Category Archives: Heart Failure

Q&A: Why is salt bad for your heart?

with Dr. Bussie Evans, Cardiologistdrevans

Why is salt bad for your heart?

Dr. Evans: Our bodies need a little salt for optimal health, however the typical American diet can contain two or three times the amount needed.  Too much salt causes the body to retain water.  This increase in fluid in the body increases blood pressure which puts a strain on blood vessels, the heart and kidneys.  As a result, people with high blood pressure have an increased risk of heart disease and stroke.

Does everyone need to monitor their salt intake?

Dr. Evans: It’s safe to say that everyone eating an American diet could benefit from paying attention to and reducing their salt intake. Most people have no idea how much salt they consume.  People assume that if they don’t use their salt shaker much, they aren’t eating much salt.  But salt / sodium is already present in many of the foods we eat.  Especially processed foods. It is important to pay attention to your salt intake if you have high blood pressure, and if you have heart failure, too much sodium and the accompanying fluid retention can be very dangerous.

How much salt is too much?salt_shaker

Dr. Evans: The Heart Association recommends no more than 2,300 milligrams of sodium a day, however for most adults, especially seniors, no more than 1,500 milligrams is a better guideline.  Our blood pressure tends to increase as we age, so lowering salt intake can help to keep it in check. To give you an idea, one teaspoon of salt is 2,300 mg of sodium.  In packaged foods, the amount of sodium is on the nutrition label, but pay close attention to the serving size.  Let’s say that a can of soup has 800 mgs of sodium per serving, but a serving is only 1/2 a cup. To be realistic, you are likely to eat one whole cup of soup if not more and then you’ve already exceeded your recommended daily sodium intake.  It’s just that easy to take in too much salt if you’re not paying attention.

How can I reduce salt if it’s already in the food I eat?

Dr. Evans: Ideally, eating more fresh foods that are prepared at home rather than packaged foods can make a big difference not just in salt consumption but in your overall health.  And when cooking at home, use more herbs and spices for flavor and less salt.  For recipes and meal plans, there are a lot of free resources you can find online by looking up the DASH Diet. When buying packaged foods, read the labels and look for lower sodium alternatives. It really doesn’t take long for your tastes to adjust to less salt and you’ll soon find that some foods taste way too salty.  Certain foods are known for containing a lot of salt, and unfortunately, they are American favorites:  pizza, sandwiches, soup, breads and baked goods, cold cuts, poultry, cheese, and of course condiments and sauces.  People tend to ignore the nutritional labels on condiments, but soy sauce or barbeque sauce, for example, can really blow up your daily sodium intake.  There are ways to make some of these salty favorites less salty and more healthy like getting the thin crust pizza with more vegetables, half the cheese and an uncured meat instead of pepperoni.  However at the very least, limit your portions of salty foods.

If I limit my salt intake will my blood pressure be normal?

Cutting back on salt is one of the easiest things you can do to help your blood pressure, but it is not a cure all.  There can be other causes of high blood pressure such as family history, poor diet, lack of exercise, being overweight, smoking, and excess alcohol consumption.  Limiting salt intake should be part of an overall heart healthy lifestyle that includes regular exercise, a heart healthy diet, and maintaining a healthy weight.  High blood pressure, much like high cholesterol, is a silent risk factor of heart disease, so having your blood pressure and cholesterol checked regularly can help you and your doctor find lifestyle modifications, or medications if needed, to reduce your risks for cardiovascular disease.

 

Heart Disease Patient Benefits from World’s Smallest Heart Pump

Nellie Smith was suffering from severe abdominal cramping and was convinced she needed to have her gallbladder removed. The problem with havingNellie_Smith this routine surgery however was Nellie’s heart. Nellie had survived a heart attack seven years ago and was told that her heart disease was severe. Multiple vessels around her heart were narrowed. She had previously been very active, but following her heart attack found that she tired very easily, was frequently short of breath and experienced chronic chest pain. She hoped to avoid further heart procedures by taking medications.

Eventually, Nellie’s abdominal pain became so severe she found herself at Bay Medical. Her cardiologist Dr. Michael Stokes was called to assess her heart health and delivered dire news. The blockages around her heart had left her with only one main vessel supplying blood flow to her heart and her ejection fraction (a measure of how well the heart is pumping blood) was only 15%. In this condition, it was far too risky to have surgery on her gallbladder and it was very high risk to perform a standard cardiac catheterization to open her heart blockages as well.

Fortunately, Bay Medical is the only hospital in the region with a unique technology designed to support heart function during high-risk cases. Dr. Stokes contacted his partner Dr. Amir Haghighat, one of three local cardiologists trained to use the Impella, the World’s Smallest Heart Pump, to help with Nellie’s case.

The Impella is roughly the size of a small writing pen and, using guide wires, can be inserted through a small incision in the groin area and navigated through the major blood vessels into the heart. The device can continuously keep blood pumping while the dangerous work of opening multiple blockages takes place.

 

Unlike an open surgery, a cardiac cath requires only mild sedation and patients are awake and able to interact with their physician. Nellie was able to see the images on screen of her blood vessels during the procedure and noted that “as he opened each blockage, it was like a road map suddenly began to appear on screen.” The previously blocked vessels filled with blood to feed the heart muscle. “I felt a difference immediately, right there on the table,” said Nellie.

The next day in the hospital, Nellie was up and walking around the cardiac nursing floor. “I feel really good,” she says. “I’m looking forward to going home, cleaning my house and cooking a meal. I know that doesn’t sound like much, but it was too tiring and too difficult to do those things before.” To her surprise, Nellie noted that she was no longer experiencing abdominal pain. She excitedly put her grandchildren on notice to expect “a NEW Granny” when she returned home.

Prior to the availability of Impella technology, patients like Nellie would not be able to have a cardiac procedure to open narrowed vessels due to the high risk involved. In many cases, bypass surgery would be too risky as well, leaving these patients with little hope of recovery. CVI cardiologists Dr. Samir Patel, Dr. Amir Haghighat and Dr. Thompson Maner have used the Impella technology to give many of these patients deemed too high-risk a second chance. “This is why we’re always learning and working to bring the latest technology to Bay Medical,” says Dr. Haghighat. “To have a great save like this one and to give those grandkids ‘a NEW Granny’ is why we do what we do.”

 

CVI to Participate in Two New Clinical Studies

The Research Department at the Cardiovascular Institute will participate in two new national studies which will provide valuable information to validate or improve current treatment protocols.

The CHAMP-HF observational study will examine treatment of heart failure and will help physicians and researchers better understand how different medications affect patients with this condition. This study will enroll up to 5,000 patients across the U.S. who have been diagnosed with heart failure and have a reduced ejection fraction (LVEF < 40% within the last 12 months). Ejection fraction is a measurement physicians use to determine how well the heart is pumping out blood. Patients who qualify and agree to participate will be asked to fill out questionnaires during their usual health care provider visits that occur during the study period (up to two years). Participants will receive payment for their study related expenses and can change their mind to opt out of the study at any time.

The Affordability and Real-world Antiplatelet Treatment Effectiveness After Myocardial Infarction Study (ARTEMIS) will assess the impact of copayment reduction by equalizing copayments for clopidogrel (Plavix) and tricagrelor (Brilinta). With financial factors removed from the equation, the ARTEMIS study will follow prescribing patterns, patient medication adherence and clinical outcomes for up to one year. This study is designed for patients 18 or older who have been hospitalized for heart attack (STEMI or NSTEMI) and treated with antiplatelet medications (P2Y12 receptor inhibitors). To qualify, patients must also carry US-based health coverage with prescription benefit. At enrollment, patients will receive a prescription voucher card to offset copayments for Plavix or Brilinta. The ARTEMIS study is a multicenter cluster-randomized trial, which means that that each participating site will be randomized as a control site or an interventional site. Sites in the interventional arm of the study will have the opportunity to offer enrolled patients the previously described voucher card to cover costs for the medications included in the study for 12 months following their discharge from the hospital for heart attack. Sites in the control arm will provide the usual standard of care.

Cardiologist Dr. Michael Morrow is the principal investigator at CVI for both of these studies however all CVI cardiologists can enroll patients. “We are grateful to have the opportunity to participate in this research,” says Dr. Morrow. “This gives us access to recent data collected from across the nation that can help us refine our treatment protocols and offer our patients the best, proven therapies currently available.”

 

Is Your Heart Ready for the Holidays?

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Study finds increase in Heart Failure hospitalizations immediately following major holidays.

Thanksgiving, Christmas, New Years. These events are filled with family, friends and lots of delicious food and drink. However according to a study published in the Journal of Cardiac Failure, these events are also associated with an increase in heart related hospitalizations – primarily among patients with heart failure. While the exact causes vary from patient to patient, the top two offenders are: 1.) overeating and increased sodium consumption; and 2.) postponing medical care. It’s understandable that no one wants to miss out on the fun, so we have some tips to help keep your heart healthy while you enjoy the holidays.

1.) Be Aware of Hidden Salt. This is especially important for patients with heart failure, however everyone, even those in perfect health, should be mindful of their sodium consumption. For example, many people do not realize how much sodium is in bread. Now think about what goes into America’s favorite holiday side dish – Stuffing (or Dressing). It’s essentially made of bread (2 oz of cornbread has 340 mg of sodium) and chicken broth (1 cup of broth has 860 mg of sodium), and later topped with gravy (1/4 cup of gravy has 290 mg of sodium). Some estimates come up with more than 5,000 mg of sodium in a typical Thanksgiving meal, more than twice the recommended daily allowance. And that doesn’t include breakfast that day or your late night turkey sandwich.

What Can You Do? With homemade dishes at holiday dinners you can’t read the labels, but you can be mindful of the ingredients. Simply substituting low sodium chicken broth which only has 70 mg of sodium per cup can make a big difference and you’ll find that if you use other seasonings, like sage for example, to give your dressing some flavor that no one will notice the difference. Use this strategy with your favorite casseroles as well. Or substitute steamed green beans and baked sweet potatoes with a sprinkle of cinnamon for some of the more caloric and sodium laden side dishes. Skip the dinner rolls, after all there is already bread on your plate in the dressing. The desserts are loaded with salt too. Pumpkin pie is usually the healthiest of the bunch. Make it healthier by skipping the crust.

2.) Portion Control. At holiday dinners there is so much good food to eat most of us tend to over load our plates making an unhealthy choice even worse when it’s supersized. And American dinner plates are larger than ever, averaging 11-12 inches in diameter. Fifty years ago the average plate was only nine inches. It’s no coincidence the average waist line was also a lot smaller then.

What Can You Do? Remember that you don’t have to fill your plate. It’s ok to have some empty space. If you don’t trust yourself to leave some empty space, eat off of a salad plate. Salad plates have also grown in size, many are nearly the size of an old school dinner plate. Speaking of salad, if that is the initial course of the meal or a veggie tray is available prior to the meal, enjoy plenty of veggies to fill your tummy so you are not so hungry when it’s time for the main course. Remember that you don’t have to eat it all now. You don’t even have to have a helping of everything that is served. Plan on left overs so you don’t have to miss out on anything. Continue to enjoy your holiday favorites in moderation for the next few days.

3.) Do Something With All Those Extra Calories. Another holiday tradition is to fall asleep after the big meal. The frenzy of activity leading up to the big meal and that big dose of tryptophan from the turkey might make it seem that a good nap is inevitable. But remember that the food we eat is fuel for our bodies. If we take in more fuel than we need, it has to be stored somewhere. Think belly, thighs, love handles.

What Can You Do? Start a new holiday tradition and take a family walk. We live in Florida after all so there is no snow or ice to keep us indoors. Look for leaves changing colors or Christmas lights. Enjoy a walk on the beach without all the spring and summer crowds. A nice long walk may not burn all those extra calories, but it will definitely help. As a bonus, you’re creating more fond family memories than you would if you were asleep on the couch. And when you eventually take that nap it will be much more gratifying.

4.) Be Mindful of Symptoms & Don’t Skip Medications. If you have a heart condition, the holidays are not the time to forget about it. After all, you’ll enjoy the holidays much more if you know you have many more of them to come. Even if that means taking the time to see your doctor when there are gatherings to attend, gifts to buy or cakes to be baked. Check your blood pressure at the grocery store and don’t just dismiss high blood pressure as holiday stress. If you have heart failure, don’t forget to weigh yourself everyday and don’t ignore any shortness of breath. Your daily schedule may be thrown off a bit by travel or family events, but keep your medications on track.

With these simple tips and using good common sense, you can hopefully avoid the most common heart health pitfalls that occur over the holidays.

The physicians and staff at Cardiovascular Institute wish you a healthy and joyous holiday season.

 

Cardiovascular Institute Offers Heart Failure Clinic

hrtflr-01Heart Failure is a chronic and progressive disease, but for patients who are willing to work closely with healthcare providers and manage their diet and exercise there can be improvement in heart function and quality of life. The Cardiovascular Institute developed a Heart Failure Clinic in the Fall of 2014 with the primary goal of helping our heart failure patients stay healthy and out of the hospital. Nurse Practitioner Karen Williams, who helped develop the program, says that she has seen marked improvement in our patients who participate fully, including increased activity levels and a reduction in hospitalizations.

The three main components of the Heart Failure clinic include Monitoring, Management and Education.

Heart Failure is caused by other conditions that have damaged the heart muscle, making it weak and unable to supply the body with sufficient blood and oxygen. In addition to monitoring the symptoms of heart failure for any changes, contributing conditions such as high blood pressure, coronary artery disease, and sleep apnea are treated in conjunction with each patient’s healthcare team.

Education plays a vital role in our Heart Failure Clinic. Patients are taught how to read food labels and plan meals that keep sodium intake in check and provide enough fluid but not too much. Excess sodium can cause fluid to back up in the lungs and swelling of the feet and ankles. Patients will learn more about their medications, how they work, potential side effects and the importance of following a proper dosage schedule. We also work with our patients to find fitness activities that are best for their condition and offer a cardiac rehab program.

“Our patients who participate in the Clinic definitely feel more empowered to manage their condition,” says Williams. “While there isn’t a cure for heart failure, our patients can regain a sense of well-being knowing that they have the knowledge and the tools to keep their symptoms in control.”

For patients with advanced stage disease, our clinic provides information for patients and their family members to make end of life care decisions and assists in connecting them with any other necessary services for their continued comfort.

Heart Failure clinic appointments are available five days a week. The frequency of visits to the clinic is dependent on each patient’s condition, however, most patients visit weekly or monthly for ongoing monitoring and treatment of their condition. Clinic visits are covered by all insurances. Talk with your primary care provider or cardiologist about your condition and if participating in our Heart Failure Clinic could be beneficial for you.