Heart Disease: Risk Factors for Heart Disease
Some heart disease risk factors you can control and some you cannot. Coronary artery disease causes roughly 1.2 million heart attacks each year, and more than forty percent of those suffering from a heart attack will die. Even more worrisome, 335,000 people with heart attacks will die in an emergency department or before ever reaching the hospital. According to the American Heart Association, over 7 million Americans have suffered a heart attack in their lifetime
Saturday, July 5, 2008
What Are the Risk Factors for Heart Disease?
What Are the Risk Factors for Heart Disease?
There are several risk factors for heart disease; some are controllable, others are not. Uncontrollable risk factors include:
Male sex
Older age
Family history of heart disease
Post-menopausal
Race (African Americans, American Indians, and Mexican Americans are more likely to have heart disease than Caucasians)
Still, there are many risk factors that can be controlled. By making changes in your lifestyle, you can actually reduce your risk for heart disease. Controllable risk factors include:
Smoking.
High LDL, or "bad" cholesterol and low HDL, or "good" cholesterol.
Uncontrolled hypertension (high blood pressure).
Physical inactivity.
Obesity (more than 20% over one's ideal body weight).
Uncontrolled diabetes.
High C-reactive protein.
Uncontrolled stress and anger.
There are several risk factors for heart disease; some are controllable, others are not. Uncontrollable risk factors include:
Male sex
Older age
Family history of heart disease
Post-menopausal
Race (African Americans, American Indians, and Mexican Americans are more likely to have heart disease than Caucasians)
Still, there are many risk factors that can be controlled. By making changes in your lifestyle, you can actually reduce your risk for heart disease. Controllable risk factors include:
Smoking.
High LDL, or "bad" cholesterol and low HDL, or "good" cholesterol.
Uncontrolled hypertension (high blood pressure).
Physical inactivity.
Obesity (more than 20% over one's ideal body weight).
Uncontrolled diabetes.
High C-reactive protein.
Uncontrolled stress and anger.
What Can I Do to Lower My Risk of Heart Disease?
Making changes in your lifestyle is a proven method for reducing your risk of developing heart disease. While there are no guarantees that a heart-healthy lifestyle will keep heart disease away, these changes will certainly improve your health in other ways, such as improving your physical and emotional well being. Also, because some risk factors are related to others, making changes in one area can benefit other areas.
Here are some ways you can reduce your risk of heart disease.
Quit smoking. Smokers have more than twice the risk for heart attack as nonsmokers. Smoking is also the most preventable risk factor. If you smoke, quit. Better yet, never start smoking at all. Nonsmokers who are exposed to constant smoke also have an increased risk.
Improve cholesterol levels. The risk for heart disease increases as your total amount of cholesterol increases. Your total cholesterol goal should be less than 200 mg/dl; HDL, the good cholesterol, higher than 40 mg/dl in men and 50 mg/dl in women (and the higher the better); and LDL should be less than 130 mg/dl in healthy adults. For those with diabetes or multiple risk factors for heart disease, LDL goal should be less than 100 mg/dl (some experts recommend less than 70 mg/dl if you are very high risk). Interpretation and treatment of cholesterol values must be individualized, taking into account all of your risk factors for heart disease. A diet low in cholesterol and saturated and trans fat will help lower cholesterol levels and reduce your risk for heart disease. Regular exercise will also help lower "bad" cholesterol and raise "good" cholesterol. Medications are often needed to reach cholesterol goals.
Control high blood pressure. About 60 million people in the U.S. have hypertension, or high blood pressure, making it the most common heart disease risk factor. Nearly one in three adults has systolic blood pressure (the upper number) over 140, and/or diastolic blood pressure (the lower number) over 90, which is the definition of hypertension. Like cholesterol, blood pressure interpretation and treatment should be individualized, taking into account your entire risk profile. Control blood pressure through diet, exercise, weight management, and if needed, medications.
Control diabetes. If not properly controlled, diabetes can lead to significant heart damage including heart attacks and death. Control diabetes through a healthy diet, exercise, maintaining a healthy weight and taking medications as prescribed by your doctor.
Get active. Many of us lead sedentary lives, exercising infrequently or not at all. People who don't exercise have higher rates of death and heart disease compared to people who perform even mild to moderate amounts of physical activity. Even leisure-time activities like gardening or walking can lower your risk of heart disease. Most people should exercise 30 minutes a day, at moderate intensity, on most days. More vigorous activities are associated with more benefits. Exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope and jogging. If walking is your exercise of choice, use the pedometer goal of 10,000 steps a day. Consult your doctor before starting any exercise program.
Eat right Eat a heart-healthy diet low in sodium, saturated fat, trans fat, cholesterol and refined sugars. Try to increase your intake of foods rich in vitamins and other nutrients, especially antioxidants, which have been proven to lower your risk for heart disease. Also eat plant-based foods such as fruits and vegetables, nuts, and whole grains.
Achieve and maintain a healthy weight. Excess weight puts significant strain on your heart and worsens several other heart disease risk factors such as diabetes, high blood pressure, and high cholesterol and triglycerides. Research is showing that obesity itself increases heart disease risk. By eating right and exercising, you can lose weight and reduce your risk of heart disease.
Manage stress. Poorly controlled stress and anger can lead to heart attacks and strokes. Use stress and anger management techniques to lower your risk. Learn to manage stress by practicing relaxation techniques, learning how to manage your time, setting realistic goals, and trying some new techniques such as guided imagery, massage, Tai Chi or yoga.
Control diabetes. If not properly controlled, diabetes can lead to significant heart damage including heart attacks and death.
Here are some ways you can reduce your risk of heart disease.
Quit smoking. Smokers have more than twice the risk for heart attack as nonsmokers. Smoking is also the most preventable risk factor. If you smoke, quit. Better yet, never start smoking at all. Nonsmokers who are exposed to constant smoke also have an increased risk.
Improve cholesterol levels. The risk for heart disease increases as your total amount of cholesterol increases. Your total cholesterol goal should be less than 200 mg/dl; HDL, the good cholesterol, higher than 40 mg/dl in men and 50 mg/dl in women (and the higher the better); and LDL should be less than 130 mg/dl in healthy adults. For those with diabetes or multiple risk factors for heart disease, LDL goal should be less than 100 mg/dl (some experts recommend less than 70 mg/dl if you are very high risk). Interpretation and treatment of cholesterol values must be individualized, taking into account all of your risk factors for heart disease. A diet low in cholesterol and saturated and trans fat will help lower cholesterol levels and reduce your risk for heart disease. Regular exercise will also help lower "bad" cholesterol and raise "good" cholesterol. Medications are often needed to reach cholesterol goals.
Control high blood pressure. About 60 million people in the U.S. have hypertension, or high blood pressure, making it the most common heart disease risk factor. Nearly one in three adults has systolic blood pressure (the upper number) over 140, and/or diastolic blood pressure (the lower number) over 90, which is the definition of hypertension. Like cholesterol, blood pressure interpretation and treatment should be individualized, taking into account your entire risk profile. Control blood pressure through diet, exercise, weight management, and if needed, medications.
Control diabetes. If not properly controlled, diabetes can lead to significant heart damage including heart attacks and death. Control diabetes through a healthy diet, exercise, maintaining a healthy weight and taking medications as prescribed by your doctor.
Get active. Many of us lead sedentary lives, exercising infrequently or not at all. People who don't exercise have higher rates of death and heart disease compared to people who perform even mild to moderate amounts of physical activity. Even leisure-time activities like gardening or walking can lower your risk of heart disease. Most people should exercise 30 minutes a day, at moderate intensity, on most days. More vigorous activities are associated with more benefits. Exercise should be aerobic, involving the large muscle groups. Aerobic activities include brisk walking, cycling, swimming, jumping rope and jogging. If walking is your exercise of choice, use the pedometer goal of 10,000 steps a day. Consult your doctor before starting any exercise program.
Eat right Eat a heart-healthy diet low in sodium, saturated fat, trans fat, cholesterol and refined sugars. Try to increase your intake of foods rich in vitamins and other nutrients, especially antioxidants, which have been proven to lower your risk for heart disease. Also eat plant-based foods such as fruits and vegetables, nuts, and whole grains.
Achieve and maintain a healthy weight. Excess weight puts significant strain on your heart and worsens several other heart disease risk factors such as diabetes, high blood pressure, and high cholesterol and triglycerides. Research is showing that obesity itself increases heart disease risk. By eating right and exercising, you can lose weight and reduce your risk of heart disease.
Manage stress. Poorly controlled stress and anger can lead to heart attacks and strokes. Use stress and anger management techniques to lower your risk. Learn to manage stress by practicing relaxation techniques, learning how to manage your time, setting realistic goals, and trying some new techniques such as guided imagery, massage, Tai Chi or yoga.
Control diabetes. If not properly controlled, diabetes can lead to significant heart damage including heart attacks and death.
How New Heart-Scanning Technology Could Save Your Life
How New Heart-Scanning Technology Could Save Your Life
Mike Fackelmann had no reason to think he had heart disease. Although his cholesterol was a touch on the high side, he had never experienced any chest pains and had just passed a stress test with flying colors. So last November, when a cardiologist at the Cleveland Clinic Foundation Hospital asked the then 49-year-old registered nurse to help demonstrate an experimental new cardiac scanner, neither the physician nor Fackelmann expected to see anything out of the ordinary. The idea was simply to slide Fackelmann through the machine and show what finely detailed images of the heart it could produce.
The favor Fackelmann did may well have saved his life. The scan revealed a major blockage in one of his coronary arteries. A few days later, doctors propped open the dangerously clogged blood vessel with a stent, thereby preventing what could have been a heart attack. "I would have been one of those guys who was just out jogging with my son or playing basketball and died," Fackelmann says. "There was never any reason for me to suspect that there was such a dramatic lesion in my heart."
What makes this story all the more remarkable is that the image that changed Fackelmann's future was generated without any kind of surgery. For years, the gold standard for discovering the location of blockages in a patient's coronary arteries has been a procedure called a cardiac catheterization, in which a specialist inserts a probe through an incision into a blood vessel in the groin, then snakes it up toward the heart, where an opaque dye is released.
Any lesions or plaques that block the arteries then show up on an X-ray picture called an angiogram. And if you don't consider catheterization real surgery, you don't understand how invasive and delicate an operation it actually is. The process can take anywhere from four to six hours and carries a 1% risk of serious complications, including death, from wayward catheters that can tear the delicate artery walls--which is why doctors don't order it lightly. Yet 20% to 40% of patients who take the risk turn out not to have needed it: they show no significant blockages in their arteries.
Or at least that's where things stood until recently. The past 18 months have brought a wave of advances in cardiac imaging, leading many doctors to wonder whether it's time to change the way they diagnose and treat heart disease. Leading the way are improvements in CT (for computed tomography) scanning, which uses highly specialized X-ray machines to take multiple, finely layered pictures of the heart and surrounding blood vessels. Sophisticated computer programs sort the data to generate amazingly detailed, three-dimensional images like the ones that alerted Fackelmann's doctors to his hidden heart problem. Advances in other techniques like MRI (magnetic resonance imaging) have astonished physicians with the clarity of details now available to them on the inner workings of the heart.
What that means is that millions of patients will probably get the treatment that better matches their condition. Some doctors are already starting to use the scans to figure out which of their otherwise healthy-seeming patients need to be taking cholesterol-lowering drugs like statins, and may even be able to decide what to do in marginal cases without having to resort to an invasive angiogram. Patients with a clean scan, on the other hand, can feel confident that they don't need statins or other medication, along with their potential side effects.
The most dramatic benefits of the heart-imaging revolution will probably show up first in emergency rooms. About 5.5 million people go to the hospital each year complaining of chest pain. Most of them are not suffering a heart attack, but it can be very tricky to separate out which ones have indigestion or a strained muscle from those who have something much, much more dangerous. A noninvasive test that shows whether or not the cardiac blood vessels are blocked could help make the diagnosis a lot easier. "We used to say to patients who came in with chest pain [BRACKET {and no other signs of cardiac disease}], 'I don't think you have coronary disease,'" says Dr. Mario Garcia at the Cleveland Clinic, which has been one of the early adopters of cardiac CT scans. "Now I can tell them, 'I know you don't have coronary disease.' That's a big difference."
Medical groups are racing to keep up with these changes. In July, the American College of Cardiology and the American Heart Association published their first guidelines on how to train doctors to perform the new cardiac scans. Three studies have shown that cardiac CT is 90% accurate at picking up blockages like Fackelmann's. But no standards have been written yet for determining under what conditions using the new scans makes the most sense, and for which patients. More definitive answers may be forthcoming at the annual American Heart Association meeting in November, when several research groups are expected to present their latest studies.
The technological boom has come so fast that doctors and patients are faced with the challenge of sorting the scans from the scams. Medicare and insurance companies are looking with growing alarm at the overall surge in the use of expensive imaging scans for all parts of the body. The reasons for the increase are complex--and hotly disputed--but many cardiologists are worried that fights over which procedures get reimbursed and who gets to order them could strangle the latest innovations.
Meanwhile, no one has given up on more tried-and-true scanning techniques. According to the IMV Medical Information Division of Des Plaines, Ill., doctors perform annually at least 11.5 million echocardiograms, which use sound waves to produce pictures of the internal structures of the heart, and more than 9 million nuclear perfusion scans, which use mildly radioactive tracer molecules to measure how well the cardiac muscle is nourished. Improvements in computer processing power and software have made these tests more reliable and more conclusive than ever before. Stress tests, which help doctors detect ischemia, or lack of blood flow to the cardiac muscle, can be performed using either echocardiograms or nuclear scans. "Echocardiograms and nuclear perfusion scanning are the bread and butter of cardiac care," says Dr. Pamela Douglas, chief of cardiovascular medicine at Duke University Medical Center in Durham, N.C., and president of the American College of Cardiology. "They aren't going away anytime soon."
The trouble is that there's no single type of scan that easily and inexpensively shows you everything you need to know about the heart. In addition, some tests are better at evaluating anatomy--the physical structure of the heart--while others tell you more about how well various parts are working. Doctors need to know both kinds of information before deciding the best course of treatment. Frequently, a new set of answers raises new questions, however, which require more extensive testing. The ultimate goal, cardiologists say, is to find the single test that provides "one-stop shopping" and eliminates the need for invasive or multiple diagnostic scans. That test doesn't exist yet, but a look at the latest advances in noninvasive imaging suggests it is getting closer.
Sharply detailed CT scans of the brain have been available for years, but it has taken much longer to get similar images of the heart. The reason is simple: the brain doesn't move. The heart does, of course, constantly, which means that conventional images are largely a blur. Some rather small (yet vitally important) blood vessels that lie on the surface of the heart compound the problem.
But the latest CT scanners address both drawbacks by dividing the heart into 64 imaginary slices, compared with 16 slices in the most common older scanners. This higher number increases the resolution of the final image and decreases the amount of time needed to make it. It takes about eight heartbeats to get a complete picture, but sophisticated computer software makes it possible for images to be taken at precisely the same part of the cardiac cycle--ensuring that the heart is in the same position. The downside: people with irregular heartbeats aren't the best candidates for cardiac CT.
Under the right conditions, CT images of the heart are so sharp, however, that they can take a lot of the guesswork out of diagnosing heart disease. "There's a fairly large middle category of people where it's not clear how much heart disease they actually have," says Dr. David Bluemke at the Johns Hopkins Hospital in Baltimore, Md. "Their cholesterol is high. Their blood pressure is high. They have a few risk factors. That doesn't mean they need to go to the catheterization lab. But it sure would be nice to get a quantitative measure of their disease."
Some doctors in emergency rooms are already starting to count on cardiac CT for what they call a "triple rule-out." Here's a typical situation: a middle-age woman walks in complaining of chest pains but otherwise seems fine. The biggest concerns are that she might be having a heart attack, that her aorta may have developed a tear or that she has a major clot in the blood vessels of the lungs. Any of these could swiftly be deadly. Her electrocardiogram comes back normal, and blood tests indicate no cardiac damage. With no compelling reason to suspect a heart attack, it's hard to make the case for ordering a cardiac catheterization. But because she continues to complain of chest pains, doctors are reluctant to send her home. So they keep her under observation, waiting to see if anything happens. A 64-slice CT scan of her heart and lungs could provide enough detail to rule any of those conditions in or out on the spot.
Or at least that's the idea. Cardiac CT is not foolproof. Unlike catheterization, it doesn't yet produce clear enough pictures of some of the smaller arteries of the heart. And any arterial plaques that contain calcium deposits, which typically appear in older people, show up like white blobs, so that the blockage could be partial or total (see box). Then there's the issue of radiation. A typical cardiac CT scan exposes a patient to 50 to 80 times the amount of radiation in a series of full-mouth dental X rays. Researchers hope to figure out ways to decrease the dose soon.
Before 64-slice CT appeared on the scene, many physicians thought the future of cardiac scans belonged to a completely different technology: magnetic resonance imaging. Instead of X rays, MRI uses powerful electromagnets that are tuned to detect the hydrogen found in water--which in turn is present in most of the body's soft tissues. An MRI machine can produce astonishingly detailed images of the heart. Just as important, it can also determine how healthy the cardiac tissue is. For example, in a heart-attack patient, an MRI can pick out precisely which sections of the cardiac muscle are getting less blood than they need and by what amount. And, unlike a CT scan, it does all that without subjecting the patient to radiation.
Advocates of MRI admit that CT scans probably have the edge when it comes to imaging the heart's arteries, but that's about all. "Coronary arteries are only a small part of the heart," says Dr. Raymond Kim, co-director of the Duke Cardiovascular Magnetic Resonance Center. MRI is better at telling you how well the heart is pumping, how healthy its walls are and what shape the valves and chambers are in. In other words, says Dr. Edward Martin of the Oklahoma Heart Institute in Tulsa, "MRI has the potential to do everything."
MRI is also ideal for scanning children with congenital heart problems, since repeated radiation exposure in youngsters leads to an increased risk of developing cancer as adults. But again there are drawbacks. MRI scans are much more expensive than CT scans, and generating and interpreting them require lots of training. Furthermore, the magnet exerts a powerful attractive force on any iron-containing metals, so special precautions must be taken to prevent accidents.
As for cost, some MRI experts predict that will become less of an issue. "Right now many heart patients have to undergo a combination of tests that add up to more than the expense of one MRI scan," says Dr. Andrew Arai, a researcher at the National Heart, Lung and Blood Institute in Bethesda, Md., who is studying the use of cardiac MRI in the emergency room. If a single MRI could replace the need for lots of echocardiograms, cardiac catheterizations and nuclear perfusion scans, it might be worth the price.
Some of the older diagnostic standards are undergoing a technological makeover of their own. Echocardiogram machines are getting smaller and smaller, and their output is increasingly being digitized, which allows doctors to calculate more accurately the ability of the heart to function. And new radioactive markers are making nuclear perfusion scans shorter and more precise.
The future, however, may belong to whoever can figure out how to make all these imaging technologies work together. One approach combines the anatomical accuracy of CT imaging with the functional information provided by a type of nuclear scan called positron-emission tomography (PET). Still in its early days in the clinic, PET/CT could help doctors see how much of the cardiac muscle is still alive after a heart attack and whether a bypass operation, balloon angioplasty or stent surgery would help damaged areas recover.
Even the sharpest pictures can't show you everything. Over the past few years, it has become increasingly clear that not all plaques that form inside a coronary artery's walls are dangerous. Some appear to be stable and don't grow much, whereas others contain an explosive combination of hardened fat and inflammatory proteins that make them likely to burst, triggering a heart attack. Neither CT nor MRI scans can reliably distinguish between the two sorts of lesions. Researchers are developing compounds that are chemically attracted to the inflammatory components of an unstable plaque with the hope of someday tagging trouble spots that need to be treated. But that could take a while.
The latest advances in scanning could backfire, moreover, if they lead to lots of unnecessary surgery. Not every blockage reduces blood flow. Sometimes the other blood vessels that nourish the heart can take up the slack--a situation that's more common than you might think. "We still don't know what to do with patients who have a number of moderate narrowings but no ischemia," says Dr. Roger Blumenthal of Johns Hopkins. "There are no data showing that taking them to the cath lab for stenting or angioplasty affects their outcome."
On the other hand, there is a lot of evidence that lowering cholesterol levels in those patients with moderate arterial blockage greatly reduces the risk of suffering a heart attack or stroke. So a growing number of cardiologists are using the new cardiac scans to determine which of their otherwise asymptomatic patients need more intense medical treatment with statins and other drugs. "It's the perfect setup," says Dr. Christopher Cannon, a cardiologist at the Brigham and Women's Hospital in Boston. "You don't want to wait until you've had a heart attack to manage your cholesterol."
Not surprisingly then, the new cardiac scans are helping to fuel a more aggressive focus on prevention. If a cardiac scan shows your doctor that you have mild coronary artery disease, then, in addition to trying to get your LDL cholesterol level under 70 mg/dL, he or she is probably going to put you on a daily aspirin regimen and make sure your blood pressure is nice and low. "Conversely," says Cannon, "if you have a scan and you're normal, you don't have to start taking five different medications."
Meanwhile, there is still an issue of professional turf left to resolve. High-tech imaging--particularly CT scanning--has long been the purview of radiologists, many of whom don't take kindly to cardiologists encroaching on their territory. After all, it has happened before. Radiologists used to perform lots of cardiac catheterizations but have pretty much given up that technique to heart specialists, in large part because they were simply outnumbered. As for who is best at reading cardiac CT scans, cardiologists argue that they have a better understanding of the heart's anatomy and function, while radiologists point out that the heart is not the only organ that shows up on the images and needs to be evaluated. Some hospitals have split the difference, decreeing that a cardiologist and a radiologist should analyze each cardiac scan.
No one expects any of these concerns to hold the field back for long. Noninvasive imaging has the potential to radically alter the way physicians diagnose and monitor heart disease. "The whole paradigm for us has been that you don't get that kind of information unless you stick things into people," says Duke University's Douglas. But as cardiac scanners become more powerful and their diagnoses more definitive, sticking probes into people is going to sound less and less like modern medicine--and more like voodoo. --With reporting by Leslie Whitaker/Chicago
The favor Fackelmann did may well have saved his life. The scan revealed a major blockage in one of his coronary arteries. A few days later, doctors propped open the dangerously clogged blood vessel with a stent, thereby preventing what could have been a heart attack. "I would have been one of those guys who was just out jogging with my son or playing basketball and died," Fackelmann says. "There was never any reason for me to suspect that there was such a dramatic lesion in my heart."
What makes this story all the more remarkable is that the image that changed Fackelmann's future was generated without any kind of surgery. For years, the gold standard for discovering the location of blockages in a patient's coronary arteries has been a procedure called a cardiac catheterization, in which a specialist inserts a probe through an incision into a blood vessel in the groin, then snakes it up toward the heart, where an opaque dye is released.
Any lesions or plaques that block the arteries then show up on an X-ray picture called an angiogram. And if you don't consider catheterization real surgery, you don't understand how invasive and delicate an operation it actually is. The process can take anywhere from four to six hours and carries a 1% risk of serious complications, including death, from wayward catheters that can tear the delicate artery walls--which is why doctors don't order it lightly. Yet 20% to 40% of patients who take the risk turn out not to have needed it: they show no significant blockages in their arteries.
Or at least that's where things stood until recently. The past 18 months have brought a wave of advances in cardiac imaging, leading many doctors to wonder whether it's time to change the way they diagnose and treat heart disease. Leading the way are improvements in CT (for computed tomography) scanning, which uses highly specialized X-ray machines to take multiple, finely layered pictures of the heart and surrounding blood vessels. Sophisticated computer programs sort the data to generate amazingly detailed, three-dimensional images like the ones that alerted Fackelmann's doctors to his hidden heart problem. Advances in other techniques like MRI (magnetic resonance imaging) have astonished physicians with the clarity of details now available to them on the inner workings of the heart.
What that means is that millions of patients will probably get the treatment that better matches their condition. Some doctors are already starting to use the scans to figure out which of their otherwise healthy-seeming patients need to be taking cholesterol-lowering drugs like statins, and may even be able to decide what to do in marginal cases without having to resort to an invasive angiogram. Patients with a clean scan, on the other hand, can feel confident that they don't need statins or other medication, along with their potential side effects.
The most dramatic benefits of the heart-imaging revolution will probably show up first in emergency rooms. About 5.5 million people go to the hospital each year complaining of chest pain. Most of them are not suffering a heart attack, but it can be very tricky to separate out which ones have indigestion or a strained muscle from those who have something much, much more dangerous. A noninvasive test that shows whether or not the cardiac blood vessels are blocked could help make the diagnosis a lot easier. "We used to say to patients who came in with chest pain [BRACKET {and no other signs of cardiac disease}], 'I don't think you have coronary disease,'" says Dr. Mario Garcia at the Cleveland Clinic, which has been one of the early adopters of cardiac CT scans. "Now I can tell them, 'I know you don't have coronary disease.' That's a big difference."
Medical groups are racing to keep up with these changes. In July, the American College of Cardiology and the American Heart Association published their first guidelines on how to train doctors to perform the new cardiac scans. Three studies have shown that cardiac CT is 90% accurate at picking up blockages like Fackelmann's. But no standards have been written yet for determining under what conditions using the new scans makes the most sense, and for which patients. More definitive answers may be forthcoming at the annual American Heart Association meeting in November, when several research groups are expected to present their latest studies.
The technological boom has come so fast that doctors and patients are faced with the challenge of sorting the scans from the scams. Medicare and insurance companies are looking with growing alarm at the overall surge in the use of expensive imaging scans for all parts of the body. The reasons for the increase are complex--and hotly disputed--but many cardiologists are worried that fights over which procedures get reimbursed and who gets to order them could strangle the latest innovations.
Meanwhile, no one has given up on more tried-and-true scanning techniques. According to the IMV Medical Information Division of Des Plaines, Ill., doctors perform annually at least 11.5 million echocardiograms, which use sound waves to produce pictures of the internal structures of the heart, and more than 9 million nuclear perfusion scans, which use mildly radioactive tracer molecules to measure how well the cardiac muscle is nourished. Improvements in computer processing power and software have made these tests more reliable and more conclusive than ever before. Stress tests, which help doctors detect ischemia, or lack of blood flow to the cardiac muscle, can be performed using either echocardiograms or nuclear scans. "Echocardiograms and nuclear perfusion scanning are the bread and butter of cardiac care," says Dr. Pamela Douglas, chief of cardiovascular medicine at Duke University Medical Center in Durham, N.C., and president of the American College of Cardiology. "They aren't going away anytime soon."
The trouble is that there's no single type of scan that easily and inexpensively shows you everything you need to know about the heart. In addition, some tests are better at evaluating anatomy--the physical structure of the heart--while others tell you more about how well various parts are working. Doctors need to know both kinds of information before deciding the best course of treatment. Frequently, a new set of answers raises new questions, however, which require more extensive testing. The ultimate goal, cardiologists say, is to find the single test that provides "one-stop shopping" and eliminates the need for invasive or multiple diagnostic scans. That test doesn't exist yet, but a look at the latest advances in noninvasive imaging suggests it is getting closer.
Sharply detailed CT scans of the brain have been available for years, but it has taken much longer to get similar images of the heart. The reason is simple: the brain doesn't move. The heart does, of course, constantly, which means that conventional images are largely a blur. Some rather small (yet vitally important) blood vessels that lie on the surface of the heart compound the problem.
But the latest CT scanners address both drawbacks by dividing the heart into 64 imaginary slices, compared with 16 slices in the most common older scanners. This higher number increases the resolution of the final image and decreases the amount of time needed to make it. It takes about eight heartbeats to get a complete picture, but sophisticated computer software makes it possible for images to be taken at precisely the same part of the cardiac cycle--ensuring that the heart is in the same position. The downside: people with irregular heartbeats aren't the best candidates for cardiac CT.
Under the right conditions, CT images of the heart are so sharp, however, that they can take a lot of the guesswork out of diagnosing heart disease. "There's a fairly large middle category of people where it's not clear how much heart disease they actually have," says Dr. David Bluemke at the Johns Hopkins Hospital in Baltimore, Md. "Their cholesterol is high. Their blood pressure is high. They have a few risk factors. That doesn't mean they need to go to the catheterization lab. But it sure would be nice to get a quantitative measure of their disease."
Some doctors in emergency rooms are already starting to count on cardiac CT for what they call a "triple rule-out." Here's a typical situation: a middle-age woman walks in complaining of chest pains but otherwise seems fine. The biggest concerns are that she might be having a heart attack, that her aorta may have developed a tear or that she has a major clot in the blood vessels of the lungs. Any of these could swiftly be deadly. Her electrocardiogram comes back normal, and blood tests indicate no cardiac damage. With no compelling reason to suspect a heart attack, it's hard to make the case for ordering a cardiac catheterization. But because she continues to complain of chest pains, doctors are reluctant to send her home. So they keep her under observation, waiting to see if anything happens. A 64-slice CT scan of her heart and lungs could provide enough detail to rule any of those conditions in or out on the spot.
Or at least that's the idea. Cardiac CT is not foolproof. Unlike catheterization, it doesn't yet produce clear enough pictures of some of the smaller arteries of the heart. And any arterial plaques that contain calcium deposits, which typically appear in older people, show up like white blobs, so that the blockage could be partial or total (see box). Then there's the issue of radiation. A typical cardiac CT scan exposes a patient to 50 to 80 times the amount of radiation in a series of full-mouth dental X rays. Researchers hope to figure out ways to decrease the dose soon.
Before 64-slice CT appeared on the scene, many physicians thought the future of cardiac scans belonged to a completely different technology: magnetic resonance imaging. Instead of X rays, MRI uses powerful electromagnets that are tuned to detect the hydrogen found in water--which in turn is present in most of the body's soft tissues. An MRI machine can produce astonishingly detailed images of the heart. Just as important, it can also determine how healthy the cardiac tissue is. For example, in a heart-attack patient, an MRI can pick out precisely which sections of the cardiac muscle are getting less blood than they need and by what amount. And, unlike a CT scan, it does all that without subjecting the patient to radiation.
Advocates of MRI admit that CT scans probably have the edge when it comes to imaging the heart's arteries, but that's about all. "Coronary arteries are only a small part of the heart," says Dr. Raymond Kim, co-director of the Duke Cardiovascular Magnetic Resonance Center. MRI is better at telling you how well the heart is pumping, how healthy its walls are and what shape the valves and chambers are in. In other words, says Dr. Edward Martin of the Oklahoma Heart Institute in Tulsa, "MRI has the potential to do everything."
MRI is also ideal for scanning children with congenital heart problems, since repeated radiation exposure in youngsters leads to an increased risk of developing cancer as adults. But again there are drawbacks. MRI scans are much more expensive than CT scans, and generating and interpreting them require lots of training. Furthermore, the magnet exerts a powerful attractive force on any iron-containing metals, so special precautions must be taken to prevent accidents.
As for cost, some MRI experts predict that will become less of an issue. "Right now many heart patients have to undergo a combination of tests that add up to more than the expense of one MRI scan," says Dr. Andrew Arai, a researcher at the National Heart, Lung and Blood Institute in Bethesda, Md., who is studying the use of cardiac MRI in the emergency room. If a single MRI could replace the need for lots of echocardiograms, cardiac catheterizations and nuclear perfusion scans, it might be worth the price.
Some of the older diagnostic standards are undergoing a technological makeover of their own. Echocardiogram machines are getting smaller and smaller, and their output is increasingly being digitized, which allows doctors to calculate more accurately the ability of the heart to function. And new radioactive markers are making nuclear perfusion scans shorter and more precise.
The future, however, may belong to whoever can figure out how to make all these imaging technologies work together. One approach combines the anatomical accuracy of CT imaging with the functional information provided by a type of nuclear scan called positron-emission tomography (PET). Still in its early days in the clinic, PET/CT could help doctors see how much of the cardiac muscle is still alive after a heart attack and whether a bypass operation, balloon angioplasty or stent surgery would help damaged areas recover.
Even the sharpest pictures can't show you everything. Over the past few years, it has become increasingly clear that not all plaques that form inside a coronary artery's walls are dangerous. Some appear to be stable and don't grow much, whereas others contain an explosive combination of hardened fat and inflammatory proteins that make them likely to burst, triggering a heart attack. Neither CT nor MRI scans can reliably distinguish between the two sorts of lesions. Researchers are developing compounds that are chemically attracted to the inflammatory components of an unstable plaque with the hope of someday tagging trouble spots that need to be treated. But that could take a while.
The latest advances in scanning could backfire, moreover, if they lead to lots of unnecessary surgery. Not every blockage reduces blood flow. Sometimes the other blood vessels that nourish the heart can take up the slack--a situation that's more common than you might think. "We still don't know what to do with patients who have a number of moderate narrowings but no ischemia," says Dr. Roger Blumenthal of Johns Hopkins. "There are no data showing that taking them to the cath lab for stenting or angioplasty affects their outcome."
On the other hand, there is a lot of evidence that lowering cholesterol levels in those patients with moderate arterial blockage greatly reduces the risk of suffering a heart attack or stroke. So a growing number of cardiologists are using the new cardiac scans to determine which of their otherwise asymptomatic patients need more intense medical treatment with statins and other drugs. "It's the perfect setup," says Dr. Christopher Cannon, a cardiologist at the Brigham and Women's Hospital in Boston. "You don't want to wait until you've had a heart attack to manage your cholesterol."
Not surprisingly then, the new cardiac scans are helping to fuel a more aggressive focus on prevention. If a cardiac scan shows your doctor that you have mild coronary artery disease, then, in addition to trying to get your LDL cholesterol level under 70 mg/dL, he or she is probably going to put you on a daily aspirin regimen and make sure your blood pressure is nice and low. "Conversely," says Cannon, "if you have a scan and you're normal, you don't have to start taking five different medications."
Meanwhile, there is still an issue of professional turf left to resolve. High-tech imaging--particularly CT scanning--has long been the purview of radiologists, many of whom don't take kindly to cardiologists encroaching on their territory. After all, it has happened before. Radiologists used to perform lots of cardiac catheterizations but have pretty much given up that technique to heart specialists, in large part because they were simply outnumbered. As for who is best at reading cardiac CT scans, cardiologists argue that they have a better understanding of the heart's anatomy and function, while radiologists point out that the heart is not the only organ that shows up on the images and needs to be evaluated. Some hospitals have split the difference, decreeing that a cardiologist and a radiologist should analyze each cardiac scan.
No one expects any of these concerns to hold the field back for long. Noninvasive imaging has the potential to radically alter the way physicians diagnose and monitor heart disease. "The whole paradigm for us has been that you don't get that kind of information unless you stick things into people," says Duke University's Douglas. But as cardiac scanners become more powerful and their diagnoses more definitive, sticking probes into people is going to sound less and less like modern medicine--and more like voodoo. --With reporting by Leslie Whitaker/Chicago
Cost of 64-Slice CT Scan
Cost of 64-Slice CT Scan
The 64-Slice CT Scan Study costs US $278, EUR 212.460, £142.551, ¥33694.94.
Payment can be done through cash, Credit or Debit Card.This is almost 1/5 th the cost that a similar study would incur in their respective countries. Typically a cardiac CT in the US would cost US $1200-1500.
Heartline: (+91)98145 09814, (+91)98145 01415, (+91)94171 17737
The 64-Slice CT Scan Study costs US $278, EUR 212.460, £142.551, ¥33694.94.
Payment can be done through cash, Credit or Debit Card.This is almost 1/5 th the cost that a similar study would incur in their respective countries. Typically a cardiac CT in the US would cost US $1200-1500.
Heartline: (+91)98145 09814, (+91)98145 01415, (+91)94171 17737
Procedure
The Procedure for CT Coronary Angiography is:
Totally Non-Invasive, i.e. the procedure involves No Catheter, No Anaesthesia, No Admission to Hospital. The procedure just takes 10 minutes
Single breathhold whole Heart Scan
To see the Coronary Arteries
For follow-up of Stents & Bypass
For assessment of Acute Chest Pain
For assessment of Cardiac Function
Totally Non-Invasive, i.e. the procedure involves No Catheter, No Anaesthesia, No Admission to Hospital. The procedure just takes 10 minutes
Single breathhold whole Heart Scan
To see the Coronary Arteries
For follow-up of Stents & Bypass
For assessment of Acute Chest Pain
For assessment of Cardiac Function
Instructions
Instructions for Patients before CT Coronary Angiography
Fasting (No Solid intake) for 4 hours before the scan.
Water/liquid can be taken till 1 hour before the scan.
Do not consume aerated drinks (Pepsi, Coke etc.), Smoke, or take any stimulant medications (cough syrup, excessive coffee) for 24 hours prior to examination
Drugs like Viagra, any exercise effecting cardiovascular system to be avoided 2 days prior to the scan.
Continue taking your regular medication prescribed by your doctor.
Please bring all your previous health records, (if any).
If you are diabetic, pregnant, asthmatic, allergic to any medication or have any kidney problem please inform us at the time of appointment.
Fasting (No Solid intake) for 4 hours before the scan.
Water/liquid can be taken till 1 hour before the scan.
Do not consume aerated drinks (Pepsi, Coke etc.), Smoke, or take any stimulant medications (cough syrup, excessive coffee) for 24 hours prior to examination
Drugs like Viagra, any exercise effecting cardiovascular system to be avoided 2 days prior to the scan.
Continue taking your regular medication prescribed by your doctor.
Please bring all your previous health records, (if any).
If you are diabetic, pregnant, asthmatic, allergic to any medication or have any kidney problem please inform us at the time of appointment.
Who Should get Cardiac CT Scan ?
Who Should get Cardiac CT Scan ?
Some factors for getting Cardiac CT Scan:
You are male and more than 45 years old
You are female and over 55 years old, OR you have passed menopause or had your ovaries removed and are not taking estrogen
Your father or brother had a heart attack before age 55, or your mother or sister had one before age 65
You smoke or live/work with someone who smokes daily
You have a cholesterol level of 240 mg/dl or higher
You have high blood pressure
You don’t exercise regularly
You are overweight
You have diabetes or use medicine to control your blood sugar
You have heart-related symptoms like chest pain or shortness of breath
You have gone to an emergency room because of sudden symptoms. You might benefit from a high-speed CT scan to see if they’re having a heart attack, stroke or rupture of a major blood vessel
You have ECG abnormalities on a routine health check-up
Anyone who cannot take "Tread-Mill test" because of knee-pain or some other reason.
Prior to Non-Coronary Heart Surgery in adults like Valular repair, ASD repair & Cardiac Tumor surgery.
Patients who may be able to avoid undergoing a convetional in-hospital invasive Coronary Angiogram & may benefit on Non-Ivasive CT Coronary Angiogram include:
Patients with chest discomfort and an equivocal treadmill test result.
Patients with a suspicion of false-positive stress test
Patients with previous Angioplasty for Bye-Pass graft who experience new symptoms.
Patients with suspected congenital anomalies or cardiomyopathy.
Patients with anomalous Coronary arteries.
Some factors for getting Cardiac CT Scan:
You are male and more than 45 years old
You are female and over 55 years old, OR you have passed menopause or had your ovaries removed and are not taking estrogen
Your father or brother had a heart attack before age 55, or your mother or sister had one before age 65
You smoke or live/work with someone who smokes daily
You have a cholesterol level of 240 mg/dl or higher
You have high blood pressure
You don’t exercise regularly
You are overweight
You have diabetes or use medicine to control your blood sugar
You have heart-related symptoms like chest pain or shortness of breath
You have gone to an emergency room because of sudden symptoms. You might benefit from a high-speed CT scan to see if they’re having a heart attack, stroke or rupture of a major blood vessel
You have ECG abnormalities on a routine health check-up
Anyone who cannot take "Tread-Mill test" because of knee-pain or some other reason.
Prior to Non-Coronary Heart Surgery in adults like Valular repair, ASD repair & Cardiac Tumor surgery.
Patients who may be able to avoid undergoing a convetional in-hospital invasive Coronary Angiogram & may benefit on Non-Ivasive CT Coronary Angiogram include:
Patients with chest discomfort and an equivocal treadmill test result.
Patients with a suspicion of false-positive stress test
Patients with previous Angioplasty for Bye-Pass graft who experience new symptoms.
Patients with suspected congenital anomalies or cardiomyopathy.
Patients with anomalous Coronary arteries.
64-Slice Cardiac Scan
64-Slice Cardiac Scan
The exquisitly detailed Coronary Artery images called Cardiac Scan or Heart Scan are obtained from Siemens Sensation-64 Slice CT Scanner. This scanner has a special X-Ray tube on one side of the patient & the detectors on the opposite side. This tube is capable of performing over 3 rotations per second around the patient. In each rotation of 0.33 seconds, we get 64-Slices. That means we get approx. 194 Slices/second.
Speed is extremely important in our ability to freeze the heart which is ever moving structure. The Scans are gated to the ECG which enables the data acquisition in a specific phase. With this fast speed, we can scan nearly as fast as the heart beats.
The older, traditional, invasive procedure is insertion of cardiac catheter and angiography – performed in a hospital and usually requiring anesthesia and a one or more days hospital stay.The new 64 Slice Cardiac Scanning procedure is safe, fast, Non-Inasive & lasting a few minutes. It has proven to be a breakthrough in technology for the diagnosis of heart disease. The procedure involves No Catheter, No Anaesthesia, No Admission.A cardiac CT scan can provide an image of the heart and its arteries so detailed that the presence of plaque, narrowing or stenosis of the arteries, calcium scoring and abnormal heart vessels can be determined with a comparable degree of detail and accuracy previously only available through an invasive procedure such as cardiac catheterization or angiography. The presence of any of these conditions could put an individual, even a strong healthy athlete or someone with no symptoms,
What all 64 Slice Cardiac Scan can do?
It is a superfast CT Scanner taking 64 slices in 0.33 seconds i.e. 194 slices in one second. The resolution of the pictures will be excellent and the doctor can pick up very minute lesions i.e. chances of missing any lesion are almost negligible.This machine can undertake the following tests:
CT CORONARY ANGIOGRAPHY
CT Angiography –ABDOMINAL AORTATHORACIC AORTA PERIPHERAL VESSELS CEREBRAL(Brain)CAROTID(Neck)RENAL(Kidney)PULMONARY(Lung).
CT 3-Dimensional Reconstruction of all/any study
Evaluation of Chest Pain- To rule out Pulmonary embolism/dissection of aorta/coronary artery disease
CHEST – High Resolution CT
ABDOMEN (Upper abdomen, Lower Abdomen, Whole Abdomen)
Pre-Transplant Triple phase scan(Liver, Kidney)
UROGRAPHY
HEAD PLAIN
HEAD CONTRAST
HEAD PLAIN & CONTRAST
SPINE CERVICAL
SPINE THORACIC
SPINE LUMBAR
WHOLE SPINE
KUB
ORBIT/NECK/PNS
LIMB/EXTREMITY
JOINT (PER JOINT)
CT GUIDED FNAC/ASPIRATION /CATHETER DRAINAGE/BIOPSY
VIRTUAL BRONCHOSCOPY/COLONOSCOPY
STROKE/TUMOR (PERFUSION) Evaluation
PRE-IMPLANT DENTA SCAN
The exquisitly detailed Coronary Artery images called Cardiac Scan or Heart Scan are obtained from Siemens Sensation-64 Slice CT Scanner. This scanner has a special X-Ray tube on one side of the patient & the detectors on the opposite side. This tube is capable of performing over 3 rotations per second around the patient. In each rotation of 0.33 seconds, we get 64-Slices. That means we get approx. 194 Slices/second.
Speed is extremely important in our ability to freeze the heart which is ever moving structure. The Scans are gated to the ECG which enables the data acquisition in a specific phase. With this fast speed, we can scan nearly as fast as the heart beats.
The older, traditional, invasive procedure is insertion of cardiac catheter and angiography – performed in a hospital and usually requiring anesthesia and a one or more days hospital stay.The new 64 Slice Cardiac Scanning procedure is safe, fast, Non-Inasive & lasting a few minutes. It has proven to be a breakthrough in technology for the diagnosis of heart disease. The procedure involves No Catheter, No Anaesthesia, No Admission.A cardiac CT scan can provide an image of the heart and its arteries so detailed that the presence of plaque, narrowing or stenosis of the arteries, calcium scoring and abnormal heart vessels can be determined with a comparable degree of detail and accuracy previously only available through an invasive procedure such as cardiac catheterization or angiography. The presence of any of these conditions could put an individual, even a strong healthy athlete or someone with no symptoms,
What all 64 Slice Cardiac Scan can do?
It is a superfast CT Scanner taking 64 slices in 0.33 seconds i.e. 194 slices in one second. The resolution of the pictures will be excellent and the doctor can pick up very minute lesions i.e. chances of missing any lesion are almost negligible.This machine can undertake the following tests:
CT CORONARY ANGIOGRAPHY
CT Angiography –ABDOMINAL AORTATHORACIC AORTA PERIPHERAL VESSELS CEREBRAL(Brain)CAROTID(Neck)RENAL(Kidney)PULMONARY(Lung).
CT 3-Dimensional Reconstruction of all/any study
Evaluation of Chest Pain- To rule out Pulmonary embolism/dissection of aorta/coronary artery disease
CHEST – High Resolution CT
ABDOMEN (Upper abdomen, Lower Abdomen, Whole Abdomen)
Pre-Transplant Triple phase scan(Liver, Kidney)
UROGRAPHY
HEAD PLAIN
HEAD CONTRAST
HEAD PLAIN & CONTRAST
SPINE CERVICAL
SPINE THORACIC
SPINE LUMBAR
WHOLE SPINE
KUB
ORBIT/NECK/PNS
LIMB/EXTREMITY
JOINT (PER JOINT)
CT GUIDED FNAC/ASPIRATION /CATHETER DRAINAGE/BIOPSY
VIRTUAL BRONCHOSCOPY/COLONOSCOPY
STROKE/TUMOR (PERFUSION) Evaluation
PRE-IMPLANT DENTA SCAN
HEART STATISTICS
Coronary artery disease is the single largest cause of morbidity amongst all diseases so much so that it has been classified as having reached pandemic proportions by none less than the WHO (World Health Organisation).
Over 7,0000,000 Indians have heart related diseases
1 in 3 adults, both men and women, has some form of cardiovascular disease.
In 90% of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed or blocked.
Brain death and permanent death start to occur in just 4-6 minutes after someone experiences cardiac arrest.
It is in the early or initial stage that the heart disease is almost certainly treatable.
The heart and brain muscles are the ones which cannot be revived once dead.
The cardiac 64 CT scan provides 3D images of the heart so detailed that the heart disease can be detected at a very early stage.
Over 7,0000,000 Indians have heart related diseases
1 in 3 adults, both men and women, has some form of cardiovascular disease.
In 90% of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed or blocked.
Brain death and permanent death start to occur in just 4-6 minutes after someone experiences cardiac arrest.
It is in the early or initial stage that the heart disease is almost certainly treatable.
The heart and brain muscles are the ones which cannot be revived once dead.
The cardiac 64 CT scan provides 3D images of the heart so detailed that the heart disease can be detected at a very early stage.
Smoking
Smoking And Heart Disease
Well is it true?
If everyone quits smoking will heart disease disapear?
Of course not, but that's not what is important.
Its the effect that smoking and heart disease is having on YOU that is important.
Everyday you get told that you should "Quit Smoking Now!". You get told how smoking is the major cause of heart disease, killing kazzillions of people every year, but you continue to smoke!
What does smoking do to you?Makes your heart beat faster
Raises blood pressure
Reduces oxygen to your heart
Increase the thickness of your blood and the likelihood of clotting
Increases the build up of plaque inside your arteries
But I've been smoking for years - what's the point of giving up ? The damage is done.Well
actually that's not quite true.
You will already be aware that your pulse and blood pressure go up when you have a cigarette.
About 30 minutes after a cigarette they will both drop back down. But did you realize that the temperature of your feet and hands will go up as well?
So if there are such noticeable changes after just 30 minutes without smoking, what happens after a longer period of time?
Well the following may surprise you.
After just 8 hours you blood's carbon monoxide level drops to normal which means that your Oxygen level increases.
After just 24 hoursyour heart attack risk starts to decrease!
After just 2 weeks your cravings will go away.
After just 2 weeks your circulation will start to improve!
After just 4 weeks your energy increases!
After just 1 year your risk of heart disease drops to half what it was when you were a smoker!
After 5 years your risk of a stroke is the same as someone who never smoked.
After 15 years your risk of heart disease is is the same as someone who never smoked.
Well is it true?
If everyone quits smoking will heart disease disapear?
Of course not, but that's not what is important.
Its the effect that smoking and heart disease is having on YOU that is important.
Everyday you get told that you should "Quit Smoking Now!". You get told how smoking is the major cause of heart disease, killing kazzillions of people every year, but you continue to smoke!
What does smoking do to you?Makes your heart beat faster
Raises blood pressure
Reduces oxygen to your heart
Increase the thickness of your blood and the likelihood of clotting
Increases the build up of plaque inside your arteries
But I've been smoking for years - what's the point of giving up ? The damage is done.Well
actually that's not quite true.
You will already be aware that your pulse and blood pressure go up when you have a cigarette.
About 30 minutes after a cigarette they will both drop back down. But did you realize that the temperature of your feet and hands will go up as well?
So if there are such noticeable changes after just 30 minutes without smoking, what happens after a longer period of time?
Well the following may surprise you.
After just 8 hours you blood's carbon monoxide level drops to normal which means that your Oxygen level increases.
After just 24 hoursyour heart attack risk starts to decrease!
After just 2 weeks your cravings will go away.
After just 2 weeks your circulation will start to improve!
After just 4 weeks your energy increases!
After just 1 year your risk of heart disease drops to half what it was when you were a smoker!
After 5 years your risk of a stroke is the same as someone who never smoked.
After 15 years your risk of heart disease is is the same as someone who never smoked.
Journal For Health
Men Or Women Having Heart Attack MUST Ring The Emergency Services IMEDIATELY!
If you are reading this because you are thinking
"I AM HAVING A HEART ATTACK”
Ring the emergency services NOW!
Waiting more than fifteen minutes to see if the pain goes away may result in permanent damage to your heart!
Women tend to delay ringing the emergency services
DON'T BE ONE OF THOSE WOMEN!
Ring NOW
Take aspirin 300mg
(Not if you are allergic to it)
When the paramedics arrive
Do Not play down your symptoms
Tell it like it is
If you are reading this because you are thinking
"I AM HAVING A HEART ATTACK”
Ring the emergency services NOW!
Waiting more than fifteen minutes to see if the pain goes away may result in permanent damage to your heart!
Women tend to delay ringing the emergency services
DON'T BE ONE OF THOSE WOMEN!
Ring NOW
Take aspirin 300mg
(Not if you are allergic to it)
When the paramedics arrive
Do Not play down your symptoms
Tell it like it is
Work After A Heart Attack
Most people will be able to go back to work after a heart attack within 6 to 8 weeks and be able to continue with their current job even if it is stressful. Some people who have jobs that are very physical however may need to change to less demanding work
You may be surprised how many famous people who have had a heart attack or have had a bypass or have been diagnosed with heart disease have carried on with demanding and stressful careers. Here are just a few:
Michael Eisner (former CEO of Disney) – Quadruple bypass 1999 back to work in 6 weeks
David Letterman – Quadruple bypass 2000 - back to work in 6 weeks
Larry King – quickly back to work after a heart attack and bypass in 1987
Sir Ranulph Fiennes (explorer) – heart attack and double bypass 2003 – four months later completed 7 marathons in 7 days on 7 continents!
Bill Clinton – quadruple bypass 2004
Many people however, reassess their life after a heart attack and decide that they want to do something different as a career or that they want an extra income to enable them to retire early or that they want to take early retirement but want to have an interest that also makes them an income.
Working frm home is a lot of peoples' dream. One great way to earn after a heart attack, is to start a business on the internet where you can develop and income at your own pace from home with no pressure, no targest and no boss.
You may be surprised how many famous people who have had a heart attack or have had a bypass or have been diagnosed with heart disease have carried on with demanding and stressful careers. Here are just a few:
Michael Eisner (former CEO of Disney) – Quadruple bypass 1999 back to work in 6 weeks
David Letterman – Quadruple bypass 2000 - back to work in 6 weeks
Larry King – quickly back to work after a heart attack and bypass in 1987
Sir Ranulph Fiennes (explorer) – heart attack and double bypass 2003 – four months later completed 7 marathons in 7 days on 7 continents!
Bill Clinton – quadruple bypass 2004
Many people however, reassess their life after a heart attack and decide that they want to do something different as a career or that they want an extra income to enable them to retire early or that they want to take early retirement but want to have an interest that also makes them an income.
Working frm home is a lot of peoples' dream. One great way to earn after a heart attack, is to start a business on the internet where you can develop and income at your own pace from home with no pressure, no targest and no boss.
Lose Your Belly Fat
5 Facts You MUST Understand if You Are Ever Going to Lose Your Belly Fat & Get Six Pack
1. Many so-called "health foods" are actually cleverly disguised junk foods that can actually stimulate you to gain more belly fat... yet the diet food marketing industry continues to lie to you so they can maximize their profits.
2. Ab exercises such as crunches, sit-ups, and ab machines are actually the LEAST effective method of getting flat six pack abs. We'll explore what types of exercises REALLY work in a minute.
3. Boring repetitive cardio exercise routines are NOT the best way to lose body fat and uncover those six pack abs. I'll tell you the exact types of unique workouts that produce 10x better results below.
4. You DON'T need to waste your money on expensive "extreme fat burner" pills or other bogus supplements. I'll show you how to use the power of natural foods in more detail below.
5. Ab belts, ab-rockers, ab-loungers, and other infomercial ab-gimmicks... they're all a complete waste of your time and money. Despite the misleading infomercials, the perfectly chiseled fitness models in the commercials did NOT get their perfect body by using that "ab contraption"... they got their perfect body through REAL workouts and REAL nutrition strategies. Again, you'll learn some of their secrets and what really works below.
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