Preventing Further Heart Disease

I am a 48-year-old female who had a mild heart attack at age 46. I have not gone through menopause yet and am wondering how this will affect my condition?
When women this young have heart attacks, often they have other major risk factors such as diabetes, smoking, family history, lack of exercise. The question of how will going through menopause affect your condition is a very good one because women post-menopause do have an increased rate of heart disease and within 10 years their rate of heart disease matches that of men. This person needs to pay attention to and manage all of the risk fators and, if there are none, consult with her physician about having a homosysteine level, a Lp(a) determined and a hs CRP drawn.
I have had a heart attack. One main artery is totally blocked, and I have an aneurysm in the left chamber. My cardiologist says I do not have congestive heart failure. The weight gain has made it difficult to breathe or function.
After someone has had a heart attack and has difficulty breathing and has had weight gain, certainly heart failure would be one consideration. I would recommend that she ask her physician the reason for her weight gain and difficulty breathing. Be sure this has been reported to the physician. If the problem is not resolved soon, a second opinion seems in order. Another point that should be stressed is that people with weight gain must make sure that dietary intake of sodium is restricted according to the doctor's or dietitian's advice.
Will a high carbohydrate diet lower risk of heart disease?
The important thing in preventing heart disease as far as diet is concerned is to eat a diet that is low in fat, particularly saturated fat, and a diet that is high in fiber. Therefore, these diets often do contain high levels of complex carbohydrates and should include lots of vegetables and fruits. The key word is COMPLEX carbohydrates that do not include foods high in refined flour and sugar.
Can smoking cause heart disease in younger people?
Yes, of course.
Why can't I do my cardiac rehab on my own?
Most people after a heart attack, a diagnosis of coronary disease, or a catheter procedure need the help of qualified professionals to guide them in the therapeutic level of exercise as well as how to modify all other risk factors. What we have found is that most people don't know how to exercise properly so as to maximize their heart health. People often don't know, for example, that the cool-down period after exercise is a very important part of exercise and is most often the time when BAD things happen, if they are going to. Often people exercise at too high an extensity or too low an intensity. In cardiac rehab programs people are monitored on electrocardiograms by qualified professionals who have been trained to detect abnormalities, as well as teach them proper techniques of exercise. It is important to at least go to a few of the sessions if you are opposed to going through a whole course of cardiac rehabilitation. Sometimes people can go on their own after just a few sessions. Another reason that cardiac rehab is important is because patients often find out little things about their condition that may surface only a few weeks after their event. It is nice to know, for example, that depression is very common after bypass surgery and when a male patient is feeling depressed and tearful, it is reassuring to know that that's a very typical response after heart surgery. Another thing that people don't realize the importance of is that when they go to a cardiac rehab program, not only is the electrocardiogram carefully monitored, but so is their blood pressure, and we may detect abnormal response in blood pressure associated with various modes of exercise. For example, let's consider a patient who uses a bicycle at home to exercise. We may find that the patient develops a higher blood pressure while on a bicycle, but not while treadmill walking. Therefore, the target heart rate recommendation for exercise on a bicycle would be appropriately less than it is for walking. For certain patients, we check the blood glucose before and after exercise. This is particulary important for diabetics, but can be informative in pre-diabetic states as well.
Will I notice effects immediately if I quit smoking? I've smoked for 15 years.
I don't know if you will notice anything immediately, but certainly within several days. There should be some favorable responses such as increased energy levels and less morning cough. For men, the likelihood of erectile dysfunction will decrease if he does not already have it. One of the things I found when I quit smoking is that I had more time. I slept better at night. I tolerated exertion better.
It would seem that with all the talk about the high cost of medical care that cardiac rehab would be a lot cheaper than bypass surgery. Are heart patients required to go?
No. Heart patients are not required to go, but they should be. Unfortunately, the participation rate of eligible patients in cardiac rehab programs across the U.S. is only about 30 percent. When you look at the cost of cardiac rehab and the medical dollars that cardiac rehab saves, the net savings are great per patient.
What is the training of people who work in cardiac rehabs? Aren't they similar to the people who work in health clubs?
Cardiac rehab programs in the United States all have to have a physician as medical director and they all have to have a specially trained staff. All programs have registered nurses and many have physical therapists, exercise physiologists, registered dietitians, occupational therapists and psychologists. The people in cardiac rehab programs have additional training beyond their basic education. For example, a nurse who works in cardiac rehab has to have additional training in cardiac rehab, plus is required to have experience in critical care. A physical therapist or exercise physiologist also need additional training to care for people with heart disease. Health clubs, on the other hand, have trained professionals but often not specifically trained to deal with heart patients. The benefits of going to a cardiac rehab program include a very high level of professionally trained staff specifically trained to deal with patients who have heart conditions and other health problems.
I have high blood pressure. Is there a place I can exercise where they will check my blood pressure while I'm working out?
I would recommend that people with high blood pressure check with their local hospital's cardiac rehab programs because these programs often have special programs for people to get into who have not had prior heart problems. For example, here at the University of Iowa, we have what we call a "Prevention Program" where anyone can come to us and exercise in our program. We routinely evaluate their physiological responses to exercise initially. So, if we detect an abnormal response to exercise, we can advise the patient or call the patient's physician, whatever the patient prefers. In summary, check with your local cardiac rehab and ask about prevention programs.
I have heard there may be a link between heart disease and erectile dysfunction (ED). Any truth to that?
You bet there is! The incidence of ED is high in men with heart disease. If a man is experiencing ED, check with your physician or cardiac rehab staff about options for you. If you are in a cardiac rehab program already, the staff can make recommendations. Sometimes the ED worsened by a medication and a change in medication may be enough to help the problem. The cardiac rehab staff can advise the patient what route to take. For example, we may say to a patient, "You are on a medicine that can cause ED. Why don't you talk to your doctor about switching to another type of medicine." The important thing is that heart patients don't go off of their medication to improve their sexual function! If a man without heart disease has ED, heart and vascular disease should be ruled out by a physician.
Is it necessary to get physician's permission to exercise if a patient has any form of heart problems?
Yes. What we do here with people who want to start an exercise program is advise them to check with their physician.
What can a bypass patient expect to encounter at rehab, or do they not go through rehab?
Of course, they go through rehab. They can expect a variety of patient education classes, depending on their risk factors and what kind of education they need. A cardiac rehab program provides diet education, education about stress management, education about the proper techniques of exercise, and also precautions particular to the bypass patient. For example, there are certain restrictions for a surgery patient that other patients in cardiac rehab would not have. Their exercise is supervised and increased according to their response. Often after bypass surgery the patient's heart rate is faster than previously and may develop arrhythmias they can't detect. Their response needs to be evaluated as to whether it is normal or requires medical intervention.
What about people that maybe can't walk? How do they go through cardiac rehab?
There are other modes of exercise that these people can use and cardiac rehab staff are trained to teach them to use whatever mode of exercise is appropriate for them. I once had a patient who had only one arm and one leg, yet we were able to impressively increase his functional capacity and fitness level.
What other benefits does going through cardiac rehab offer a patient?
Weight loss, increased muscle tone and strength, decreased blood pressure, decreased insulin resistance, improved lipids, helps you quit smoking. It attenuates the stress response; prevents osteoporosis. Exercise reduces the incidence of breast and colon cancers. Exercise improves lower back pain, and prevents gallstones. A lot of what we do has positive effects in areas other than heart health. Plus you get to meet new people, some of whom may have had problems like yours, so you learn that you are not alone in trying to get and stay healthy.
Is weight lifting a good idea for heart patients?
Yes, providing the people who teach it are trained in coronary disease and experienced in working with this type of patient. It is a wonderful complement to an exercise program, and most cardiac rehab programs offer strength training in addition to aerobic training.
What is the average age of the cardiac rehab patients you see in your facility?
Our patients range in age from 16 to 90. The mean age for men is 58 and for women 60. Twenty-nine percent are women and 71 percent male. We don't know for sure why more women don't participate in cardiac rehab programs, but this subject is receiving much-deserved research attention.
What do you think is the most beneficial aspect of cardiac rehab from your standpoint?
One of the most important aspects of cardiac rehab that people don't hear about, but is most common, is what the cardiac rehab programs do for patients in terms of their medical management. Often problems are detected before the problem is noticed by the patient and appropriate interventions made. Cardiac rehabilitation programs save many doctors office calls, diagnostic tests, and emergency room visits.

Patricia Lounsbury, RN
Division of Cardiovascular Disease
University of Iowa Hospitals and Clinics