Showing posts with label Heart Disease. Show all posts
Showing posts with label Heart Disease. Show all posts
Jan 9, 2012
Sep 11, 2011
More Info about the Heart.....
How Does It Work?
The heart is located under the rib cage, to the left of the
breastbone (sternum) and between the lungs. Your heart is an amazing
organ. Shaped like an upside-down pear, this fist-sized powerhouse pumps
five or six quarts of blood each minute to all parts of your body. Outside the Heart
Looking at the outside of the heart, you can see the heart is made of muscle. The strong muscular walls contract (squeeze), pumping blood to the arteries.The major blood vessels that enter the heart include:
- aorta
- superior vena cava
- inferior vena cava
- pulmonary artery takes oxygen-poor blood from the heart to the lungs
- pulmonary vein -- brings oxygen-rich blood from the lungs to the heart
- the coronary arteries.
Inside the heart
The heart is a four-chambered, hollow organ.It is divided into the left and right side by a muscular wall called the septum. The right and left sides of the heart are further divided into:
- two atria - top chambers, which receive blood from the veins and
- two ventricles - bottom chambers, which pump blood into the arteries
The normal aortic valve
- mitral valve
- tricuspid valve
- aortic valve
- pulmonic valve (also called pulmonary valve)
The heart valves work the same way as one-way valves in the plumbing of your home, preventing blood from flowing in the wrong direction.
Each valve has a set of flaps, called leaflets or cusps. The mitral valve has two leaflets; the others have three. The leaflets are attached to and supported by a ring of tough, fibrous tissue called the annulus. The annulus helps to maintain the proper shape of the valve.
The leaflets of the mitral and tricuspid valve are also supported by tough, fibrous strings called chordae tendineae. These are similar to the strings supporting a parachute. The chordae tendineae extend from the valve leaflets to small muscles, called papillary muscles, which are part of the inside walls of the ventricles
The atria and ventricles work together, alternately contracting and relaxing to pump blood through your heart. The electrical system of your heart is the power source that makes this possible.
The heart's electrical system
Your heartbeat is triggered by electrical impulses that travel down a special pathway through your heart:
- SA node (sinoatrial node) – known as the heart’s natural pacemaker
The impulse starts in a small bundle of specialized cells located in the right atrium, called the SA node. The electrical activity spreads through the walls of the atria and causes them to contract. This forces blood into the ventricles.
The SA node sets the rate and rhythm of your heartbeat. Normal heart rhythm is often called normal sinus rhythm because the SA (sinus) node fires regularly. - AV node (atrioventricular node)
The AV node is a cluster of cells in the center of the heart between the atria and ventricles, and acts like a gate that slows the electrical signal before it enters the ventricles. This delay gives the atria time to contract before the ventricles do. - His-Purkinje Network
This pathway of fibers sends the impulse to the muscular walls of the ventricles and causes them to contract. This forces blood out of the heart to the lungs and body. - The SA node fires another impulse and the cycle begins again.
How fast does the normal heart beat?
How fast the heart beats depends on the body's need for oxygen-rich blood. At rest, the SA node causes your heart to beat about 50 to 100 times each minute. During activity or excitement, your body needs more oxygen-rich blood; the heart rate rises to well over 100 beats per minute.Medications and some medical conditions may affect how fast your heart-rate is at rest and with exercise.
How do you know how fast your heart is beating?
You can tell how fast your heart is beating (your heart rate) by feeling your pulse. Your heart-rate is the amount of times your heart beats in one minute.You will need a watch with a second hand.
You should feel a tapping or pulsing against your fingers.
Count the number of taps you feel in 10 seconds.
Multiply that number by 6 to find out your heart-rate for one minute:
Pulse in 10 seconds x 6 = ____ beats per minute (your heart-rate)
When feeling your pulse, you can also tell if your heart rhythm is regular or not.
The right and left sides of the heart work together
Right Side
Blood enters the heart through two large veins, the inferior and superior vena cava, emptying oxygen-poor blood from the body into the right atrium.Left Side
The pulmonary vein empties oxygen-rich blood, from the lungs into the left atrium.Atrial contraction
Right Side
Blood flows from your right atrium into your right ventricle through the open tricuspid valve. When the ventricles are full, the tricuspid valve shuts. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze).Left Side
Blood flows from your left atrium into your left ventricle through the open mitral valve. When the ventricles are full, the mitral valve shuts. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze).Ventricular contraction
Oxygen and carbon dioxide travels to and from tiny air sacs in the lungs, through the walls of the capillaries, into the blood.
Right Side
Blood leaves the heart through the pulmonic valve, into the pulmonary artery and to the lungs.Left Side
Blood leaves the heart through the aortic valve, into the aorta and to the body. This pattern is repeated, causing blood to flow continuously to the heart, lungs and body.How does blood flow through your lungs?
Once blood travels through the pulmonic valve, it enters your lungs. This is called the pulmonary circulation. From your pulmonic valve, blood travels to the pulmonary artery to tiny capillary vessels in the lungs. Here, oxygen travels from the tiny air sacs in the lungs, through the walls of the capillaries, into the blood. At the same time, carbon dioxide, a waste product of metabolism, passes from the blood into the air sacs. Carbon dioxide leaves the body when you exhale. Once the blood is purified and oxygenated, it travels back to the left atrium through the pulmonary veins.The heart receives its own supply of blood from the coronary arteries. Two major coronary arteries branch off from the aorta near the point where the aorta and the left ventricle meet. These arteries and their branches supply all parts of the heart muscle with blood.
Right Coronary Artery (RCA)
The right coronary artery branches into:
- Right marginal artery
- Posterior descending artery
The right coronary artery supplies:
- right atrium
- right ventricle
- bottom portion of both ventricles and back of the septum
Left Main Coronary Artery (also called the left main trunk)
The left main coronary artery branches into:
- Circumflex artery
- Left Anterior Descending artery (LAD)
The left coronary arteries supply:
- Circumflex artery - supplies blood to the left atrium, side and back of the left ventricle
- Left Anterior Descending artery (LAD) - supplies the front and bottom of the left ventricle and the front of the septum
What is collateral circulation?
Collateral circulation is a network of tiny blood vessels, and, under normal conditions, not open. When the coronary arteries narrow to the point that blood flow to the heart muscle is limited (coronary artery disease), collateral vessels may enlarge and become active. This allows blood to flow around the blocked artery to another artery nearby or to the same artery past the blockage, protecting the heart tissue from injury.- Learn more about coronary artery disease
-
There are four valves within your heart. They are the mitral, tricuspid, aortic and pulmonic valve.The mitral valve and tricuspid valve lie between the atria (upper heart chambers) and the ventricles (lower heart chambers). The aortic valve and pulmonic valve lie between the ventricles and the major blood vessels leaving the heart.
As blood leaves each chamber of the heart, it passes through a valve. Your heart valves make sure that blood flows in only one direction through your heart.
A Closer Look at the Valves
Mitral Valve Mouse-over image to see the mitral valve open.
Aortic Valve Mouse-over image to see the aortic valve open.The valve is made of strong, thin pieces or flaps of tissue called leaflets.The leaflets are attached to and supported by a ring of tough fibrous tissue called the annulus. The annulus helps to provide support and maintain the proper shape of the valve.
The valve leaflets can be compared to doors opening and closing. While the annulus functions as the door frame.
The leaflets of the mitral and tricuspid valve are also supported by tough, fibrous strings called chordae tendineae. These are similar to the strings supporting a parachute. The chordae tendineae extend from the valve leaflets to small muscles, called papillary muscles, which are part of the inside walls of the ventricles. The chordae tendineae and papillary muscles keep the leaflets stable against any backward flow of blood.
How Valves Work
The right and left sides of the heart work together to pump blood throughout the whole body. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward leakage.
1. Blood flows from your right and left atria into your ventricles through the open mitral and tricuspid valves.
2. When the ventricles are full, the mitral and tricuspid valves shut. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze).
3. As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the ventricles through the open valves into the pulmonary artery toward the lungs, and the aorta, to the body.
4. When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves snap shut. These valves prevent blood from flowing back into the ventricles.This pattern is repeated, causing blood to flow continuously to the heart, lungs and body. - Learn more about valve disease
- Your system of blood vessels -- arteries, veins and capillaries -- is over 60,000 miles long. That's long enough to go around the world more than twice!
- The adult heart pumps about 5 quarts of blood each minute - approximately 2,000 gallons of blood each day - throughout the body.
- When attempting to locate their heart, most people place their hand on their left chest. Actually, your heart is located in the center of your chest between your lungs. The bottom of the heart is tipped to the left, so you feel more of your heart on your left side of your chest.
- The heart beats about 100,000 times each day.
- In a 70-year lifetime, the average human heart beats more than 2.5 billion times
- An adult woman's heart weighs about 8 ounces, a man's about 10 ounces
- A child's heart is about the size of a clenched fist; an adult's heart is about the size of two fists.
- Blood is about 78 percent water.
- Blood takes about 20 seconds to circulate throughout the entire vascular system.
- The structure of the heart was first described in 1706, by Raymond de Viessens, a French anatomy professor.
- The electrocardiograph (ECG) was invented in 1902 by Dutch physiologist Willem Einthoven. This test is still used to evaluate the heart's rate and rhythm.
- The first heart specialists emerged after World War I.
Resources
Topol EJ (ed). Cleveland Clinic Heart Book (2000) New York: Hyperion.Topol EJ (ed). Textbook of Cardiovascular Medicine (1998), Philadelphia: Lippincott-Raven.
The Heart and Blood Vessels
Large red vessel- the aorta;large artery that carries blood from of the left ventricle to the arteries of the body
Large blue vessel- vena cava;
(includes the superior and inferior vena cava);
large vein that empties blood into the right atrium of the heart.
Right Coronary Artery (RCA) - supplies blood to the right atrium, right ventricle, bottom portion of the left ventricle and the back of the septum
Left Coronary Artery (LCA) - divides into two branches: the circumflex artery & the left anterior descending artery
Left anterior descending artery (LAD) - supplies blood to the front and bottom of the left ventricle and the front of the septum
Coronary veins (in blue) -take oxygen-poor ("deoxygenated") blood that has already been "used" by muscles of the heart and returns it to the right atrium
Circumflex artery - supplies blood to the left atrium and the side and back of the left ventricle
Pulmonary veins - bring oxygen-rich blood back to the heart from the lungs
As the heart beats, it pumps blood through a system of blood vessels,
called the circulatory system. The vessels are elastic tubes that carry
blood to every part of the body.
Blood flows continuously through your body's blood vessels. Your heart is the pump that makes it all possible.
The aorta is the large artery leaving the heart. The superior vena cava is the large vein that brings blood from the head and arms to the heart, and the inferior vena cava brings blood from the abdomen and legs into the heart.
Veins (in blue) are the blood vessels that return blood to the heart.
Deep veins, located in the center of the leg near the leg bones, are enclosed by muscle. The iliac, femoral, popliteal and tibial (calf) veins are the deep veins in the legs.
Superficial veins are located near the surface of the skin and have very little muscle support. The great saphenous vein is a superficial vein.
Blood is essential
- It carries oxygen and nutrients to your body's tissues
- It takes carbon dioxide and waste products away from the tissues.
- It is needed to sustain life and promote the health of all the body's tissues.
There are three main types of blood vessels
Arteries
The arteries (red) carry oxygen and nutrients away from your heart, to your body's tissues.
The veins (blue) take oxygen-poor blood back to the heart.
The veins (blue) take oxygen-poor blood back to the heart.
- Arteries begin with the aorta, the large artery leaving the heart.
- They carry oxygen-rich blood away from the heart to all of the body's tissues.
- They branch several times, becoming smaller and smaller as they carry blood further from the heart.
Capillaries
- Capillaries are small, thin blood vessels that connect the arteries and the veins.
- Their thin walls allow oxygen, nutrients, carbon dioxide and waste products to pass to and from the tissue cells.
Veins
- These are blood vessels that take oxygen-poor blood back to the heart.
- Veins become larger and larger as they get closer to the heart.
- The superior vena cava is the large vein that brings blood from the head and arms to the heart, and the inferior vena cava brings blood from the abdomen and legs into the heart.
Blood flows continuously through your body's blood vessels. Your heart is the pump that makes it all possible.
Upper Body Circulation
In the lungs, the pulmonary arteries (in blue) carry unoxygenated blood from the heart into the lungs. Throughout the body, the arteries (in red) deliver oxygenated blood and nutrients to all of the body’s tissues, and the veins (in blue) return oxygen-poor blood back to the heart.The aorta is the large artery leaving the heart. The superior vena cava is the large vein that brings blood from the head and arms to the heart, and the inferior vena cava brings blood from the abdomen and legs into the heart.
Lower Body Circulation
Arteries (in red) are the blood vessels that deliver blood to the body.Veins (in blue) are the blood vessels that return blood to the heart.
Deep veins, located in the center of the leg near the leg bones, are enclosed by muscle. The iliac, femoral, popliteal and tibial (calf) veins are the deep veins in the legs.
Superficial veins are located near the surface of the skin and have very little muscle support. The great saphenous vein is a superficial vein.
Educational Opportunities
Additional Secure Online Services include:
- MyChart - a secure online tool connecting patients to their own health information from the privacy of their home - clevelandclinic.org/mychart
- MyConsult Online Medical Second Opinion - a secure online service providing remote medical second opinions. Learn more at clevelandclinic.org/myconsult
Cleveland Clinic offers a variety of learning opportunities for health care professionals.
Live and Online Presentations
- Grand Rounds and Conferences - Plan to attend a lively CME-approved presentation related to advancements in the diagnosis and treatment of cardiovascular disease. (Access our calendar).
- OnLine CME - FREE CME credit. Heart and vascular topics, and more.
- Physicians can manage their CME credits by using the myCME Web Portal. Available 24/7, the site offers CME opportunities to medical professionals across the globe.
- Presentations - Non-CME presentations from our Heart and Vascular Institute physicians on our website
Journals, Books and Resources
- Cardiac Consult - Free newsletter for physicians, available online and by subscription.
- Cleveland Clinic Journal of Medicine - Published twelve times yearly by Cleveland Clinic, available online and by subscription.
- Disease Management Project - An online medical resource authored by physicians from Cleveland Clinic.
- Books - Textbooks & information for medical professionals from leading authorities.
- Physician eNewsletter - Have the latest cardiovascular health information delivered to your inbox.
Diabetes and Diet and Excercise
A healthy diet, not a "diabetes diet"
Diets for people with diabetes, weight, heart disease or other health problems are all very similar. That is because a healthy diet is the same for almost everyone. That means:
- Eat less fat and less sugar
- Eat smaller portions of meats and dairy products
- Eat more vegetables, fruits and whole-grain or unprocessed starches
Plan healthy meals
It is important to plan so you are balancing the different foods you need each day. Every meal should include something from each of the basic food groups:- Vegetables and starches (carbohydrates)
- Low-fat meats, dairy products or certain types of beans (proteins)
- Margarine, oils or fats present in the foods you eat or prepare
Done correctly, good meal planning can reduce the need for insulin or other medicines. The best way to find a way that will work for you and your family is to talk to a dietician. Either your doctor or Priority Health can suggest a dietitian available to help in your local area.
Watch portions
For example, a healthy portion of protein - chicken breast, or steak, or a hamburger - is 3 oz., which is about the size of a pack of cards. Some people weigh their food to make sure they are eating the right amounts. There are other ways that your doctor or a dietitian can show you.Eating smaller meals more often during the day is a good way to keep your blood sugar at the best levels for you.
- Eat about the same amount of sugars and starches at each of your meals and snacks to keep your blood sugar consistent.
- Don't skip meals so you can avoid having blood sugar levels from going up and down like a yo-yo.
- Avoid fried foods.
- Eat smaller servings of foods with cheese or creamy sauces.
- Choose low-fat offerings.
- Restaurants serve very large portions. Split your entrees with others or ask for half-orders. Ask for a doggie bag before you eat and put half your plateful into it to limit the food in front of you.
- Choose broiled, grilled or baked meat or fish. These cooking methods reduce fat and usually do not have fats added.
- Ask for steamed vegetables and ask your waiter or host not to put any other butter or sauces on them
Exercising is essential when you have diabetes, pass this information on to your clients....
Whether you have Type 1 or Type 2 diabetes, exercise can help you live a longer and better life.Exercise can help to strengthen your heart, control your weight, and increase how much you enjoy life. If you have Type 2 diabetes, exercise could eliminate your need to take insulin or other drugs.
If you haven't been exercising up until now, you have plenty of good reasons to start. And if you have been exercising, congratulations.
Set goals
Start without goals and it is too easy to stop. Most people start a fitness program for personal reasons. Some common reasons are:- "My clothes are a little tight around the waist."
- "It's getting a little harder to keep up with the kids or grandkids."
- "I miss going out with my friends."
Take out a sheet of paper and at the top, write, "Why Exercise?" Then start writing why you think exercise would help you. Those reasons become your goals.
No excuses
You are not alone in thinking you have good reasons not to get started. But those are probably just excuses. The American Diabetes Association dedicates an entire page on their website (www.diabetes.org) just to the excuses people have for not getting exercising. Here are a few we hear all the time:- "I don't have time."
You can get positive benefits just by starting with a few minutes a day. Work up to 30 min. a day. - "I'm too tired."
Try walking at lunchtime, in the morning or whenever you're rested and ready. - "It hurts."
If exercise leaves you with sore muscles, go easy at first. Build up over time and there is no reason to be sore or uncomfortable. If your knees or joints hurt when you walk, consider pain-free alternatives like swimming or lifting light weights. - "I can't afford a gym."
The sidewalk in front of your house is free. The bike in your garage can be dusted off. Some people do more housework for exercise. - "It's boring."
It's a simple truth: if you don't enjoy it, you won't do it. So bring a friend along. Read a magazine on a treadmill. Walk in a mall and window-shop along the way. Ride your bike in a new direction. If one exercise is getting boring, add others.
Get professional advice
Talk with your doctor. Everybody can add or enjoy some form of exercise, but diabetics have good reason to make certain they choose an activity that fits their current health.- If you have experienced numbness in your feet, you should not do an impact sport like running or step aerobics without your doctor's approval.
- If your eyes have been impacted by diabetes, you probably should not be doing an activity that either causes impact or raises your blood pressure (like weight lifting).
- For people who are already active in sports, there are a lot of sources of online information dedicated to athletes with diabetes. For example, a group called the Diabetes Exercise and Sports Association has information and many links to help anybody from weekend warriors to professional sportspeople continue enjoying their fitness routines and activities.
Get geared up
Don't start by investing a lot of money in equipment. Start with a good pair of shoes and absorbent, seamless socks, some comfortable clothes and you're ready. Get a medical ID bracelet in case you are exercising and experience any difficulties.Plan your blood tests
Until you know for certain how an exercise is going to affect you, test your blood glucose levels before and after an activity. Your doctor can provide good advice on what to look for and what any changes mean.Get moving!
- Write a plan, be realistic
Just the act of writing what you intend to do and patting yourself on the back when you do it is a big boost to building fitness. Write down what you will do on a calendar and watch how it all adds up. - Don't rush it
Improving fitness takes time. It takes time during your day and it takes days or even weeks to reach your goals. If you push too hard, you'll feel uncomfortable. Take your time, enjoy the trip and you will enjoy the goal when you reach it. - Make it a team sport
To have a plan and stick to it is a lot easier if you have the encouragement and support of friends and family members. Invite someone to join you. - Everything counts
When all is said and done, fitness is what you get for moving a little more than you did the day before. Every move you make during your day adds to your fitness. If it's raining outside, get out your vacuum cleaner. If your day is going to be too busy, park at the far end of the parking lot and walk a little further.
Diabetes, Heart Disease, and Stroke....
Diabetes and heart health
Diabetes raises the chances of developing heart problems... eating well and getting or staying active. Even if you have had a heart attack already, you can do a lot more than just take medicines your doctor prescribes.What causes heart disease?
Atherosclerosis is when, over time, fat deposits from cholesterol build up on the walls of your arteries. As the fat builds up, less blood is flows through. If the blood to your heart is blocked enough, you have a heart attack. If these fat deposits break loose, the result is a stroke. This is why doctors focus on reducing cholesterol.
Diabetes is also more likely to cause heart problems due to damage from high glucose levels and high blood pressure.
Managing A1c levels
A1c is a measure of your blood sugar control over a period of time....daily testing for glucose levels will help manage how well you feel. Regular A1c tests help you know what steps you have to take to keep your blood sugar under control to protect your heart.Managing blood pressure
High blood pressure can cause heart and kidney disease. Some people can reduce it with changes in diet or physical activity. Others require medicines. Your doctor or doctors will help you make the best decision for your specific situation.Managing cholesterol
This chart shows you what most doctors agree are good measures of the scores you get.| Normal | less than 150 mg/dL |
| Borderline High | 150-199 mg/dL |
| High | 200-499 mg/dL |
| Very High | 500 mg/dL |
What are the risk factors for heart disease and stroke in people with diabetes?
Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.You can't change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here:
- Having central obesity. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.
- Having abnormal blood fat (cholesterol) levels.
- LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries-the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease.
- Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.
- HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease. - Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.
- Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.
What is metabolic syndrome and how is it linked to heart disease?
Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes. It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions:| Traits and Medical Conditions | Definition |
|---|---|
| Elevated waist circumference | Waist measurement of
|
| Elevated levels of triglycerides |
|
| Low levels of HDL (good) cholesterol |
|
| Elevated blood pressure levels |
|
| Elevated fasting blood glucose levels |
|
Note: Other definitions of similar conditions have been developed by the American Association of Clinical Endocrinologists, the International Diabetes Federation, and the World Health Organization.
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What can I do to prevent or delay heart disease and stroke?
Even if you are at high risk for heart disease and stroke, you can help keep your heart and blood vessels healthy. You can do so by taking the following steps:- Make sure that your diet is "heart-healthy." Meet with a registered dietitian to plan a diet that meets these goals:
- Include at least 14 grams of fiber daily for every 1,000 calories consumed. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber. Increase the amount of fiber in your diet gradually to avoid digestive problems.
- Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount.
- Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.
- Keep the amount of trans fat in your diet to a minimum. It's a type of fat in foods that raises blood cholesterol. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kinds of vegetable shortening and margarines have trans fat. Check for trans fat in the Nutrition Facts section on the food package.
- Make physical activity part of your routine. Aim for at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. If you haven't been physically active recently, see your doctor for a checkup before you start an exercise program.
- Reach and maintain a healthy body weight. If you are overweight, try to be physically active for at least 30 minutes a day, most days of the week. Consult a registered dietitian for help in planning meals and lowering the fat and calorie content of your diet to reach and maintain a healthy weight. Aim for a loss of no more than 1 to 2 pounds a week.
- If you smoke, quit. Your doctor can help you find ways to quit smoking.
- Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.
- Get prompt treatment for transient ischemic attacks (TIAs). Early treatment for TIAs, sometimes called mini-strokes, may help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache.
How will I know whether my diabetes treatment is working?
You can keep track of the ABCs of diabetes to make sure your treatment is working. Talk with your health care provider about the best targets for you.A stands for A1C (a test that measures blood glucose control). Have an A1C test at least twice a year. It shows your average blood glucose level over the past 3 months. Talk with your doctor about whether you should check your blood glucose at home and how to do it.
| A1C target |
|---|
| Below 7 percent |
| Blood glucose targets | |
|---|---|
| Before meals | 90 to 130 mg/dL |
| 1 to 2 hours after the start of a meal | Less than 180 mg/dL |
| Blood pressure target |
|---|
| Below 130/80 mm Hg |
| Blood fat (cholesterol) targets | |
|---|---|
| LDL (bad) cholesterol | Under 100 mg/dL |
| Triglycerides | Under 150 mg/dL |
| HDL (good) cholesterol | For men: above 40 mg/dL For women: above 50 mg/dL |
What types of heart and blood vessel disease occur in people with diabetes?
Two major types of heart and blood vessel disease, also called cardiovascular disease, are common in people with diabetes: coronary artery disease (CAD) and cerebral vascular disease. People with diabetes are also at risk for heart failure. Narrowing or blockage of the blood vessels in the legs, a condition called peripheral arterial disease, can also occur in people with diabetes.Coronary Artery Disease
Coronary artery disease, also called ischemic heart disease, is caused by a hardening or thickening of the walls of the blood vessels that go to your heart. Your blood supplies oxygen and other materials your heart needs for normal functioning. If the blood vessels to your heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in a heart attack.Cerebral Vascular Disease
Cerebral vascular disease affects blood flow to the brain, leading to strokes and TIAs. It is caused by narrowing, blocking, or hardening of the blood vessels that go to the brain or by high blood pressure.Stroke
A stroke results when the blood supply to the brain is suddenly cut off, which can occur when a blood vessel in the brain or neck is blocked or bursts. Brain cells are then deprived of oxygen and die. A stroke can result in problems with speech or vision or can cause weakness or paralysis. Most strokes are caused by fatty deposits or blood clots-jelly-like clumps of blood cells-that narrow or block one of the blood vessels in the brain or neck. A blood clot may stay where it formed or can travel within the body. People with diabetes are at increased risk for strokes caused by blood clots.A stroke may also be caused by a bleeding blood vessel in the brain. Called an aneurysm, a break in a blood vessel can occur as a result of high blood pressure or a weak spot in a blood vessel wall.
TIAs
TIAs are caused by a temporary blockage of a blood vessel to the brain. This blockage leads to a brief, sudden change in brain function, such as temporary numbness or weakness on one side of the body. Sudden changes in brain function also can lead to loss of balance, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache. However, most symptoms disappear quickly and permanent damage is unlikely. If symptoms do not resolve in a few minutes, rather than a TIA, the event could be a stroke. The occurrence of a TIA means that a person is at risk for a stroke sometime in the future.Heart Failure
Heart failure is a chronic condition in which the heart cannot pump blood properly-it does not mean that the heart suddenly stops working. Heart failure develops over a period of years, and symptoms can get worse over time. People with diabetes have at least twice the risk of heart failure as other people. One type of heart failure is congestive heart failure, in which fluid builds up inside body tissues. If the buildup is in the lungs, breathing becomes difficult.Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heart beats. People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet. Diabetes can also interfere with pain signals normally carried by the nerves, explaining why a person with diabetes may not experience the typical warning signs of a heart attack.
Peripheral Arterial Disease
Another condition related to heart disease and common in people with diabetes is peripheral arterial disease (PAD). With this condition, the blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. PAD increases the chances of a heart attack or stroke occurring. Poor circulation in the legs and feet also raises the risk of amputation. Sometimes people with PAD develop pain in the calf or other parts of the leg when walking, which is relieved by resting for a few minutes.How will I know whether I have heart disease?
One sign of heart disease is angina, the pain that occurs when a blood vessel to the heart is narrowed and the blood supply is reduced. You may feel pain or discomfort in your chest, shoulders, arms, jaw, or back, especially when you exercise. The pain may go away when you rest or take angina medicine. Angina does not cause permanent damage to the heart muscle, but if you have angina, your chance of having a heart attack increases.A heart attack occurs when a blood vessel to the heart becomes blocked. With blockage, not enough blood can reach that part of the heart muscle and permanent damage results. During a heart attack, you may have
- chest pain or discomfort
- pain or discomfort in your arms, back, jaw, neck, or stomach
- shortness of breath
- sweating
- nausea
- light-headedness
Women may not have chest pain but may be more likely to have shortness of breath, nausea, or back and jaw pain. If you have symptoms of a heart attack, call 911 right away. Treatment is most effective if given within an hour of a heart attack. Early treatment can prevent permanent damage to the heart.
Your doctor should check your risk for heart disease and stroke at least once a year by checking your cholesterol and blood pressure levels and asking whether you smoke or have a family history of premature heart disease. The doctor can also check your urine for protein, another risk factor for heart disease. If you are at high risk or have symptoms of heart disease, you may need to undergo further testing.
What are the treatment options for heart disease?
Treatment for heart disease includes meal planning to ensure a heart-healthy diet and physical activity. In addition, you may need medications to treat heart damage or to lower your blood glucose, blood pressure, and cholesterol. If you are not already taking a low dose of aspirin every day, your doctor may suggest it. You also may need surgery or some other medical procedure.
For additional information about heart and blood vessel disease, high
blood pressure, and high cholesterol, call the National Heart, Lung,
and Blood Institute Health Information Center at 301-592-8573 or see www.nhlbi.nih.gov on the Internet.
How will I know whether I have had a stroke?
The following signs may mean that you have had a stroke:- sudden weakness or numbness of your face, arm, or leg on one side of your body
- sudden confusion, trouble talking, or trouble understanding
- sudden dizziness, loss of balance, or trouble walking
- sudden trouble seeing out of one or both eyes or sudden double vision
- sudden severe headache
What are the treatment options for stroke?
At the first sign of a stroke, you should get medical care right away. If blood vessels to your brain are blocked by blood clots, the doctor can give you a "clot-busting" drug. The drug must be given soon after a stroke to be effective. Subsequent treatment for stroke includes medications and physical therapy, as well as surgery to repair the damage. Meal planning and physical activity may be part of your ongoing care. In addition, you may need medications to lower your blood glucose, blood pressure, and cholesterol and to prevent blood clots.
For additional information about strokes, call the National Institute
of Neurological Disorders and Stroke at 1-800-352-9424 or see www.ninds.nih.gov on the Internet.
- If you have diabetes, you are at least twice as likely as other people to have heart disease or a stroke.
- Controlling the ABCs of diabetes-A1C (blood glucose), blood pressure, and cholesterol-can cut your risk of heart disease and stroke.
- Choosing foods wisely, being physically active, losing weight, quitting smoking, and taking medications (if needed) can all help lower your risk of heart disease and stroke.
- If you have any warning signs of a heart attack or a stroke, get medical care immediately-don't delay. Early treatment of heart attack and stroke in a hospital emergency room can reduce damage to the heart and the brain.
Hope through Research
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is one of the National Institutes of Health (NIH) under the U.S. Department of Health and Human Services. The NIDDK conducts and supports research in diabetes, glucose metabolism, and related conditions. Several studies related to diabetes, heart disease, and stroke are under way.- The Look AHEAD (Action for Health in Diabetes) trial is studying whether strategies for weight loss in obese people with type 2 diabetes can improve health. This trial is also sponsored by other NIH Institutes and by the Centers for Disease Control and Prevention. For more information on the Look AHEAD trial, visit the website at www.niddk.nih.gov/patient/SHOW/lookahead.htm.
- The EDIC (Epidemiology of Diabetes Interventions and Complications) study is examining the long-term effects of prior intensive versus conventional blood glucose control. It is a follow-up study of patients who took part more than a decade ago in the Diabetes Control and Complications Trial (DCCT), a major clinical study funded by the National Institutes of Health.
- The BARI 2D (Bypass Angioplasty Revascularization Investigation 2
Diabetes) trial, sponsored by the National Heart, Lung, and Blood
Institute, in partnership with NIDDK, is studying approaches to the
medical care of people with type 2 diabetes who also have coronary
artery disease. For more information on the BARI 2D trial, visit the
website at www.bari2d.org
or call the nearest research center (listed on the website).
- The ACCORD (Action to Control Cardiovascular Risk in Diabetes)
trial is studying three approaches to preventing major cardiovascular
events in individuals with type 2 diabetes. For more information on the
ACCORD trial, visit the website at www.accordtrial.org
- The NIDDK and other components of the NIH will continue to fund research on the best ways to enhance health promotion, self-management, and risk reduction in people with diabetes.
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