Friday, November 7, 2008

Is Bad News Bad For Your Heart?

Your grandmother learns her husband has passed away and immediately begins complaining of chest pain. This sort of reaction — experiencing chest pain or a heart attack after hearing bad news — is sometimes shown in television and movies. But it's not just fiction. Some people seem to actually get symptoms mimicking a heart attack after hearing bad news or experiencing other types of stress, a phenomenon doctors now refer to as broken heart syndrome.

First described medically in 1991 by Japanese doctors, the condition was originally called takotsubo cardiomyopathy. Takotsubo is a type of pot used by Japanese fishermen to capture octopuses. When doctors take images of a person who's experiencing broken heart syndrome, part of his or her heart resembles the pot. Today, the condition is also referred to as stress cardiomyopathy, stress-induced cardiomyopathy or apical ballooning syndrome. Much about broken heart syndrome is a mystery.

Charanjit Rihal, M.D., a cardiologist and director of Mayo Clinic's Cardiac Catheterization Laboratory, and his colleagues have studied broken heart syndrome. Here he discusses the syndrome.

What causes broken heart syndrome?
It's thought that a surge of stress hormones, such as adrenaline, might temporarily damage the heart of some people. How these hormones might hurt the heart or whether something else is responsible isn't clear.What we do know is the onset of broken heart syndrome is often preceded by an intense physical or emotional event. Some of the triggers of broken heart syndrome have included news of an unexpected death of a loved one, a frightening medical diagnosis, domestic abuse or losing a lot of money. Physical stressors, such as an asthma attack or car accident, also have been known to trigger broken heart syndrome.

Is broken heart syndrome harmful?
In rare cases, those with broken heart syndrome can die of the disorder. However, most people who experience broken heart syndrome quickly recover and don't suffer long-lasting effects.

Who is at risk of broken heart syndrome?
We don't know why, but broken heart syndrome affects women far more often than men. Some research indicates nearly 9 out of 10 cases occur in women, and of those, almost all are in women 50 or older.

What are the symptoms of broken heart syndrome?
Broken heart syndrome can mimic a heart attack, with common symptoms being chest pain or shortness of breath. Any persistent chest pain could be a sign of a heart attack, so it's important you take it seriously and call 911 if you experience chest pain.

How is broken heart syndrome treated?
There are no standard treatment guidelines for treating broken heart syndrome because of the limited knowledge about the condition. Initially, it's treated similar to a heart attack until the diagnosis is clear. There is no specific therapy, and most people recover spontaneously. Your doctor might prescribe diuretics (water pills), vasodilators or beta blockers. Diuretics and vasodilators may not be required long term, because heart function usually returns to normal. The duration of beta blockers treatment is unknown; however, these medications might prevent recurrent attacks. Many people with broken heart syndrome are hospitalized for suspected heart attack, and the diagnosis of broken heart syndrome is often made in the hospital. Most people are hospitalized for a week or so.

How is broken heart syndrome different from a heart attack?
Most heart attacks are caused by a complete blockage of a heart artery due to a blood clot forming at the site of narrowing from fatty buildup (atherosclerosis). In broken heart syndrome, the heart arteries are not blocked, although blood flow may be sluggish.Coronary angioplasty and stent placement are commonly used for treatment during a heart attack, but these procedures are not helpful in broken heart syndrome since there is no blockage.

Can broken heart syndrome recur?
Possibly. Some of our research indicates broken heart syndrome can occur multiple times in about 10 percent of those affected by broken heart syndrome.

Heart disease? That’s something we need to worry about when we get older, right? Wrong. By adopting heart-healthy habits starting as early as your twenties, you’ll be less likely to face the challenges of heart disease. Coronary heart disease doesn’t just affect men, it’s the number one cause of death in U.S. women. But the good news—which Dr. Philip Ades, author of the new book EatingWell for a Healthy Heart Cookbook, has made it his mission to spread—is that heart disease is mostly preventable. Research shows that up to 90 percent of heart disease can be prevented by changing one’s diet, exercising more, maintaining a healthy weight and not smoking. Reduce your risk by following these 10 simple steps, cooking delicious heart-healthy recipes and snacking heart-smart.

Step #1: Know your numbers. High blood cholesterol is linked with about one-third of heart disease cases worldwide, according to data from the United Nations. Your blood cholesterol (lipid profile) is made up of several readings: high-density cholesterol (HDL), low-density cholesterol (LDL) and triglycerides (TG). LDL cholesterol and triglycerides are often referred to as “bad” cholesterol; high levels (greater than 160 mg/dL and 200 mg/dL, respectively) are considered risk factors for developing heart disease. On the other hand, “good” HDL protects against cardiovascular disease. (A healthy HDL target is 60 mg/dL or higher.) But an undesirable lipid profile doesn’t mean that developing heart disease is inevitable. Research shows that changing your diet for the better can help lower “bad” LDL and TG levels, as well as increase “good” HDL cholesterol, if they’re out of healthy ranges. Talk with your doctor about a screening. Medications are sometimes needed.

Step #2: Calculate your risk. Having multiple factors for heart disease increases your risk exponentially. For example, if you smoke, have high blood pressure or high cholesterol, any one of these factors doubles your likelihood of developing heart disease in the next six years. But having all three increases your chance eightfold. The good news: treating any one of these risk factors effectively—say, you quit smoking or bring your cholesterol into a healthy range—halves your likelihood of developing heart disease (i.e., you’ll have four times, rather than eight times, the risk of someone who doesn’t have any of these risk factors).

Step #3: Lose weight if you need to. Losing as little as 5 to 10 percent of your body weight—about 8 to 15 pounds if you start at 150—will result in better blood pressure, lower risk for diabetes and improved cholesterol levels, research suggests. Are you toting around too many pounds? There are two ways to find out. First, calculate your body mass index (BMI). A normal BMI is 18.5 to 24.9. A BMI of 25 to 29.9 is overweight, and 30 and above is considered obese. Some complain that, if you are muscular or “large-boned,” you may get a BMI that suggests you’re overweight when you’re really not. To double check, Phil Ades suggests you perform the “Ades-ocular” test: Strip down to your underwear and stand sideways in front of a full-length mirror. If your abdomen droops or sticks out, the high BMI is correct. If it’s flat and firm, your BMI may, indeed, be incorrect.

Step #4: Slash your intake of saturated fat. Butter. Sour cream. Mayo. These foods—as well as fatty cuts of meats—are high in the saturated fats that elevate “bad” LDL cholesterol, leading to plaque buildup in arteries. Limit saturated fats to 5 percent or less of your total calories (divide your weight by 12 to get the daily total limit in grams). For example, try replacing butter with vegetable-based oils, particularly olive and canola oil, both of which contain good amounts of heart-healthy monounsaturated fats, and swap lean poultry, fish and beans for higher-fat meats.

Step #5: Junk the junk food. Many packaged snacks, crackers, bakery goods and some margarines contain artificial trans fats (a.k.a. hydrogenated oils), which increase “bad” LDL even more than saturated fats, according to recent research by Walter Willett, M.D., at the Harvard School of Public Health. In a 2003 interview with EatingWell, Willett blamed trans fats for millions of unnecessary premature deaths from heart disease. Read labels carefully: if a package claims “zero trans fat,” the amount per serving may be less than 0.5 g and could have been rounded down to zero. The only way to be sure you’re getting a product without trans fats is to avoid products that include “hydrogenated oil.” Better yet, stock up on nutrient-rich vegetables, fruit and nuts and make your own using healthy snack recipes.

Step #6: Fill up on fiber. Various studies link a high-fiber diet with a lower risk of heart disease. In a Harvard study of female health professionals, people who ate a high-fiber diet had a 40 percent lower risk of heart disease than those who ate a low-fiber diet. Aim to include plenty of foods that are rich in soluble fiber, which, studies show, can help lower “bad” LDL. Soluble fiber binds bile acid, a key component in fat digestion that our bodies make from cholesterol. We can’t digest fiber, so when bile acids are bound to it, they get ushered out of the body as waste. This causes the body to convert more cholesterol into bile acids, which ultimately has the effect of lowering circulating cholesterol levels. Foods high in soluble fiber include oatmeal, barley, beans, okra, eggplant and citrus fruit, such as oranges. Try them in high-fiber recipes.

Step #7: Replace refined grains with whole ones. Eating too many refined carbohydrates (e.g., white bread, pastries, white pasta) fuels the body’s ability to make triglycerides. What’s more, processed grains are quickly converted to glucose, which raises blood glucose levels and may predispose one to developing type 2 diabetes, a risk factor for developing heart disease. Choose whole grains, such as brown rice, wheat berries and quinoa and whole-wheat pastas, which contain more fiber (which slows down the conversion of starches to glucose) and healthful fats than processed grains. Try out new grains with healthy whole-grain recipes.

Step #8: Go fish. Consuming two or more servings of fish per week is associated with a 30 percent lower risk of developing coronary heart disease over the long term, studies show. Fish contain omega-3 fats, which lower levels of triglycerides in the blood that may contribute to blood clotting. Omega-3s also lower blood pressure slightly and can help prevent irregular heart rhythms. (Flaxseed oil, canola oil and walnuts also contain omega-3 fats.)

Step #9: Get nuts. Research suggests that people who eat nuts—walnuts, pecans, almonds, hazelnuts, pistachios, pine nuts and peanuts (which actually are legumes)—two to four days or more per week have a lower incidence of heart disease than people who eat them less. All nuts contain good amounts of heart-healthy monounsaturated fats and low levels of saturated fats.

Step #10: Enjoy alcohol in moderation. Scientific literature indicates that people who drink moderately are less likely to have heart disease than those who abstain. Alcohol appears to raise “good” HDL cholesterol. Wine, in particular, “thins” the blood (making it less prone to clotting) and also contains antioxidants that prevent your arteries from taking up LDL cholesterol, a process that can lead to plaque buildup. Remember, one drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor.


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