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Heart Care for Life

Heart Care for Life: Developing the Program That Works Best for You

Barry L. Zaret
Genell J. Subak-Sharpe
Copyright Date: 2006
Published by: Yale University Press
Pages: 304
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  • Book Info
    Heart Care for Life
    Book Description:

    More than 70 million Americans have some form of heart disease. For each of them, obtaining accurate information about the disease and the many options for dealing with it can be both empowering and life saving. In this book, cardiologist Dr. Barry L. Zaret and Genell Subak-Sharpe offer up-to-date facts about the best treatments available and an innovative approach that shows how treatment programs can be tailored to meet the needs of each unique patient.

    There are no short-term fixes and no one-size-fitsall programs, explain Zaret and Subak-Sharpe. Although certain characteristics are common to each form of heart disease and its treatments,these constants must be tempered against individual variables. The authors outline the constants for the full range of cardiovascular conditions, from angina and heart attacks to high blood pressure and cardiac arrhythmias. They then guide readers through the process of assessing personal variables to develop an individual treatment and life-style program.

    Written in a warmly reassuring style, this indispensable guide to heart care offers realistic hope and specific directions for designing a lifelong heart care program. Filled with practical advice, instructional case histories, a philosophy for controlling your health, self-tests to assess risk, and questions to ask your doctor, it looks toward an even better future for those with heart disease.

    eISBN: 978-0-300-12740-9
    Subjects: Health Sciences, Public Health

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Abbreviations
    (pp. ix-x)
    (pp. xi-xv)
    (pp. xvi-xviii)

    Virtually all heart patients go through a process of trial and error to find a long-term program that fits their lifestyle while providing optimal treatment. They also experience occasional lapses and setbacks. In this book, we describe composite illustrative cases and situations culled from the long-term experience of treating patients. These particular cases highlight issues relating to cardiac care.

    Stanley, for example, is a fifty-five-year-old executive whose work requires twelve-hour days and extensive, almost weekly travel. On one of these trips away from home he suffered a small heart attack, and later he had coronary artery bypass surgery. Beyond his...

  6. CHAPTER 1 A Personalized Plan: The Key to a Lifelong Heart Program
    (pp. 1-24)

    Although people often think of heart disease as a single, well-defined problem that affects all patients similarly, nothing could be further from reality. Just as no two people are exactly alike, heart disease (and its risk factors, symptoms, and successful treatments) varies greatly from one person to another. In our experience, a one-plan-fits-all approach—be it diet, medication, or lifestyle modification—simply does not work. Thus, an essential first step toward developing your lifelong heart health regimen is to identify what makes you different from your parents, siblings, neighbors, and the other patients in your doctor’s office. This is why...


    • [PART I: Introduction]
      (pp. 25-30)

      A prudent lifestyle is critical for achieving and maintaining good health, especially when it comes to benefiting the heart. How many times has your doctor advised you to exercise more, eat less, reduce stress, and—if you smoke—stop? If you’re a typical American, the answer is probably almost every time you see your doctor. You leave the office determined to change, and you make a serious effort to do so, only to find that after a few weeks you have slipped back into the same old sedentary, fast-food, stressed-out rut.

      Why is it so hard to adopt a more...

    • CHAPTER 2 Exercise Your Way to a Healthy Heart and Body
      (pp. 31-49)

      Hundreds of scientific studies document the long-term benefits of regular exercise. These include increased longevity in both men and women and a markedly reduced risk of developing cardiovascular disease and type II diabetes. Regular exercise can produce modest reductions in blood pressure and total cholesterol, LDL (the bad cholesterol), and triglycerides (another blood lipid), while raising levels of HDL (the good cholesterol). (People who have significantly elevated cholesterol and high blood pressure, however, usually need medication in addition to exercise and dietary changes to bring these problems under control.)

      Heart attack patients especially benefit from regular exercise. A statistical review...

    • CHAPTER 3 Adopting a Heart-Healthy Diet
      (pp. 50-68)

      Just as there is no successful one-size-fits-all exercise regimen, there is no single diet or nutrition program that works for everyone. The trick is to find a lifelong eating program that suits your taste while fitting in with your overall treatment goals. There is no doubt that the typical American diet—which is high in calories, saturated fats, red meats, cholesterol, potatoes and other starchy foods, sugar, and salt, and skimpy on vegetables, fruits, and whole grains—is a key factor in excessive weight gain. It also contributes to high blood pressure, high levels of blood cholesterol, and perhaps poor...

    • CHAPTER 4 Stress, Depression, and Other Psychological Factors
      (pp. 69-81)

      Practicing physicians and researchers alike have long observed that a sizable percentage of heart attack patients are apparently free of the accepted risk factors, such as high blood pressure, elevated blood cholesterol, and tobacco use. Why do these seemingly healthy, low-risk persons fall victim to a heart attack? A number of studies conducted in the last two decades suggest that psychological factors may play an important role.

      We are not trained psychologists, so although much of what we discuss here is based on our experience treating patients and observing family interactions, we cannot offer professional advice on how to treat...

    • CHAPTER 5 Controlling and Stopping Smoking
      (pp. 82-92)

      Cigarette smoking is by far the leading cause of preventable mortality in the United States, accounting for about 440,000 premature deaths a year. By now, everyone is well aware of the role smoking plays in the development of lung cancer and other pulmonary diseases. But despite all the publicity of recent years, many Americans either do not know or ignore the fact that cigarettes also damage the cardiovascular system and are a major risk factor for heart attacks.

      Numerous studies confirm that smoking greatly accelerates coronary artery disease and the buildup of fatty deposits in blood vessels (atherosclerosis). The precise...


    • [PART II: Introduction]
      (pp. 93-96)

      Lifelong heart care involves not only the lifestyle changes described in the previous chapters, but also proper diagnosis and, when appropriate, medical treatment for your specific cardiovascular disease. Obviously, any diagnostic or treatment program must take into consideration your individual circumstances and be prescribed and overseen by a physician. As stressed in previous chapters, early diagnosis and treatment often can slow or even prevent the progression of disease. So if you are found to have what was once considered mild high blood pressure or borderline elevated blood cholesterol or blood sugar levels, treatment at this stage may forestall the need...

    • CHAPTER 6 Diagnostic Tests and Procedures
      (pp. 97-119)

      The many advances in medical technology of recent decades have revolutionized the diagnosis of cardiovascular disease. Not long ago, a cardiovascular workup was pretty much limited to a physical exam, listening to heart and lung sounds through a stethoscope, and a few basic tests including an electrocardiogram (ECG or EKG), blood pressure measurement, and perhaps a chest X-ray. Today we have an array of sophisticated tests that allow us to view the heart in action and assess how it is functioning; look into the heart, coronary arteries, and other blood vessels; and quickly home in on the nature of myriad...

    • CHAPTER 7 Treating Your Heart Condition
      (pp. 120-153)

      Great advances in the medical treatment of heart disease now enable millions of Americans to lead longer, more productive lives than would have been possible just a few decades ago. Indeed, some forms of cardiovascular disease that were once common and claimed many lives are now rare or virtually nonexistent. Take malignant hypertension, the disease responsible for the stroke that killed President Franklin D. Roosevelt in 1945. At that time, there was no effective drug treatment for high blood pressure, which often progressed to heart and kidney failure or, as in the case of FDR, the highly lethal malignant hypertension...

    • CHAPTER 8 Alternative and Complementary Therapies
      (pp. 154-164)

      Until about a hundred years ago, doctors and their patients had little choice but to rely largely on folk medicine and herbal remedies to treat illnesses such as cardiovascular disease. This changed radically in the 1900s with the development of the modern pharmaceutical industry and, by the mid-1950s, we had scores of new drugs to treat everything from infections and cancer to diabetes and high blood pressure. Today’s pharmacopoeia lists thousands of standardized medications, most of them synthesized from chemical compounds. Most have undergone extensive testing and have been approved by the Food and Drug Administration as safe and effective....


    • [PART III: Introduction]
      (pp. 165-168)

      Throughout this book, we’ve emphasized the importance of creating a lifelong heart-care program that is suited to your individual needs. In developing this personalized approach, you may benefit from learning about groups that require special strategies for improving heart health. For example, advancing age is an important consideration, and treatment of heart disease in the elderly may be quite different from that in a young person. Not only is heart disease itself more severe among the elderly, but its long-term treatment is likely to be affected by changing physiology and by coexisting diseases that become increasingly common as we age....

    • CHAPTER 9 Heart Care for Women
      (pp. 169-178)

      Cardiovascular disease is by far the leading cause of death of American women, accounting for more than 493,000 deaths a year compared to about 433,000 fatalities among men. Yet all too often, cardiovascular disease goes undiagnosed or undertreated in this population group. Why? Doctors must share part of the blame because they often overlook the warning signs or downplay risk factors in their female patients, which can result in delaying treatment until the disease reaches an advanced stage. Furthermore, the biology of cardiovascular disease and its symptoms are often different in women than men.

      Women themselves are also, at least...

    • CHAPTER 10 Heart Disease in the Elderly
      (pp. 179-185)

      Thanks to modern medicine, along with improved nutrition and sanitation, people in developed countries are living longer, healthier lives. Indeed, the elderly make up the fastest growing segment of the American population, with more than 35 million Americans over the age of sixty-five and some 10 million over age eighty. By 2030, more than 70 million Americans will fall into the over-sixty-five set. But even though today’s elderly are healthier than in past generations, there’s no escaping the fact that as we age, we are increasingly vulnerable to a host of ailments, including cardiovascular disease.

      Bob Hope often quipped that...

    • CHAPTER 11 Heart Disease in Minority Populations
      (pp. 186-191)

      The U.S. population, with its great racial, ethnic, and cultural diversity, is often likened to a human melting pot. Each year, the population balance shifts. Today, people of African, Hispanic, Asian, and Native American background comprise about 30 percent of the U.S. population; by the year 2050, this proportion is expected to grow to almost 50 percent.

      Until very recently, many assumed that as minority groups became assimilated into the population at large, their health problems would mirror those of the majority. But in the area of cardiovascular disease, this has not always been the case. Some minority groups appear...

    • CHAPTER 12 Young Athletes and Heart Disease
      (pp. 192-198)

      Athletes of all ages occupy a unique place in our culture. They are thought of as the very paragons of health. Collegiate and professional athletes are idolized by society both on and off the playing field or court. Indeed, it is hard for us to understand the existence of heart disease and sudden cardiac death in such individuals. Yet every year we hear about sudden cardiac death in young or relatively young athletes. How could an all-American basketball player suddenly drop dead on the court? These events often make nationwide headlines and raise concern about the safety of organized sports...

    • CHAPTER 13 Adults with Congenital Heart Disease
      (pp. 199-205)

      Congenital heart disease is an abnormality of the heart’s structure or function that is present at birth. The malformations, which develop in the fetus, are often detected before or at birth, or shortly thereafter—occasionally, they show up much later in adult life. Congenital heart defects are relatively rare, occurring in only about one of every hundred live births, and just 15 percent of these result in serious or complex heart disease. Moreover, the tremendous improvements in medical and surgical techniques over the past thirty years now enable many patients with even complex congenital heart disease to survive into adult...

    • CHAPTER 14 Practical Advice for Travelers
      (pp. 206-212)

      Within reason, heart patients can engage in most day-to-day activities, including work, recreational pursuits, and travel. But travel may require certain precautions, especially when it includes air travel or visiting very high altitudes. Although the occurrence of heart attacks and other significant cardiac events during air travel is relatively low, they account for as much as 10 to 20 percent of all medical incidents on airplanes. Consequently, both the airlines and the Federal Aviation Administration (FAA) have taken steps to minimize the cardiovascular risk of air travel. There are also a number of precautions that individuals can take.

      Generally speaking,...


    • [PART IV: Introduction]
      (pp. 213-216)

      Heretofore, we have concentrated on the two key components of treating cardiovascular disease: namely, the importance of understanding the nature of your individual disease and the need to commit to a lifelong plan designed to provide the best outcomes. This commitment requires that you, as a patient, become an integral member of your health management team. It involves both lifestyle changes and when appropriate, medical therapy. It requires not only learning about your condition, but also working with your doctor to modify or effectively treat it. But the educational process does not stop with today’s approaches. Just as the disease...

    • CHAPTER 15 Recently Developed Devices and Procedures
      (pp. 217-227)

      In recent decades, the treatment of cardiovascular disease has been revolutionized by the development of highly effective medications and exciting new procedures and operative techniques. Many of these treatments are now becoming routine in modern cardiovascular care, but they are only part of an ongoing process. New devices and procedures, as well as medications, are being introduced at an amazing pace, and even more are being developed and tested in laboratories and research centers throughout the United States and abroad. In this chapter, we offer a brief overview of some of the new devices and procedures. Given the scope and...

    • CHAPTER 16 Biologically Based Therapies
      (pp. 228-238)

      The revolution in molecular and cell biology has led to a remarkable understanding of the biology of the cardiovascular system. This new knowledge has also been applied to developing entirely new forms of treatment. In this chapter we will briefly review three types of such biologically based therapies: growing new blood vessels, stem cell therapy, and gene therapy. Research advances in those areas are among the most exciting new approaches to the treatment of cardiovascular disease, although each has possible drawbacks.

      At present, persons who suffer from serious heart disease, such as frequent bouts of chest pain due to angina...

    • CHAPTER 17 Experimental Treatments and Clinical Trials
      (pp. 239-243)

      Clinical trials—scientific studies that involve human subjects—are the method by which new medical treatments are evaluated for safety and effectiveness. At one time, the general public was barely aware of this process; in recent years, however, the results of clinical trials have made headlines, often prematurely. These days, the public often learns the results of important clinical trials when a company, agency, or sometimes the researchers themselves hold a press conference or issue a press release, often at the time of initial presentation at a professional society. Almost immediately the media report the “news,” often with great fanfare...

    (pp. 244-245)

    Throughout this book, we described short case histories that illustrate the type of problems faced by heart patients.Virtually all patients will experience occasional lapses and setbacks, and our sample patients are no different. Stanley, the fifty-five-year-old executive, continues to work long hours but he is more diligent about taking the medications to control his high blood pressure and elevated cholesterol. He also has kept his weight down to around normal. After undergoing knee-replacement surgery, rehab, and physical therapy, he again can work out at his gym without suffering severe knee pain.When he’s not on a business trip, he enjoys long...

    (pp. 246-246)
    (pp. 247-255)
    (pp. 256-260)
  15. INDEX
    (pp. 261-285)