February 7th    Dr. Robert Fishberg will be speaking in Westfield at the Westfield YMCA at 7pm on Heart Disease – signs and symptoms. If you would like to attend please call the Westfield YMCA to register.

February 27th   Dr. Michael Weinrauch will be speaking in Union at the Union Senior Center at 10am on Heart Disease - signs and symptoms

Dr. Roberti has been very active in teaching the residents and taking time to answer their questions and further their education.
Congratulations Dr. Roberti!

Americans Still Eat Too Much Salt

Despite repeated warnings about the health effects of a high-salt diet, Americans haven’t cut back – at all.

A new study found that salt consumption is the same today as it was nearly 50 years ago, an amount well above current U.S. guidelines.

Eating too much salt can increase blood pressure – and boost the risk for heart disease and stroke.

Long-term study

Harvard researchers analyzed 38 studies that involved a total of 26,000 people and that spanned more than four decades – from 1957 to 2003. They focused on the amount sodium that people had in their urine. This test is the best way to check salt consumption, because 40 percent of salt is sodium.

You need sodium for proper body functioning. But most fresh foods – vegetables, fruits, and meats, for instance – already contain sodium as a natural ingredient. There’s no need to add any.

More processed food

Because people eat more processed foods today than in 1957, the researchers thought they would find that salt intake had increased over time. But decade after decade, people consumed about 3,700 mg of sodium a day.

That’s more than half again the maximum amount of sodium recommended. Current guidelines say adults should consume no more than 2,300 mg (about one teaspoon) a day. For people who have or are at risk for high blood pressure, the upper limit is 1,500 mg a day.

Since the 1980s, the federal government has advised Americans to cut back on salt to reduce the risk for high blood pressure and cardiovascular disease.

The study, published in the American Journal of Clinical Nutrition, also notes that although salt intake has remained constant for almost 50 years, rates of high blood pressure and heart disease have increased in the last two decades.

Rising obesity rates, however, may play a more critical role in hypertension than salt intake, the researchers note.

Personalize the right amount

The study’s main message, says David McCarron, M.D., lead author of an accompanying journal editorial, is that the intense effort to get people to limit their salt intake hasn’t worked.

It may be that people need a set amount of salt and are hard-wired to seek it, he says. To wit:

• Dr. McCarron led a 2009 study that looked at urine samples of 19,151 people in 33 countries over a 24-year period. The average daily sodium intake was 3,726 mg a day, even across diverse groups of people and diets, and without change over time.

• In a 12-year study of more than 13,000 people from Switzerland, people averaged around 3,680 mg a day.

In light of these studies, the editorial says, guidelines should limit salt for those at risk for high blood pressure and heart disease rather than issue a broad, one-amount-fits-all recommendation.

Always talk with your health care provider to find out more information.

Go Easy on the Salt

The American Heart Association offers these suggestions to keep your salt intake under control:

• Eat mostly foods that are fresh or unprocessed.

• When shopping, choose low-sodium or no-salt-added frozen and canned foods.

• Perk up dishes with alternatives to salt, such as herbs, vinegar, spices, or even citrus fruits.

• Go easy on salty snacks like chips, popcorn, salted nuts, and pretzels.

• Check the labels of baked products. Many contain baking soda (sodium bicarbonate), a significant source of sodium.

Always talk with your health care provider to find out more information.

Peripheral Artery Disease Treatment Improved

A new approach to clearing plaque from arteries is helping doctors treat patients who require a procedure called balloon angioplasty.

Balloon angioplasty is among the standard treatments for peripheral artery disease (PAD). In the U.S., about 8 million people have peripheral artery disease, and about half have no symptoms.

PAD is frequently found in people with coronary artery disease because atherosclerosis, which causes coronary artery disease, is a widespread disease of the arteries.

Disease requires careful management

In PAD, plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue.

Symptoms include painful cramping in the hips, thighs, or calves when walking, climbing stairs, or exercising.

To correct this problem, a doctor inserts a catheter into an artery and guides it to the blockage, then opens the artery by inflating a balloon at the tip of the catheter.

The doctor typically uses a stent to keep the artery open. A stent is a tiny metal “scaffold” that is left open inside the artery to it from reclosing.

Inflating the balloon can knock loose particles of plaque, which travel down the leg. A large particle can block blood flow, a condition called distal embolization. In the most severe cases, distal embolizations can require leg amputation or even be fatal.

Some doctors have used a filter device to prevent debris from escaping, but using this filter isn’t yet approved by the FDA.

New device increases safety for patient

The new report shows that the device that was studied opens the artery just like a standard angioplasty balloon.

After the artery is opened, the doctor deflates the balloon. The negative pressure sucks up the debris, which is trapped inside as the balloon retracts.

Researchers report their findings in the medical journal Endovascular Today.

In two clinical trials totaling 123 patients, the device had a success rate of 97 to 99 percent and consistently outperformed filter devices typically used to capture debris particles, report the study authors.

Robert Dieter, M.D., of the Loyola University Health System, and Dr. Aravinda Nanjundappa, M.D., of West Virginia University, say they expect to see a shift by doctors to using this new method now that it has been approved by the FDA.

Always talk with your doctor to find out more information.

More about PAD

When PAD symptoms occur, the most common is a painful calf cramping called intermittent claudication. It happens with exercise and eases with rest.

The cramping may occur in one or both legs, depending on the location of the clogged or narrowed artery. The pain disappears when you rest because the muscles need less blood at rest.

Other symptoms of PAD may include:

• Changes in the skin, including decreased skin temperature, or thin, brittle, shiny skin on the legs and feet

• Diminished pulses in the legs and the feet

• Gangrene (dead tissue due to lack of blood flow)

• Hair loss on the legs

• Impotence

• Wounds over pressure points like heels or ankles that don’t heal

• Numbness, weakness, or heaviness in muscles

• Burning or aching pain at rest, commonly in the toes and at night while lying flat

• Paleness of the skin when the legs are elevated

• Reddish-blue discoloration of the extremities

• Restricted mobility

• Severe pain

• Thickened, opaque toenails

Steps to prevent PAD are primarily aimed at managing risk factors:

• Smoking cessation, including avoiding secondhand smoke and all tobacco products

• Dietary changes, including reducing fat, cholesterol, and sugar, and increasing amounts of fruits and vegetables

• Treatment of dyslipidemia (high blood cholesterol levels) with medications as determined by your doctor

• Weight loss

• Moderation in alcohol consumption

• Medications as determined by your doctor to reduce your risk for blood clot formation

• Exercising a minimum of 30 minutes daily

• Control of type 2 diabetes

• Control of high blood pressure

A prevention plan may also be used to prevent or lessen the progress of PAD once it has been diagnosed.

Always talk with your doctor to find out more information.

Fat in Arteries Can Worsen Cardiovascular Problems

Some people with abnormal fatty deposits in their arteries are at higher risk than others for heart attack, stroke, and cardiovascular death, a new study shows.

The fatty condition, referred to as atherothrombosis, puts people at increased risk for heart attack and stroke stemming from reduced blood flow from the artery blockage.

The large, multi-center study is reported in the Journal of the American Medical Association (JAMA) and was presented at a recent meeting of the European Society of Cardiology in Sweden.

SECTION HEADER

Dr. Deepak L. Bhatt, of Harvard Medical School, and his team studied 45,000 patients who were enrolled in the Reduction of Atherothrombosis for Continued Health (REACH) study.

Detailed information was gathered at the start, with additional annual follow-up at one, two, three, and four years.

The researchers found that patients with abnormal fatty deposits in an artery were at highest risk if they had a prior history of heart attack or other emergencies linked to an artery blockage.

They also discovered that of the participants studied, 81 percent had hypertension, 70 percent had high cholesterol levels in the blood, and nearly 16 percent had narrowing of the arteries in numerous locations.

In fact, 48 percent of the patients had prior heart attacks, unstable angina, or other problems related to the artery blockage. About 28 percent of those patients had such an event within the previous year.

Studies Provide Clues to Help Physicians

During the follow-up period, 5,481 patients experienced cardiovascular events that included 2,315 with cardiovascular death.

The researchers also found that 1,228 people with myocardial infarction (heart attack), 1,898 with stroke, and 40 with both a myocardial infarction and stroke occurring on the same day.

Among patients with atherothrombosis, those with a prior history of ischemic events at the beginning had the highest rate of new ischemic events, while patients with stable coronary, cerebrovascular, or peripheral artery disease had a lower risk.

Patients without known atherothrombosis, but with risk factors only, had the lowest risk of new ischemic events.

The researchers say this information can help physicians identify patients with various stages of atherothrombosis who are at high risk of future heart and vascular problems.

Always consult your physician or other healthcare provider for more information.

About Cardiac Arrest

Cardiac arrest occurs when the heart unexpectedly stops beating, usually because of abnormal heart rhythms, called arrhythmias.

Surprisingly, cardiac arrest most often strikes people in the prime of their lives–in their mid-30s to mid-40s. Victims may appear healthy before cardiac arrest and have no obvious symptoms of heart disease. But they typically have undiagnosed coronary artery disease (CAD) – the most common cause of the dangerous heart rhythm problems that can lead to this condition.

Other heart diseases that increase the risk for cardiac arrest include:

• heart failure (caused by the heart’s decreased pumping ability)
• inherited conditions that affect the heart

CAD occurs when fatty plaque deposits accumulate on the walls of the coronary arteries, which supply blood to the heart. Over time, the plaque buildup causes the coronary arteries to narrow. The plaque may rupture and form blood clots, which can cause heart attacks by limiting blood flow in the coronary arteries or by blocking them completely.

Scar tissue may replace the heart cells that die during a heart attack. The scar tissue can disrupt the heart’s electrical system and increase the risk of developing harmful arrhythmias.

Physicians may prescribe beta-blockers or other medications to help lower the risk for cardiac arrest in people who have severe CAD or who have suffered a recent heart attack. Some people may also need angioplasty or coronary artery bypass surgery to improve blood flow to the heart.

Implantable cardioverter defibrillator devices, which detect and respond to dangerous heart rhythms, are another option doctors may consider in certain high-risk patients, including those who have already experienced cardiac arrest.

People with CAD or other heart conditions should see their physicians regularly and follow their treatment plans. Healthy habits may also help reduce the risk for cardiac arrest:

• Choose a balanced diet of nutritious foods that are low in saturated fat, trans fat, cholesterol, salt, and added sugar.
• Shed excess weight.
• Exercise as regularly as possible, preferably at least 30 minutes a day on five or more days each week.
• Quit smoking.

Always consult your physician or other healthcare provider for more information.

CPR Using Chest Compressions Alone Effective

Performing only chest compressions to help keep the blood flowing during a heart attack can be as effective as standard cardiopulmonary resuscitation, or CPR, that includes mouth-to-mouth breathing, says a new study.

The technique forces air into the lungs, which can help a heart attack victim survive three to five minutes long – possibly enough time until emergency medical services arrive.

If a person has not been well-trained in CPR and sees someone having what appears to be a heart attack, it is okay to only use only chest compressions.

Two new studies, appearing in the New England Journal of Medicine, found that when bystanders were instructed by emergency dispatchers to give either standard CPR or chest-compression-only CPR, survival rates were similar between the two techniques.

Experts hope that by making the procedure easier and removing the mouth-to-mouth contact that more bystanders might be willing to attempt CPR.

“Bystander CPR can double your chances of survival, but the biggest thing is getting more people to try it,” explains the lead author of one of the studies, Dr. Thomas Rea, medical director of the Emergency Medical Services Division of Public Health for Seattle and King County in Washington.

“Only one in three people who need it get bystander CPR,” says Dr. Rea. “If we can make it less complicated, it may enable more people to perform CPR.”

Start with Compression, Others Can Bring Defibrillator

Rescue breathing can be difficult, especially for someone who is not trained in the technique, says Dr. Rea. Even in people who are trained, but do not often have the chance to practice rescue breathing, it can be hard to do.

Dr. Dana Peres Edelson, director of clinical research at the emergency resuscitation center at the University of Chicago Medical Center, says, “Even for myself as a physician, because I don’t do mouth-to-mouth on a regular basis, it’s hard to do.”

Dr. Edelson says that when you see a seemingly healthy adult suddenly drop, call 911 and then begin chest compressions. Emergency dispatchers can provide instructions on where to place your hands.

If someone else is available to help, she says to have them call 911 and to go look for an automatic external defibrillator (AED). AEDs are now present in many public places, such as malls, schools, and stadiums.

“Push hard, push fast, and don’t stop unless you have to give a breath or use a defibrillator,” says Dr. Edelson. “If you do stop, keep the pause as brief as possible.”

Two Studies Show Similar Results

Dr. Rea and his colleagues studied dispatcher-assisted bystander CPR. Adults who needed CPR were assigned to receive either traditional CPR or chest-compression-only CPR.

The second study was similarly designed, but conducted in Sweden. Both groups of researchers concluded that compression-only CPR with instructions from emergency dispatchers was likely to be as effective as traditional CPR, possibly even slightly more so.

The findings do not apply to emergency workers and others who are well-trained in CPR, says Dr. Rea.

There are some times when rescue breathing is necessary. Dr. Edelson says that it is recommended that children generally receive rescue breathing, as well as anyone who was choking or looked like they were having trouble breathing before they became unconscious.

But, she notes, that lay people might not be able to discern who needs rescue breathing or not, so she advises, “If you haven’t been trained in CPR, just start doing chest compressions as fast as you possibly can.”

Dr. Rea agrees. “You can make a life-and-death difference by providing chest compressions. You don’t have to be perfect; all you can do is provide benefit. Your actions can save a life.”

Always consult your physician or other healthcare provider for more information.

More about CPR

Cardiopulmonary resuscitation, or CPR, is administered when someone’s breathing or pulse stops. If both have stopped, then sudden death has occurred. While some of the causes of sudden death include poisoning, drowning, choking, suffocation, electrocution, or smoke inhalation, the most common cause is from heart attack.

The following are the most common symptoms of a heart attack:

• severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes
• pain or discomfort that spreads to the shoulders, neck, arms, or jaw
• chest pain that increases in intensity
• chest pain that is not relieved by rest or by taking cardiac prescription medication
• chest pain that occurs with any/all of the following (additional) symptoms of a heart attack:
  • sweating, cool, clammy skin, and/or paleness
  • shortness of breath
  • nausea or vomiting
  • dizziness or fainting
  • unexplained weakness or fatigue
  • rapid or irregular pulse

Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders. It is important to note that not all of these symptoms are present in every heart attack.

If you or someone you know exhibits any of the above warning signs, act immediately. Call 911, or your local emergency number. If necessary, give CPR if you are trained, or ask someone who is. CPR certification means you have received the necessary training and practice and can comfortably perform this lifesaving technique. More than five million people each year receive training.

Both the American Red Cross and the American Heart Association (AHA) provide excellent training programs in CPR, which helps to save thousands of lives each year. Ask your physician or healthcare provider for more information on becoming trained in CPR.

With an increasing fear of disease among the public, some people may be reluctant to perform the mouth-to-mouth resuscitation portion of CPR. The AHA is now recommending that 911 emergency dispatchers be trained to instruct reluctant bystanders in the compression-only CPR that involves no mouth contact.

Always consult your physician for more information.