Do Your Heart Good

Take care of your ticker and it will take care of you

We put a lot of trust in our heart. “The heart
is responsible for feeding the rest of our body,”
says Dr. Thanh Nguyen, a cardiologist at
Touro Infirmary, Crescent City Cardiovascular
Associates Group.

Dr. Salman Arain, an interventional cardiologist
at Tulane University Heart and Vascular
Institute, says it’s the ultimate machine. “It is a
well-designed pump. It works nonstop from the
time you are born to the day you die; there is no
other machine that functions that long.”
Keeping the heart in good shape is especially
important in New Orleans, where food and
drink are a priority. We have to make a conscious
effort to take good care of ourselves here. “This
area of the country is high-risk for cardiovascular
disease, which is lifestyle-dependent. What
people have to understand is that cardiovascular
events are preventable, at least at early ages, and
individuals can modify their outcomes,” says
Dr. Gary Sander, a professor of medicine and a
cardiologist at Tulane.

There are three ways the heart works: It has a
pumping function, an electrical function and
a plumbing function, which moves the blood
supplies of the heart.

“For most people, when we talk about heart
disease, we talk about problems that occur in
the blood supply to the heart itself, which leads
to problems with the pumping function,” says
Arain. In the case of a heart attack, blood vessels
that supply the heart have a blockage and part of
that muscle dies. “Even though we tend to think
of heart attacks as sudden events that bring
people to the emergency room with chest pain,
it turns out that most people have blockages that
develop over the course of years,” says Arain.
This is why prevention is key.

To improve your heart health, it’s important to
set reasonable goals. “I tell my patients to get at
least 30 minutes of activity a day for five days
a week and do things like park farther away
from the door so they can walk or to walk up
stairs instead of taking the elevator and just
stay active,” says Nguyen. Gradually increase
the amount of time you spend doing physical
activity. “You can do 10 to 15 increments five to
10 times a day, but the idea is to give your heart a
workout from that stimulus that allows the heart
to maintain its own health by building muscle,”
says Arain.

Watch what you eat. “Stay away from fatty foods,
watch your salt intake and have high portions
of fruits and vegetables and a fiber-rich diet,”
says Nguyen. You should aim to have less than
1,500 milligrams of sodium each day. Unrefined
whole grains are good choices because they
can help lower your cholesterol and make you
feel full, which helps in managing your weight.
Fish a few times a week, particularly those that
contain omega-3 fatty acid, can lower your risk
of coronary artery disease. Avoid saturated fats
because they tend to form the cholesterol that
gets deposited. The Mediterranean diet is often
recommended as well. “Take in foods that are
grilled or broiled as opposed to being fried,” says
Arain. Remember that the best diet is one that
includes foods from each of the food groups.
Avoiding both first and secondhand smoking is
another factor we can control. Smoking is the
leading preventable cause of death in the United
States. In addition to increasing the tendency for
your blood to clot, smoking reduces your ability
to tolerate physical activity, which is essential for a healthy heart. Sometimes it can take a few
attempts to quit, but the key is to not give up
trying. You may contact a local smoking cessation
program or seek out support from family and
friends as you go through the quitting process.
Talk to your doctor about things you can do
to minimize your risk. “We have really good
outcomes when patients stick to our plan,”
says Nguyen. If you have a preexisting medical
condition like hypertension, diabetes, high
cholesterol or you are obese, you should be
screened by your primary care physician on a
more regular basis for risk factors. Knowing
your numbers is important. “There are
treatment guidelines for specific numbers for
blood pressure, cholesterol and diabetes that
we individualize to each patient while defining
risk factors to see what we can accomplish
reasonably,” says Sander. According to the
American Heart Association, by keeping your
blood pressure in the healthy range, you are
reducing the risk of your vascular walls becoming
overstretched and injured, decreasing the risk of
your heart having to pump harder to compensate
for blockages and protecting the entire body so
your tissue receives regular supplies of blood that
is rich in the oxygen it needs.

There is a lot you can control, but you cannot
control genetics or age. By focusing on
modifiable risk factors, you can minimize the
effects of genetics. “Because of various risk
factors, people start depositing cholesterol within
the walls of the arteries, which is a defense
mechanism,” says Arain, meaning that since
our risk factors damage the artery walls, the
lining gets damaged. “The body is repairing the
cholesterol’s damage to the blood vessel wall, but
if you keep depositing cholesterol in the same place, it builds up and causes a blockage and the
inside starts narrowing,” says Arain.

If you are diagnosed with heart troubles, try to
think positively. “Once you have the diagnosis,
it is an opportunity to address issues. What
ends up happening is that once you are aware,
you tend to make the extra effort to control risk
factors and lead a healthy lifestyle,” says Arain.
Heart health is about making the right choices.
“There is nothing more gratifying than seeing
someone who gets the message and turns their
life around—that is amazing,” says Arain.

Secondary prevention is important. “You may
require medication, but that is an investment
in your health and future,” says Arain. In
the past, there were only two medications
available, so patients with side effects did
not have other options. Nowadays, there is a
better understanding, along with more choices.
“There is more aggressive medical therapy and
stent technologies have improved and are an
alternative to bypass surgeries,” says Arain.

It is amazing how far we have come in cardiology.
“Ten years ago, most corrective procedures were
done with heart surgery, while today most things
are done with catheters and not surgery,” says Dr.
Christopher White, director of the John Ochsner
Heart and Vascular Institute and chairman of
the Department of Cardiology. The PET Scan is
a new test for heart disease. “It is a new way to
look at the circulation in the heart, for people
with blockages in their arteries,” says White.
They have replaced stress tests or nuclear scans.
The latest thing is the replacement of valves
without surgery. “By the time folks get to be 75
and 80, it is common to have aortic stenosis,
which is a disease of wear and tear,” says White.
It is not a genetic or cholesterol-related disease,
but it causes serious problems that are hard to
operate on because of the risk. “We are able to
open the valves using a keyhole procedure, just
like an angiogram. By putting a catheter in the
femoral artery, we can advance the valve and
blow it up with a balloon, expand it, fix it and
it takes the place of their old valve,” says White.
Research is showing that mortality is reduced
by half in patients who were given the valve
compared with those who were not. “It was an
amazing result,” says White.

Left ventricular assistive devices are also playing
a major role. “People have sick ventricles and
do not quite need a transplant but can have
devices that piggyback on the heart and give it a
booster pump,” says White. Some cardiologists
do nothing but specialize in heart failure and see
a continuous stream of patients who have been
told they are debilitated, but the vast majority
return to normal activity. “It is reasonable to
be optimistic. With appropriate therapy,” says
White, “patients with heart failure can live
normal lives.”