clots.

 

 

What are the complications?

Complications of atherosclerosis depend on the location of the narrowed or blocked artery.

Coronary artery disease: Complications of coronary artery disease include chest pain (angina), heart attack, congestive heart failure, arrhythmia (abnormal heart rhythm), or pericarditis (inflammation of a layer of the heart).

Peripheral vascular disease:

 

 

How is it diagnosed?

Dr. Jamnadas will have a better idea if you have atherosclerosis by:

 

 

How is it treated?

The treatment for atherosclerosis may include lifestyle changes, medications, or procedures.

It is very important to reduce any risk factors in order to manage the symptoms and progression of atherosclerosis.

 

 

Lifestyle changes

 

• Quit smoking!!

• Limit alcohol intake if you chose to drink.

• Lower blood sugar levels

• Maintain a normal blood pressure and cholesterol

• Eat a well balanced diet.

• Eat foods high in fiber such as whole grain cereals, oatmeal, and figs. Eat plenty of fruits such as apples, bananas, prunes, oranges, and pears. Include fish and legumes such as beans or chickpeas.

• Lower your salt intake.

• Avoid fatty foods including bad saturated fat that is found in some meats, dairy products, chocolates, baked goods, and deep-fried food.

• Exercise regularly for 30 minutes at least 3-4 times a week and be more physically active.

• Maintain a healthy weight with a BMI below 25.

• If you have diabetes, practice proper foot care and prevent injury to the foot. Avoid walking barefoot and wear proper shoes. Maintain toenails and skin care. Be sure to inspect the soles of your feet regularly.

• Relax and reduce stress.

For some people these changes may be the only treatment needed.

 

 

Medications

If lifestyle changes are not enough to control the effects of atherosclerosis, medications may be prescribed to you including:

 

 

Supplements

Food and supplements rich in omega 3 fatty acids help reduce inflammation throughout the body, lower blood pressure, and the risk of heart attack.

 

 

Procedures to restore blood flow

 

Angioplasty and stent placement: this is a procedure considered as non-surgical because it is done by Dr. Jamnadas or Dr. Kelly, who accesses the artery by inserting a long, thin tube (catheter) into the narrowed part of your artery while being visualized under x-ray. 

A wire with a deflated balloon is passed through the catheter to the narrow area. The balloon is then inflated, compressing the plaque against the artery wall and widening it, so it no longer restricts blood flow.

 

 

Blocked arteries in the coronary, renal, iliac, and legs can easily be treated with stenting or endarterectomy.

Unlike stenting done in the coronary arteries, only bare metal stents are used in the peripheries. Bare metal stents act as a scaffolding to keep an artery open but suffer a 30% re-stenosis rate.

This is due to a process called intimal hyperplasia which is attributed to a keloid. A keloid is an overgrowth of the inner lining of the blood vessel that covers over the stent.

However, this reparative process lasts no more than 6 minutes. After 6 minutes, if an artery has not re-narrowed at the site of the stent, it is unlikely to re-narrow.

If symptoms were to reoccur, it would be due to New blockages at another site within the arteries.

 

**Patients will need to improve risk factor modifications to prevent New blockage formation.

 

• Enhanced external counterpulsation (EECP): This is for patients who have angina (chest pain) and have already exhausted the standard treatments without successful results or for those who do not qualify for the other treatment regimens. This is a non-invasive procedure which promotes the formation of collaterals to bypass the clogged arteries as another means of getting oxygen rich blood to those areas of the heart that are not getting it. This is carried out in our office daily for 7 weeks.

 

 

How can I prevent this?

 

• Do not smoke!

• Maintain a healthy weight with a BMI <25

• Maintain a normal blood pressure, cholesterol and sugar levels.

• Eat nutritious, low fat foods and avoid foods high in cholesterol.

• Exercise regularly for 30 minutes at least 3-4 times a week.

 

 

Updated February 27th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

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 combined in one 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.

• Call our office before making any changes in Coumadin doses, even if suggested by another facility.

 

 

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)

• 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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Pacemaker

 

What is a pacemaker?

A pacemaker is a small device that sends electrical impulses to the cardiac muscle. This helps to regulate a normal heart rate and rhythm.

Insertion of a pacemaker is known as implantation. A pacemaker is placed just below the skin near your heart to help regulate the heart beat.

 

 

Who needs it?

A pacemaker is used to treat patients with:

 

 

How a normal heart beats:

In a normal heart, the muscles and chambers within the heart synchronize in a regulated type of harmony together. This occurs only when there is a normal rate and rhythm of the heart.

If the heart is beating too slow or too fast, sufficient amount of blood is unable to flow throughout the body. When this happens patients may get symptoms of arrhythmia. These symptoms include fatigue, shortness of breath, fainting, or loss of consciousness.

The electrical signals of the heart follow through a conduction pathway. The origin of this pathway is from the Sinoatrial node that is known as the natural pacemaker of the heart. The impulses are transmitted throughout the heart keeping it beating in sync in rate and rhythm.

 

 

What does a pacemaker do?

When the Sinoatrial node is not functioning properly, a pacemaker is needed to help initiate the correct electrical impulses. The pacemaker acts by mimicking the Sinoatrial node, generating a normal heart rate and rhythm.

©2012 St. Jude Medical, Inc.

 

A pacemaker consists of:

• Battery: the pacemaker battery supplies the power to the pacemaker. This is a small, sealed, lithium battery that can lasts for years. Battery life usually lasts 5-10 years depending on how active your pacemaker is.

• Computerized generator: this is a miniature computer inside the pacemaker. The battery transmits electrical impulses that go through this generator to stimulate the heart to beat.

Pacemakers not only monitor your heart beat, but also your body motion and breathing pattern. This can signal the pacemaker to increase during times of exercise.

 

What are the different types of pacemakers?

Depending on the condition of the heart, Dr. Jamnadas or Dr. Kelly will determine the number of chambers in your heart that need to be paced.
Pacemakers can be implanted temporarily or permanently.

The different types of pacemakers are:

• Single Chamber pacemakers: this uses one lead which connects either to the right atrium or ventricle.

 

 

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

 

 

How is this diagnosed?

Dr. Jamnadas or Dr. Kelly will discuss with you about your history and symptoms.

Following this a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done to find out the cause of irregular heartbeats including:

 

• Electrocardiogram (EKG) – a simple, non-invasive test that records the electrical activity of the heart and its beating pattern.

 

What to expect:

Before the procedure:

Today pacemaker devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

A pacemaker is usually implanted just beneath the skin of your chest, below the collarbone.

Pacemakers are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay over night in the hospital.

You will need to arrange for someone to pick you up and drop you off.

 

 

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an i.v. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the pacemaker will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the pacemaker leads will be threaded through the vein and fixed to the wall of the right atrium or ventricle or both, depending on your pacemaker.

The other end of the lead will be secured to the generator box.

The pacemaker settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the pacemaker underneath the skin of the chest.

After the pacemaker is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

 

 

After the procedure:

After the procedure you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks. 

On the side of incision, Do NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your pacemaker affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you and when it is best to start.

Make sure to:

• Change your dressing as often as instructed and avoid getting the area wet for about a week.

 

Keep all follow up appointments to check your pacemaker and lead. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

Follow up appointments will be scheduled for you in the initial one month, and then the following 2 months, then every 3 months to get your device checked. 

 

 

What can I use?

The following items are all ok to use:

 

 

Call Dr. Jamnadas if you experience any symptoms of:

 

• Dizziness

 

 

Updated January 27th, 2012- JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Biventricular Pacemaker

 

What is it?

A biventricular pacemaker a small device used for cardiac resynchronization therapy for patients with heart failure. This delivers small electrical impulses to both the left and right ventricles to help them contract at the same time. This helps the heart to pump blood more efficiently with each beat.

 

 

 

 

Who needs it?

A biventricular pacemaker is used to treat patients with:

 

How a normal heart beats:

In a normal heart, the muscles and chambers of the heart contract and relax in a synchronized regulated type of harmony together. This timed synchronization or rhythm allows the ventricles to relax and fill with sufficient amount of blood then contract, pumping out a sufficient amount of blood throughout the body.

 

 

How does it work?

In a patient with heart failure, the chambers of the heart are not in sync with each other. This leads to an inadequate blood supply throughout the body and can lead to symptoms of heart failure. These symptoms include shortness of breath, dry cough, swelling of the legs, irregular heart beats, or fatigue.

A biventricular pacemaker sends a steady pattern of electrical impulses first to the right atrium then to both the right and left ventricles of the heart.

These small impulses help by keeping the contractions in sync and in a regular rhythm to provide adequate blood flow throughout the body.

This treatment resets the ventricular pumping system and is referred to as Cardiac Resynchronization Therapy (CRT).

 

What are the parts of a biventricular pacemaker?

A biventricular pacemaker consists of:

Biventricular Pacemakers not only monitor your heart beat, but also your body motion and breathing pattern. This can signal the pacemaker to increase during times of exercise.

 

 

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

 

How is this diagnosed?

Dr. Jamnadas or Dr. Kelly will discuss with you about your history and symptoms.

Following this a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done including:

 

What to expect:

Before the procedure:

Today pacemaker devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

A biventricular pacemaker is usually implanted just beneath the skin of your chest, below the collarbone.

Biventricular pacemakers are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay over night in the hospital. Pack an overnight bag just in case.

You will need to arrange for someone to pick you up and drop you off.

 

 

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an I.V. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the pacemaker will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the pacemaker leads will be threaded through the vein and fixed to the wall of the right atrium and both right and left ventricles. The other end of the leads will be secured to the generator box.

The pacemaker settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the pacemaker underneath the skin of the chest.

After the pacemaker is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

 

 

After the procedure:

After the procedure you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks.

 
On the side of incision, DO NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your pacemaker affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you and when it is best to start.

Make sure to:

 

Keep all follow up appointments to check your pacemaker and leads. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

 

 

What can I use?

The following items are all ok to use:

 

 

 

Call Dr. Jamnadas if you experience any symptoms of:

 

 

Updated February 6, 2012-JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Implantable Cardioverter Defibrillators (ICDs)

What is an ICD?

An ICD is a small device that monitors the electrical activity of the heart. This not only evaluates the hearts activity, but can also store the electrical events so Dr. Jamnadas can assess them. 

In the event a dangerously fast heart rhythm is detected, the ICD quickly delivers therapy in the form of electrical energy.

This helps to regulate a normal heart rate and rhythm.

 

 

 

Who needs it?

An ICD is used to treat patients with:

• Ventricular Fibrillation

 

 

How a normal heart beats:

In a normal heart, the muscles and chambers within the heart synchronize in a regulated type of harmony together. This occurs only when there is a normal rate and rhythm of the heart.

If the heart is beating too slow or too fast, sufficient amount of blood is unable to flow throughout the body. When this happens patients may get symptoms of arrhythmia. These symptoms include fatigue, shortness of breath, fainting, or loss of consciousness.

The electrical signals of the heart follow through a conduction pathway. The origin of this pathway is from the Sinoatrial node that is known as the natural pacemaker of the heart. The impulses are transmitted throughout the heart keeping it beating in sync in rate and rhythm.

 

 

What does an ICD do?

An ICD is needed when the heart has the potential to develop a dangerously fast heart rhythm due to the improper activity of the hearts electrical system.

As soon as this occurs, the ICD will send a shock to the heart muscle to defibrillate it or stop the cycle of rapid twitching to normalize the hearts rhythm.

The shock sensation varies amongst people. Some may not even be aware of the shock, where as others may be uncomfortable after responding to such a dangerous rhythm.

An ICD consists of:

 

 

What are the different types of ICDs?

Depending on the condition of the heart, Dr. Jamnadas or Dr. Kelly will determine the right ICD for you.

The different types of ICDs are categorized by the type of pacemaker they contain:

 

 

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

 

 

 

How is this diagnosed?

Dr. Jamnadas or Dr. Kelly will discuss with you about your history and symptoms.

Following this a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done to find out the cause of irregular heartbeats including:

 

 

 

What to expect:

Before the procedure:

Today ICDs devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

An ICD is usually implanted just beneath the skin of your chest, below the collarbone.

ICDs are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay over night in the hospital.

You will need to arrange for someone to pick you up and drop you off.

 

 

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an i.v. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the ICD will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the ICD leads will be threaded through the vein and fixed to the wall of the right atrium or ventricle or both, depending on your ICD. The other end of the lead will be secured to the generator box.

The ICD settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the ICD underneath the skin of the chest.

After the ICD is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

 

 

After the procedure:

After the procedure you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks. 

On the side of incision, Do NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your ICD affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you.

Make sure to:

Keep all follow up appointments to check your ICD and lead. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

Follow up appointments will be scheduled for you in the initial one month, and then the following 2 months, then every 3 months to get your device checked. 

 

 

What can I use?

The following items are all ok to use:

 

 

Call Dr. Jamnadas if you experience any symptoms of:

• Dizziness

• Palpitations

• Shortness of breath

• Fatigue

• Fainting spells

• Twitching chest muscles

• Chest pain or pain at ICD site

• Fever

• Hiccups that won’t stop

 

 

Updated January 27th, 2012- JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

 

Biventricular Implantable Cardioverter Defibrillators
(ICDs)

 

What is it?

A biventricular ICD a small device used for cardiac resynchronization therapy for patients with heart failure. This constantly monitors your heart rate and rhythm and delivers small electrical impulses to both the left and right ventricles to help them contract at the same time.

This helps the heart to pump blood more efficiently with each beat. If any abnormal rhythm is detected, the ICD will deliver a shock to the heart back into a normal rhythm again.

This helps in treating dangerously fast rhythms that can lead to sudden cardiac arrest.

 

Who needs it?

A biventricular ICD is used to treat patients with:

 

How a normal heart beats:

In a normal heart, the muscles and chambers of the heart contract and relax in a synchronized regulated type of harmony together.

This timed synchronization or rhythm allows the ventricles to relax and fill with sufficient amount of blood then contract, pumping out a sufficient amount of blood throughout the body.

 

How does it work?

In a patient with heart failure, the chambers of the heart are not in sync with each other. This leads to an inadequate blood supply throughout the body and can lead to symptoms of heart failure.

Symptoms include shortness of breath, dry cough, swelling of the legs, irregular heart beats, or fatigue.

A biventricular ICD not only monitors the heart rate and rhythm but also senses dangerously fast heartbeats that can lead to cardiac arrest. If the device senses a life threatening heart beat, it will deliver a shock to the heart. This shock or defibrillation stops the abnormal rhythm and sets the heart into a regular rhythm again. This shock helps keep the contractions of the heart in sync and in a regular rhythm to provide adequate blood flow throughout the body.

This treatment resets the ventricular pumping system and is referred to as Cardiac Resynchronization Therapy (CRT).

 

 

What are the parts of a biventricular ICD?

A biventricular ICD consists of:

Biventricular ICDs not only monitor your heart beat, but also your body motion and breathing pattern. This can signal the ICD to increase during times of exercise.

 

 

What are the risks?

Although risks are very rare, as with any surgical procedure it does carry a small risk of complication.

These complications include:

 

 

How is this diagnosed?

Dr. Jamnadas or Dr. Kelly will discuss with you about your history and symptoms.

Following this a physical examination will be performed to get a better idea of your condition.

A number of different tests can be done including:

 

 

What to expect:

Before the procedure:

Today ICD devices are amazingly small and average about 5 x 5cms, weighing only 1 to 3 ounces.

A biventricular ICD is usually implanted just beneath the skin of your chest, below the collarbone.

Biventricular ICDs are typically placed on the left side of the chest, but this may not be suitable for everyone.

The procedure will take place within a hospital and does not require general anesthesia.

You may or may not stay over night in the hospital. Pack an overnight bag just in case.

You will need to arrange for someone to pick you up and drop you off.

 

 

During the procedure:

The entire procedure usually takes about one to two hours.

A sedative will be given to help you relax through an I.V. in your hand or arm that may make you sleepy.

Under sterile precautions, Dr. Jamnadas will inject a local anesthetic until you are fully numb in the area where the ICD will be inserted.

A needle will be inserted into a large vein to get access to the heart.

A dye will be given to view the heart under x-ray guidance.

To enter the heart, the ICD leads will be threaded through the vein and fixed to the wall of the right atrium and both right and left ventricles. The other end of the leads will be secured to the generator box.

The ICD settings are programmed to help your heart beat at a rate that is right for you.

Once the leads are fixed, Dr. Jamnadas will place a single incision just below the collar bone to insert the ICD underneath the skin of the chest.

After the ICD is placed within the chest, it will be tested to make sure it is working properly.

The incision will then be closed and a dressing will be applied.

 

 

After the procedure:

After the procedure you may feel some mild pain, tenderness, or swelling in the area of implantation. Full recovery from surgery can take several days to weeks.

 
On the side of incision, DO NOT raise your arm above your shoulder for a week. This will give the lead time to attach to the heart wall properly. Raising your arm can make the lead separate from the site of attachment.

Do not drive until you know how your ICD affects you.

Do not be afraid to exercise. Ask Dr. Jamnadas which exercise plan is best for you and when it is best to start.

Make sure to:

Keep all follow up appointments to check your ICD and leads. Following the surgery, an x-ray will be required to make sure the position of the lead is still intact.

 

What can I use?

The following items are all ok to use:

 

 

Call Dr. Jamnadas if you experience any symptoms of:

 

 

Updated February 6, 2012-JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Stress Test

 

What is it?

 

A stress test records the electrical activity of the heart during the stress of exercise. This test may show areas of low blood flow and damaged tissue.

 

 

Why do I need a 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 a possible blockage within the vessels of the heart.

A 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.

An accurate stress test Decreases the use of unnecessary stenting.

 

 

How do I prepare for the test?

 

Wear sneakers and comfortable clothes (preferably a button down shirt with no metal buttons or zipper). 

Avoid wearing long chains and necklaces.

Continue your medications up to the day of the procedure.

Stop this medication on the day of the test-

Do Not smoke on the day of the test… or ever!!!

Do not apply body lotion on the day of the test

If you need to cancel your appointment, please do so at least 24 hours prior to your test or you may be charged.

 

 

What should I expect during the test?

 

A trained 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.

Next, 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.

The test lasts about 30 minutes. 

 

 

What are the risks?

 

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:

 

 

The result:

 

Once the test is completed, the results of your test will be assessed to determine the condition of your heart.

This is useful in planning for your treatment and also helps in determining whether further testing is needed.

A stress test may reveal:

 

 

 

Updated February 29th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

 Nuclear Stress Test

 

What is it?

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 it?

 

• If the doctor suspects you have coronary artery disease

• Experiencing symptoms of chest pain or sudden loss of breath

• To asses the amount of possible blockage within the vessels of the heart

• To asses the effectiveness of the treatment you are on.

• To assess 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 do I prepare for a test?

 

• Do not eat or drink 4 hours prior to the test. Small sips of water are permitted.

• Avoid all caffeinated products for 12 hours before the test. This includes decaffeinated coffee, coffee, tea, soda. Avoid fatty foods as well as dairy products including butter, milk, and cheese. Fatty foods can alter the imaging results.

• Bring a light breakfast or lunch sandwich and non-caffeinated drink with you.

• Wear sneakers and comfortable clothes (preferably a button down shirt with no metal buttons or zipper).  Avoid wearing long chains and necklaces.

• If you are taking heart medications:

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

Stop these drugs:

• If you have diabetes and are taking insulin to control your blood sugar:

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 should I 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.

Your blood pressure and EKG will be monitored throughout the test.

During the test you may develop symptoms or signs of:

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.

 

 

What are the 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:

 

The Result:

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 March 2nd, 2012 -JS

For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Echocardiogram

 

What is it?

An echocardiogram (ECHO) is a simple diagnostic study used to assess the condition and function of the heart using high frequency waves.

This study is performed here in our office.

 

 

When is it used?

An ECHO may show signs of:

 

What is the risk?

There is no risk associated with this study.

No radiation exposure is used during this study.

 

 

How do I prepare for the study?

No specific preparation is required. You may follow your daily eating habits before and after the study.

Clothing and jewelry need to be removed from the waist up to perform the study.

 

 

What happens during the study?

You will lie on a table while a trained ultrasound technician applies a clear jelly over the desired area. A probe is used to glide over this jelly which helps in transmission of sound waves through the skin.

The probe is pressed firmly over the chest to view the heart. Sound waves produced by the heart, create an echo that can be formed into an image. These images are recorded on to a monitor to be interpreted.

You may be asked to momentarily hold your breath or turn into a different position to enhance the images of the heart.

Sound waves given off the blood help to assess the direction of blood flow and blood pressures in the arteries of the heart. This also detects any abnormal sounds that may be produced by the heart.

The study may last up to 30 minutes.

 

 

What happens after the study?

After the study is over, the jelly is wiped off and you may return to your daily activities.

 

 

The result:

Dr. Jamnadas or Dr. Kelly will review the results of your study to look for healthy heart valves and chambers, as well as normal heart functioning.

This is useful in planning for your treatment and also helps in determining whether further testing is needed.

An ECHO may reveal:

The results of your ECHO will be discussed with you during your office visit.

 

 

Updated February 28th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Transesophageal Echocardiogram

 

What is it?

A transesophageal echocardiogram (TEE) is a diagnostic procedure used to asses the condition and function of the heart using high frequency waves.

This is done in a hospital setting where images of your heart are recorded by introducing an ultrasound transducer into the esophagus.

 

 

 

 

Why do I need this?

A TEE may have been ordered for you to obtain a more detailed image of your heart compared to a transthoracic echocardiogram done over the chest.

The transmission of beams to the heart may be difficult to reach in patients with over-crowding of the ribs, obesity, or emphysema.

In a transesophageal approach, the esophagus sits directly behind the heart without having to pass through any barriers.

 

 

When is it used?

A transesophageal echocardiogram may show signs of:

 

 

What are the risks?

TEE is a common diagnostic procedure, although with any medical procedure it carries risks.

These include:

Notify the physician if you have known esophageal problems (i.e. difficulty in swallowing) or have undergone any radiation to the esophagus.

Let your physician know if you have any bleeding disorders.

If you are pregnant or suspect you may be pregnant, let the physician know.

If you are allergic to any medications or to latex notify the physician.

 

 

How do I prepare for this procedure?

The possible risks and benefits will be explained to you and any questions you or your family may have will be answered before your procedure.

You will be asked to have blood work done some time before the procedure.

You will be asked to sign a consent form to perform the diagnostic procedure.

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

Do not eat or drink anything from midnight the night before your procedure. You may have small sips of water to take your medicine. The procedure is usually done in the morning. This is done to reduce the risk of vomiting and aspiration during the procedure.

A sedative will be given to you prior to the procedure to help you relax.

Make arrangements to have someone drive you to and from the hospital. You will not be permitted to drive after the procedure.

You will be asked to empty your bladder before the procedure.

The procedure is done on an outpatient basis so you will leave the same day as the procedure.

 

 

What happens during the procedure?

The procedure will take place in the hospital in the ECHO lab.

You will be asked to change into a hospital gown before entering the lab.

An I.V. line will be started in your hand or arm for the administration of a sedative.

You will lie on your back on a table and a pillow may be wedged underneath your back.

A local anesthetic spray will be applied to the back of your throat. This will make the back of your throat numb so you will feel more comfortable while the probe is being passed down your throat.

If required, oxygen may be administered through nasal tubes.

Then, you will be asked to lie on your left side.

The physician gently inserts a well lubricated probe into your mouth. You may be asked to swallow to help pass the probe down the esophagus.

Once the probe is in position, images of the heart can be obtained. This does not hurt or interfere with your breathing.

Throughout the procedure your heart rate, blood pressure, and oxygen will be closely monitored.

The procedure usually lasts 30 minutes, but the prep time may take longer.

 

 

What happens after the procedure?

Once the procedure is completed, you will be moved into a recovery area where your heart rate, blood pressure, and oxygen levels will be monitored.

Wait at least one hour after the procedure or until your throat is no longer numb to eat and drink again.

You may resume your daily activities after the procedure is completed.

No driving permitted for 24 hours.

Be sure to keep to your follow up appointment.

 

 

The result:

The results of your study will be reviewed to look for healthy heart valves and chambers, as well as normal heart functioning.

This is useful in planning for your treatment and also helps in determining whether further testing is needed.

A transesophageal echocardiogram may reveal:

The results of your ECHO will be discussed with you during your office visit.

 

 

Updated February 29th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Arterial Doppler

 

What is it?

An arterial Doppler study is a noninvasive, painless study used to assess the blood flow and pressure within the arteries using high frequency sound waves.

 

 

Why do I need it?

An arterial Doppler may be used to diagnose a variety of conditions including:

 

 

What is the risk?

No risks are associated with this study.

No radiation exposure is used during this study.

 

 

How do I prepare for the study?

No specific preparation is required. You may follow your daily eating habits before and after the study.

Clothing will need to be removed over the area being examined.

 

 

What happens during the study?

You will lie on a table while a trained ultrasound technician applies a clear jelly over the desired area. A probe is used to glide over this jelly which helps in transmission of sound waves through the skin.

Two blood pressure cuffs are applied over the limb being studied. Each cuff is inflated one at a time. Inflation is done to determine the pressure within the artery and to detect the moment blood flow is returned to the vessel.

Blood pressures can be measured at different levels to assess arterial narrowing or occlusion. These readings are used to determine the site and size of arterial narrowing.

The study lasts up to 1 hour.

 

 

What happens after the study?

After the study is over, the jelly is wiped off and you may return to your daily activities.

 

 

 

 

The result:

The results of the test will show either a normal or abnormal study.

A normal study shows normal blood flow and pressure.

An abnormal study shows reduced blood flow and high pressure.

This will help diagnose atherosclerotic (narrowing due to plaque) changes.

 

 

Updated February 28th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Venous Doppler

 

What is it?

A venous Doppler study is a noninvasive study used to measure the direction of blood flow through a vein using high frequency waves.

This study is useful in detecting any abnormalities which may present within a vein.

 

 

Why do I need it?

A venous Doppler study may be used for the following reasons:

 

 

What is the risk?

There is no risk associated with this study.

No radiation exposure is used during this study.

 

 

How do I prepare for the study?

No specific preparation is required. You may follow your daily eating habits before and after the study.

Clothing will need to be removed over the area being examined. You may consider wearing shorts for the study, if not a gown will be provided.

 

 

What happens during the study?

You will lie on a table while a trained ultrasound technician applies a clear jelly over the desired area. A probe is used to glide over this jelly which helps in transmission of sound waves through the skin.

The probe is pressed firmly over the skin in various angles and locations tracing over the area of interest. The limb may be squeezed at various times to check for the flow of blood through the vein. These sound waves show up as images on a monitor to be recorded and interpreted.

The study may last up to 30 minutes.

 

 

What happens after the study?

After the study is over, the jelly is wiped off and you may return to your daily activities.

 

 

The result:

The results of the study will show as either normal or abnormal.

A normal study shows normal blood flow with no evidence of deep vein thrombosis.

An abnormal study shows reduced blood flow with or without deep vein thrombosis.

This study helps in coming to a conclusion to some of the symptoms you may be having, assess the patency of the vein, as well as detecting any other abnormal findings.

 

 

Updated February 28th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Home Blood Pressure Monitoring

 

Home blood pressure monitoring is important in the diagnosis and management of high blood pressure (hypertension). Self monitoring helps monitor your blood pressure within a comfortable and familiar setting.

This allows your physician and you to know whether your blood pressure is under control or how well your blood pressure medication is working.

Home blood pressure monitoring helps in the early prevention of potential health complications.

 

 

Who needs to be doing this?

Home blood pressure monitoring is particularly useful in clinical situations including:

 

 

Why do I need it?

Since blood pressure fluctuates throughout the day, multiple recordings need to be taken. Readings can vary throughout the day and can be triggered by emotions, diet, or medications. Multiple blood pressure readings give a more accurate range of what your actual blood pressure is oppose to your clinical office visits. 

Blood pressure recording in a comfortable and familiar surrounding helps to eliminate emotional stress or anxiety some patients may have after walking into a doctor’s office.

Blood pressure monitoring can help in a personal self improvement for controlling blood pressure. Most patients become encouraged and better motivated about their own health with a home monitoring system.

 

 

Who should not be doing this?

For patients with an irregular heartbeat (arrhythmia), home blood pressure monitoring is not advised.

This is because home monitoring does not give accurate readings in these patients.

 

 

What is the risk?

There are no known risks associated with home blood pressure monitoring.

A temporary and brief squeezing or sensation of tingling and numbness may be felt during the inflation of the cuff.

 

 

How is it done?

For the diagnosis of hypertension, multiple readings should be taken at various times throughout a patient’s day in addition to regular monitoring at the physicians office.

Blood pressure should be measured twice daily, at the same time everyday. Blood pressure should be measured once in the morning about one hour after waking and before taking your medications or foods. An evening blood pressure can be taken before dinner and before your evening medications.

Avoid caffeine, tobacco, and food 30 minutes before recording your blood pressure. Make sure to be seated, comfortable, and relaxed before taking your blood pressure. Avoid speaking while taking your blood pressure.

The correct method to check blood pressure is to place the cuff over your Left arm about 2cms above the elbow. Place the lined marking on the cuff against the artery of the inner arm, on the inside area of the biceps muscle. The cuff should not be too tight or too loose. Two fingers should be able to pass beneath the cuff. Turn the machine on and the cuff will automatically inflate.

It is important to make a diary of your activities. Normal daily activities including exercise, eating, sleeping, and even when you take your daily medications must be noted. Record the time of day or any symptoms you may feel accurately in your diary.

Bring your diary with you to your next appointment so your physician can assess how well your blood pressure is controlled.

 

 

Interpretation:

Interpreting your blood pressure readings may be confusing. 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

 

If the presence of hypertension has been made, the following information should be assessed:

 

 

What are the benefits?

Several benefits of home blood pressure monitoring include:

 

 

 

Updated March 5th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

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:

-  Congenital defects

-  Sleep Apnea

-  Kidney diseases

-  Adrenal gland tumors

-  Thyroid disorders

-  Birth control pills, pain relievers, and cold remedies.

 

What are the risk factors?

 

• 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.

 

 

What are the symptoms?

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 in 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.

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 it?

White coat syndrome (WCS) is a temporary elevation of blood pressure caused by excitement or anxiety that does not necessarily constitute hypertensive disease, but may indicate an inclination towards its development.

White coat syndrome occurs in a patient whose blood pressure is consistently higher at a physician’s office than when measured at home. Patients may or may not have an existing diagnosis of hypertension.

Patients with white coat syndrome have an increased risk of cardiovascular disease, although the risk is greater in a true hypertensive patient.

Ambulatory 24-hour blood pressure monitoring is useful in the evaluation of these patients.

 

 

 

What are the causes?

The causes of white coat syndrome are usually always caused by:

These emotions stimulate the fright or flight response.

This stimulates hormones (i.e. adrenaline) and the nervous system to constrict the blood vessels causing a temporary increase in blood pressure.

 

 

What are the symptoms?

There are no symptoms of white coat syndrome.

Patients are generally asymptomatic.

 

 

How is it diagnosed?

The goal in diagnosis is to avoid unnecessary drug therapy, provide a better diagnostic and prognostic assessment, and reduce costs. 

A good way to overcome white coat syndrome is by multiple office blood pressure readings done in a routine fashion, to minimize anxiety.

Blood pressure may also be recorded outside the physician’s office at home or at a local grocery store. This is referred to as blood pressure self-monitoring.

The best way to diagnose white coat syndrome is with a 24 hour ambulatory blood pressure monitor, which is provided here at CVI. This is a small portable monitor that takes regular readings of your blood pressure over the day and night. A 24 hour ambulatory blood pressure monitor allows the physician to assess blood pressure under the conditions of a typical day. Blood pressure will also be monitored during sleep. Obtaining recordings during sleep is beneficial as normal blood pressure decreases or “dips” during sleep. With the lack of this “dip” during sleep, the diagnosis of true hypertension can be clarified.

If you have been diagnosed with white coat syndrome, the risk of developing heart disease is greater and many patients go on to develop hypertension (high blood pressure) in the future.

It is essential to have your blood pressure recorded on a regular basis to ensure that if blood pressure escalates, action can be taken promptly to bring blood pressure down and minimize the risk of heart disease.

Lifestyle modifications are reinforced in patients with white coat syndrome.

 

 

How is it prevented?

Lifestyle modifications are highly recommended in patients with white coat syndrome.

This includes:

 

 

Updated April 20th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

Glycemic Index

 

What is it?

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 a high GI (above 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.

 

 

How is it measured?

Glycemic index measures the amount of carbohydrates in food and the glucose levels after eating.

Different carbohydrate containing foods affect blood glucose levels differently.

Food items are charted as high, medium, and low according to the GI value measured.

 

 

Who should be using this?

By watching what you eat, your hunger and energy levels will have a beneficial affect.

Your total blood glucose, cholesterol, and triglyceride levels will significantly improve.

Those who may benefit from using the glycemic index include:

 

 

What guidelines should be followed?

Glycemic index depends on a variety of factors such as the presence of starch, protein, fat, fiber, and organic acids in food.

Elevated glucose in the blood stream produces elevated levels of insulin in the body. Constant elevation of glucose may exhaust insulin levels that can lead to diabetes, weight gain, and inflammation.

Some ways to avoid this include:

 

 

Low Glycemic Index food (GI < 50)

FOOD ITEM	GI	FOOD ITEM	GI
Yogurt low-fat (sweetened)	14	Rye	34
Peanuts	15	Milk, semi-skimmed	34
Artichoke	15	Vermicelli	35
Asparagus	15	Spaghetti, whole wheat	37
Broccoli	15	Apples	38
Cauliflower	15	Pears	38
Celery	15	Haricot beans, boiled	38
Cucumber	15	Plums	39
Eggplant	15	Ravioli, meat filled	39
Green beans	15	Carrots, cooked	39
Lettuce, all varieties	15	Snickers bar	40
Low-fat yogurt, artificially sweetened	15	Apple juice	41
Peppers, all varieties	15	Wheat kernels	41
Snow peas	15	Spaghetti, white	41
Spinach	15	Black-eyed beans	41
Young summer squash	15	All-Bran	42
Tomatoes	15	Peaches	42
Zucchini	15	Chickpeas, tinned	42
Soya beans, boiled	16	Oranges	44
Cherries	22	Lentil soup, tinned	44
Peas, dried	22	Carrot juice	45
Milk, chocolate	24	Macaroni	45
Pearl barley	25	Pineapple juice	46
Grapefruit	25	Rice, instant	46
Milk, whole	27	Grapes	46
Spaghetti, protein enriched	27	Grapefruit juice	48
Kidney beans, boiled	29	Multi grain bread	48
Lentils green, boiled	29	Rice, parboiled	48
Soya milk	30	Baked beans, tinned	48
Apricots  (dried)	31	Porridge, non-instant	49
Milk, Fat-free	32	Chocolate bar; 30g	49
Milk ,skimmed	32	Jams and marmalades	49
Fettuccine	32	Whole grain	50
M&Ms (peanut)	32	Barley, cracked	50
Chickpeas	33	Ice-cream (low- fat)	50

 

 

Moderate Glycemic Index Foods List (50 to 70)

FOOD ITEM	GI	FOOD ITEM	GI
Yam	51	Hamburger bun	61
Orange juice	52	Ice-cream	61
Kidney beans	52	Potato, tinned	61
Lentils beans	52	Muffin (unsweetened)	62
Kiwi fruit	53	Shortbread	64
Pound cake	54	Rye-flour bread	64
Banana	54	Apricots  (tinned in syrup)	64
Sweet potato	54	Raisins	64
Crisps	54	Macaroni cheese	64
Oat bran	55	Beetroot	64
Rice, brown	55	Mars bar	64
Fruit cocktail	55	Black bean soup, tinned	64
Spaghetti, durum wheat	55	Cake , tart	65
Popcorn	55	Water biscuits	65
Muesli	56	Potato, steamed	65
Mangoes	56	Table sugar (sucrose)	65
Potato, boiled	56	Barley, flakes	66
Pita bread, white	57	Pineapple	66
Mini Wheats (whole meal)	57	Green pea soup, tinned	66
Rice, wild	57	Cake, angel	67
Apricots	57	Croissant	67
Potato, new	57	Taco Shell	68
Digestives	58	Whole meal bread	69
Rice, white	58	Shredded  Wheat	69
Danish pastry	59	Potato, mashed	70
Pizza, cheese	60

 

High Glycemic Index Foods List (GI > 70)

FOOD ITEM	GI	FOOD ITEM	GI
White bread	71	Broad beans	79
Golden Grahams	71	Jelly beans	80
Millet	71	Pretzels	81
Watermelon	72	Rice Krispies	82
White rolls	73	Potato, micro waved	82
Puffed wheat	74	Cornflakes	83
Corn chips	74	Potato, instant	83
Chips	75	Potato, baked	85
Waffles	76	Rice pasta, brown	92
Doughnut	76	Baguette	95
Wafer biscuits	77	Parsnips	97
Rice cakes	77	Dates	103
Weetabix	77

 

 

Updated March 12th, 2012 -JS
For further information please contact Cardiovascular Interventions, PA at 407-894-4880

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

 

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Updated February 4, 2009 - MJ