Your Heart Questions Answered by the Women’s Heart Center – pt 2

Thank you for your patience and for your participation in American Heart Month! We received so many great questions, it took us a while to get through them all. We hope you find our Part 2 answers helpful. Thank you to our Emory Women’s Heart Center experts  Dr. Alexis Cutchins, Dr. M Carolina Gongora, Dr. Gina Lundberg, Dr. Susmita Parashar, and Stacy Jaskwhich for answering these submitted questions.

Review Part 1 questions and answers here!

What are the signs of heart disease? Are there any silent signs? 
Signs of heart disease may include the ones we would typically think about:

• chest pain
• shortness of breath
• palpitations

Some other signs of heart disease that may not be as distinguishable (or considered silent as they are not recognized as a heart problem) could be:

• dizziness
• nausea
• sweating or flushing
• neck pain
• jaw pain
• back pain
• general fatigue

All symptoms are more suggestive of heart disease when they occur with exertional activity or are triggered by emotional stress.  Some symptoms occur over time and people acclimate to them or shrug them off as “being out of shape” or “going through menopause”.  Progressive symptoms, such as increased shortness of breath with walking up stairs, can be a worrisome change and you should definitely mention to your physician.

How do you know when you have heart disease? 
Bottom line is, you won’t know if you don’t look. Studies have shown that 2/3 of women have no previous symptoms prior to their heart attack. There are many types of heart problems that an individual could have such as an enlarged heart, electrical abnormalities of the heart (arrhythmias) or blood flow issues.  We usually think of heart disease as blood flow issues or blockages that might cause a heart attack. You will likely notice some signs or symptoms in this scenario, but the best way to know for sure is by having a screening or seeing a Cardiologist for testing. Common sense would tell us that the more risk factors that you have for heart disease, the higher the probability.

There are many screening tests which can be performed to give you a better idea of your cardiac status.  You can actually have heart disease for a long period of time prior to having an event.  If you have a strong family history of heart disease or multiple risk factors, it may be a good idea to have a Coronary Calcium Score.  This is a CT of your heart that identifies hard, calcified plaques in your heart arteries.  It really helps to determine if you have the disease and to quantify the amount of disease that is present.  The result will be given in an age-matched reference so that you can see how you are doing in comparison to other women/men in your same age group.  The more plaque you have, the more aggressive your treatment plan should be.  If you are having any type of symptoms, you should have diagnostic testing.  Most people start with a simple EKG, but a treadmill stress test is a better tool.  If the stress test is positive for EKG changes with exercise, further tests may be indicated.

What are the most common kinds of heart troubles? 
In a cardiology practice, we commonly see a multitude of heart problems, many of which are brought about by the risk factors such as:

• high blood pressure
• high cholesterol
• sleep apnea
• being overweight
• diabetes
• depression
• lifestyle choices

Think of your heart as a house with 3 basic responsibilities: pump, plumbing, and electricity.

• You can have a pump issue in which your heart muscle is enlarged, thickened or damaged. Consequences of this can result in a condition called congestive heart failure.
• You can have a plumbing issue in which you have plaque build up that eventually closes your arteries and prevents well-oxygenated blood from reaching your heart muscle. Consequences of this could lead cause a heart attack.
• You can have an electrical issue in which your heart loses the ability to normally conduct impulses.  These can stem from the upper and lower chambers of the heart and some are more worrisome than others- the most common electrical problem that we see is Atrial fibrillation. Consequences of Atrial fibrillation can lead to blood clots or stroke when the heart beats irregularly and sets up the perfect scenario for a blood clot to form and then be lodged into the systemic circulation.

While all of these consequences seem very frightening, many can be avoided if we prevent risk factors from occurring by maintaining heart-healthy lifestyles in the first place.

By what percentage is the reduction of heart disease changed, as backed by scientific studies, when one makes positive changes.  
It is somewhat difficult to predict because it depends on different variables. Some risk factors are non-modifiable, such as genetics, age, gender, and race.  Of the modifiable risk factors, several studies have highlighted the critical importance of lifestyle modifications in heart disease prevention.  A Nurses’ Health Study demonstrated that women were able to reduce their risk of coronary events by >80% by not smoking, maintaining healthy body weight-BMI< 25, consuming a healthy diet, participating in moderate to vigorous exercise for 30 minutes a day, and consuming no more than a moderate amount of alcohol.

Another study named INTERHEART identified 9 easily measured risk factors (smoking, lipids, hypertension, DM, obesity, diet, physical activity, alcohol consumption, and psychosocial factors) that account for over 90% of the risk for acute heart attack.  This study also demonstrated that although the magnitude of the cardiovascular risks for men and women were similar, the impact of modifying the risks was greater in women.

What are some natural supplements that keep our hearts healthy?  
Heart health starts with exercise and a healthy diet.  The majority of the diet should come from vegetables, lean protein, low glycemic fruits, and some whole grains while limiting carbs and sugars.  Diet should consist of low sodium and high fiber.  It should include healthy fats such as nuts and olive oil.  Certain foods can be especially helpful for different cardiac problems.  For example, blueberries, leafy greens, seaweed, mushrooms, and celery have been shown to be beneficial in lowering blood pressure.

To further support your heart health, certain supplements may be helpful; however, these should always be recommended by a healthcare provider who has experience and training in the use of supplements. If you have a heart condition or are high risk for a heart attack, you must always follow your doctor’s advice before using any supplement.  Some supplements may interfere with blood thinners. Actually being tested for certain deficiencies prior to taking certain vitamins and minerals, may be the safest practice. It is way too risky to treat a serious health condition on your own with over-the-counter supplements. Some commonly used supplements for the heart are:

• Omega 3 fish oil
• flax seed
• plant sterols
• CoQ10 enzyme
• Vitamin D
• certain B Vitamins
• Vitamin C
• Zinc
• Folate
• Garlic
• Magnesium
• Turmeric

What are the best types of vegetables and fruits to eat when you have blood clots?  
If you have a blood clot, you are likely on a blood thinner.  If you are on Coumadin, you will have to be aware of the vegetables that contain Vitamin K as it acts as an antidote for Coumadin (blocking blood-thinning properties).  Most green, leafy vegetables contain Vitamin K.  This doesn’t mean that you should avoid these vegetables if, on Coumadin, you just have to eat them consistently in order to keep your blood levels of Coumadin therapeutic.  We currently have much better options for blood thinners though (Eliquis, Xarelto, Pradaxa) which work on a different bleeding pathway and don’t interfere with foods that we eat.

Many patients are prescribed an aspirin a day to reduce the risk of blood clotting. The component in aspirin that is responsible for reducing blood clotting risk is called salicylates. Salicylates can also be found in a wide variety of fruits and vegetables such as oranges, blackberries, blueberries, pineapple, plums, prunes, raisins, raspberries, strawberries, grapes, cranberries, tangerines, hot peppers, olives, radishes, and tomatoes.

Omega-3 fatty acids are essential nutrients that aid in the regulation of normal blood clotting. Most people believe that in order to receive omega-3 fatty acids, they must consume a high a diet that is high in fish. While fish is a good source of omega-3 fatty acids, they can also be found in many vegetables including brussel sprouts, kale, spinach and salad greens.

Vitamin E is also capable of inhibiting platelets (the cells responsible for clotting) that works as a natural anticoagulant. Vitamin E can be found in spinach, broccoli, kiwifruit, mangos, and tomatoes.

Review Part 1 questions and answers here!

To learn more about Emory Healthcare’s Heart and Vascular Center, please visit: www.emoryhealthcare.org/heart

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