As we approach Mother’s Day, our gift to you is a primer on heart disease and women. According to the National Heart, Lung and Blood Institute (NHLBI), one in four U.S. women dies from heart disease.
Coronary heart disease, or atherosclerotic cardiovascular disease, occurs when plaque builds up in artery walls, narrowing them and making it harder for blood to flow through. If a blood clot forms, the blood flow can stop and cause a heart attack.
Signs and Symptoms
“Women tend to think of themselves as caregivers, but they also need to be care getters,” stresses Lili Barouch, M.D., a Johns Hopkins cardiologist on staff at HCGH. “Women should not ignore their symptoms, even if they don’t seem typical, because women with heart disease get a wider variety of symptoms than men. Although ‘classic’ heart disease symptoms include chest pain radiating down the left arm at rest or with exercise, women may only experience more atypical types of chest discomfort such as squeezing, burning or tightness, or even have no chest discomfort at all. Their ‘chest pain’ may feel like indigestion or acid reflux, nausea, cold sweats or they may only have shortness of breath. Women and men with diabetes often do not experience chest pain due to diabetic nerve damage; rather, they may just feel short of breath, nauseous and sweaty. If you aren’t sure, or if you sense something is wrong, see your doctor.”
“In general, women have the same risk factors as men, but they may affect women differently from men,” says Dr. Barouch. “There are several risk factors for heart disease—including those you can’t control and those you can.”
Age and menopause. Estrogen provides women with some protection before menopause, so women who are 55 and younger have a lower risk compared to men. However, the risk for heart disease increases in both men and women after 55.
Women who undergo early menopause (before age 46) are at an increased risk.
Family history. Your risk for heart disease increases if your father or a brother was diagnosed with heart disease before 55 or if your mother or a sister was diagnosed with heart disease before 65. A family history of stroke—especially a mother’s stroke history—also can help predict the heart attack risk in women.
Preeclampsia during pregnancy, which occurs when women have a rise in blood pressure and excess protein in the urine.
High cholesterol and triglyceride levels
High blood pressure
Birth control pills
Weighing In on What Matters Most
“It is more important to be fit than thin. Even if you don’t lose weight, exercise improves cardiac efficiency and lowers blood pressure, blood sugar and cholesterol,” says Dr. Barouch. “Start by exercising at least three days a week and see what you can do comfortably. Don’t push yourself to exhaustion, or you will not sustain it. Pick a moderate exercise that you enjoy; once it becomes a habit, increase your time until you get to the goal of 30 minutes or more of exercise each day.”
According to NBLHI, inactive people are nearly twice as likely to develop heart disease compared to those who are physically active. In addition, a lack of physical activity can worsen other heart disease risk factors.
“None of us are prepared for a family member or friend to have a stroke. We end up relying on the skills and experience of a whole team of people. It is phenomenal that HCGH has a designated stroke center just 10 minutes from our home. We got the best therapy from wonderful people who are a part of our community.” – Claire Cohen, Clarksville, Md.
The HCGH Stroke Program has demonstrated higher standards for care, thus increasing recovery for many stroke patients. The Maryland Institute for Emergency Medical Services Systems (MIEMSS) has designated HCGH as a primary stroke center for the State of Maryland, which means that our treatment of stroke patients is monitored and measured.
HCGH is ready to treat stroke, any time of night or day. A special protocol is initiated the moment Howard County Emergency Medical Services (EMS) calls the hospital with a potential stroke victim. While EMS transports the patient, the hospital team prepares. Within minutes of arrival at the hospital, a physician assesses the patient, blood is drawn for lab work and a CT scan of the brain is conducted.
Sobering National Stroke Statistics from the American Heart Association
Someone has a stroke every 45 seconds in the United States.
Only 20 to 25 percent of patients admitted to the hospital with a stroke arrive within three hours of the onset of symptoms, the “critical window” for treatment of certain strokes.
Less than five percent of patients in the United States receive thrombolytics, a critical treatment for some strokes.
Eric Aldrich, M.D., Ph.D., vice president of Medical Affairs and a neurologist who was instrumental in refining HCGH’s stroke program, believes that we must treat stroke according to the latest guidelines. A patient’s family can help ensure their loved one gets the best care. Dr. Aldrich explains, “I can’t emphasize enough the importance of calling 9-1-1 to get a head start on treatment. First responders begin treatment in the field and gather critical information about when the symptoms began.
“Our physicians can then diagnose and determine whether to administer thrombolytics, also known as tPA or clot-busting drugs. (Theses drugs are used in ischemic strokes, those caused by a blood clot, but not in hemorrhagic strokes, those caused by a bleed.) According to the National Stroke Association, carefully selected patients who receive these drugs within three hours from the onset of symptoms are 33 percent more likely to recover from their stroke with little or no disability after three months.” Dr. Aldrich adds, “Our focus is getting lifesaving, brain-saving care to patients within the critical three-hour window.”
(l. to r.) Susan Groman, RN, stroke program coordinator, laughs with Claire Cohen, Jose Maldanado and Jerry Cohen at a recent stroke support group.
Treatment at HCGH continues beyond diagnosis and acute care. According to Susan Groman, R.N. Stroke Program coordinator, HCGH encourages stroke patients to receive individualized rehabilitation services, including physical, occupational and speech therapy, for at least 24 months following a stroke. Stroke survivor, Jerry Cohen, began the program in 2010 and continues to benefit from what was learned from his therapists. “The team is excellent, they really know their business,” Jerry’s wife, Claire Cohen, says. “Best of all, physical, occupational and speech therapies are in one location, which makes scheduling back-to-back appointments easy. Transportation can be a huge issue, so convenience is key.” Today, Jerry is much improved. “The old myth was that after 18 months, there is little progress, but for everyone in this stroke group the progress continues,” says Claire. “We were told my husband would never be able to walk. He is walking. He came out of the hospital on a ventilator and a feeding tube. Now he can walk into a restaurant and enjoy normal food with family and friends.”
A monthly stroke support group is described by many patients and caregivers as an essential part of recovery. “The group is extremely helpful and is part of our routine,” Claire says. Group members are all ages and Claire notes that, like her, a number of caregivers are still working. Susan says; “Everyone is welcome, patients and caregivers alike.” Claire believes a diverse group is important. She says, “All strokes are different, they affect patients and families uniquely, but when you gather together in a supportive setting, there is much similarity. We discuss clinical trials, legal issues, home modification, transportation resources and how to find respite care. We share concerns and work together to find solutions.”
Education is also a part of the Stroke Program. Susan says, “We know that by teaching people the symptoms of stroke and the importance of calling 9-1-1 we can make a difference. Most of my patients wish they had called 9-1-1 sooner.”
Susan and her husband, cardiologist George Groman, M.D., have a commitment to stroke and emergency care in Howard County. Susan explains, “I’ve been an emergency nurse and a caregiver to aging parents and in-laws – so I know firsthand how valuable timely emergency treatment and rehabilitation are to a patient’s recovery and quality of life. Knowing this care exists can also give peace of mind to caregivers.”
Signs of Stroke Every minute counts, so act FAST when you see these signs:
Face – Droopy face on one side? Ask the person to smile.
Arms – Weak or numb arm? Ask them to raise their arms. Does one drift down?
Speech – Slurred speech? Ask them to repeat a simple sentence to see if they can.
Time – If the person shows any of these symptoms, call 9-1-1 immediately.
The HCGH Stroke Program recently received the American Heart Association (AHA) “Get With the Guidelines Stroke” Gold Quality Achievement Award. To learn more about our stroke support groups, call 410-740-7601 or visit www.hcgh.org/stroke.
Dr. Groman explains more about symptoms and treatment for stroke in these videos:
At age 37 in 1984, Jim Greco had his first heart attack. No longer able to perform his job as a Washington, D.C. firefighter, he retired in 1985 and moved to Columbia shortly thereafter. Today, at 66, thanks to cardiac rehabilitation and a heart transplant, he is one of the few surviving males in his family, one with a strong history of heart disease.
Helping Jim to rebound from a series of significant cardiac events throughout the last 28 years were several caregivers involved with the HCGH Cardiac Rehabilitation Program. “This program and these people are the reason I am here today,” Jim says.
The first such person is Anne Headrick, RN BSN, who started the cardiac rehabilitation program nearly 25 years ago with David Jackson, M.D., a local cardiologist. “In the early years, cardiac rehabilitation was a treadmill in a small office at the hospital,” remembers Jim.
Jim has endured a total of four heart attacks, quintuple bypass surgery, multiple implanted pacemakers and defibrillators, and an ejection fraction of only about 20 percent, meaning his heart could barely pump blood throughout his body. His heart was literally broken. After other treatments had been exhausted, cardiologist Steven Kaufman, M.D., ultimately referred him to Stuart Russell, M.D., a heart transplant specialist at the Johns Hopkins Comprehensive Transplant Center, who became involved in his care five years ago. Jim was placed on the waiting list for a new heart.
Jim waited almost three years – until finally, a heart that matched his needs became available. Although he never felt “that sick,” after the surgery, doctors remarked about how he had survived all those years with such a sick heart. “His heart was large, it looked much worse than our testing told us it was,” Dr. Russell says. Jim’s recovery and adjustment to life as a transplant recipient is ongoing and difficult at times, but he credits many people for saving his life.
Jim is grateful to his wife, Pam, to whom he proposed marriage the day before one of his heart attacks seventeen years ago. That day, the HCGH emergency room called her with the bad news and she has stayed by his side ever since. Jim says this kind of support was essential to his survival.
He also credits the clinical team in today’s Cardiac Rehabilitation Program, Preeti Benjamin and Suzie Jeffreys, among others. “I have been through cardiac rehabilitation four times and, as a result, I have healthy habits and was strong enough to be a transplant candidate,” says Jim.
The Cardiac Rehabilitation staff and classmates are his built-in support group, so he gives back by serving on a hospital committee and by participating with local organizations.
Jim, thankful to be alive, appreciates his family, the caring rehabilitation specialists, the gift of life from the person who donated his heart…and the miracles performed at Johns Hopkins.
See the full story on video
Learn More About Life-saving Organ Donation and Transplant
By jchatoff from venice beach, usa (berries Uploaded by hike395) [CC-BY-2.0], via Wikimedia Commons
A blackberry is a beautiful thing. In its own red-black, tiny, grape-like cluster, one blackberry delivers juice, crunch, and many health benefits. Like its fellow berries, straw, blue, ras and cran, to name a few, the blackberry is delicious and nutritious. While each type of berry is beautiful in its own way–the glorious color, lovely shape and unique taste–all berries provide us with antioxidants, vitamins, minerals, carbohydrates, electrolytes, dietary fiber, and even a small amount of protein.
Plants produce compounds called phytochemicals. Many phytochemicals are antioxidants. Anitoxidants are molecular substances that in some studies have been shown to protect cells from the negative effect of free radicals. Free radicals arise in the body as a byproduct of normal internal processes such as digestion or due to exposure to external toxins such as cigarette smoke and radiation. Free radicals’ effects on cells may contribute to the aging process and to the development of cancer. Berries are an excellent source of antioxidant phytochemicals.
Phytochemicals with antioxidant effects include vitamins A, C, and E. These vitamins have other beneficial properties as well. Our bodies use vitamin A to produce pigments for the photoreceptor cells for night vision. Vitamin C is utilized in collagen production. As a component of connective tissues, collagen is important for wound healing and maintenance of strong bones. Vitamin C is also used in chemical pathways that synthesize molecules critical to brain function and energy production. Vitamin E plays an important role in maintaining normal platelet and immune cell function.
Carotenoids, the red, yellow, and orange pigments in plants, are also a type of phytochemical with antioxidant and health-supportive properties. Studies have shown that carotenoids may help reduce the incidence of heart attack and cancer. Carotenoid molecules are found in the lens and retina of the eye, making this nutrient important to eye health. Carotenoids’ antioxidant properties may lend some protection against acute macular degeneration. Because of its unique molecular structure, carotenoids absorb light and may also have a vision-protective effect, including the possible prevention of acute macular degeneration (AMD). Carotenoids are converted to vitamin A as well, helping to assure the ability to see in low lighting conditions. Carotenoids give berries their orange and gold color.
Polyphenols are a type of phytochemical that include the flavonoid subgroup. In addition to its antioxidant effects, flavonoids interact with various enzyme systems in the body, resulting in anti-inflammatory, antiviral, and anti-allergic activity. Studies have shown that flavonoids may also be cardioprotective. One category of flavonoids, anthocyanins, has been linked to the prevention of memory loss. Anthocyanins give berries their blue, purple, and red color.
The Blackberry. The anthocyanins that give blackberries their rich color also lend this fruit its antioxidant capacity. In addition to their high-fiber content, blackberries also contain omega-3 fatty acids, which have been shown to help decrease cholesterol levels. Studies have been conducted on blackberry wine for its potential health benefits. Although data to date is inconclusive, studies on the health effect of the beautiful berries continue.
The Blueberry. High in vitamin C and anthocyanins, blueberries have a substantial amount of fiber as well. The fiber makes blueberries particularly filling and a good choice for those who are watching their calorie intake. Blueberries are also a good source of manganese, a mineral that helps optimize the conversion of carbohydrates and fat into energy. Blueberries contain the carotenoid lutein, which may help slow the progression of AMD.
The Cranberry. Traditionally, cranberry juice has been promoted as helpful in preventing urinary tract infections (UTIs). The thinking was that the berry juice acidified the urine, making it inhospitable to bacteria growth. More recent studies suggest that chemicals (possibly the anthocyanins) in the cranberries prevent bacteria from adhering to the walls of the urinary tract, thus preventing UTIs. Cranberries also contain salicylic acid, an ingredient in aspirin, and may help prevent blood clots. Proanthocyanidine, a flavonoid found in cranberries, has been found to prevent dental plaque formation.
The Raspberry. Usually a pink-red color, raspberries are also available in white, gold, purple, and black varieties. They are an excellent source of vitamin C and anthocyanins. Raspberries are also high in potassium, an electrolyte important to maintaining a healthy blood pressure.
The Strawberry. Strawberries are high in vitamin C, polyphenols, fiber, potassium, and manganese. Just 8 strawberries provide more vitamin C than an orange. It is commonly noted that strawberries are both heart-shaped and heart-protective. Because they are high in fiber, they may help lower cholesterol levels. Their antioxidant components may offer anti-inflammatory protection and decrease the risks for blood clots.
Please, enjoy the spring with a bowl of beautiful berries.
Cherise Tasker is an Instructor & Research Specialist at the Central Branch and has a background in health information. Most evenings, Cherise can be found reading a book, attending a book club meeting, or coordinating a book group.
Daylight Saving Time (DST) was yesterday. One hopes you remembered to reset any clocks that don’t rely on satellites, like your car, your watch, and your cellphone that’s so out of date it uses a rotary dial. If not, SURPRISE! You’re probably going to be late for work.
In addition to making you sleepy or awake at odd hours and confusing you by being sunny at 7pm, the time shift affects your health in a number of ways. Anyone’s sleep patterns can be disrupted by the switch, but “night owls” tend to be more affected by springing forward than early birds.
If your health is already compromised, the effect on your body is greater. If you’re stressed, depressed, have poor dietary or exercise habits, you are at a greater risk for and adverse reaction. The time changes can raise the levels of inflammatory chemicals and stress hormones, which can lead to serious side effects.
Because the start of DST can result in sleep deprivation for many, affecting heart health, there is a spike in heart attacks the first week after the time shift. The first week also sees a spike in car accidents due to sleepy drivers, but in general people are safer drivers during daylight hours, causing a drop in accidents during the rest of the period. U.S. News Health claims that DST can prevent hundreds of car accidents each year.
DST can keep you healthy by serving as a reminder to change the batteries in your smoke detectors. Have you done that yet? Because seriously, you should do that even if the smoke detector is hard to reach and it makes an annoying sound when you change batteries.
If you find you are not adapting to DST, you can always try these tips from Dr. Praveen Rudraraju, director of the Center for Sleep Medicine at Northern Westchester Hospital: get up five to 10 minutes earlier for the first two weeks of DST to accommodate any increased sluggishness; incorporate 30 to 40 minutes of exercise in bright daylight to your daily routine; space out your meals before you go to bed, at least 3-5 hours before hitting the hay; quit the caffeine before noon, limit drinking to one with dinner, and do not have any alcohol after dinner; don’t work on the computer at least an hour before bedtime; and stay out of the bedroom until bedtime. You can also try any of HCLS’s many resources on sleep, such as:
February is Heart Month – Howard County Resident Learns the Importance of Calling 911
Columbia, Md. – As he finished dinner on Oct. 2, Bob Kronberger was focused on preparing for an evening meeting…the last thing on his mind was a heart attack. “I got up from the table
and was sweating like crazy,” he explained. “I laid down and felt pain in my chest, but I was in total denial. I didn’t think it was any kind of emergency.” It was Bob’s wife, Barbara, who insisted they call 911. “I said ‘no way’ but she was adamant and thank God she did. I really credit her with saving my life. People like me will try to get out of calling 911, but someone has to take charge and make the call and she did it!”
When a heart attack happens, delay in treatment can be deadly. Learn the warning symptoms of a heart attack, and know the single most important thing you can do to save a life: call 911 immediately for emergency medical care. Bob Kronberger is thankful that his wife insisted on making that call.
When firefighters and paramedics arrived, the electrocardiogram (EKG) showed that Bob was in the middle of a specific type of heart attack, called a STEMI (ST segment elevation myocardial infarction). “The paramedic said, ‘we are taking you to the hospital you’re having a heart attack’,” said Bob. “Once I heard her say it out loud, everything felt real – that’s when I got scared.”
Because of the strong, cooperative relationship between Howard County Department of Fire and Rescue Services (HCDFRS) and the Howard County General Hospital Emergency Department, the EMTs were able to activate the hospital’s Heart Attack Team of physicians, nurses and technologists, so that the cardiac catheterization suite was prepared for his arrival.
“When I got to the emergency room, I felt like a rock star with all of these people gathered around me,” said Bob. He was whisked off to the cardiac catheterization laboratory, where interventional cardiologist Feroz Padder, M.D., was able to remove the blood clot that was creating a 100 percent blockage in Bob’s right coronary artery and place a stent to keep the artery open.
“From the 911 call takers, to the staff at the hospital to our paramedics – it’s really because of great partnerships like these that we can bring about the best patient outcome,” said Kevin Seaman, M.D., HCDFRS Medical Director. “It’s also important to emphasize the importance of learning CPR because bystanders can make all the difference in helping save someone’s life.”
In the months since his heart attack, Bob has been participating in HCGH’s Cardiac Rehabilitation program. With the help of supervised exercise sessions and educational presentations about healthy eating and lifestyle, Bob says he has a whole different attitude on life. He has lost 30 pounds and is making healthier food choices.
“My whole experience has been great,” says Bob.
HCGH’s Cardiac Catheterization Program is co-chaired by Peter Johnston, M.D., from The Johns Hopkins Hospital, and George Groman, M.D., from HCGH.
Additional Helpful Information
Heart Attack Symptoms
Chest pain or pressure, tightness, squeezing, burning, aching, or heaviness in the chest