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High Blood Pressure: Respect the Readings
By Felecia S. Williams, MSN, RN, CCRNBy Cam Patterson, MD

Felecia S. Williams, MSN, RN, CCRN

You don’t need to be a medical practitioner or to visit a physician’s office to check your own blood pressure on a regular basis. Respecting a high reading and then tracking trends in your blood pressure can be a life-saving decision.

Mention the words “heart health” and many people may immediately think of their cholesterol levels. This highly publicized heart health measure is important, but, there is a companion risk factor deserving equal attention and awareness. According to the American Heart Association, as many as one in three Americans may suffer from hypertension.

As an educator/supervisor in WakeMed’s Coronary Care Unit, I intimately understand the importance of awareness and respect for this health issue. My passion for educating others about hypertension is not only professional, but personal. My grandmother suffered from unchecked hypertension and died at age 55 due to kidney disease. And, at age 29, I was diagnosed with life-threatening high blood pressure. I learned quickly that if severe hypertension goes untreated, an organ could be severely impacted in less than ten years.

The Silent Killer
Hypertension is when blood pressure is consistently elevated over several readings and—ideally—recorded in different lifestyle settings. Longstanding elevated blood pressure causes tension on arterial walls, which may mechanically damage the lining of coronary arteries. Hypertension may also eventually wear down the heart’s mechanical ability to be an effective pump. If the heart is not pumping at maximum strength, it cannot supply the proper amount of blood to the body. This makes hypertension a risk factor for stroke, heart attack, renal failure and congestive heart failure.

“Patients contend they feel fine, their readings are not normally high, or there is a misconception that a stressful lifestyle is the culprit for a high pressure reading on any given day. This is why I encourage getting a reading any chance you can and knowing your own blood pressure readings over time,” Dr. Mangano said. I too have found people create excuses for their high blood pressure reading by saying, ‘Oh well, I’m feeling stressed today,’ or ‘It’s not normally this high.’ But if you have one high reading, it is important that you start to track your blood pressure in different settings. Screening leads to prevention, which is key in combating heart disease.

It is not even necessary to purchase your own blood pressure cuff or make a special trip to the doctor’s office. There are many places to get screened. Take advantage of employer health fairs, public screenings and local retail pharmacies with blood pressure stations as convenient places that usually offer free or low cost ways to obtain a reading.

Dr. Mangano continued, “After a diagnosis takes place, what we are really talking about is a partnership between physician and patient. I tell my patients, you brush your teeth every day in order to prevent tooth decay, so why would you not be as proactive about your heart? People tend to embrace this wait-and-see attitude, but I’m a bit more impatient, especially after high pressure readings are recorded.”

There should be no stigma attached to taking a heart medication everyday, especially if you are predisposed to heart disease such as Williams, and it is important to stick to the therapy regimen even when you are feeling fine. Still, Dr. Mangano estimates 70 percent of people with confirmed hypertension have inadequate control of their blood pressure because they do not take the medications or hypertension itself seriously due to the symptomless characteristics of the disease.

Controlling the Heartbreak
So now you are thinking about getting your blood pressure reading the next time you are at your local retail pharmacy. What should you know? While you don’t necessarily need to know the exact meaning of systolic (the top number referencing pressure while the heart is beating) and diastolic (the bottom number referencing pressure while the heart is resting), it is a good idea to know the ideal numbers to look for in
a reading.

A normal reading is 120/80. High blood pressure is defined as 140/90. But just as patients are being encouraged to become more proactive about their heart health, medical practitioners also are becoming more proactive in the diagnosis. “We are not sitting back and waiting for those numbers to elevate to the known danger zone,” explains Dr. Mangano. “We are now diagnosing patients as pre-hypertensive who register 130/80.”

It is also vitally important to manage the risk factors, including controlling salt intake, not smoking, controlling weight, reducing alcohol consumption and getting regular exercise can all be essential in battling high blood pressure. If necessary, medications coincide with these treatment options.

As you begin to enjoy more time for yourself at this stage of life, you may have started tackling a long neglected book list that has accumulated over the years. Be sure to give the same attention to a different kind of reading, your blood pressure. Additionally, many large group studies have indicated a poor level of awareness, treatment, and control of high blood pressure in all age groups. So encourage your children and family members to be aware of their blood pressure readings over time. You may feel fine today, but what we are talking about is protecting the heart’s ability to pump for the long haul.

Felecia S. Williams, MSN, RN, CCRN is an educator/supervisor in WakeMed Health & Hospitals Cardiac Care Unit. She also serves as clinical adjunct faculty for Wake Tech Community College. Williams has worked for WakeMed for 25 years.

Our hearts beat, sixty to eighty times a minute, for our entire lives, never stopping to take a break. When we think of our hearts racing, we usual conjure the sensations after brisk exercise or a sudden fright, when our hearts appropriately speed up in response to stress or increased demands on the heart. This is completely normal, and in a few minutes our hearts appropriately slow down and we no longer notice its constant beating.

Palpitations, or the sensation of the heart beating rapidly or irregularly at inappropriate times, are one of the most common symptoms of heart disease. Anyone who is concerned about palpitations should see their doctor promptly. Palpitations indicate a disorder of the rhythm of the heart, and by far the most common cause of palpitations is a heart disease called atrial fibrillation.

Atrial fibrillation means that the upper chambers of the heart, called the atria, fail to beat rhythmically, resulting in an irregular and often rapid heart rate. It affects two million people in the United States, and is particularly common in older individuals. Atrial fibrillation may be an indication of other underlying diseases, such as thyroid disease, heart valve problems, and hypertension. Excessive alcohol use can also trigger atrial fibrillation (the so-called “holiday heart” syndrome). In many cases, atrial fibrillation occurs without an obvious underlying cause, and doctors call this lone atrial fibrillation. When atrial fibrillation is first diagnosed, doctors will perform blood tests and other studies such as echocardiograms to determine whether other medical problems are causing or exacerbating the heart rhythm problem.

Regardless of the cause, atrial fibrillation can produce debilitating symptoms as well as severe problems such as stroke, and therefore cardiologists will initiate careful and often aggressive management strategies even if palpitations aren’t a major symptom for the patient.

The first step in treatment is to slow the heart down, and this can be done with medicines like beta-blockers or calcium channel blockers. These drugs prevent the heart rate from approaching dangerous levels, especially during exercise, and can be very effective in reducing the palpitations that accompany atrial fibrillation. In some cases, digoxin, a very old drug, is also added for additional heart slowing effects, although most cardiologists agree that it is not an ideal first choice in this situation. Cardiologists refer to this type of treatment as “rate” management.

A second treatment approach, called “rhythm” management, attempts to keep the heart out of atrial fibrillation altogether and in what doctors call normal rhythm. Medicines called anti-arrhythmics can be used to achieve normal rhythm in patients with atrial fibrillation, and are effective in some but not all patients. Unfortunately, anti-arrhythmics are powerful drugs that sometimes cause side effects that can be severe, and are not effective in all patients.

Another approach to rhythm management, used by itself or in conjunction with anti-arrhythmics, is called cardioversion. During cardioversion, an electrical shock is delivered through the chest wall to the heart, and often this jolts the heart back into normal rhythm. This sounds scary, but patients are sedated during cardioversion, and it is actually a safe and simple therapy in some circumstances. Choosing the appropriate therapy for rhythm management depends on a number of factors, and so expert care by a cardiologist with expertise in atrial fibrillation is usually required at this point.

Rhythm therapy can be an effective means to reduce irritating and debilitating symptoms of palpitations, dizziness, and weakness in patients with atrial fibrillation. By the same token, patients who are in atrial fibrillation with few or no symptoms may have little to gain from rhythm management. It is important to understand that rhythm management is highly effective for treatment of symptoms of atrial fibrillation, but probably has little impact on other complications of this abnormal heart rhythm.

The most severe complication of atrial fibrillation is stroke. When the upper chambers of the heart beat irregularly, blood flow in these chambers is sluggish and blood clots are prone to form. These clots can shake loose and travel to other parts of the body. When they travel to the brain, strokes can occur. So common is the association of atrial fibrillation and stroke that neurologists routinely look for blood clots in the heart as a cause when a patient suffers a stroke. Stroke is a risk whether a person with atrial fibrillation is receiving rhythm or rate management therapy.

Because of the devastating consequences of stroke, patients with atrial fibrillation will need to receive additional treatment, in addition to rate or rhythm control, to reduce the chances that a stroke will occur. Two choices are available—aspirin and coumadin.

The decision between these two choices depends on the presence of features such as advanced age, diabetes, hypertension, heart failure, or previous stroke that indicate increased risk of a new stroke. Patients with atrial fibrillation who are at lower risk of stroke should receive aspirin, and patients at higher risk should be treated with the blood thinner coumadin. Coumadin is more effective at preventing clot formation within the heart, but is more likely to cause serious bleeding complications and requires frequent monitoring with blood tests. Obviously, these are tough decisions, and should be made in consultation with a physician experienced in the benefits and side effects of these therapies.

What we’ve talked about so far indicates that atrial fibrillation is no fun to have—it is a chronic condition with severe symptoms. Severe complications can occur. Why can’t we just cure it and move on?

Well, maybe we can. New approaches can cure atrial fibrillation, at least in some patients. A surgical approach, called the Maze procedure, can turn atrial fibrillation to normal rhythm by tracing a map through the upper chambers of the heart. This procedure carries the risks of other heart surgeries, so it is rarely performed by itself, but surgeons frequently add this procedure to operations like valve and bypass surgery when their patients have atrial fibrillation, and it can cure atrial fibrillation in some patients.

What if heart surgery isn’t something you are excited about? Fortunately, another new option is available to treat atrial fibrillation using catheters that don’t require surgery. Atrial fibrillation ablation therapy frequently cures the abnormal rhythm without the need for surgery, and spares patients from the symptoms and complications of atrial fibrillation and the need for drugs that have side effects. Ablation therapy can only be performed in highly specialized centers of excellence for the treatment of atrial fibrillation, and is not an appropriate therapy for everyone with this problem, but in many circumstances this new therapy has outstanding results.

We’ve described a number of different approaches for the management of atrial fibrillation and the reduction in risk of severe side effects such as stroke. The best care for patients with atrial fibrillation requires a teamwork approach that includes cardiologists, electrophysiologists, nurses and pharmacists working together to treat all aspects of the problem. Fortunately, recent advances offer the possibility of cure for atrial fibrillation in many cases, and so individuals with atrial fibrillation should seek out centers where the teamwork approach and advanced therapies are offerred for the best outcomes.

Cam Patterson, MD is chief of cardiology for the University of North Carolina at Chapel Hill School of Medicine, UNC Hospitals, and the UNC Health Care System.

The Heart of a Woman
By Teri deMatas, Rex Healthcare

The “Forgotten Fat” & Women’s Hearts
Thanks to recent outreach efforts many of us now know that heart disease is a real danger to women. Cardiovascular disease kills almost half a million women each year in the United States alone – more than twice the number of deaths due to ALL forms of cancer.

Many women also understand that there is a “bad” cholesterol called LDL and a “good” one called HDL. But chances are most of us don’t know as much about how triglycerides affect heart health. Sometimes called the “forgotten fat,” triglycerides are a type of fat found in blood that can increase the risk of heart disease.

Triglycerides are made by your body and found in food. When you eat a meal your body uses some of the food as an immediate source of energy, but most of it is changed to triglycerides to be used for energy at a later time.

Normal triglycerides levels should be below 150. Women who have triglyceride levels above 200 double their risk for heart disease. If triglycerides are above 200 and "good" (HDL) cholesterol is below 40, the risk for heart disease is four times the average.

“Recent findings show us that women with very high triglyceride levels had a major increase in myocardial infarct (heart attack). So, focusing on cholesterol levels alone as a predictor of heart disease is not enough,” says Daryl Emery, M.D. North Raleigh Cardiovascular Diseases.

Reducing Triglycerides
Some women can combine a healthy diet with regular exercise to lower their triglycerides, others may need medication. Medications that are effective against the "bad" cholesterol may not improve the "good" cholesterol or lower triglycerides," so work with your physician to create a custom plan that fits your specific needs.

Doctor Visit Checklist
It's important to talk to your doctor about your HDL, LDL and triglyceride levels. Consider discussing the following during your next visit as well as how you can limit your chances of developing heart disease.

• What are my risk factors for heart disease?
• What are my LDL, HDL and triglyceride levels?
• What lifestyle changes can I make to improve my risk?
• What types of food should I be eating or avoiding?
• When do I need to have my lipid profile repeated?

Heart Attack Action Plan
Learning the warning signs of a heart attack and making a plan for how to respond to them could help save your life. While it may not be pleasant to think about, planning what to do in the event of a heart attack could prove to be a lifesaving move.

Who's at Risk?
The American Heart Association identifies that heart disease is the No. 1 cause of death for both men - and women - in the United States. While a heart attack can occur at any age, the risk increases for men older than 45 years old and women older than 50. In addition to age, other factors that increase the risk of heart attack include:

• A previous heart attack
• Family history of early heart disease
• Diabetes
• High blood pressure
• High cholesterol
• Smoking
• Being overweight
• Physical inactivity

Recognize the Warning Signs
In the movies, heart attack victims often clutch their chest in pain and keel over. But in reality, most heart attacks start slowly as mild pain or discomfort. Signs and symptoms of a potential heart attack in women can differ from men:

Women may experience one or more of the following symptoms:
• Tightness, squeezing or pressure in the chest, throat, upper abdomen or neck
• Nausea and indigestion-like symptoms including heartburn or an upset stomach
• A numbing or tingling sensation in the left arm
• Difficulty breathing or shortness of breath that occurs with or without exertion
• Waking during the night out of breath
• Unexplained severe anxiety, fatigue and/or overall lack of energy
• Rapid heart beat, cold sweat breakouts and/or paleness

Help recognize heart attack symptoms in your loved ones. Any of these "classic symptoms" may occur in both men and women:
• Squeezing or pressure in the center of the chest
• Shortness of breath
• Sweating
• Recurring chest discomfort
• Discomfort in one or both arms, the back, neck, jaw or stomach
• Lightheadedness

If you experience any of these symptoms or think you may be having a heart attack, call 911 immediately. During a heart attack, a clot blocks the flow of blood to your heart. The longer you delay medical attention, the greater the damage to your heart muscle.

Both men and women should:
• Eliminate tobacco use
• Regulate a healthy blood pressure level
• Control cholesterol, LDL,HDL and triglyceride levels
• Control your blood sugars if you have diabetes
• Eat plenty of fruits, vegetables, lean meats and fish
• Maintain a healthy weight for your age and height
• Get involved in regular physical activity that you enjoy

Plan Ahead
If you are at high risk, it's a good idea to plan now what you would do if you had a heart attack. Along with learning the heart attack warning signs, you should:

• Talk to your doctor about your risk and learn what you can do to reduce it.
• Decide what you would do at home, work or other places if you have heart attack symptoms.
• Figure out who would care for your kids or other dependents in an emergency.
• Talk with your family and friends about heart attack warning signs.