Heart Attack

From Out of Nowhere, a Heart Attack at Age 56

My husband, Jim, suffered an unexpected heart attack last week. I am writing this blog to detail and chronical what happened. Here is this blog's home page and navigation guide. Except for this post, which will remain at the top of this blog, the posts are in reverse chronological order-so the most recent posts are at the top, immediately below this post. Most of this blog's readers will want to navigate around here using the categories which are listed in the far right column, and also on this blog's home page. Jim's heart attack occured on January 8, 2008. I started this blog the same month. You can find the first posts of this blog, including the telling of how the heart attack happened, on the January 2008 archive page here. The following month, February 2008, posts are here - these posts include a post describing the follow-up visit with our primary care physician.

It is our hope that the information here helps others.

vadkins

Heart Attack: HDL & Cholesterol Levels 20 Months Later

Jim saw his cardiologist yesterday to see how his HDL level is doing since he stopped taking Niaspan two months ago. The blood test show that Jim's HDL (good cholesterol) level did drop from 48 to 43 in the last two months. That is a drop of more than 10%. So it does appear that taking Niaspan did improve Jim's HDL level. But Jim has had no stomach pains since he stopped taking Niaspan and Plavix. The doctor did not recommend going back on Niaspan though. But Jim does need to do all he can to raise his HDL level. The cardiologist recommends:

• Drinking 6 oz. of red wine/day
• Eating lots of salmon and other cold water fish
• Increase intake of olive oil
• Increasing the time spent walking on the treadmill from 20 minutes to 40 minutes/day, 5 days a week-at 11%-12% incline

The doctor did say that Jim's C-Reactive Protein level is not elevated, which is good news. That indicates that Jim does not have an increased risk of a heart attack in the next 5 years.

It will be two years since Jim had the heart attack in January. After two years the risk of having more problems related to the heart attack declines. Therefore, Jim will not have to see his cardiologist for a full year. He will have his cholesterol levels checked every 6 months though.

Jim's blood pressure was measured at the doctor's office yesterday at 128/64, and his pulse was 64 BPM.

vadkins

Heart Attack: Improved HDL Number Is Great News

Jim saw his cardiologist today for his 4 month checkup. As usual, the doctor reviewed Jim's latest blood test/lipid panel/cholesterol results. His total cholesterol is 90, the HDL cholesterol (good cholesterol) is 48, the LDL (bad cholesterol) is 33, the triglycerides are 46 and the VLDL cholesterol is 9. These are very good cholesterol numbers for a heart attack survivor. The HDL has risen to 48 from 44 in 4 months. The month after Jim had his heart attack (February 2008), his HDL cholesterol was 27, which is very low. At that time the cardiologist prescribed Niaspan (500MG/day) to get the HDL cholesterol level up. (HDL needs to be at least 40 for a male, and 50 for a female.) Jim has taken Niaspan for about a year, and has had some problems as a result. A year ago he was diagnosed with stomach ulcers from the Niaspan and Plavix that he's been taking. And the Niaspan often causes flushing of the skin, which is irritating to live with. Other likely factors in the improved HDL number is that Jim has also lost 40 pounds since the heart attack, and he walks on a treadmill for 30 minutes 5-6 times/week.

Because Jim's cholesterol numbers are so good, the doctor told him to stop taking Plavix and Niaspan, to see how that affects his cholesterol numbers. Jim was told to take 1 low dose aspirin a day instead of Plavix. Jim will see the doctor in 2 months to check his cholesterol and see if he can continue not taking Niaspan.

Below the jump is a table of Jim's blood tests for the last 10 years or so.

All in all, Jim is doing very well.

vadkins

Heart Attack: Blood Test Result Comparisons

Here is an updated table of my husband's blood tests going back to 1998. Jim's unexpected heart attack occurred on 1/8/2008. The test results taken before the heart attack have a shaded background. What is notable about these results to me, is the abnormally low HDL (good cholesterol) levels that Jim had back to 1998. From what I understand, HDL is the substance in our blood that transports plaque out of the arteries so that the body can dispose of it (known as reverse transport). Since Jim lacked HDL, his body wasn't able to get rid of the plaque in his arteries. So the one blockage in his coronary artery that caused the heart attack was able to get larger and larger because he didn't have enough HDL in his blood stream to carry (transport) the offending plaque away.

Since the heart attack Jim has been taking Niaspan daily to raise his HDL levels. The Niaspan plus the 40 minute aerobic workouts he does 6 times/week on the treadmill plus the 40 pounds of weight that he has gotten rid of have contributed to raising his HDL to 44-which is above normal and a vast improvement.

Date of test	Feb 2009	Jun 2008	Apr 2008	Feb 2008	Jan 2008	Nov 2006	Mar 2000	Nov 1998
Cholesterol	90	82		96	169	143	<100	159
Triglycerides	51	59		109	93	108		176
HDL Cholesterol	44	40		27	41	38	33	30
LDL Cholesterol	36	30	45	47	109	83	95	95
LDL/HDL Ratio	0.8	0.8		1.7			3.0	5.4
Hemoglobin A1c		5.5	5.5
Lipoprotein (a)			3
Homocysteine			18.9
C-Reactive			0.18
Hemoglobin		5.5	5.5			16
Glucose		111	109		117	104
CK					240
Platelets					172	166
Troponin		0.01			3.4

Jim, fortunately, is doing very well.

vadkins

Heart Attack: Recurring Heart Attacks from Drug Interactions

Previously, I posted that my husband (who is a heart attack survivor) had developed stomach ulcers that were caused by the Plavix, aspirin and (probably) Niaspan that he has taken since his heart attack on January 8, 2008. His gastroenterologist prescribed Pantoprazole to heal the ulcers, to be taken twice a day until the ulcers heal. Once the ulcers are healed he will have to take Pantoprazole for the rest of his life to prevent recurrence of stomach ulcers. After the ulcers were diagnosed, Jim saw his cardiologist who changed his heart medications because of the ulcers. The cardiologist cut Jim's Niaspan dose in half and took him off aspirin all together.

The Heart of the Matter blog, which is written by a cardiologist in Malaysia, notes that recent studies show that heart attack survivors who take PPIs have a significantly increased chance of suffering a repeat heart attack. PPI stands for Proton Pump Inhibitors which is a class of drugs that reduce stomach acid production. PPIs are used to heal/prevent ulcers. Pantoprazole, which my husband takes to heal the stomach ulcers he has, is a PPI. But fortunately, Pantoprazole is one of the exceptions to this. Pantoprazole has so far been shown NOT to increase the risk of another heart attack.

vadkins
QT Monster Blog Home

Heart Attack: Blood Test Results

This is a table of my husband's blood tests going back to 11/10/2006. Jim's unexpected heart attack occurred on 1/8/2008. The test results taken before the heart attack have a shaded background.

Date of test	6/18/08	4/2/08	2/26/08	1/8/2008	11/10/06
Cholesterol	82		96	169	143
Triglycerides	59		109	93	108
HDL Cholesterol	40		27	41	38
LDL Cholesterol	30	45	47	109	83
LDL/HDL Ratio	0.8		1.7
Hemoglobin A1c	5.5	5.5
Lipoprotein (a)		3
Homocysteine		18.9
C-Reactive		0.18
Hemoglobin	5.5	5.5			16
Glucose	111	109		117	104
CK				240
Platelets				172	166

Jim is currently taking Crestor (lowers cholesterol), Coreg (betablocker), Plavix (prevents blood clots), Niaspan (raises HDL level) and PantoPrazole (to heal ulcers and protect stomach from Niaspan and Plavix) daily. His blood pressure runs around 105/68. He walks a treadmill for 40-50 minutes 4 times/week, walks or swims or bikes 3 days/week. He is doing very well.

vadkins

Heart Attack: Which Type of Exercise Is Best?

When Jim and I met with his cardiologist last week, I asked the doctor if taking spinning classes would be as good for Jim's cardiac fitness as walking on a treadmill. The doctor replied that walking on the treadmill at a 10-12% grade at 2.7-3 miles/hour is one of the best ways to strengthen the heart. So clearly, it is best for Jim that he keeps on walking the treadmill, which Jim does for 50 minutes 3-4 times/week.

I also mentioned to the doctor that we were swimming 1/2 mile each Saturday and Sunday. The doc was impressed, and he told us that swimming is almost the perfect exercise for the heart. It may be a little better for Jim because the upper body is strengthened with swimming, more than it is on the treadmill.

The doctor told Jim that his weight is no longer too high. (Jim now weighs 186 pounds in the morning.) Now Jim needs to develop more muscle tone and to have his body fat measured. His body fat needs to be less than 18%.

vadkins
QT Monster Blog Home

Heart Attack: Cardiologist Changes Meds to Help Heal Ulcers

About 2 weeks ago, Jim had an endoscopy which confirmed that he has 3 partially healed stomach ulcers. His gastroenterologist doubled his dose of pantoprazole to 40mg twice a day, instead of once a day. Jim is to take the increased dose until the ulcers are healed. After the ulcers are healed, he will then return to the 40mg of pantoprazole/day for the rest of his life. Jim will have to continue taking the pantoprazole so that the ulcers do not recur. The doctor is convinced that the ulcers have been caused by the heart medications that Jim must take for the rest of his life.

On Tuesday we met with Jim's cardiologist to see what he has to say about the ulcers. As usual, the doctor was extremely helpful, here's what he had to say:

• Aspirin and Niaspan are the 2 heart medications that Jim takes daily, that are most likely to have caused the ulcers
• Jim was taken off of aspirin all together. Because Jim's stent is a bare metal stent (as opposed to a drug eluting stent aka DES), he could have been taken off of aspirin 6 weeks after the stent was inserted in his heart via angioplasty.
• Niaspan dosage cut in half. Niaspan also tends to cause stomach ulcers. Jim began taking Niaspan a few weeks before he started to have the chest pains which turned out to be ulcer symptoms (that was in June). Jim has been taking 1000mg of niaspan a day, so he will now take 500mg of niaspan a day. The reason that Jim began taking niaspan was because his HDL cholesterol (the good cholesterol) had dropped to 27 because of the statin drug (Crestor) he's been taking. After taking niaspan for 3 months, the HDL level rose to 40, and 40 is the minimum acceptable HDL level for a male.
• Pantoprazole can negate/lessen the effectiveness of Plavix if taken at the same time of day. Fortunately, this is easy to fix - Jim just needs to not take the two doses of pantoprazole at the time that he takes Plavix each day. (Plavix is the medicine that keeps the stent in Jim's heart clear of obstructions and he must take it every single day for the rest of his life.)

P.S. Jim's blood pressure was measured as 104/64. His weight was 5 pounds less than it was 3 months ago when he last saw the doctor.

vadkins
QT Monster Blog Home

Heart Attack: Plavix/Aspirin Cause Ulcers

On the drive to the airport to leave on our family vacation in June, Jim tells us that he has chest pains. Since my husband, Jim, had had a heart attack on January 8th, this was very serious. While walking to the airline ticketing counter and rolling our luggage behind us, Jim spoke to his cardiologist's office. The cardiologist told him that he should go to an Emergency Room to have the chest pains checked out. One family member decided to go ahead and fly to our vacation destination. The rest of us, drove Jim to the local ER.

One thing we have learned, if a heart attack survivor goes to an EM with chest pains, they will have to spend at least 12-18 hours in the hospital. It takes that long to check the troponin blood levels, to see whether there has been a heart attack. Jim's troponin levels were not elevated which confirms that his chest pains were not the result of another heart attack. Jim spent the night at the hospital so that he could have a echocardiogram stress test the next morning. (That evening, I flew to our vacation destination, since it looked like Jim's chest pains were the result of acid reflux.)

The next morning, Jim passed the echocardiogram with flying colors. Jim was able to exercise on the treadmill for 8 minutes with his pulse at 165 beats/minute. The doctor prescribed a PPI (proton pump inhibitor), Protonix (the generic name is pantoprozole), to reduce the amount of stomach acid and thus reduce Jim's pain from acid reflux. Jim then flew to Williamsburg to join us on vacation. Over the following weeks and months, Jim continued to take Pantoprozole 40mg daily. He also took Tums as needed to reduce the pain. The acid reflux pains subsided somewhat.

We saw our primary care physician when we returned home from vacation. She ordered an endoscopy, to confirm whether Jim's esophagus showed signs of irritation from acid reflux.

Last week Jim's gastroenterologist did the endoscopy. The doctor saw 3 small non-bleeding ulcers in Jim's stomach. The biopsy indicates that the ulcers are partially healed, and are non-cancerous. The pantoprozole that has been taking, is probably the reason that the ulcers are partially healed. These stomach ulcers need to completely heal, because stomach ulcers are more likely to become cancerous than duodenal ulcers are. (2% of stomach ulcers become cancerous.) To heal the ulcers, the doctor told Jim to double his dose of pantoprozole - to take 40mg in the morning and 40mg at night. In 3 months, she will perform another endoscopy to see if the ulcers have completely healed.

Because these ulcers were most likely caused by the Plavix and aspirin that Jim must take daily (since he is a heart attack survivor and has a stent in his heart), he will have to take 40mg pantoprozole for the rest of his life so the ulcers don't recur. She recommended that Jim take Malox for stomach discomfort through the day. When Jim needs to take a pain reliever, he will need to use only Tylenol, not Motrin or Ibuprofen.

As far as lifestyle/diet changes, the doctor told Jim that he can continue to eat as he normally does but that he might want to eliminate citrus juices and raw vegetables from his diet until the ulcers are healed. Citrus juices can cause acid to enter the esophagus. Raw vegetables cause a lot of gas when they are digested.

At the doctor's office Jim's blood pressure was 110/70, his pulse was 64 and his weight was 187.5 lbs.

I have posted all of Jim's test results from his hospital stay in June below the jump.

vadkins
QT Monster Blog Home

Heart Attack: 9 Predictive Risk Factors

A recent study of 29,000 people from all over the world, half of whom have previously had a heart attack, lists 9 risk factors, in order of importance, for heart attack:

1. Increased LDL/HDL ratios (i.e.,, elevated LDL and low HDL levels)
2. Smoking
3. Diabetes
4. Hypertension
5. Abdominal obesity
6. Psychosocial (i.e., stress or depression)
7. Failure to eat fruits and vegetables daily
8. Failure to exercise
9. Failure to drink any alcohol

Now let's compare these risk factors to my husband, Jim's, situation at the time of his heart attack on January 8, 2008:

1. Increased LDL/HDL ratios - At the time of the heart attack, Jim's total cholesterol was 169 which is considered low risk. His HDL (the good cholesterol) was 41 which is considered low risk. His LDL (the bad cholesterol) level was 109 which is considered low risk. Doing the math, Jim's LDL/HDL ratio = 109/41 = 2.65. This result is low risk for heart attack. So Jim did not have increased LDL/HDL ratios.
2. Smoking - Jim has never smoked anything in his entire life.
3. Diabetes - Jim was not, and is not, diabetic.
4. Hypertension - Jim's blood pressure was not high at the time of the heart attack, and he has never been diagnosed with high blood pressure.
5. Abdominal obesity - Jim's waist measurement at the time of the heart attack was 42".
6. Psychosocial - Jim was not in a stressed or depressed state at the time of the heart attack.
7. Failure to eat fruits and vegetables daily - Jim has always eaten lots of fruits and vegetables.
8. Failure to exercise - Jim had been living a sedentary lifestyle at the time of the heart attack.
9. Failure to drink any alcohol - Jim has never drunk alcohol.

So, of these 9 heart attack risk factors, Jim had 3 at the time of the heart attack: abdominal obesity, failure to exercise and failure to drink any alcohol. Of these 9 risk factors the first 2 are the most significant:

The first two of these risk factors (bad lipid readings and smoking) predicted 2/3 of all heart attacks.

But this does not apply in Jim's case.

Jim has reduced his weight from 225 lbs. to 188 lbs. since the time of the heart attack in January. His waist has reduced from 42" to 35". He also exercises daily. The only risk factor he now has is the failure to drink alcohol, and that's not going to change, because Jim just doesn't like it.

vadkins
QT Monster Blog Home

Heart Attack: Exercise at High Altitude

My husband. a heart attack survivor, was in Denver on business last week. He was exercising on the treadmill at his hotel fitness center as usual. Jim wears a heart rate monitor when he exercises. About twenty minutes into his workout, his pulse suddenly rose from 120 bpm to 155 bpm. Jim stopped exercising and cooled down. His pulse returned to normal. Why had his pulse shot up so quickly? He called his cardiologist back home and was told to continue monitoring his heart rate. If his pulse stayed normal, then he was safe to fly back home the following day. Jim's pulse has remained normal since. The morning after he returned home, he went back to the cardiac rehab center for his monthly maintenance workout session. He was monitored for the 50 minute workout as usual. The results of this exercise session were excellent. Jim's heart stayed in his acceptable target heart rate range, and the monitors indicated that his heart had strengthened since he had graduated from the cardiac rehab program the month before. And Jim's pulse did not race during this workout session.

The nurse who leads the rehab staff told Jim that his racing pulse rate in Denver was most likely caused by the high elevation of that city. She says that it takes a full week to acclimate to a rise in elevation. He should have exercised at only an 4 percent grade on the treadmill instead of his usual 8 percent grade.

vadkins

Heart Attack: What is the Karvonen Formula?

My husband, a 57 year old cardiac patient and heart attack survivor, finished 36 sessions of cardiac rehab last week. The cardiac rehab staff gave him a fitness program to follow at home. (Jim will attend cardiac rehab once/month on a maintenance program though.) Part of the at home fitness program is to exercise at an aerobic heart rate training zone. To do that, he was told to calculate his target heart rate using the Karvonen formula. So what is the Karvonen formula? I had no idea, until I found this web page that defines it as:

The Karvonen Formula is a method that uses your age and fitness level to determine your target heart rate training zones. Developed by Dr. M Karvonen, the Karvonen Formula offers a more personalized number than the standard equation and is considered the most accurate means of determining heart rate.

The formula is: (MHR - RHR x (.60 & .80) +RHR) where MHR is your maximum heart rate and RHR is your resting heart rate.

The resting heart rate is calculated by measuring your heart rate before getting out of bed in the morning, each day, for 3 days. Add the 3 resting heart rates together and divide that sum by 3 so that you have your average resting heart rate. (As fitness improves the resting heart rate usually goes down.)

The maximum heart rate can be determined by a stress test, or by subtracting your age from 220.

For example, if an individual has a resting heart rate of 63 and is 45 years old then their maximum heart rate is 220-45=175. Using the Karvonen Formula to calculate their 60% target heart rate:
(175 - 63 x .60) + 63 = 130

and, using the same formula to calculate their 80% target heart rate:
(175 - 63 x .80) + 63 = 152

So that person's target heart rate would be 130-152.

UPDATE: Let's apply the Karvonen Formula to Jim, specifically. Jim's average resting heart rate is 67 bpm. His maximum heart rate is 165 bpm (from a stress test he passed in June).

So Jim's 60% target heart rate formula is:
(165-67x.60) + 67 = 125.8

And Jim's 80% target heart rate formula is:
(165-67x.80) + 67 = 145.4

Therefore, Jim stregthens his heart when he exercises with a heart rate between 125.8 and 145.4.

Cardiac Rehab Fitness Improvement
Cardiac Rehab Outcome Objectives for Maintenance Program
Exercise Guidelines for Home Exercise, From Cardiac Rehab
What Is Hyperlipidemia?

vadkins

Heart Attack: Weight Lifting Program From Cardiac Rehab

Part of the materials that my husband was given yesterday by the cardiac rehab staff was a Weight Training Instruction sheet. The program that they recommend he do at home is simple, just a set of 5 different weight lifting exercises:

 

Bicep Curls:

 

1. Stand erect, back straight, head up, feet shoulder-width apart, palms out
2. Start with weights at arms' length against upper thighs
3. Curl bar up in semicircular motion until forearms touch biceps
4. Keep upper arms close to sides
5. Lower to starting position using same path
6. Exhale up, inhale down

 

Upright Rows:

 

1. Stand erect, back straight, head up, feet shoulder-width apart, palms in
2. Start with weight at arms' length against upper thighs
3. Raise weights up to chest keeping them close to your body while lifting elbows directly to the side until they are at shoulder height
4. Lower to starting position using same path
5. Exhale up, inhale down

 

Tricep Presses:

 

1. Lunge on one foot supporting your weight on the front leg
2. Lift one arm (with the weight) up in back so the elbow and shoulder are aligned and the weight is in at the chest
3. Extend the weight backward for 2 seconds, being sure to keep the upper arm completely still
4. Return to starting position in 3 seconds, while keeping the elbow up
5. Exhale out, inhale in

 

Chest Presses:

 

1. Stand erect, knees bent, feet shoulder-width apart, upper arms to the side and parallel to the floor, elbows at a 90 degree angle
2. For 2 seconds bring the weights and elbows together until they lightly touch, being careful not to let the upper arm droop
3. Return to starting position in 3 seconds
4. Exhale in, inhale out

 

Chest Lift:

 

1. Stand erect, knees bent, feet shoulder-width apart, both hands holding the bottom of one weight. Keep the entire forearms together.
2. Gently lift the weight as high as possible while keeping the elbows together
3. Return to starting position
4. Exhale up, inhale down

 

Training Schedule:

 

Week	Repetitions	Sets	Weight (lbs)
1	10-12	1	1-3
2	10-12	1	1-3
3	10-12	2	1-3
4	10-12	2	1-3
5	10-12	3	1-3
6	10-12	3	1-3
7	10-12	3	1-3
8	10-12	3	1-3
9	10-12	2	3-5
10	10-12	2	3-5
11	10-12	3	3-5
12	10-12	3	3-5
13	12-15	3	3-5
14	12-15	3	3-5
15	12-15	2	5-10
16	12-15	2	5-10
17	12-15	3	5-10
18	12-15	3	5-10
19	12-15	3	5-10
20	12-15	3	5-10

 

Happy Training!

 

Related Cardiac Rehab Posts:

Cardiac Rehab Fitness Improvement

Cardiac Rehab Outcome Objectives for Maintenance Program

Exercise Guidelines for Home Exercise, From Cardiac Rehab

What Is Hyperlipidemia?
What Is the Karvonen Formula?

 

vadkins

Heart Attack: Cardiac Rehab Fitness Improvement

Jim finished 36 cardiac rehab sessions yesterday. In this cardiac rehab program he went to rehab 3 times/week, early in the morning. Overall, Jim was able to greatly improve his fitness level by going through this program. There were periods when Jim had to travel on business, and one week when we went away for a family vacation. But when he was out of town, Jim made sure to continue exercising.

 

Jim began rehab on April 1, 2008 and he finished on July 24, 2008. Here is a comparison between his first and last rehab sessions:

 

Cardiac Rehab Results	April 4, 2008 First rehab session	July 24 , 2008 First rehab session	Difference Between First and Last Rehab Sessions
Heart Rate	64	61	-3
Weight	205	196	-9
Training Heart Rate	94-104	107-115	(+) 13-11
Systolic Blood Pressure	116	110	-6
Diastolic Blood Pressure	62	70	8
Time on Treadmill	25	35	10
Workload	Speed 2.9, Level Grade	Speed 3.3, Grade 8.0	Speed: .4, Level: 8
Heart Rate	120	118	-2
METS	3.2	7.2	4
Rate of Perceived Exertion (RPE)	2	3	1
% Training Heart Rate	121%	106%	-15%
Systolic Blood Pressure	128	120	-8
Diastolic Blood Pressure	62	60	-2
Recovery Time	1.73	1.85	.12
Recovery Heart Rate	67	70	3
Recovery % Training Heart Rate	68%	63%	-5%
Recovery Systolic BP	92	98	6
Recovery Diastolic BP	60	66	6

 

Related Cardiac Rehab Posts:

Weight Lifting Program for Cardiac Rehab

Cardiac Rehab Outcome Objectives for Maintenance Program

Exercise Guidelines for Home Exercise, From Cardiac Rehab

What Is Hyperlipidemia?
What Is the Karvonen Formula?

 

vadkins

Heart Attack: Cardiac Rehab Outcome Objectives for Maintenance Program

My husband finished his 36 sessions of cardiac rehab this week. This is the list of Cardiac Rehab Outcome Objectives for Maintenance Program that the rehab staff gave him:

1. Participant will exercise within target heart rate range that has been prescribed for him/her in outpatient cardiac rehabilitation, which will also include stretches, warm up and cool down before and after exercise, 3 to 5 days a week, 30 to 60 minutes per day.
2. Participant will practice self monitoring to determine levels of intensity during exercise by taking pulse rate, observing rate of perceived exertion, and by looking at previous day performance.
3. Participant will follow a low fat, low cholesterol diet.
4. Participant will not use tobacco products.
5. Participant will manage stress in their daily lives.
6. Participant will take medication as prescribed by their physician in a timely and consistent manner.
7. Participant will maintain an optimum body weight.
8. Participant will manage hypertension/diabetes through diet, medication, and exercise as prescribed by their physician.
9. Participant will maintain vocational objectives.

 

Related Cardiac Rehab Posts:

Weight Lifting Program for Cardiac Rehab

Cardiac Rehab Fitness Improvement

Exercise Guidelines for Home Exercise, From Cardiac Rehab

What Is Hyperlipidemia?
What Is the Karvonen Formula?

 

vadkins

Heart Attack: Exercise Guidelines for Home Exercise, From Cardiac Rehab

These are the home exercise guidelines that the cardiac rehab program gave my husband after his last rehab session:

 

Prepare yourself with proper diet, clothing, equipment and workout conditions.

 

1. Diet
   -Wait at least 2 hours after a heavy meal before exercising vigorously. The reason for this is that for at least 1 1/2 hours following a meal, blood is diverted from different parts of the body to the stomach to aid in digestion.
   -Replace fluids lost during exercise due to seating, and avoid ice-cold drinks immediately after exercise. Drink plenty of cool water before, during, and after your workout.
2. Clothing
   -2 pair of socks may help avoid blisters.
   -There are many types of shoes for different physical activities. Be choosey, and get some expert advice on shoes. Correct, well-fitting shoes can prevent strains, blisters, sprains and sore legs and ankles. Good shoes may mean the difference between enjoying your program and dropping out.
   -If your legs chafe around the thighs, rub vaseline on them prior to workout.
   -Most women find it more comfortable to wear a good supportive bra during exercise. Sports bras are excellent
   -Wear some form of identification, in case of accident or illness while exercising.
   -If you are outdoors and it is cold, wear a hooded sweatshirt or cap that comes over the ears.
   -Do not put on too many clothes. They will hamper your movements and cause you to perspire excessively, making it hard to avoid chilling after exercise.
3. Equipment: Make sure the equipment you are using is in proper working order. The use of poorly maintained equipment may cause injury.
4. Workout Conditions
   -If the temperature is above 90 degrees with 60 percent humidity, do not exercise strenuously. Morning or evening workouts may be the solution for the extreme heat, or you may want to swim for your exercise. Walking in a shopping mall or cycling on an exercise bike at home are other alternatives.
   -When it is extremely cold, below zero degrees, a mask or scarf can be worn over the face.

 

Exercise Prescription: Your exercise prescription is based on the F.I.T. principle, consisting of 3 main things:

 

1. F - Frequency:  How often you are to exercise.
2. I - Intensity:  How fast to walk or how much resistance to use on the bicycle. (In order to measure the intensity at which you are exercising, you may rely on your rate of perceived exertion (RPE), the "talk test," and your heart rate. Your RPE should be no higher than 5/10, or moderately strong. The "talk test" is simply done by talking as you exercise. If you are too breathless to talk, SLOW DOWN. Finally, your heart rate can be measured by checking your pulse and keeping it within your target heart rate range.)
3. T - Time: The length of time for an individual exercise session.

 

Target Heart Rate:  At the completion of the rehabilitation, you will know the target heart rate range you should be within while exercising. Your pulse should be taken before, during, and after exercise and recorded in your exercise diary.

 

Your Pulse.

 

1. Get a wristwatch with a second hand and place it where you can easily see it.
2. With a mild to moderate pressure find your pulse on your neck or wrist. Count the pulse beats for 10 seconds, starting the count with 0, then multiply by six.
3. Record the rate in terms of how many times your heart beats in one minute.

 

Warm Up:  A warm up should be thorough, adequate, and precede every type of workout. A combination of flexibility and stretching exercises can prevent cramps, strains, sprains, and even heart problems. Slow whole-body activities should also be included in the warm-up to allow the body to adjust from resting to exercise conditions. Follow the routine that you learned in the rehabilitation program. These exercises should be done slowly and gently. Do not bounce with stretching exercises.

 

Signs of Overexertion

 

1. Do not push yourself into trouble. A little enthusiasm and drive is needed, but too much, too soon, will only lead to sore muscle and discouragement.
2. Here are some immediate signs of overexertion to look for during and after exercise:
   -Tightness or pain in the chest, severe breathlessness, light-headedness, dizziness, loss of muscle control and nausea. When you experience any of these symptoms, STOP EXERCISING IMMEDIATELY. If the symptoms do not subside, consult your physician.
3. If you find yourself over fatigued during the day after exercising, if may be that you are exercising too hard.
4. Ten (10) minutes after you stop exercising, if you are still short of breath you are overdoing it.

 

Cool Down

 

1. Strenuous exercise causes the muscles to demand large amounts of oxygen. The heart responds by beating harder and faster and by sending greater volumes of oxygen-carrying blood to those hard working muscles, especially the thigh and calf muscles. The squeezing action of those muscles and one way valves in the leg veins shunt the used blood back to the heart. If strenuous exercise is suddenly stopped, the squeezing action of the muscles also stops and blood tends to pool in the legs. This pooling causes the brain and heart to be deprived of blood and the much needed oxygen. When this happens, fainting and serious heart problems can result. This problem is further complicated if the exerciser enters a hot shower or sauna without a cool down period. Heat opens up (dilates) the skin's small vessels and allows blood to flow to the skin's surface in an effort to cool down the body. This creates an additional lack of surface in an effort to cool down the body. This creates an additional lack of blood to the vital centers with sometimes serious consequences.
   As you can see, a cool down period is very important. It allows your body to maintain an adequate blood and oxygen supply to the vital organs and to gradually adjust to a resting or non-exercising state. Your minimum cool down time should be 8-10 minutes.
   A cool down will contain a slow aerobic activity. Whatever activity you have chosen, the important thing is TAPER OFF GRADUALLY; do not suddenly stop. Follow this slow aerobic activity with a series of stretching exercises which may prevent sore muscles and increase flexibility. The same series of exercises prescribed for the "warm-up" period is ideal for the "cool-down" period.

 

Related Cardiac Rehab Posts:

Weight Lifting Program for Cardiac Rehab

Cardiac Rehab Fitness Improvement

Cardiac Rehab Outcome Objectives for Maintenance Program

What Is Hyperlipidemia?
What Is the Karvonen Formula?

 

vadkins

Heart Attack: What Is Hyperlipidemia?

After my husband suffered a heart attack on January 8, 2008, a bare metal stent was inserted into the main artery in his heart (known as the LAD). In April he began his cardiac rehabilitation program. The cardiac rehab report lists his primary diagnosis as: SA/P MI, PTCA w/stent, HTN, hyperlipidemia (see definitions below in this post). We are kind of puzzled some of this diagnosis because Jim has never had hypertension or hyperlipidemia-unless having an LDL level of 109 qualifies as hyperlipidemia. We are thinking that Jim's cardiologist directed the cardiac rehab center to put Jim on a cardiac rehab program that is effective for a cardiac patient with this diagnosis.

 

Not knowing was hyperlipidemia is, I did just a little internet searching and found that hyperlipidemia is:

 

Lipid is the scientific term for fats in the blood. At proper levels, lipids perform important functions in your body, but can cause health problems if they are present in excess. The term hyperlipidemia means high lipid levels. Hyperlipidemia includes several conditions, but it usually means that you have high cholesterol and high triglyceride levels.

 

Definitions of the diagnosis listed above in the fits paragraph:

 

• SA stands for stable angina
• MI stands for myocardial infarction/heart attack
• PTCA stands for percutanueous transluminal coronary angioplasty  (percutanueous indicates that the blood vessel is accessed via a needle through the skin, transluminal means that this procedure is performed through the blood vessel, coronary is the artery that is being treated, angioplasty is the reshaping of the blood vessel)
• HTN stands for hypertension

 

Related Cardiac Rehab Posts:

Weight Lifting Program for Cardiac Rehab

Cardiac Rehab Fitness Improvement

Cardiac Rehab Outcome Objectives for Maintenance Program

Exercise Guidelines for Home Exercise, From Cardiac Rehab
What Is the Karvonen Formula?

 

vadkins

Heart Attack: What Is the Risk of Stent Restenosis?

My husband had a stent placed in his major coronary artery the day after the heart attack on January 8, 2008. He is now doing very well. Since his heart attack we are always looking for information as to what to look for as far as possible problems/complications are concerned. During the course of our research, we have noticed some reports restenosis of stents (). Today I came across this article on a medhelp.com forum that asks some questions that Jim and I have wondered about, that sounds similar to Jim's case. The questions that are asked at this forum are answered by doctors at the Cleveland Clinic.

The forum questioner asks in part:

...the need to perform another PTCA on the lesion due to restenosis is about 10-15% by 6 months. When and how would restenosis be noticeable to me? What tests could my cardiologist run to determine if restenosis is happening? Finally, is there anything I should be doing or taking, medication or supplement, to help myself and reduce the risk of complication?

The doctor's reply is:

Restenosis within a stent is caused by proliferation of the intimal cells which line the inside wall of the artery. This process occurs in approximately 15% of patients and is usually identified by a recurrence of angina or the presence of ischemia on a stress test. Routine stress tests after a stent procedure are not recommended but many cardiologists prefer to perform such a test 3-6 months after the procedure to ensure that restenosis hasn't occurred. Many different therapies have been tested to prevent restensosis, but there are no medications that you could take that have been shown to be effective. However, to prevent the progression of atherosclerosis in areas other than the stented segment, you should exercise daily, eat a low-fat and low-cholesterol diet, and avoid tobacco.

vadkins

Excellent Heart Attack Prevention Book

My husband and I started reading Hidden Causes of Heart Attack and Stroke, Inflammation, Cardiology's New Frontier, a book by Christian Wilde, and we highly recommend it. Since my husband's heart attack on January 8, 2008, we have been confounded as to why it happened. Jim's cholesterol at the time of the heart attack was 169, and he has never smoked or drunk alcohol. He was not, and is not, diabetic. He did have a waist measurement, at that time, of 42" and he was 35 pounds overweight. Regardless, our primary care physician was shocked that Jim had had a heart attack.

Reading through t his book by Christian Wilde is answering a lot of our questions as to why Jim had the heart attack. We haven't yet finished reading the book, but from what we have read, it appears that there are many hidden risk factors for heart attack that we did not know about. And it looks like what modern medicine has decided are healthy upper limits for cholesterol, triglycerides, etc. are actually too high. For example, I learned from reading this book that physicians very often consider an overall cholesterol level of 200-220 healthy. But the upper limit for overall cholesterol should probably be more like 150-160. According to the Framingham study, that's cited in this book, of people with cholesterol levels under 150-NONE of these people suffered any heart attacks or cardiac episodes over many years! And this is only a sample of what we are learning by reading this book.

I will be charting/analyzing my husband's medical tests in the next week or two. I will then post those results.

vadkins

Heart Attack: Trans Fats, the Dirty Little Secret

This post expands on my previous post which summarized the advice that a dietician gave us during one of my husband's cardiac rehab sessions.

During my husband's recovery from a heart attack in January, one of the facts that was repeatedly pounded into our heads by the cardiology staff at the Boston Medical Center, was that trans fats are really really bad for us. Eating trans fats is like injecting plaque plugs directly into our arteries. I've often wondered since then, why the medical staff made such a point of it though, because I have yet to find one food for sale that lists any trans fat content.

Well the dietician told us that a food manufacturer can put trans fats in a food product, but not be required to list it in the nutritional labeling. If a food has less than .5 grams in a serving, then that item does not have to be listed on the nutritional labeling list. That means that a food can contain .4 grams of trans fats, can say on the label Trans Fats: 0.

The rub in this is that, according to the dietician, people should not consume more than 2 grams of trans fats per day. The limit is so low because it is so dangerous for us. So, if we eat 6 servings a day of foods that each contain .4 grams of trans fats, then we are exceeding the amount of trans fats that we can safely ingest.

So the dietician recommends that we do what she does: always read the list of ingredients in a food. If the list contains anything that says "hydrogenated", don't eat it.

Here's what the FDA has on their web site about trans fats:

Q: Is it possible for a food product to list the amount of trans fat as 0 g on the Nutrition Facts panel if the ingredient list indicates that it contains "partially hydrogenated vegetable oil?"

A: Yes. Food manufacturers are allowed to list amounts of trans fat with less than 0.5 gram (1/2 g) as 0 (zero) on the Nutrition Facts panel. As a result, consumers may see a few products that list 0 gram trans fat on the label, while the ingredient list will have "shortening" or "partially hydrogenated vegetable oil" on it. This means the food contains very small amounts (less than 0.5 g) of trans fat per serving.

vadkins

Heart Attack: Dietician's Recommendation

My husband has been in cardiac rehabilitation for about 7 weeks now. He goes to cardiac rehab to exercise 3 mornings a week. During one of his rehab sessions, a dietician came by to answer questions about how they, cardiac patients, should be eating. The foods that cardiac patients eat is vitally important to survival after a heart attack, because heart disease is a life style disease.

Here is summary of what we were told by the dietician:

• Can HDL (the good cholesterol) levels be raised by diet alone?

No. The only way to raise HDL levels is by regular, aerobic exercise.

• It is best to eat all kinds of heart healthy foods. Eat the fruits and vegetables that are in season.
• How much salt can a heart attack survivor eat daily, if they do not have high blood pressure?

  If a heart attack survivor does not have high blood pressure, then they can consume up to 4000 mg/day. Heart attack survivors who do have high blood pressure issues need to limit their salt/sodium consumption to 2400 mg/day.

• Trans fats are really bad for us-don't eat them.

We learned that it's very easy to be eating trans fats and not know it, because of the FDA's labeling regulations. I've expanded on this in this post.

vadkins

Heart Attack: Blood Pressure Still Normal

Last month, my husband who is a heart attack survivor, had a few dizzy spells one evening. We went to the Emergency Room to make sure that he wasn't having a stroke or another heart attack. He was kept in the hospital for about 12 hours so they could measure his blood troponin levels, and make sure that he hadn't had another heart attack. The blood tests confirmed that he had not had another heart attack, and that they did not find anything to explain the dizziness. I mentioned that all of the prescription medicines he is taking list dizziness as a side effect, and that his blood pressure had been running pretty low-around 110/60.

Jim has never had high blood pressure, but after the heart attack he had been given Lisinopril to take every day for high blood pressure. It's standard medical precedure to prescribe blood pressure medicine to patients after a heart attack. So I asked the cardiologist if Jim could take less Lisinopril or stop taking it all together. The cardiologist agreed, and told Jim to stop taking Lisinopril.

That was about a month ago, and happily Jim's blood pressure remains normal or below normal-and he's not taking any blood pressure medication.

vadkins

Heart Attack - Benign Dizziness and a Short Detour to the Hospital

On Wednesday evening my husband, Jim, had a few dizzy spells beginning at about 10:15 PM. He had about 4 dizzy spells that lasted only about 30 seconds each. The spells were about 10 minutes apart. One time he got dizzy when he stood up from a chair. During the other dizzy spells he was sitting in the living room and using his laptop computer.

This was the first time that Jim has felt dizzy since his heart attack on January 8, 2008. We had no idea why this was happening. He called his cardiologist's office and the doctor who was on-call for his cardiologist said that the dizziness might be caused by one of the heart medications that he is taking. Jim's pulse was running between 55 and 85 that evening, which is normal for him. His blood pressure was the usual 100/60. That's what his blood pressure has been running since the heart attack when he was put on a 5 mg dose of Lisinopril to lower his blood pressure. (Before the heart attack Jim's blood pressure had been running about 120/80, so high blood pressure has not really been one of his problems.) The doctor said that the dizziness could be caused by his medications. That was probably the case since his pulse was normal and steady. He said that a low pulse was about 40 bpm. The doctor told Jim that he could go to the Emergency Room and have his heart checked, but that it probably wasn't necessary, and that he should call his cardiologist the next day. If Jim felt anymore dizziness that night, he should go to the ER.

About an hour later, Jim felt dizzy again for about 30 seconds. At that point we decided that he'd better go to the ER to get checked out. The hospital is only about 5 miles from our house, so we drove there.

Within only about 30 minutes after arriving, Jim had been admitted and was in an examining room. The hospital had none of Jim's medical records since his heart attack occurred while he was traveling on business in Massachusetts, and he was treated at Boston Medical Center. So we verbally gave the ER doctor Jim's heart attack history and how that had been treated. The doctor ordered blood work for Jim, a chest x-ray and an EKG. All were normal. But the doctor told us that he would probably admit Jim so that they could measure the troponin levels in his blood for the next 12 to 18 hours. (Troponin is an enzyme in the blood that, if elevated, indicates that the patient has had heart damage, usually from a heart attack.)

After about 2 hours in the ER, one of our primary care physician's partners came by to examine Jim. He was especially checking to see if Jim had any signs of having had a mini-stroke. Thankfully, Jim did not. And Jim had not had any more dizzy spells in about 4 hours.

At 4 AM I went home, confident that Jim was really OK and in very good hands. By about 1 PM the next afternoon, all of Jim's blood tests had normal troponin levels, so he had not had another heart attack. Jim's cardiologist came by and said that all of Jim's tests were fine. He said that the dizziness could have been caused by the blood pressure lowering medicine, Lisinopril. He told Jim to stop taking that medication, and to keep an eye on his blood pressure. If Jim's blood pressure rises above 120/80, then he should call his cardiologist.

Today was Jim's first day since the heart attack when he did not take the Lisinopril. Tonight his blood pressure is 115/65, so it is a little higher than it had been when he was taking Lisinopril. But Jim has had no more dizziness either.

vadkins

Heart Attack - Cardiologist Appointment

Last week Jim had his second appointment with his cardiologist since his heart attack on 1/8/2008. The appointment began, as most doctor appointments do, with the nurse checking his weight, blood pressure, pulse and a review of the medicines Jim is now taking.

The cardiologist came in to the examining room after only about a 5 minute wait. He spent about 15 minutes with us. After he listened to Jim's heart, he reviewed the blood test results. Jim's test results showed that Jim has a low relative risk for a future cardiovascular event. This is measured as the C-Reactive Cardiac Protein. Jim's result for this is 0.18 (less than 1.00 is low, 1.00-3.00 is average, greater than 3.00 is high). The A1C lab test (see the Heart Attack: Tests and Diagnosis category of this blog for a definition) for diabetes, which was ordered by our primary care physician, shows that Jim is not diabetic (good news!). The A1C result is 5.5 (normal range is 4.8-5.9). The lipoprotein result is 3 mg/dL (desirable range is less than 20, borderline high risk is 20-30, high risk is 31-50 and very high risk is more than 50; values greater than 30 may indicate independent risk factor for CHD (coronary heart disease)).

So far, so good-all of the blood test results are excellent and in normal range. But Jim's homocysteine (plasma homocysteine, P) result is 18.9 umol/L. This is high as the normal range is 0.0-15.0. The cardiologist tells us that, fortunately, it's not difficult to lower the homocysteine level. It's treated with over-the-counter vitamin supplements. Jim needs to take a vitamin supplement each day. The supplement must contain 1 mg of folic acid plus vitamin B6 and vitamin B12. The doctor told us that eating a handful of almonds and 2 tablespoons of olive oil per day will help to decrease the homocysteine level.

Then the cardiologist reviewed the lipid panel test results that our primary care physician had reviewed with us a few weeks ago. The test shows an overall cholesterol level of 96 mg/dL (100-199 is the normal range), triglycerides level of 109 mg/dL (1-149 is the normal range), HDL cholesterol level is 27 mg/dL (40-59 is the normal range), VLDL cholesterol cal level of  22 mg/dL (5-40 is the normal range), LDL cholesterol calc level is 47 mg/dL (1-99 is the normal range, for cardiac patients this needs to be under 70), and the LDL/HDL ratio is 1.7 (ratio units is 0.0-3.6). Here's a summary post of the daily medication regime.

The cardiologist says that Jim's HDL cholesterol level is very low (27) and it needs to be above 40! To do that, he changed Jim's medications. He told us to cut the dosage of Crestor (a cholesterol lowering, statin drug) in half (or to 20 mg/day), and that Jim needs to begin taking Niaspan 500 mg, once a day in the evening. Niaspan is difficult for many people to take because it, not infrequently, causes flushing. The nurse told Jim to take his daily aspirin 1/2 hour before taking Niaspan. And he is to eat applesauce just before taking the Niaspan pill. The pectin in the applesauce helps to reduce or prevent completely the flushing. And the doctor will be doubling the Niaspan dosage after 30 days.

The cardiologist and the professionals at the cardiac rehab center tell us that Jim's very low HDL cholesterol level may well be caused by heredity. The doctor says that vitamin B3 can help raise the HDL level.

vadkins

Heart Attack - Cardiologist Prescription to Raise HDL Cholesterol

One of the most important action items from my husband's cardiologist appointment last week, was to follow the doctor's prescriptions for getting Jim's HDL levels up. Here's what cardiologist says to do to get the HDL cholesterol level increased:

• Decrease the Crestor (cholesterol reduction medicine) dosage in half, to 20 mg
• Take 400 mg daily of Niaspan. Niaspan is said to be very effective in raising HDL cholesterol levels. But many people have had problems taking Niaspan because it often causes flushing. The doctor's nurse told Jim that he should take the Niaspan at night, and with applesauce. She said that something about the pectin in the applesauce helps prevent the flushing. And it's very important that Jim take his daily aspirin 1/2 hour before he takes the Niaspan. Jim took the Niaspan as the nurse directed, and he has had no flushing at all-except for the one night that he decided to take Niaspan without eating the applesauce. Sure enough, a couple hours later he flushed-and he described the flushing as fairly obnoxious.

vadkins

Heart Attack - Cardiologist Changes Medication Regimen Again

Jim met with his cardiologist last week , and because of blood test results (the HDL cholesterol level is way too low and the homocysteine level is too high) the doctor changed some of Jim's medications. This is what Jim is now taking each day to treat the coronary heart disease:

Prescription medicines taken daily:

• Niaspan 500 mg (to increase to 1000 mg after 30 days)
• Crestor 20 mg
• Coreg 10 mg
• Lisinopril 5 mg
• Plavix 75 mg

Over-the-counter medicines/supplements taken daily as advised by cardiologist

• Aspirin 325 mg
• Co (enzyme) Q-10 150 mg
• Vital Remedy MD's Daily Multiple Dietary Supplement (3 pills/day); Jim takes this especially for the folic acid and vitamins B3/B6/B12 (to lower his homocysteine level and raise his HDL cholesterol blood levels)

Jim's previous medication regimens are posted here and here.

vadkins