Management of Heart Failure: Secondary to Left Ventricular Systolic Disfunction

Medivision presents an excerpt from our 60 minute medical education video Management of Heart Failure: Secondary to Left Ventricular Systolic Disfunction, featuring Denise Drummond Hayes MSN, RN, CCRN from Allegheny University Hospitals.
The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com and discusses the physicians need to differentiate between heart failure secondary to left-ventricular systolic dysfunction and heart failure secondary to left-ventricular diastolic dysfunction, describe the initial pharmacologic management for patients with heart failure in the setting of reduced left-ventricular systolic function, as well as the current AHCPR recommendations for patient and family education and counseling in reference to left - ventricular systolic dysfunction.

Older people living with heart abnormalities that could lead to heart failure may have never had those abnormalities diagnosed, meaning they miss out on treatments that could help. But deciding whether someone would benefit from taking these drugs in the last stages of life is also important.

The heart naturally gets weaker as people age, but scientists don't often study heart failure in the elderly. A new study looked at 375 people ages 87 to 89 in northeast England, and found that about one-third of them had a reduced ability to pump blood due to a left ventricular systolic dysfunction. Another 20 percent had a diastolic dysfunction; heart muscles that could not relax enough to allow the heart's chambers to fill with blood, which keeps the heart from pumping enough blood to the rest of the body.
These abnormalities increase as people age and develop cardiovascular diseases, such as high blood pressure and coronary artery disease. They can also lead to heart failure.

For 26 percent of the people in the study, the problems had never been diagnosed by a physician.

About 5.8 million Americans have heart failure according the National Heart Lung and Blood Institute, and as greater numbers of people age and survive heart attacks in Western countries it's possible that that number will grow.

Doctors say although the symptoms of these heart abnormalities seem common for older people, it's important that they not be dismissed as simply signs of "old age."
There are few treatment options for patients whose hearts don't relax enough to fill with blood, but patients whose hearts don't pump hard enough can take classes of drugs called beta blockers and ACE inhibitors, both of which increase the heart's ability to pump blood effectively. Those drugs come with side effects such as weakness, drowsiness or dizziness that may make it not feasible to give them to an older person.

 http://heart.bmj.com/site/misc/heartjnl-2012-302457.pdf

Cardiology Perspectives: Effective Management of Cholesterol

Medivision.com is pleased to present an excerpt from our 2 hour educational video; Cardiology Perspectives: Effective Management of Cholesterol, featuring John Kane, MD; Alan Chait, MD; John LaRose, MD; Tom Bersot, MD; Stephen G. Young, MD; Gustav Schoenfeld, MD and Virgil Brown, MD. The full length video is available on DVD or VHS from health-e-mall.com and discusses the importance of controlling cholesterol in patients with heart disease and other high risk individuals.

High cholesterol is a well-known risk factor in heart disease, the number one killer of both women and men in the United States, with more than a million heart attacks and about a half million deaths annually.
High cholesterol doesn't cause overt symptoms, and many people are unaware of elevated cholesterol levels and how it may influence their cardiac risk. To complicate matters, high cholesterol is not the only predictor of cardiovascular events such as heart attack and stroke; somewhere between 30-50 percent of first heart attacks occur in people with normal cholesterol levels, but it is essential to test and monitor cholesterol levels, especially for anyone with a family history of heart disease. Lowering high cholesterol does seem to lessen the risk for developing heart disease, and reduces the chance of a heart attack or dying of heart problems if you already have them. However, some research has indicated that all-cause mortality (that is, dying from any disease, not just heart disease) actually increases when cholesterol is lowered in those over age 65.

Genetics and lifestyle both combine in individuals to create high levels of cholesterol in the blood. Those who are overweight tend to have increased cholesterol.
Diet is an important component of controlling cholesterol ratios and maintaining heart health. Recent evidence indicates that added sugar and overabundance of flour in the diet are probably greater contributors to heart disease than saturated fat; certain components of full-fat dairy foods may be cardio-protective.
However, a chemically altered type of fat known as trans fatty acids (TFAs) can worsen cholesterol ratios. TFAs are mostly found in animal fats and vegetable oils, and are also created in the hydrogenation process that makes fats more stable, giving them a longer shelf-life.
In addition to diet, LDL cholesterol levels appear to be heavily dependent on genetic factors. Anyone at increased risk of heart disease should have tests for LDL particle size in addition to the basic lipid profile. Best results show low numbers of LDL particles overall.
A different cholesterol problem is present when one shows a tendency towards low HDL cholesterol and high triglycerides. This pattern, sometimes called “Syndrome X,” is associated with insulin resistance. It is frequently influenced by diet and lifestyle, but is also genetically driven and appears to affect at least 30 percent of the population. It carries with it an increased risk of high blood pressure and diabetes as well as heart disease. Dietary and nutritional supplement treatments are often quite effective in treating this pattern, but are a bit different from those for high total and LDL cholesterol levels.

High cholesterol is treated conventionally with lifestyle changes focusing on diet, physical activity and weight management. For patients seen in busy medical practices this approach is frequently difficult to fully implement and utilize. If lifestyle changes are not effective, drug therapy is often recommended. Statin drugs are commonly used to lower cholesterol and protect against heart disease and heart attacks by blocking an enzyme that is necessary for the synthesis of cholesterol in the liver. They can be very effective, and there is growing medical enthusiasm for them because they also seem to provide antioxidant and anti-inflammatory properties. These drugs can reduce plaque formation in coronary arteries by preventing the oxidation of LDL ("bad") cholesterol, and their anti-inflammatory properties may help prevent plaque from rupturing.
Despite their benefits, they do have adverse effects including liver toxicity: physicians need to monitor liver function carefully in patients with liver disease of any kind.

Don’t Have a Seat: New study shows that we spend too much time on our butts and it’s killing us.

How much time do you spend sitting? Think about it: an average American office worker gets out of bed, and then sits in a car on the way to work where they sit down at their desk. Maybe you’ll go out for lunch and sit at a table. Back to work, a commute home, then a few hours sitting in front of the TV before bed.

A new study published in the Journal of the American Heart Association has found that every hour per day spent sitting without physical activity increases a person's risk of dying from heart disease by almost one-fifth, regardless of how physically fit or unfit they are. "Even if someone has a healthy body weight, sitting for long periods of time still has an unhealthy influence on their blood sugar and blood fats," according to Professor David Dunstan, head of the Physical Activity laboratory at Australia’s Baker IDI Heart and Diabetes Institute.

The study measured the intensity of physical activity in 168 subjects over seven days. It found that regardless of how much moderate-to-vigorous exercise they did or their total sedentary time, those who took more breaks from sitting had lower waist circumferences, lower body mass indexes and lower levels of triglycerides and glucose in blood. Higher levels of triglycerides, or blood lipids, have been linked to a heightened risk of heart disease and stroke. High blood glucose levels are linked to the development of diabetes, which itself is a major risk factor for heart disease.

The studies found that the enzymes responsible for breaking down fat are suppressed when a person is sitting instead of standing.

"To hold a body that weighs [77 kilograms] upright takes a fair amount of energy from muscles," he said. "There is a large amount of energy associated with standing every day that can't easily be compensated for by 30 to 60 minutes in the gym."

His studies found that the enzymes responsible for breaking down fat are suppressed when a person is sitting instead of standing.

But the good news is that pottering about the house or gently walking around the office while on the phone might be enough to keep you fit: regardless of how much moderate-to-vigorous exercise they did or their total sedentary time, those who took more breaks from sitting had lower waist circumferences, lower body mass indexes and lower levels of triglycerides and glucose in blood. In fact, the sheer effort of standing up is enough to double the metabolic rate and the amount of calories burnt.

"If you stand up, you are much more likely to end up pacing or pottering around and that seems to make a crucial difference."