HOW TO EVALUATE THE HEART

Many signs can reveal the existence of impaired circulation. The color of the body is extremely important. Since skin color is partially due to blood circulating just beneath it, it is important to compare skin hues in areas where your skin is particularly thin. The conjunctiva of the lower eyelid, the lips, the fingernail beds, and the palms are often valuable indicators of the state of your oxygen supply. A dusky color or bluish cast (cyanosis) indicates an

inadequate supply of oxygen in the blood. Cyanosis may be seen in congenital heart afflictions, as is the case with “blue babies.” Sometimes cyanosis

develops when the blood is too thick (hemoconcentration) and the flow is sluggish.

Frequently in advanced heart failure, cyanosis will be seen. Deep

breathing, sitting upright, or administering oxygen may correct this problem. The pulse should be examined; remember my description in Chapter One. It is normally regular and equal from side to side in the respective wrist

arteries. Your blood pressure can also indicate the general state of the circulation, as well as the force of contraction in your heart itself. The veins along side your neck also are indicators of cardiac function. Normally little pulse waves are seen, but unusual distention usually means that the right side of the heart is unable to keep up with the demand. Examine the jugular veins particularly when a patient is sitting upright.

Finally, your heart itself is evaluated by first looking at the chest to see if there are unusual pulsations, then feeling with the hand to detect unusual vibrations or heaves, and finally listening with a stethoscope. The presence of turbulence as the blood flows through the valves is reflected in sounds called

murmurs. These can occur during either phase of the heart cycle.

Considerable practice is needed to hear these specific sounds and understand their meaning.

Diagnostic tests are frequently performed to evaluate the efficiency of the heart. A chest x-ray can determine enlargement of one or more chambers. The electrocardiogram provides an excellent look at your electrical activity during each cardiac contraction. During exercise your heart rate should increase. An evaluation of the pulse and blood pressure during mild exercise on a motorized treadmill or bicycle (called a stress test) can be extremely helpful in assessing the dynamic function of this marvelous organ. More specialized tests are done in hospitals today, using x-rays, flow studies involving radioactive isotopes, Thallium scanning procedures, and the coronary angiogram which x-rays the heart in rapid sequence while a radiopaque dye is simultaneously injected into a coronary artery or blood

lifestyle, and principally involves the type of food eaten and other unhealthful habits formed. Arteriosclerosis actually begins in early childhood. Thus our preventive efforts must be directed toward infants and children to truly prevent the relentless progression of this degenerative condition.

Arteriosclerosis develops as our dietary fat intake increases. The modern unhealthful, refined diet uses large amounts of grease, oil, sugar, soft drinks, and desserts producing a state in the blood known as hyperlipidemia. The sluggish circulation of this excess fat promotes deposits in the walls of the arteries. Normal arteries have three layers, the middle one being muscular and the inner and outer layers being thin, delicate linings. Cholesterol enters the inner cells and deposits throughout the first two layers of the artery. This frequently occurs where there is a division or bend in the vessel.

The habit of smoking is especially harmful, as carbon monoxide in mainstream cigarette smoke tends to open these tiny lining (endothelial) cells and actually creates openings in the vessel wall, enabling cholesterol to penetrate more easily. As the years go by, this cholesterol plaque builds up, becoming thicker and eventually obstructing the vessel. Roughness in the lining cell creates more turbulence, which adds to the danger of thrombosis, or sudden clot formation in the vessel, That is the event which is known as a heart attack, or myocardial infarction.

It is not known why some individuals tend to form these deposits in the heart more readily, while others select out the brain, the aorta, or other vascular structures. Nevertheless, arteriosclerosis is affecting nearly every American and was even significant in 70% of the American youth killed in action during the Korean War. For reasons of lifestyle, mostly lower animal fat intake, few Koreans or Japanese get coronary heart disease. The picture changes rapidly, though, when they move to Hawaii or the continental USA.

A number of risk factors are directly associated with the development of arteriosclerosis and the inherent risk of coronary heart disease. Obesity, afflicting over one third of all adults, is directly associated with heart risk. Every five pounds of extra body fat requires four extra miles of blood vessels just to keep the cells nourished. Not only consult height and weight charts, but also measure skin folds to evaluate a person’s obese potential. If the fold

of pinched abdominal skin is an inch or more thick, men are definitely obese; for women the skin fold measure allowed is 1½ inches.

Insurance statistics show the obese individual to be at high risk, not only for cardiac disease, but also for several types of cancer, diabetes, gallstones, and numerous other health problems. America’s overweight now number over 50 million people, still growing both in population and total accumulated pounds. Excess calories in the diet are either burned up or stored, but all calories must be accounted for. Our appetite problem is right in the center of a major preventive health program today,

Smoking directly causes an increased risk for coronary heart disease. Nicotine, the addictive alkaloid in tobacco, abnormally speeds the heart rate and raises the blood pressure. Carbon monoxide, as mentioned above, “shoots holes” in the artery walls for cholesterol to enter. An average tobacco

smoker, according to the Framingham study has three times the risk for a heart attack and more than a 75% increased chance of dying from one! With increasing nonsmoking years, these risks fall gradually to normal for the ex- smoker.

Hypertension or high blood pressure is a major risk factor in both heart attacks and strokes. The extra load imposed upon the heart as it pumps against increased resistance is a major factor in congestive heart failure, which may occur either gradually or in association with a sudden heart attack. This problem will be considered below, as it frequently is preventable.

The sedentary habits of Americans have also come under scrutiny.

Inactivity is another major risk for the development of heart disease. Exercise is protective in many ways. It not only improves the peripheral circulation elsewhere in the body, but also lowers the resting pulse rate, improves the volume of blood delivered with each heartbeat, and dilates the coronary arteries, both large and small. Many research studies comparing active with sedentary workers have demonstrated numerous protective benefits of moderate exercise in avoiding a fatal heart attack. Walking is especially beneficial. Nearly everyone can do it, too.

Other factors, such as the excessive intake of sugar, a positive family history for heart disease, longstanding presence of diabetes, advanced age, and male gender are related to a higher risk. Some of these can be modified in a healthful way.

Because dietary prevention is so important concerning the risk of coronary heart disease, we wish to spend more time on this vital yet

controversial factor. Several simple principles must be understood and applied by anyone desiring to have a healthy heart. First of all, our dietary fat intake must be reduced. The average American takes in daily over 40% of his or her calories as fat. Half this much fat (10 to 20%) would definitely be more

fiber. Bran, found abundantly in whole grains and legumes, is an excellent source of dietary fiber. Increasing your fiber intake has been shown to help with elimination of cholesterol from arteries via your liver and the intestinal tract. Plant sterols present in whole grains and some vegetables will inhibit in a competitive fashion the absorption of cholesterol from the intestines. All these changes will make your food more interesting and grant much improved health for heart, brain, and longevity.

Most shoppers are aware that cholesterol is always of animal origin. With increased meat being used, the intake of fruits and vegetables as dietary staples have fallen off conspicuously for the average household. The richest source of food cholesterol is the yoke of an egg, over 230 mg. in one of medium size. The butterfat portion of milk and all derived milk products— such as cheese, butter, ice cream and cottage cheese—contain cholesterol. Meats, especially those rich in fat, are exceptionally abundant in cholesterol. Even poultry and fish are not excepted. The more cholesterol you take into your body, the higher the level blood cholesterol is likely to be. This accelerates the development of arteriosclerosis. I advise that as much as possible all dietary sources of cholesterol be eliminated. Then comes the good news; for most people coronary heart disease can begin to regress.

Actually, contemporary and very encouraging data is available to show that the cholesterol problem is in fact reversible. First you should begin with a change in diet and curtailment in the type of fat eaten. By lowering the total fat intake and eliminating cholesterol, your special protein-fat carriers, called lipoproteins, are mustered to mobilize cholesterol for transportation to the liver and eventual excretion in the bile. Modern measurements of blood HDL

(high-density lipoprotein) cholesterol have enabled even more accurate

prediction of the state of this efficient cleansing mechanism.

Second, the avoidance of excess calories and refined sugars also helps combat the problem of fat deposition in the vascular structures. Combining a natural diet with adequate exercise will increase the preventive dividends.

With your general decrease in the use of fat, it is time next to take a look at oil. Biochemists agree that some fat is needed in the diet. For most people this can be obtained entirely from non-animal sources, such as nuts, olives, or avocados. In areas where these are scarce, in colder climates, or for extremely

active occupations where more calories are needed, some vegetable fats could be taken in their refined form. Usually these are combined in the cooking process, as in making bread.

Certain fats, however, are clearly better from the standpoint of cholesterol control. Measuring the ratio of polyunsaturated to saturated fat (P: S Ratio) will help to establish the relative risk or benefits of certain seed oils. Corn, safflower, and soy oils are the best from the standpoint of polyunsaturated fats. The monounsaturated fats found in olives and olive oil convey a protective benefit on the heart and arteries. Peanut and cottonseed oil are of lesser value. It is crucial to avoid entirely the consumption of shortening, lard, and butter, for these hardened fats will always tend to increase the cholesterol content of the blood. Recipe books are available, which enable the average cook to lower greatly total fat consumption as well as choose the most healthful sources.

Signs and symptoms of heart disease challenge medical experts as well as laymen to find an accurate diagnosis. Chest pain is usually one of two

principal qualities in heart disease. One type, called angina pectoris, is a transient pain, usually described as a pressure, aching, or squeezing in the area behind the left breast and associated with exercise. It may come on gradually as in walking up a hill or while mowing the lawn, or the pain may be triggered by stress, as in watching violent sports on television or by getting into an argument. Sometimes angina may arise after a heavy meal, because of the increased workload that digestion imposes on the heart. When exercise is a triggering factor, rest will within minutes relieve the pain. Sometimes an improvement of circulation results in the hands or feet by immersion in warm water to accelerate this relief process. In fact, it is important to keep the extremities warm when exercising on a cold day, to avoid chilling and thus reduce congestion around the heart.

The heart attack, or acute myocardial infarction, presents suddenly with chest pain of a much different character. Although in the elderly this serious event may occur silently, for most younger individuals a sudden heart attack produces definite symptoms. Occasionally, however, it may resemble heart- burn, a digestive problem, or may be thought to be related to indigestion. Classically the pain of a heart attack is located beneath the breastbone or left portion of the chest. Patients describe their chest pain as vise-like, squeezing, a tense, aching pain that at times radiates into the left shoulder or arm, or up into the neck or jaw. This pain persists, sometimes for hours, and may be associated with collapse or a catastrophic sudden death. About two out of seven individuals having an acute heart attack will die before reaching the emergency room.

questionable whether our state-of-the-art coronary care units considered so essential in the United States do significantly reduce mortality from these attacks. In Great Britain, many heart attacks are treated at home, and with careful observation, rest and home nursing care, survival is about the same.

Usually the sufferer of a heart attack is well advised to stay in bed. With frequent movement of arms and legs to prevent blood clots (thrombosis) and deep breathing exercises to keep the lungs ventilated (preventing atelectasis— collapsed air sacs in the lungs), bed rest provides the safest treatment for each acute episode. Oxygen is usually administered and vital signs carefully

monitored to detect any rhythm disturbances or signs of heart failure. Serve the patient a liquids only diet for a day or two, then a gradual progression to healthful solid foods at regular intervals (5 or 6 hours between each meal).

Recommended exercise consists of steady, progressive activity in the room, then inside the home, and finally carefully supervised cardiac

reconditioning through prescribed outdoor exercises such as walking. These methods will enable most of afflicted heart patients to return to their desired level of function, eventually enjoying as good if not better health than before the heart attack. We have seen this happen in reconditioning centers around the country, including at Poland Spring.

Cardiac preventive exercises today are taking many forms. Although some doctors recommend no specific program, most physicians believe in exercise, Many are enthusiastic about fitness, some even joggers. Because of the orthopedic disadvantages, the risks, and the lack of objective data that running really saves lives. I believe that our main emphasis should be on walking. After a brief warm-up period, the fitness walker can begin at his most comfortable leisurely pace, then gradually increase the time, distance, and speed of this activity. Dr. Kenneth Cooper’ s “Aerobics” program, Dr. Dean Ornish’s books, and many other popular books on heart disease prevention contain guidelines for the prudent approach to heart reconditioning.

Years of experience at both the Wildwood Lifestyle Center & Hospital and the Poland Spring Health Institute have convinced me that walking is your best overall protective exercise for the heart, the nerves, healthy blood vessels, optimum weight control, and normalizing the blood pressure for

optimum prevention of arteriosclerosis. Any physical activity must be pursued regularly with enthusiasm and consistency in order to be effective, however. Noncompetitive sports, swimming, bicycle riding, and cross-country skiing, wood chopping, and gardening make excellent seasonal variations to the daily walk.