Facts and Important General Information for Convalescent Cardiac Patients
By Dr. Ilan Kitzis, In-House Cardiologist
Risk Factors (Reversible) for Cardiovascular Diseases
- High cholesterol (especially the LDL).
- Diabetes/visceral (central) obesity.
- Lack of physical activity.
Blood Pressure (Hypertension)
- Optimal values: 60 – 80/120 – 130, in a mature/older population, the low value has no importance (even if it is very low).
- Medications for hypertension:
- Calcium channel blockers – for example: Norvasc, Vasodip.
- ACE inhibitors and ARB (angiotensin receptor blockers) blockers – for example: Tritace, Enaldex, Diovan, Losartan, Atacand.
- Diuretic – for example: Disothiazide, Aldactone, Pamid.
- Alpha blockers – for example: Cadex.
- Combining two medications within a single tablet is a very effective approach for balancing blood pressure and it is particularly convenient for the patient (less tablets).
- Blood pressure measurement:
- Sitting down, after a respite of several minutes… measure and register the results (it is preferable to measure several times a day and register, while maintaining a difference of several days).
- An Ambulatory Blood PressureMonitoring (ABPM) device or a halter monitor, is the best method for estimating the blood pressure balancing quality.
- The desired weight BMI – around 20 – 25.
- The BMI is measured in the following manner – the weight divided by the height (in meters) squared.
For example – if the weight is 90 kg and the height is 1.70 meters, hence 90/1.702 = 90/2.89 = 31.14, therefore the BMI is 31.
The leading causes of morbidity and mortality in diabetic patients are cardiac problems (heart attacks and cardiac insufficiency). Recently, several new diabetes medications were introduced into the market, instigating a very significant decline in heart morbidity in diabetic patients (for example – Victoza, Jardiance). All the diabetic patients who have undergone a certain cardiac event (old or recently), must be examined by a diabetes specialist in order to begin receiving the new medications.
The HbA1c is measured once every three months and it expresses the average sugar level in the patient’s blood during the last three months. A normal level is less than 8.5.
Sleep Apnea (Respiratory Arrest)
Sleep apnea (obstructive sleep apnea) is characterized by frequent pauses in breathing or periods of shallow breathing during sleep, without the patient noticing it. This illness derives mainly from obesity (particularly visceral (central) obesity) and it causes many symptoms – fatigue, sleepiness during the daytime, weakness, hypertension that is very difficult to balance, atrial fibrillation and heart diseases.
The most qualitative treatment is a significant loss of weight and a CPAP mask.
Night snores are the identifying mark of this disease and snoring patients (men and women alike) must undergo a sleep study test (PSG – polysomnogram) in order to negate the disease.
Preferred diet – “Mediterranean”, based on eating primarily vegetables, fish, poultry, whole-wheat, olive oil and much less sugars/candy and dough (see the Food Pyramid).
Nonetheless, it should be emphasized that this is not a diet intended for weight loss and it is not necessarily the suitable diet for extremely obese people who must lose weight.
Drinking any kind of alcohol to a moderate extent, is possible for all cardiac patients and this habit does not “clash” with most of the standard medications provided to cardiac patients (although this must be clarified with the treating physician).
Two glasses of wine or two glasses (30 g) of hard liquor or beer are certainly possible and even desired daily or several times a week. On the other hand, a large amount of alcohol is certainly forbidden.
LDL – the “bad” cholesterol.
The healing process at the Heart Center constitutes an opportunity for rest and relaxation.
Particularly on the first day, the convalescent patients are confused and fatigued from the hospitalization and the road they traversed, and in order to support the healing process, it is important to relax well and go to sleep early. After a personal therapy, we highly recommend to relax and process the experience you underwent.
It is recommended to avoid making further plans for the evenings during these days, watch less television and talk as little as possible on the mobile phone – this way, you will allow the process to assimilate within you in the best manner possible.
Likewise, we recommend that you refrain from conducting unnecessary conversations on your mobile phone during the recess times of the workshop and try to ensure that your presence is silent.
Convalescent patients that arrive to the Heart Center and have special needs, disabilities or difficulties, please contact us for further consultation and provision of solutions (patients with diabetes, celiac disease, some king of sensitivity or allergy, physical disabilities, background diseases etc.).
- HDL – “good” cholesterol. A high level of good cholesterol (above 45) is a good indicator, however, it does not annul the essentiality of treating the “bad” cholesterol.
- Triglycerides TG – connected mainly to the food’s quality and the calories’ quantity.
- The general cholesterol TC (total cholesterol), is a general measure which expresses all the cholesterol components. It is of lesser importance.
- Statins – for example – Crestor, Lipitor, Simvastatin. Widely-used medications are essential for every patient with a coronary artery disease. These medications reduce the level of
“bad” cholesterol by about 30 – 40% and also diminish the risk of a repeat heart attack/repeated catherization by about 30 – 40%.
- Ezetrol – a medication that prevents cholesterol released from the intestine from being reabsorbed into the bloodstream.
- Immunologic medications from the I-PCSK9 group – this group comprises two medications – Repatha and Praluent. These medications are administered by means of subcutaneous injections once every two weeks. They reduce the LDL level by about 60%!! These medications have hardly any side effects, they are very expensive and they are contained within the healthcare basket for defined patient groups.
Recommended Physical Activity
Half an hour up to one hour, at least 5 days a week. A combination of aerobic and anaerobic/power exercises. Aerobic activity during two thirds of the training session (walking, jogging). Anaerobic/power exercises during one third of the training session (light weights, resistance exercises).
Patients with mechanical valve implants must take Coumadin for the rest of their lives. The new blood thinning medications are not suitable for these patients!!
Patients with biological valves or those who underwent a valve repair surgery should consult with a cardiologist specialist regarding the need for taking blood thinning medications. All the patients having any type of valve must receive a prophylactic antibiotic treatment for bacterial infection on the valves (prophylaxis SBE), especially before dental treatments.
- Coumadin– an old blood-thinning medication. The daily dose is determined according to the results of a blood test called INR. The INR level of people who do not take blood-thinning medications is 0.1. Patients who do take Coumadin are usually required to take a Coumadin dose that will increase their INR level to values of 2 – 3. INR values exceeding 5.3 may cause hemorrhage and INR levels lower than 2 do not thin the blood as required.
The treatment with Coumadin is designated mostly for patients with valvular heart diseases, atrial fibrillation, pulmonary embolism, deep vein thrombosis (DVT) (blood clots) in the limbs (with or without pulmonary embolism), thrombophilia and other conditions.
Balancing the INR (the blood coagulation level) by Coumadin depends among others on the type of nutrition. Mainly green foods which contain Vitamin K may decrease the level of INR (sub-coagulation). Every Coumadin patient must receive a precise explanation by his physician regarding the new anticoagulant medications (NOAC’s – new oral anticoagulants). These medications have generated a real revolution. Three medications pertaining to the NOAC’s group can be found in Israel – Pradaxa, Eliquis, Xarelto. These medications thin the blood in a more qualitative manner than Coumadin.
Their most significant advantage is that it is unnecessary to perform a blood test in order to determine the dose and the blood’s thinning quality – they are taken consecutively and permanently at a preset dose. Due to their high price, these medications are indeed contained within the healthcare basket yet not for all the patients who require blood thinning.
Arrhythmias (Cardiac Rhythm Disturbances) – Concepts
- Extrasystole – premature contractions of the heart that can originate from an atrial source (APB’s – atrial premature beats) or from a ventricular source (VPB’s – ventricular premature beats).
- Atrial fibrillation – a common arrhythmias at an older age, characterized by an irregular heartbeat. The fibrillation can be:
- Paroxysmal (alternately, paroxysmal atrial fibrillation).
- Persistent – chronic or still not chronic (persistent chronic).
The treatment of atrial fibrillation is divided into two branches:
- Treatment of the arrhythmias.
- Treatment intended for preventing emboli and cerebrovascular accident (strokes).
Sexual activity after a heart attack or heart surgery:
- The overwhelming majority of men with heart diseases (of any kind) can use medications in order to strengthen the erection (Viagra, Cialis, Levitra), without any fear.
- These medications cannot be taken by patients who take preparations that contain nitrates (Mononit, Monocord, Isoket spray) and by patients suffering from extremely severe cardiac insufficiency.