Heart Lessons
What you don’t know about your heart
By Terri Akman

Your heart – you love it. It loves you (and others). But how much do you really know about it? In any close relationship, it’s important to get to know your love interest as much as you can, so take a look at these heart facts and love your heart just a little bit more.


You can have a heart attack without having heart disease.

“I had a patient who had an incredibly stressful experience climbing a mountain. She was on a ledge and almost fell, and was holding on for dear life,” recalls Reginald Blaber, MD, executive director of the Lourdes Cardiovascular Institute. “She was able to pull herself up, but then felt terrible crushing chest pain and had a heart attack. She was airlifted to a hospital, where they found her coronary arteries to be completely normal. She had released a surge of adrenaline that caused her coronary artery to spasm, so her heart attack was because the artery spasmed, not because a clot formed. I have been seeing her now for 13 years, and she’s never had a problem. She’s also never climbed again. It is a very rare event.”

Though rare, it does happen, especially when people’s lives are extraordinarily stressful. “I had a patient whose house was being foreclosed upon,” adds Robert Singer, MD, section chief of cardiology at Virtua Cardiology Group. “When she got that foreclosure letter, she was distraught. She was put on medications for her reduced heart function, and over the next three to six months her heart function returned to normal. She had been keeping things from her family, and when they found out this was going on they gave her much-needed support. Usually it’s something that does not reoccur. It’s a timely example of what’s going on in our world today.

“If you have this emotional output where your epinephrine level goes up and your blood pressure goes from a normal of 120 over 80 to 240 or 250, your heart muscle is beating under such pressure that you can lose heart muscle cells and have cardiac enzymes that are consistent with a heart attack. A Type 1 heart attack is where you have unstable plaque in a coronary artery, and a Type 2 heart attack is where the body can’t keep up with the heart muscle’s demand for blood.”


Trim your waist and lower your risk for heart disease.

“Waist circumference is an easy way to talk about obesity,” says Blaber. “The bigger your waist circumference, the more insulin resistance you have, and that means your insulin levels go up. Insulin not only lowers blood sugars, but is also a growth factor for hardening of the arteries.

Women whose waists are greater than 35 inches and men who have a waist larger than 40 inches have a higher risk of heart disease, stroke, high blood pressure, high cholesterol and Type 2 diabetes.

“There are two different shapes of obesity. The pear-shaped body where the fat is housed more in the hips than the belly is less likely to result in hardening of the arteries and heart attack than the apple-shaped distribution where the fat is more in the belly. Nonetheless, any form of obesity increases the risk for hypertension, diabetes and high cholesterol.”


A child can die suddenly by being hit in the chest.

“If a ball, bat or terribly fierce tackle hits someone hard enough in the chest, it could create an electrical impulse that courses through the chest wall to the heart,” says Blaber. “If it happens during the tiniest time window when the heart is electrically vulnerable – just a couple of milliseconds of the cardiac cycle – it can cause the heart to fibrillate. It’s exceedingly rare – we’re talking one in a 100,000 to one in a million. But when it happens, every second counts. That’s why it’s so important that we have defibrillators at athletic events – soccer, baseball and football fields, and basketball gyms. At that point in time, the only way to save the child is to shock the heart back into rhythm.”

While the scenario above is extremely rare, some children have congenital heart defects that may be undetected until tragedy strikes on a sports field. “Most commonly when a child dies suddenly, it is because they were predisposed to some type of arrhythmia. Children should be screened by a doctor before participating in sports,” says Vic Bahal, DO, of Advanced Cardiology of South Jersey. “They should have an EKG, which can identify an electrical problem in a child. If a murmur is heard, an echocardiogram should be done. We’ve had several examples where we’ve screened children for a sports physical and found they had something significant which would preclude them from taking part in competitive sports. Someone who has electrical problems of the heart or has any structural heart disease should not play contact sports, but they can exercise, swim, run or do other non-contact sports in moderation.”


Poor dental hygiene is bad for your heart.

“Patients with poor teeth and especially poor gums have a higher instance of cardiovascular disease,” says Singer. “Increased inflammation in the body from those bacteria can cause plaque to form and break in the coronary arteries. If the plaque breaks, a blood clot forms on top of it and cuts off the vessel, and that’s how you get a heart attack.”


For every pound you are overweight, that’s an extra mile of blood vessels that your heart has to work to pump blood to.

“When you have an extra pound of fat, you have a lot of blood vessels in that fat,” says Blaber. “Every one of these fat cells is living and needs a blood supply, so the heart has more cells to pump blood to. If you’re 35 pounds overweight, you have 35 miles of extra capillaries for the heart to pump those blood cells through. That  doesn’t  mean  the  heart  is  necessarily working harder to pump the blood to it, but because of that extra weight, the blood pressure, blood sugar, cholesterol,  and risk of heart disease and stroke do go up.”


Children can have heart disease.

“Children are afflicted with cardiac and vascular disease much the same as an adult,” says Bahal. “The same risk factors apply. I had a 12-year-old child who came in with palpitations and everybody thought it was anxiety. In examining him, we found he had lesions called xanthomas around his eyes. We checked his cholesterol, and it was 300 plus [normal is 200]. We put him on a low-fat diet, and supplemented him with fish oil and an exercise program. He’s now 16 years old and has lost a lot of weight and normalized his cholesterol. His eyes have returned to normal.

“You have to examine children head to toe. If a child doesn’t exercise and has a high body mass index, he can develop hypertension, high cholesterol and all the risk factors for heart disease can follow. Some children will have visual loss or even strokes, caused when a piece of cholesterol flicks off and goes into the retina.”


Laughter is good for your heart (really).

“Laughter relaxes you. Your brain sends out messages to the blood vessels to relax, which lowers blood pressure and risk factors for cardiovascular disease,” says Singer. “People who are happier and calm have a lower heart rate. Just look at people who are laughing. They are happier and more relaxed. With all risk factors being equal, like smoking, cholesterol and family history, those people tend to do better.”

In fact, Bahal, who is also an assistant professor of medicine at Cooper University Health Care, encourages all his patients to meditate. “People who meditate are more relaxed. Your heart rate goes down when you meditate,” he explains. “As the heart rate decreases, so does the oxygen demand for your vital organs. Meditation causes the endothelium, the inner lining of our arteries and organs, to relax. Maintaining endothelial health is the first step in preventing cardiovascular disease. Endothelial injury is the first thing that happens to cause vascular disease. Meditation decreases energy expenditure and enhances endothelial function. Some of the yogis in the Himalayas who do meditation live until they are 100 or 125 years of age.”

February 2013
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