Heart facts

• While heart weight varies with height and weight, an average female heart weighs approx 250-300 grams and a male heart weighs 300-350 grams.


• Hold out your hand and make a fist. Your heart is about the same size as your fist.


• Your heart beats about 100,000 times in one day and about 35 million times a year.


• Give a tennis ball a hard squeeze. You're using about the same force your heart uses to pump blood out.


• Even at rest, the muscles of the heart work twice as hard as the leg muscles of a person sprinting.


• Feel your pulse by placing two fingers at pulse points on your wrist. The pulse is produced by the blood as it moves through your arteries. While a child's resting pulse might range from 90 to120 beats per minute, an adult's pulse rate is around 72 beats.


• The aorta, which arises from the left ventricle, is the largest artery in the body and is almost the diameter of a garden hose. Capillaries, on the other hand, are so small that it takes 10 of them to equal the thickness of a human hair.


• Your body has about 5.6 litres of blood . This circulates through the body every minute. The heart pumps about 1 million barrels of blood during an average lifetime.

Coronary Heart Disease is the single most prevalent disease in the world. More people die of Coronary Heart Disease each year than all other causes of death combined including Cancer, Aids, Infections, Accidents and Homicides.

Indians are genetically more prone to get Coronary Heart Disease than other ethnic groups. Indian women are as vulnerable to Coronary Heart Disease as men.

However, genes alone don't explain the present sudden spurt in Coronary Heart Disease. The major reason is faulty life style. Genetics load the gun, and lifestyle pulls the trigger.

Risk Factors

Although it is not precisely known why a person develops heart disease, research has identified some factors that puts your heart at risk, these are:

• Smoking


• High blood cholesterol


• Family history of heart disease


• High blood pressure


• Gender


• Increasing age


• Diabetes


• Obesity


• Excessive use of alcohol


• Lack of exercise


• Chronic Stress

Some of the common diseases of the heart are explained below:

Coronary Artery Disease

Coronary heart disease (or coronary artery disease) is narrowing of coronary arteries, the small blood vessels that supply blood and oxygen to the heart. Coronary disease usually results from the build up of fatty material and plaque within the artery. As the coronary arteries narrow, the flow of blood to the heart can slow or stop.

Angina

At times when the heart has to work harder and require more oxygen, this increased need is met by increased blood flow through the coronary arteries. If one of the coronary arteries is narrowed by a plaque formation (atheroma), the heart may not be able to get enough blood. It becomes ischaemic and a warning pain develops. This pain, called angina is generally felt as a tightness of the chest, sometimes spreading into the shoulder, arm or neck.

Heart attack

A heart attack is a sudden blocking of a coronary artery by a clot (coronary thrombosis). Obviously, the heart muscle supplied by the blocked artery does not get enough blood. This causes pain, like that of an angina, but here it does not recede with rest. Part of the muscle dies. This is called Myocardial Infarction.

The heart attack may be complicated by serious and even fatal disturbances of the heart rhythm called Arrhythmias. Most of these occur soon after the onset of the attack. The most important rhythm disturbance is called ventricular fibrillation. This prevents any effective heart beat at all so that circulation stops. The result is a cardiac arrest. Cardiac massage with artificial respiration helps postpone death by a matter of minutes, but the real need is to correct the rhythm. Ventricular fibrillation is corrected by applying electric shock. It is therefore important to take the patient to a coronary care unit as early as possible.

Stroke

A stroke occurs when blood supply to the brain is disrupted. Brain cells need a continuous supply of oxygen-rich blood. If deprived of blood for even a few minutes, they cease to function and die. When nerve cells die, the body functions they control also cease. The result may be difficulty in speaking or seeing or losing a limb (paralysis) or even loss of consciousness. The commonest cause of a stroke is the blockage of brain artery by a blood clot (thrombosis) or embolus.

A stroke can also occur when an artery in the brain leaks and bursts. This is called cerebral hemorrhage. It is more likely to happen when you also have high blood pressure. Once the brain cells die, they will not recover. However, the neighboring brain cells can be encouraged and 'taught' to take over the work of the damaged cells.

Rheumatic heart disease

Rheumatic heart disease is a condition in which heart valves are damaged by a disease process that begins with a streptococcal infection. If not treated, the infection can develop into rheumatic fever, which is an inflammatory disease that can affect many of the connective tissues of the body especially those of the heart, the joints, the brain or the skin. When rheumatic fever causes permanent heart damage, it is called rheumatic heart disease. While people of all ages can develop rheumatic heart disease, it usually occurs in children 5 to 15 years old.

After an attack of rheumatic fever, some people may have no problem for years. Others may feel only mild discomfort for years. Eventually, defective heart valves can cause serious, even disabling, problems. These problems depend on the severity of the damage and the valve that is affected. Shortness of breath and palpitation are common symptoms.

Congenital heart disease

Congenital heart diseases are abnormalities of the heart's structure and function caused by abnormal or disordered heart development before birth. Congenital heart disease is, by definition, present at birth although its effects may not be obvious immediately. In some cases, such as coarctation of the aorta, it may not present itself for many years and a few lesions such as a small ventricular septal defect (VSD) may never cause any problems and are compatible with normal physical activity and a normal life span.

Ventricular septal defect is the most commonly diagnosed congenital heart defect (about one-third of all cases) and it is seen almost three times as often as Atrial septal defect and Patent ductus arteriosus, which are the next most common.

Some congenital heart diseases can be treated with medication alone, while others require one or more surgeries.

Cardiac Arrhythmia

Any irregularity in your heart's natural rhythm is called an arrhythmia. Arrhythmias may indicate a serious problem and lead to heart disease or sudden cardiac death.
The contractions of the heart are controlled by an electrical signal that begins in the heart's natural "pacemaker" (called the sinoatrial node). The rate of the contractions is influenced by nerve impulses and hormones in the blood. A problem in any of these can cause an arrhythmia. The most common cause of arrhythmias is heart disease, particularly coronary artery disease, abnormal heart valve function and heart failure. However, arrhythmias can occur for no known reason.
Treatment depends on the type of arrhythmia. Some mild arrhythmias require no treatment. Others can be treated with medicines. In serious cases, treatments like artificial pacemaker or surgery is done.

Surgery for Heart Diseases

Coronary Angioplasty

It can rectify a narrowed coronary artery. It involves inflating a balloon inside the narrowed section of the artery to enlarge and open it and improve the blood flow to the heart muscle.

Normally, hospital stay after the procedure is for around 2-3 days. Medication is prescribed to aid post-procedure recovery and to prevent future blocking of the artery.

However, in 2 percent of the cases where there is a small possibility of the artery becoming blocked, threatening serious damage to the heart, a bypass operation may be needed.

In many patients, when an artery is blocked, a device called a stent is inserted at the site of the blockage to prevent further occurrence of narrowing. The stent is rather like a small, coiled spring which is placed (using the angioplasty catheter) in the blocked section of the artery. When it is released from the catheter, the spring expands and holds the artery open.

Occasionally, angioplasty fails to achieve the desired result . In about 20 percent of the cases of the angina, pain may recur within six months. However, a repeat procedure is usually successful.

Coronary artery bypass surgery

Coronary artery bypass grafting does not remove the obstructing blockages in the arteries. The procedure “reroutes' the flow of blood. Typically, the blockages occur in the first centimeter or two of the major branches feeding the heart. Thus, it is possible to hook a new source of blood into the artery just beyond the last major blockage. Blood flows into the artery through a different path (such as a vein or artery bypass graft) and reaches the heart muscle tissue.

The most common material used to build this new pathway is a vein from the lower extremity. In each of us, there is a long straight vein called the Greater Saphenous Vein (GSV) running from the ankle bone to the groin. It is the right size, shape and length for use as a bypass conduit. The other major vessel used as a bypass graft is the Left Internal Mammary Artery (LIMA).

The advantage of this surgical approach is the restoration of blood supply to the affected part of the heart.

Valve replacement surgery

The heart's valves are responsible for keeping blood flowing in one direction within the heart. The valves most commonly affected by valvular heart disease are the mitral and aortic valves. Diseased or damaged valves may fail to open and close freely, disrupting normal blood flow and resulting in excess strain on the heart muscle.

Congenital defects (heart defects present at birth), rheumatic fever and bacterial endocarditis (an infection of the heart valves) can cause the valves to become 'hard' or damaged and unable to operate smoothly.

Valve replacement surgery removes your damaged heart valve and replaces it with an artificial valve made of plastic, metal and cloth or animal tissue. Mechanical valves are more durable, but valves made of animal tissue tend to be accepted more readily by the body. It is performed under general anesthesia and takes three to five hours. Heart valve replacement is a major surgical procedure and like any surgery does carry some risks, so discuss any possible complications with your physician beforehand. During this kind of operation, the function of the heart and lungs of the patient is temporarily taken over by an artificial heart-lung machine and the surgery is often referred to as 'open heart surgery'.

CARDIAC REHABILITATION

The ultimate goal of rehabilitation program is to allow the patient to attain the highest level of performance possible and preserve the patient's role in the family and society. Rehabilitation involves training and adaptation and stimulus for further progress.

The program helps you to:

• Understand and reduce your risk factors of heart disease.
• Learn how to manage your condition with a healthy diet.
• Develop a safe exercise program that will return you to optimal physical condition.
• Reduce stress and anxiety.
• Rebuild a healthy life-style.

Education & Counselling

Education improves your knowledge of the heart, cardiovascular system and your recent illness, helping you to understand your condition and how to reduce your risk of any repeat problems in the future. Regular educational conferences share information on the heart and health maintenance.

Family members are encouraged to attend and participate in the lectures by the Rehabilitation staff and guest speakers.

Exercise, Meditation, Diet and avoiding smoking etc. are all an integral part of cardiac rehabilitation education.

Heart-Healthy Food

It is never too late to change your eating habits and lifestyle to promote heart health, even if you have already suffered a heart attack or have arteriosclerosis. Feasting on fantastic heart-healthy foods can help prevent heart disease and reduce blockages.

Feast on high-fiber foods

Eat more foods high in fiber. Apples, citrus fruits, carrots, oat bran, lima beans and psyllium are superior sources of soluble fiber that promote healthy bowel function and reduce cholesterol levels in the blood. Wheat bran, rye, lentils, asparagus, brussel sprouts and flax meal (grind it, then refrigerate) are good sources of insoluble fiber that help to prevent constipation.

Kick the salt habit

Limit sodium to 2,400 mg
(½ teaspoon) a day. Eat less processed and convenience foods. Use herbs and spices to flavor foods instead of adding salt.

Keep it lean

Choose lean cuts of meat, remove the skin from poultry, limit the amount of cheese and other high-fat dairy products to reduce the amount of animal fats in your food. Dairy products with 1% butterfat or less are recommended.

Fish, fish and more fish

Guess who has the lowest rate of heart disease in the world? It is those countries whose main source of protein is fish! Coldwater fish is a source of heart-protective omega 3 fatty acids. Choose salmon, mackerel, herring, sardines and tuna. Eat shellfish in place of red meat to reduce cholesterol.

Regular exercise

Exercise is a vital part of your recovery. The health care team helps you determine the exercise program that is right for you. Your heart is monitored to measure your cardiovascular system’s response to exercise.

Type of Exercise

Walking and swimming are forms of aerobic exercise. These exercises increase the efficiency of the cardiovascular system.

Your Exercise Program

• You will receive information about exercise from your physiotherapist.
• Home activity complements supervised workouts.
• Your workouts each week start at a low level and build gradually.
• After completing Rehab, you may continue to exercise either on your own or in a   structuredcommunity program.

Guidelines

•Exercise at least six days a week.
•Wear loose-fitting clothes and comfortable shoes.
•Wait 1 hour and 30 minutes after meals before exercising.
•Exercise should be continual moderate and rhythmic.
•Exercise at a pace that keeps your heart rate within your target zone. Don’t exceed your target zone.
•Begin your program with 5 to10 minutes of walking, 1 to 2 times per day.
•Gradually add several minutes of walking and exercise.
•Avoid dehydration. Water is a must during exercise.

Warm-up

Begin with five minutes of stretching; pay special attention to leg and ankle muscles. Exercise the first few minutes at a slower pace to gradually increase your heart rate.

Weather

• Exercise indoors in bad weather. Do not exercise outside if windy, or in temperatures above 90    degrees F or below 30 degrees F.
• If it’s below 40 degrees F, cover your mouth and nose with a scarf to avoid breathing very cold air.
• Extreme temperatures or very windy conditions make your heart work harder and may cause you to    tire more easily or experience chest pain more often.

Walking Program

Walk on level surfaces when possible for the first few weeks, then gradually include inclines. Walk indoors in bad weather.

Stationary Bike Program

• Adjust the seat so that one leg is almost fully extended when the pedal is in the down position.
• Grip the handlebars lightly.
• If using a stationary bike, start cycling without any resistance. Increase your time if you are not    having symptoms and your heart rate does not exceed target heart rate.

Normal Feelings During Exercise

During exercise it is normal to feel:
•Moderate shortness of breath.
•Moderate sweating.
•Pleasant sense of muscle fatigue.
•During exercise you should be in a position to carry on a normal conversation.

Cool Down

When you finish, check your pulse and begin 5-10 minutes of stretching. After exercise, your muscles are warm and more flexible. Stretching helps prevent sore muscles and cramping. Cool down slowly until your pulse returns to almost normal.

Warning Symptoms

Always carry your nitroglycerin with you. Use it if you have chest pain or angina.
Stop if these symptoms occur and report to your doctor if they continue after you use nitroglycerin:

• Pain, pressure or heaviness in your chest, jaw, neck or arms.
• Dizziness or lightheadedness.
• Excessive shortness of breath or fatigue.
• Nausea.

Healthy lifestyle for a healthy heart

Leading a healthy life style helps in controlling the risk factors present.

Control your diabetes

The normal levels of blood sugar in a fasting person are between 80-100mg/dl. If the fasting blood sugar is more than 110mg/dl, or if the blood sugar 2 hours after a meal is more than 160mg/dl, then diabetes mellitus is diagnosed. In diabetic patient sugar can be detected in the urine also. Diabetic patients have a higher chance of developing coronary blockages. Patients with diabetes are usually obese, have high blood pressure and high blood cholesterol levels; all of which are responsible for blockages. Heart attack at a younger age can also access in severe diabetes. Controlling diabetes is a must for heart patients.

Manage your Hypertension

Blood pressure is the force of the circulating blood against the walls of the blood vessels. This pressure is created by the heart as it pumps blood. When arterioles (the small arteries that regulate blood pressure) contracts, it is hard for the blood to flow through them. That means the heart has to pump harder to force the blood through. This extra effort increases the blood pressure in the arteries.

It is possible for a person to have high blood pressure for years without realizing it, because usually there are no symptoms. That is why a regular check is a must.

Blood pressure reading varies depending on age and other factors. Generally high blood pressure is defined as a systolic pressure greater than 140mmHg and a diastolic pressure greater than 90mmHg. If this is too confusing, just remember that the harder it is for the blood to flow, the higher the number will be. There are several factors that may contribute to high blood pressure. Age and Race are risk factors that cannot be changed. The older a person gets, the more likely he or she is develops high blood pressure. African Americans are more likely to have high blood pressure than white Americans and Europeans. Asians have their risk centered between the two.

Heredity is another factor. People whose parents have had high blood pressure are more likely develop it. While gender is not a risk factor, a woman taking oral contraceptives is more likely to develop high blood pressure if she is overweight, has had high blood pressure during pregnancy, has a family history of high blood pressure or has a mild kidney disease.

Lower your Blood Cholesterol

Cholesterol forms a part of the fatty deposits that can build up in your arteries and cause heart disease. The deposits form faster if the cholesterol level in your blood is high. This process is accelerated if you smoke, are overweight or have high blood pressure. People whose blood cholesterol levels are more than 200mg/dl are more prone to heart disease. The best way to lower it is to exercise and change your diet. Lowering your dietary fat intake is one way of reducing cholesterol.

Cholesterol is found naturally in all animal cells and is essential for a healthy nervous system and hormone production. In your blood, it is found in combination with proteins called lipoproteins. There are two types of lipoproteins.

Low Density Lipoprotein (Bad Cholesterol) deposits excess cholesterol on the walls of your arteries, narrowing them down.

High Density Lipoprotein (Good Cholesterol) scavenges and collects excess cholesterol from the inside of the arteries and takes it to the liver.

Lower amounts of LDL in the body and higher amounts of HDL denote a healthy body.

Obesity Management and Diet

Cut down on refined white sugar products and white bread, white rice and all forms of sugar. Eat more wholesome carbohydrates such as whole wheat, brown rice, grains, beans and fresh green vegetables.

If you are overweight, you are likely to have high blood pressure and your heart will have to work harder. You will have a greater risk of heart disease, stroke, diabetes, bronchitis, and gallstones. Excess weight can also affect your joints and lead to decreased mobility. Major causes of obesity are eating too much fat and too much sugar. Foods containing sugar are high in calories and because our taste buds have been trained to crave for sugar, we are likely to eat more. This leads to weight gain.

The best way to reduce weight is to eat a low-fat, high fibre balanced diet and exercise regularly. Losing weight should be a gradual process. You should aim to reduce 2-3kgs a month until you reach your ideal weight. Losing weight reduces your risk of serious illnesses.

Keep your fat intake at around 10-15% of your daily diet.

Fat is of three types: saturated fats, monounsaturated fats and polyun-saturated fats.

The liver makes cholesterol from saturated fats. These fats increase your blood cholesterol level and are, therefore, to be avoided. They are solid at room temperature and are found mostly in animal products. You can lower your blood cholesterol levels if you eat less saturated fat.

Polyunsaturated fats are liquid at room temperature. They are found in nearly all vegetables oils, fish oils, nuts and seeds. Polyunsaturated fats lowers LDL but also lowers HDL.

Monounsaturated fats are found in all animal products and vegetables. Particularly good sources are olive oil, avocados and nuts. Monounsaturated have come to the forefront recently as they not only lower LDL but do not lower HDL and may even increase it.

You must include unsaturated fats in your diet because they contain essential fatty acids. However, it is not enough to replace saturated fat by unsaturated fat. You must try to cut down on the total amount of fat you eat.

If your diet is not balanced you may be deprived of essential nutrients you may have an inadequate supply of vitamins and minerals.
Supplement your diet with multi vitamin tablets once a day if prescribed by your doctor.

Customize your diet depending on your weight lifestyle and health status, find foods with a low glycemic index. Take a lot of vegetable juices. Fasting is not a panacea for all troubles.

Exercise


Research has shown that sedentary people almost double their risk of having a heart attack. Also, complications after a heart attack or surgery are more likely to occur in people who are physically inactive.

Exercise regularly, preferably daily or at least 3-4 times a week for 20-30 minutes each time.

Benefits of exercise

•More energy.
•Greater resistance to stress.
•Increased stamina, strength and joint mobility.
•Improved efficiency of the heart and lungs.
•Balanced weight and blood pressure.
•Increases good cholesterol.
•Extra blood vessels around blocked coronary arteries.

Exercises for the circulatory and respiratory system should be brisk, sustained and regular. However, consult your physician before you begin any exercise program.

It is important to begin at a slow pace. As your fitness level improves you will find that you are able to gradually increase the pace of your exercise. exercising at around 75% of your maximum target heart rate (220 minus your age ) is usually considered the best activity level. Ensure that you are never gasping for breath during exercise.

Stamina or aerobic exercises use oxygen to produce the energy needed for the activity. Good aerobic exercises are brisk walking , jogging, running, cycling and swimming.

However, swimming and walking are most advisable exercises for you. Start your session with these stamina exercises and finish your program with stretches and deep breathing to cool down. In your daily life quit the sedentary habit and become more physically active.

Manage your stress


While stress may not cause heart disease, it is a strong aggravating factor. It also has a role to play in all other risk factors. So manage your stress well.

Identify sources of stress, prioritise them in order of significant and trivial. What is significant must not be allowed to linger or else it will become chronic. An aggressive type A Personality also causes much stress to the individual. Anger and hostility are behaviors that must be managed as well.

Learning to relax is very important. Relaxation and Meditation techniques teach how to let go, relax and lower all the body's biorhythms such as heart rate, brain waves, blood pressure etc. Develop a balanced, calm and positive attitude to reduce stress from life in future.

Alcohol


Though many western studies have shown good effects of alcohol consumption, the same can not be taken to be in Indian scenario. India is a temperate country and many people are in the habit of excessive alcohol consumption unlike those in the west. Alcohol increases the concentration of Triglycerides in the blood which predisposes further deposits. Its intoxicating effect leads people to more fat and food which also indirectly promote heart diseases.

Quit Smoking

It is a globally accepted fact that smoking causes several dangerous and lethal diseases and affects major systems in the body. Smoking a pack of cigarettes a day doubles your risk of heart attack.

This risk is particularly high for women over 35 who are on the contraceptive pill. Smoking affects the heart because tobacco smoke contains nicotine and carbon-monoxide, harmful chemicals that can damage the heart and coronary arteries.

Your risk of having a heart attack starts decreasing from the day you give up cigarettes.

Do u Know ?

• Your bad cholesterol (LDL) should be less than 100-130 mg%.
• Good cholesterol (HDL) should be in the range of 40 to 60 mg%.
• Passive smoking is as bad as active smoking.
• More and more young Asians are developing heart disease.
• Drink more tea than coffee. It has less caffeine and more antioxidants .
• Among oils, oils which become solid in cold weather are bad.
• Soya oil and fish oils are less harmful. They have polyunsaturated fatty acids. The Japanese and    people living around the Mediterranean who eat fish suffer fewer heart diseases.
• Do not use more than half a kilo of oil per person per month.
• Eat sensibly. Exercise regularly.