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Copyright (c) 1991   Tribune Media Services, Inc.


Health Update

by Dr. Allan Bruckheim

The Human Heart:  An Owner's Manual


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THE HEART OF THE MATTER

     In the best of all possible worlds, you could go through life without
ever thinking about your heart, which would beat, pump blood, function
perfectly, and never call attention to itself.  Most people, however, are
aware of their hearts.
     If you're healthy, you feel your heart beating during a moment of emotion
or exertion.  If you aren't so lucky, you must learn to pay attention to your
heart when you have hypertension, feel chest pains or have a heart attack.
     This single, relatively small organ controls your life.  More than once a
second, it beats and pumps blood through the body, getting vital oxygen to the
tissues and keeping you alive.  It beats more that 85,000 times a day in
adults and even more than that in children.
     The heart is so important that for many years the legal definition of
death was the stopping of the heartbeat.  Its importance in health is mirrored
by its importance in culture.  For centuries, people believed the heart was
the center of emotions, especially of love.  We speak of having
"heart-to-heart talks," of "setting our hearts on something," and of course,
of "a broken heart."  In truth, the heart has nothing to do with emotions or
feelings, which are controlled by the brain.
     For many other body systems, there is duplication--two kidneys, two
lungs, two eyes--so that if one fails, the other can take over and do all the
work.  But each of us has only one heart, so it pays to keep this important
organ in good working order.  Yet, heart disease is the leading cause of death
in the United States, a sobering thought considering that most types of heart
disease can be prevented.  This booklet will explain how a healthy heart
functions and the best ways to keep it in good working order.

HOW THE HEART WORKS

     The heart is one part of the cardiovascular system ("cardio" means
"heart" and "vascular" refers to blood vessels).  Your heart is located
between the lungs directly under the breastbone of your chest.  The bottom tip
of the heart tilts to the left, which is why we think of the heart as being on
the left side of our chests.  An adult heart is about the same size and shape
as a man's clenched fist.
     The heart is made of muscle, some of the strongest muscles in the body.
It is hollow and divided into four chambers.  The two top chambers are called
atria (the singular is atrium), and the two lower chambers are called
ventricles, with the right atrium connecting to the right ventricle and the
left atrium connecting to the left ventricle.  A thin wall between the atria
and ventricles divides the heart in half.  There are large blood vessels
leading into the atria and large blood vessels leaving the ventricles.  At the
entrance and exit to each ventricle, there is a valve that prevents backflow
of blood and keeps it moving in the right direction.
     Blood flows through the heart in a pattern that supplies the entire body
with oxygenated blood.  Blood goes from the superior and inferior vena cava
into the right atrium, where it is pumped into the right ventricle.  The right
ventricle then pumps the blood through the pulmonary arteries into the lungs
to pick up oxygen.  Oxygenated blood then flows through the pulmonary veins
into the left atrium, which pumps it into the left ventricle.  The left
ventricle, the largest and most powerful of the four heart chambers, then
pumps the oxygenated blood through the aorta, the biggest blood vessel in the
body, to the rest of the body.
     When the blood leaves the heart, it is carried through blood vessels
called arteries to the tissues of the body.  In the tissues, the blood flows
through microscopically tiny vessels called capillaries, where it gives up
oxygen to the tissue cells.  The capillaries feed into veins which then carry
the blood back to the heart where the whole cycle starts again.  Each time the
heart beats, it pumps about 2.5 ounces of blood, which allows for a
continuously pulsing flow of blood through the body.
     For the heart to pump blood through the entire body, it must put a great
deal of force into each heartbeat.  Arteries are strong and stretchy to
withstand this pressure.  Veins do not need to be as elastic, since by the
time blood reaches them, the pressure is reduced.  However, because the
pressure is lower, veins have many small valves that prevent backflow of
blood.  The force with which the heart pumps blood through the arteries is
called blood pressure and is an important measure of cardiovascular health.
If blood pressure is too low, it may mean that not enough oxygenated blood
will reach the tissues.  If blood pressure is too high, it can blow out a
blood vessel, leading to stroke or death.
     All parts of the body need the oxygen that blood carries and the heart is
no different.  The heart does not take oxygen from the blood passing through
its chambers; it depends on a series of arteries found on the outside surface
of the heart.  These are called the coronary arteries, so named for their
crown-like appearance as they branch out from the aorta girdling the outer
surface of the heart.

HEART DISEASE

     There are many types of diseases that affect the heart.  But unlike other
organ systems in the body, most diseases of the heart and circulatory system
are not due to infections, although cardiac infections can and do occur.  Most
cardiovascular diseases are a result of many factors, including diet,
heredity, lifestyle and weight.  About 60 million people in the United States
have some form of cardiovascular disease.  Heart disease is the leading cause
of death in this country.  The most common types of cardiovascular problems
are coronary artery disease, angina, atherosclerosis and high blood pressure.

   - HEART ATTACKS

     The three coronary arteries are vital to the health of the heart.  When
blood flow through one of the coronary arteries is blocked for an extended
time, heart muscle can become deprived of oxygen, causing it to die.  When
this happens, we call it a "heart attack."
     A heart attack can occur when a blood clot, a narrowing, or a plug of
fat-like material blocks a portion of one of the coronary arteries that supply
the heart muscle with blood.  Any condition that narrows the inside channel of
the arteries is called coronary artery disease.  When a portion of heart
muscle dies, it reduces the heart's ability to pump precious blood to the
body.  The leading cause of coronary artery disease is arteriosclerosis, the
hardening and blocking of blood vessels.  Depending on the site of the
blockage and the amount of muscle that dies, a heart attack can be extremely
serious or relatively minor.  You may hear the term myocardial infarction used
by your physician.  This is the clinical term for heart attack.
     Most heart attacks occur to people in their middle or later years,
although they can occur at any time in life.  When we are born, our blood
vessels are healthy, open and clear of obstacles.  As we age, the walls of the
arteries become thickened and deposits of fatty substances start to develop
within the artery wall.  The inner opening of the arteries begins to narrow.
These deposits of fat are called atherosclerosis.  Depending upon the
severity, they may block the heart's arteries completely.  Although everyone
has some degree of fatty buildup in their arteries, heart attacks occur only
when the buildup completely blocks the arteries, or when a small blood clot
that would not cause a problem in a healthy, open artery gets jammed in a
narrowed section and stops the flow of blood.  A blood clot that causes a
heart attack is called a coronary thrombosis.
     Atherosclerosis can develop silently, with no symptoms until the day a
heart attack occurs.  In some people, however, narrowing of the coronary
arteries causes recurring chest pain, called angina pectoris (or simply,
angina).  This chest pain most often is felt during exercise or periods of
emotional stress, but also may occur during rest.  Angina generally feels like
heaviness, pressure, burning or tightness in the chest and usually lasts only
a few minutes, stopping when the activity is terminated or the emotional
stress passes.  Angina is not a heart attack, and many people who suffer with
angina never develop a heart attack.  However, in some cases, angina is merely
a prelude to a real heart attack.
     The root cause of atherosclerosis is cholesterol, a fat-like substance
that is the main ingredient in the fatty plaques that develop within the
artery walls.  People who have high blood-cholesterol levels are more likely
to develop these trouble-provoking fatty clogs in their arteries.
     Your physician may test your blood to determine your blood cholesterol
level.  A blood cholesterol level below 200 mg/dl (milligrams of cholesterol
per deciliter of blood) is desirable, and worth working for.  Someone who has
a level of 250 mg/dl is thought to be at almost twice the risk of heart attack
as someone whose blood level is 200 or below.
     Atherosclerosis develops gradually and narrows the opening within the
artery slowly over a period of time.  As this process is occurring in some
people, the blood starts to try to compensate for this problem by developing
new paths for blood circulation (collateral circulation) in which smaller
arteries enlarge to make up for the loss of circulation in the nearby, larger
arteries.  Not everyone develops collateral circulation and, if
atherosclerosis is serious enough, these newly enlarged arteries start to
clog, too.
     In the past, a person with severely, blocked or clogged coronary arteries
had to live with the condition.  Now, these arteries can be replaced.
Coronary bypass surgery is an operation in which a cardiac surgeon adds a
section of vein taken from elsewhere in the body, or a synthetic "artery" to
bypass a blocked section of coronary artery.  Usually, two or more arteries or
sections of artery are bypassed during the procedure, and the flow of blood to
the heart muscle is improved.  Bypass surgery can reduce or eliminate angina
attacks and will usually improve a person's ability to exercise and function
normally.

   - SYMPTOMS OF A HEART ATTACK

     Symptoms of a heart attack can differ somewhat from person to person, but
there is a common pattern.  People having a heart attack usually feel an
uncomfortable pressure in the chest, as if it were being squeezed.  They may
feel dizzy, hot and short of breath, and may break out in a cold sweat.  Many
people also feel nauseous and have severe indigestion-like pain.  Although
pain in the chest is most common, heart attacks also can cause pain in the
neck, left shoulder, jaw and left arm.
     The symptoms of a heart attack can be similar to the pain of angina, but
it usually lasts longer.  When the pain persists longer than two minutes, it
is time to get help.  If you ever suspect you are having a heart attack, call
for medical assistance immediately.  Don't try to tough it out.  If you're
having a heart attack, "waiting it out" may kill you.  Each year, about
300,000 heart attack victims die before getting to the hospital, in many cases
because they waited too long.  It's far better to go to the hospital for
something that turns out not to be a heart attack, than to misjudge and pay
the enormous price resulting from delayed treatment.
     Getting the victim to the hospital as soon as possible during a heart
attack allows the opportunity to consider various treatment options.  If the
attack is due to a blood clot, medications are available that can be used to
dissolve the clot, restore circulation and save precious heart tissue.

   - PROBLEMS WITH RHYTHM

     Some forms of heart disease involve the rhythm of the heartbeat.  A
healthy adult heart beats about 70 times a minute at rest.  This rate speeds
up during exercise to accommodate a greater need for oxygenated blood.  Each
heartbeat is actually two beats.  The atria pulse an instant before the
ventricles do, causing the lub-dub, lub-dub sound of a healthy heartbeat.  At
any speed, the beat should be regular, with the same amount of time between
beats.  If the beat is not regular or is inappropriately fast or slow, it is a
condition called arrhythmia.
     The rhythm of the heart is controlled electrically.  A small bit of
tissue in the heart called the sinus node sends out an electrical signal that
tells the muscle cells to contract.  This signal passes from the atria to the
ventricles, telling each to contract in turn.  If something is impeding the
signal, or if the sinus node is damaged, arrhythmia can occur.  In some forms
of arrhythmia, heart tissue in a different area of the heart may start to send
out its own electrical signal, causing an abnormal rhythm.
     Some problem arrhythmias relate to the speed at which the heart beats.  A
heartbeat that is too fast is called tachycardia.  During exercise or times of
illness or stress, a fast heartbeat is normal, but a resting heartbeat of more
than 100 beats per minute is not.  The opposite problem, bradycardia, where
the heart is beating too slowly, also occurs.  However, a heart rate
considered to be bradycardia for one person may be normal for another.
Well-trained athletes, especially runners, can have a resting heartbeat of 50
beats per minute or less, which would be considered too slow for someone who
is not in shape.
     One form of arrhythmia that sounds menacing is called complete heart
block.  It is not a blockage of blood flow, but a blockage of the normal
electrical current of the heart, from the atria to the ventricles.  This
causes the atria and the ventricles to beat independently and out of sequence.
     Your doctor will test you for arrhythmias as well as other heart problems
by performing an electrocardiogram (EKG).  An EKG measures the electricity
generated within the heart.  It picks up this information through electrodes
attached to the skin on your chest, arms and legs.  An EKG is never painful,
but it is helpful if you remain quiet while the tracing is being done.  The
machine translates the pattern of the heartbeat into a pattern of wiggly lines
on paper that a physician can interpret and evaluate.
     Certain types of slow heart rate that can be life threatening or that
restrict the quality of life of a patient can be treated by implanting a
pacemaker, which is like an artificial sinus node.  It generates a regular
electrical impulse to control the heartbeat.  The pacemaker may be placed just
under the skin on the chest, where it is almost unnoticeable, and thin
electrical wires are threaded through the blood vessels into the heart to
carry the signal.  The batteries in a pacemaker usually last several years and
when they wear out, a new pacemaker is implanted during a minor operation.

   - HIGH BLOOD PRESSURE (HYPERTENSION)

     High blood pressure, or hypertension, is the most prevalent chronic adult
illness in the United States today.  One in every four people in the United
States has high blood pressure, and this ratio is even greater among black
Americans.  One of the greatest dangers of hypertension is that it has almost
no symptoms, allowing it to develop unnoticed and untreated while it does its
damage.
     The heart must pump blood through the blood vessels with a certain amount
of pressure in order for it to reach all the tissues and return to the heart.
If blood pressure is too high, it is exerting too much force on the walls of
the arteries and veins and the risk of a rupture of the blood vessel is
increased.  If a blood vessel bursts in the brain, it produces a stroke.
Long-term high blood pressure can result in a thickened heart wall and also
can damage the kidneys and the eyes.
     The force of the flow of the blood increases and decreases with each
heartbeat.  This is why a blood pressure measurement is expressed as two
numbers, like 120/80 (read as 120 over 80).  The first number is the pressure
created during the contraction of the ventricles and is called the systolic
pressure.  The second, lower number is the pressure that exists while the
ventricles are resting, and this is the diastolic pressure.  Normal adult
blood pressure is about 120/80.  Having pressures that are slightly higher,
say, up to 140/90, is not considered dangerous.  If your blood pressure is
higher than that, your physician will want to discuss treatment and changes in
diet and lifestyle with you.
     In many people, high blood pressure develops for no apparent reason.  But
high blood pressure can result from problems in the kidney, or a tumor of the
adrenal gland which produces too much norepinephrine.  Heredity may be an
important factor; if one of your parents had a history of hypertension, you
have a greater chance of having it too.  Eating a diet containing large
amounts of salt is another risk factor for some people.  Obesity is also
associated with high blood pressure.  Stress is a fact of life and may also be
another factor in causing high blood pressure, but even people who lead calm
lives can develop hypertension.
     The rate of heartbeat may vary during the course of the day.  In like
manner, blood pressure varies with activity and with time of day.  One or two
blood pressure readings that are high do not mean you have high blood
pressure.  Your physician will usually measure your blood pressure several
times before making a diagnosis.  In some cases, people are nervous about
being seen by a doctor and only have elevated pressure when they are in their
doctor's office (it's called "the white coat syndrome"), but your doctor will
take this into account when making an evaluation.
     High blood pressure can and should be treated.  Mild cases can often be
helped by lowering the amount of salt in one's diet, reducing weight to
normal, exercising and stopping smoking.  Not every case of high blood
pressure will respond to a low-salt diet, however, and some do not respond to
weight loss, either.  However, both are still good ideas that help most people
lower their blood pressure to some extent, as well as make for a healthier
lifestyle.
     Exercise also contributes to a lower blood pressure.  Regular aerobic
exercise improves the way the heart functions by improving its efficiency.  It
also seems to help people cope better with stress in their everyday lives.
     Many people with high blood pressure will need to take medication to
lower it.  There are several different classes of antihypertensive drugs and
many compounds.  Some lower blood pressure by causing blood vessels to expand
and others do so by removing excess water from the body.  Your physician may
need to prescribe more than one drug and may need to switch you from one to
another or vary the dosage when hypertension is difficult to control.  Follow
the directions for taking the drugs carefully.  Do not skip doses or change
the regimen without speaking to your doctor.  It's hard enough to get the
schedule perfected without complicating matters further through bad
communication.

   - CONGESTIVE HEART FAILURE

     Congestive heart failure is a serious condition, but often not quite as
bad as it sounds.  Your heart has not failed and is not going to stop beating.
In this situation, heart failure means your heart has been weakened and is not
pumping efficiently.  Circulation is poor and can cause a backup of fluid into
the lungs, as well as swelling of the ankles and hands.  This swelling is
called edema.  Congestive heart failure may follow a heart attack, in which
some muscle tissue has died, or may be due to an infection that has damaged
the heart valves.  It also can be caused by long-standing high blood pressure
that has not been treated.
     The most important symptoms of congestive heart failure include edema in
the legs and feet and shortness of breath.  Treatment for congestive heart
failure depends to some extent on the underlying cause.  If high blood
pressure is present, your doctor will try to bring that under control.
Diuretics arc often prescribed to help remove excess fluid from the body.
Digitalis and digitalis-like medications can also be used to help strengthen
heart muscle and improve the heart's pumping action.

   - HEART MURMURS

     Many people experience anxiety when they are told by their doctor that a
heart murmur has been discovered.  A heart murmur is a sound made by the blood
circulating through the heart, like the sound water makes when passing through
a pipe.  In many cases, there is no problem with the heart and no cause for
alarm.  Frequently, children will be diagnosed as having an innocent heart
murmur, which may come and go and usually disappears before adulthood.
     Depending upon history, the patient's age and the type of murmur, it may
be prudent in some cases to undergo further testing.  These tests may include
the standard EKG and echocardiography, which uses sound waves to create
pictures of your heart.
     One condition that can cause a heart murmur is mitral valve prolapse,
which is relatively common.  The mitral valve is between the left atrium and
left ventricle.  It is called "prolapse" because the valve has a little extra
tissue and it can balloon out into the atria when the valve closes.  Most
people with mitral valve prolapse lead a perfectly normal life and never even
know they have a slightly loose valve.  Others may have some symptoms of
fatigue or shortness of breath, which may be treated medically.  For some
unknown reason, mitral valve prolapse occurs more often in women than in men.

   - CONGENITAL HEART DISEASE

     Congenital heart defects are malformations of the heart that people are
born with.  Some heart defects are due to the genes that are inherited and
that control the development of our body parts, while others may occur as the
fetus develops during pregnancy.  In some cases, the malformation of the heart
may be serious enough to cause an early death, the baby living no more than a
few days or months.  Others are less severe, but may still mean a shortened
life-span unless they can be corrected surgically.  In the past, congenital
malformations of the heart could not be repaired.  Now, pediatric
cardiologists and surgeons have created ways to fix many congenital heart
problems, allowing affected children to grow and lead normal lives.  Before
this delicate surgery is performed, careful testing is necessary to confirm
the diagnosis and to provide the surgeons with all the information they
require to perform the operations successfully.

RISK FACTORS FOR HEART DISEASE

     In a very real sense, you are in a position to decide whether or not you
will have heart disease.  While certain risk factors, such as heredity, age
and sex are beyond your control, many are due to the way we live and how we
treat our bodies.  Heart disease, to a great extent, can be prevented by
avoiding those factors that increase risk.  These "lifestyle" risk factors
include obesity, improper diet, smoking and a sedentary lifestyle.  Some risk
factors for heart disease result from certain chronic medical conditions, such
as diabetes and hypertension, which require ongoing medical attention to
achieve control.  No program of heart disease prevention can be successful
without attention to these important medical situations.  If, in addition to
these medical conditions, you smoke, are overweight, exercise little and eat a
high-fat diet, you are more likely to suffer a heart attack than if you are a
non-smoker who exercises regularly and eats a healthy diet.  That makes it
most important to correct all the risk factors we can, and achieve all that is
possible to prevent unnecessary heart disease.  Read on for some useful tips
that can help you win your contest with heart disease.

   - HEREDITY

     A completely unavoidable risk factor for heart disease is heredity, along
with age and sex.  If one of your parents had a heart attack before the age of
50, you are at increased risk.  High blood-cholesterol levels and high blood
pressure tend to run in families as well.  The family connection, however, is
not completely clear-cut.  Remember that people tend to mimic their parents'
habits, eating the same foods, exercising the same amount and smoking if their
parents did so.  People who were raised eating a high-salt, high-fat diet
usually continue to do so throughout their lives and then, in turn, raise
their children the same way.  Because of this, it is difficult to say how much
of a heart condition that "runs" in the family is due to heredity and how much
is due to upbringing.  This is why switching to a healthier lifestyle is so
important.  It not only helps reduce your risk of heart disease, it sets a
healthy example for your children.
     If your family has a history of heart problems, it does not mean that
your fate is settled.  You can reduce or eliminate most of the other risk
factors.  In addition, new medications and medical treatments that may not
have been available in your parents' time can control blood pressure and
angina and add years to your life.

   - SMOKING

     Smoking is probably the single most preventable cause of heart attacks
and heart disease in the United States.  Anyone who smokes a pack of
cigarettes a day is twice as likely to have a heart attack as a non-smoker.
Someone who smokes more than a pack a day is three times as likely to have a
heart attack.  This increased risk of heart attack is in addition to the known
risks of lung cancer, emphysema, chronic bronchitis and other forms of cancer
that are linked to smoking tobacco.  According to the American Heart
Association, most of the 350,000 people who die each year from smoking-related
diseases die from heart attacks.  Smoking increases a person's risk of
suffering a heart attack because nicotine increases the rate of heartbeat and
causes arteries to constrict.  In addition, carbon monoxide in smoke reduces
the amount of oxygen available to the bloodstream, causing the heart to work
harder to carry the same amount of oxygen.  Smoking also increases the buildup
of atherosclerotic plaques which, with the constrictive action of nicotine,
can mean blockages in the coronary arteries and a heart attack or angina.  The
lung conditions that smoking causes also tax the heart.  When the lungs start
to fail, the heart must work harder and eventually it will fail, too.  Smokers
are less likely to survive a heart attack than non-smokers and are more likely
to have a second attack.
     Why do people smoke?  Many people started smoking when they were young
and it was considered a sophisticated thing to do.  They continue to smoke
because nicotine is very addictive, perhaps more addictive than drugs such as
cocaine and heroin.  In recent years, tobacco companies have introduced
cigarettes that are lower in tar and nicotine, implying that these are safer
than regular cigarettes.  There are no safe cigarettes.  People who switch
from regular to low-nicotine cigarettes seem to smoke more to deliver the same
amount of nicotine to their bloodstream.

   - DIET

     Improper diet can be an important risk factor in heart disease.  A diet
high in saturated fat and cholesterol is directly linked to atherosclerosis
and coronary artery disease.  A diet high in salt may be linked to high blood
pressure in some individuals.  And a diet high in calories leads to obesity,
which is linked to heart disease as well.
     Cholesterol is found naturally in the bloodstream, and a certain amount
is normal.  The body makes cholesterol in the liver, but gets most of it from
the diet.  Most authorities believe that eating a diet high in cholesterol and
saturated fat increases the risk of suffering a heart attack.  Cholesterol and
saturated fat (saturated fat is fat that is solid at room temperature) are
high in meats, eggs, dairy products and seafood.  Most people can lower their
blood cholesterol levels by eating less fat in their diet and reducing the
amount of cholesterol-rich foods they eat.  Other people may need to change
their diet and, additionally, take cholesterol-reducing medications before
their blood cholesterol levels will drop to a safer range.
     A high-salt diet can be a risk factor for heart disease.  Some people are
very sensitive to salt and respond to it with an elevated blood pressure.  Too
much salt causes the body to retain water, increasing the volume of blood to
be pumped, adding another burden on the heart.  Most people who have high
blood pressure can help themselves considerably by reducing their salt intake.

   - WEIGHT

     Obesity is a leading risk factor in heart disease.  People who are
overweight generally have higher cholesterol levels than those with normal
weights.  Overweight individuals are more likely to have high blood pressure
as well.  Increased blood pressure is often linked to obesity, and reducing to
normal weight may be all that is required to lower the blood pressure levels
to normal.  In addition to the increased risk of heart disease, obesity is a
risk factor for diabetes, certain forms of cancer and arthritis.
     Essentially, obesity overworks the heart.  Like any other body tissue,
fat is laced with blood vessels that bring in oxygenated blood.  Each
unnecessary pound of fat increases the number of blood vessels that the heart
has to pump blood through, and thus increases the work load.

   - PREVENTING HEART DISEASE

     It cannot be stressed enough that, in most cases, heart disease can be
prevented.  The way you live, the food you eat, your weight, the amount of
exercise you get and whether you smoke, these are determining factors to
whether or not you will develop a heart problem.  You, and only you, can
decide whether you want to do something about heart disease.  Consider the
importance of these actions, and then make a decision to do something today
that may prolong your life.

   - STOP SMOKING

     No matter how long you have smoked, no matter what your age, stopping is
a good idea.  The risk of heart disease goes down rapidly when you stop
smoking.  Fifteen years after quitting, you will have about the same amount of
risk as someone who has never smoked.  But quitting will not be easy.  Some
people can stop smoking abruptly and succeed, but most people do better if
they get some counseling from a doctor or other health professional.  You may
need to quit several times before you're successful.  Do not give up.  There
are many different programs available to help people who want to stop smoking,
and if one doesn't work, try another.

   - EAT HEALTHIER FOODS

     Reducing the amount of fat, cholesterol and salt in your diet will reduce
your risk of heart disease and high blood pressure.  Remember, your diet is a
habit and any habit can be changed.  Eating a low-fat, low-salt diet is not a
matter of doing without, but rather of making intelligent choices.  Many
common recipes can be modified easily to reduce the salt and fat content.
There are dozens of good cookbooks and books of nutritional advice that you
can use to plan healthier meals.  Reducing the amounts of fat and cholesterol
in your diet will have added benefit of helping you control your weight.
Foods that contain large amounts of cholesterol can generally be avoided.
Switching away from foods high in cholesterol to those with less or no
cholesterol, will lower your overall intake.  Cholesterol is only found in
foods that come from animals, which is also the source of most saturated fat
in the diet.  Eating more vegetables, including beans, which are an excellent
source of protein, is one way to reduce cholesterol and fat intake.  Certain
meats have less cholesterol than others.  Lean meats, fish and skinless
chicken generally contain less cholesterol than fatty cuts of red meats.
Remember that eating chicken with skin is no help, since poultry skin is where
most of the fat and cholesterol lurk.  Skim milk has all of the calcium and
vitamin content of whole milk and far less cholesterol and fat.  Many low-fat
cheeses are now on the market and there are even several varieties of non-fat
yogurt.
     There is no way to completely eliminate salt from the diet, but the
amount of salt you eat can be reduced greatly.  Large amounts of salt are
found in snack foods, processed foods, pickles, olives, soy sauce, and
preserved meats such as ham and cold cuts.  Avoiding these foods, and throwing
away your salt shaker, will help you reduce your salt intake.  When you cook,
remember that salt is rarely needed and can be reduced or totally eliminated
from most recipes.  For example, many people add salt to the water that rice
or pasta is boiled in.  It is unnecessary and no one misses it when the salt
is omitted.
     If you think you need help in planning a low-fat or low-salt diet, ask
your physician to refer you to a registered dietitian or nutritionist.  A
registered dietitian is a health professional who can give you advice about
your diet and help you modify recipes and create healthier menus.

   - EXERCISE MORE!

     Leading a sedentary life is bad for you and your heart.  Regular exercise
can help you reduce weight, lower your blood pressure, and help you cope with
daily stress.  But even if your weight and blood pressure are normal, exercise
is good for your heart.  And an added bonus is that it makes you feel and look
better.  Someone who is physically fit is at less risk for having a heart
attack than a similar person who does not exercise.  Like any other muscle in
your body, your heart gets stronger when you exercise regularly.  A strong
heart does not have to work as hard because it is more efficient at pumping
blood through the body.
     There are three basic types of exercise:  aerobic exercise, strengthening
exercise and stretching exercise.  The best exercise for cardiovascular
fitness is aerobic exercise, but a good exercise program will combine all
three types.  Aerobic exercise is any activity that uses large groups of your
muscles rhythmically for a long enough time to increase your pulse.  Running,
brisk walking, bicycling, swimming, jumping rope, and aerobic dancing are all
examples of aerobic exercises.  Pick one that you enjoy most and then stick
with it.
     A good exercise program for your heart would include three sessions of
aerobic activity per week that last 20 to 40 minutes each.  Each session
should start out with some stretching exercises and a light warm-up for five
to 10 minutes, which will prepare your body for exercise.  Then exercise for
20 minutes and follow that with a five-minute cool-down.
     If you've never followed an exercise program, start slowly.  A big
mistake many people make is to go out the first day and try to run for an
hour.  They feel like a wreck and ache all over for the next few days and then
give up on exercise.  Don't push yourself to the point of exhaustion.  If you
keep up with your exercise program, you will be able to increase the length of
each session.  Enjoying your exercise program is an end in itself.
     If you have a heart condition, talk to your physician before starting an
exercise program (although it's likely the suggestion to exercise will come
from your doctor).  If you don't have a heart condition, it's still a good
idea to consult with your doctor if you are over age 35 and have not exercised
regularly in a few years.  If you have had a heart attack, the risk of your
suffering another during exercise is minimal.  The benefits of regular
exercise far outweigh the risks.

SEX AND HEART DISEASE

     The goal of reducing your risk of heart disease is to have a longer,
happier, healthier life.  One aspect of a happy life is sexuality and sexual
activity.  Sexuality, the aspect of personality that encompasses all sexual
feelings and behavior, is a natural, vital part of life; it is present even in
people who are not sexually active.  Intercourse is only one part of sexual
activity and sexual activity is only one part of sexuality.  Unfortunately,
many people who have had heart attacks or have heart disease think they have
to give up all sexual activity.
     There are many myths that surround sex and heart disease.  The most
common, and most incorrect, is that having relations after a heart attack will
cause another heart attack.  Sexual activity is very rarely the cause of
sudden death.  Sexual activity, however, does cause an increase in heart rate,
respiration and blood pressure; this is normal and healthy, and should not
cause anxiety or fear.
     Some heart medications may affect sexual activity.  Certain medications
used to control angina or blood pressure have been known to interfere with a
man's ability to achieve an erection or control ejaculation.  Others have been
known to reduce a woman's interest in sex.  If you believe a sudden change in
sexual performance or sex drive is due to your medications, discuss it with
your physician, who can modify the dosage or switch you to a different
medication.  Do not stop taking your medication before you talk to your
doctor.
     The first, and perhaps only, thing to remember about sexual activity
following a heart attack is that it is safe and healthy when you feel ready
for it.  Intercourse requires some energy, which you may not feel up to
immediately after getting home from the hospital, but hugging, kissing and
touching are healthy ways to build up to intercourse and help build
self-confidence.

TIME TO TAKE CHARGE

     You are only as healthy as your heart.  Heart disease and heart attacks
are largely preventable problems.  By taking an active interest in keeping
your heart healthy, you can reduce your risk of suffering a heart attack.
Lower your intake of fat, cholesterol and salt, exercise more, and you can
live a longer, healthier life.
     When it comes to your heart, it can truly be said that you have the
ability to take your life in your own hands.  Now that you have the knowledge,
it's time to take charge, to act.

     I wish you well.


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Research for this issue of Health Update by Valerie DeBenedette; Consulting
Editor:  Robert DeMarco, M.D.
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
