anemia and your heart

[© Skypixel | Dreamstime.com] Some common anemia symptoms include lack of color in the skin, increased heart rate, fatigue, headaches, and irregular or delayed menstruation. When anemia is left untreated or is severe, it can affect your whole body—especially your heart.

Many people suffer from anemia but do not realize how it can affect your heart’s function. Anemia can cause your heart to work harder to pump blood and result in a rapid or irregular heartbeat.

What is Anemia?
Anemia is a common blood disorder that occurs when there are fewer red blood cells than normal, or there is a low concentration of hemoglobin in the blood. “Anemia stems from a variety of conditions,” says Karl Kasamon, M.D., a hematologist on staff at Howard County General Hospital, “but the most common cause is iron deficiency.” Common symptoms include lack of color in the skin, eyes and lips, increased heart rate, fatigue, breathlessness, irritability, headaches, irregular or delayed menstruation and jaundice.

“Those at the highest risk for anemia are menstruating females and generally elderly patients who have gastrointestinal related blood loss or bleeding,” says Dr. Kasamon. When anemia is left untreated or is severe, it can affect your whole body—especially your heart.

“The connection between anemia and heart complications is clear,” says Dr. Kasamon. “Red blood cells carry oxygen from lungs to tissues. When your red blood cells are low (you are anemic), your heart has to pump and carry blood cells much faster to deliver the same amount of oxygen. This strains the heart to contract faster and more intensely than normal.”

If you already have a heart condition, the condition can worsen if you develop anemia. Other factors, such as demographics, can determine the risk of anemia linking to heart conditions. “For example, 20 year olds with severe anemia rarely have dangerous complications, whereas older adults are at a much higher risk even if they are just mildly anemic,” says Dr. Kasamon.

Getting Treatment
Anemia is a reversible disorder. To optimize heart health, seek treatment for anemia to correct the red-blood-cell level back to normal, which will take strain off and positively affect your heart. Treatment varies depending on the cause of anemia and can include iron supplements, changes in diet, vitamins, prescription medication, blood transfusions or bone marrow transplant.

Dr. Kasamon also encourages those with anemia symptoms to be screened by a physician. “Patients often assume their anemia is caused by iron deficiency and self-medicate with iron. In some cases, this can cause iron overload and ironically lead to a variety of complications, including heart failure.”

Karl Kasamon, M.D., is a hematologist with Chesapeake Oncology-Hematology Associates in Columbia.

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congestive heart failure (CHF)

[Credit: Nastco]/[iStock]/Thinkstock] Common CHF may be due to a weak heart muscle, leaking or narrowed valves, untreated high blood pressure, cardiac arrhythmias and, less often, diseases of the sac around the heart. Our Dr. George Groman offers advice for managing CHF.

The human body is a sponge, and for those with congestive heart failure (CHF), keeping their heart from being overwhelmed by too much fluid accumulating in their body can be an ongoing challenge.

According to George Groman, M.D., a cardiologist on staff at Howard County General Hospital, common causes of CHF can include a weak heart muscle damaged by a heart attack; leaking or narrowed valves; untreated high blood pressure; some cardiac arrhythmias; and, less often, diseases of the sac around the heart. These conditions can make the heart too weak to pump blood adequately. Another cause of CHF is diastolic dysfunction—when the heart is stiff and can’t sufficiently relax to fill with blood. This dysfunction becomes increasingly common with age and uncontrolled blood pressure as well as other causes.

Preventing Fluid Complications
If you have CHF, to reduce fluid buildup, Dr. Groman recommends you should:

  • Limit salt intake. Use pepper or herbs and spices instead. Check with your doctor before using a salt substitute, which could cause a dangerous elevation of potassium.
  • Be evaluated for sleep apnea if you snore.
  • Use alcohol prudently—it can weaken the heart in some cases.
  • Not use illicit drugs.
  • Not smoke.
  • Eat heart healthy—minimize saturated fat, trans fat and sugar.
  • Maintain a healthy weight, and monitor your weight daily. If you see a progressive increase of three or more pounds in a week, call your cardiologist, who may adjust your diuretic dose.
  • Exercise.
  • Take medications prescribed by your cardiologist.

Treating Fluid Buildup: New Hospital Service
“There can come a time when your small intestine becomes so waterlogged that your medications cannot be adequately absorbed,” says Dr. Groman. “This can result in further fluid buildup and may put you at risk for needing hospitalization and other types of intensive care.” To help patients avoid having to stay in the hospital, HCGH has begun an outpatient IV diuresis service to which your cardiologist can refer you. Appointments are offered weekdays in the hospital’s Infusion Center and last several hours to allow your nurse to record urinary output in response to the diuretic.

During treatment, nurses will speak with you about your diet and medications. All patients will receive a referral for a home care evaluation and remote, nursing-based patient monitoring. Lab work will be done (primarily to evaluate kidney function) and reviewed prior to you returning home.

“This collaborative effort between the patient’s physician, clinic nurses and home health has the potential to keep patients out of the hospital—and that is a very good thing,” notes Dr. Groman.

George Groman, M.D., is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

 


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cardiovascular exerciseI was an overweight and inactive kid and never an athlete during my school years. About 15 years ago, my weight was increasing and my cholesterol was high, so I began going to the gym. I found I liked spin classes, but I wanted to get out of the hot spin studio. My cardiology practice partner at the time, Dr. Jack McWatters, was an avid cyclist and lent me a bike so I could try cycling outdoors. That was the start of my addiction to cycling, which eventually led me to participate in many long-distance bike rides both locally and in such far-flung destinations as California and the French Alps.

Around the same time, a neighbor of mine, who was a ‘couch potato’ and a cigar smoker, announced he was going to do a triathlon and I thought, “Why can’t I do that?”

So, in 2005, I found a triathlon training group. I started competing in local events, like the Columbia Triathlon held in Howard County every May. Triathletes are so exuberant, excited and inclusive—they suck you into their world and you want to be part of the next challenge.

In 2011, a cycling buddy encouraged me to compete in my first IRONMAN in Florida, and it went exceptionally well. In 2014, I completed IRONMAN Lake Placid, which was scenic and beautiful. Afterward, my coach encouraged me to race in another IRONMAN in Lake Tahoe to keep momentum and training. As it happened, an arsonist set a forest fire in the area around Lake Tahoe that week and, just as we were warming up for the swim, the organizers cancelled the event. In every IRONMAN competition, spots are given to winners for the world championship. Because no winners came from that event, those spots were chosen from a lottery, and I was selected for one of those coveted spots as IRONMAN World Championship.

An international race, the IRONMAN World Championship in Kona, Hawaii, features the best professional triathletes and best athletes from every age group. For this event, 2,300 athletes started the race and 2,144 finished on a 97-degree day with 100 percent humidity and 20 mph headwinds during much of the bicycle portion. During the race, I burned 10,500 calories!

I train between eight and 17 hours a week, depending on the season. I swim, bike and run, but adding strength training has kept me injury-free for the past three years. I limit processed carbohydrates. I don’t eat out of a box, I eat foods in their least processed form. I eat a variety of fruits and vegetables, lean protein, grains, nuts, dark chocolate and I drink almond milk.

Why do I do this? I like a challenge, I like how it feels and I want to set an example for my patients. I know the profound effect that exercise and diet have on your heart. My lipids were terrible before I started exercising regularly, and now they are off the charts good! My HDL/good cholesterol was under 30, now it’s 86; my LDL/bad cholesterol was 150-160, now it’s 79; my triglycerides were 250, now they are 38.

High, intense and regular levels of exercise cause a release of endorphins—cycling is my legal addiction.  If I can’t exercise because it’s snowing or I am too busy, you can tell by my lousy mood.

I tell my patients who don’t exercise that anything is possible—if I can do this, you can do this. You’ve got to start somewhere and build exercise into your routine. You don’t have to be like me, because I’m nuts! But you must build muscle mass and participate in aerobic exercise.

After running, biking and swimming the IRONMAN, I feel an overwhelming elation that I can’t even describe. Coming across the finish line makes me feel like there’s nothing I can’t do.

You don’t have to be like me and do extreme exercise, but you should exercise regularly. The American Heart Association recommends at least 150 minutes of moderate exercise (or 75 minutes of vigorous exercise) every week for adults. This translates into 30 minutes a day, five times a week—but ANY amount of exercise is better than none!

In September 2014, Michael Silverman, M.D., started a year of intense training in preparation for the IRONMAN World Championship. The training included biking 3,915 miles, swimming 414,240 yards, running 898 miles and completing 98 hours of strength training. A cardiologist with Cardiovascular Associates of Central Maryland, Dr. Silverman could be seen on the roads of Howard County starting his day running or biking at 5:30 a.m.

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jimmy brothers heart attack story

Jimmy Brothers, Battalion Chief in EMS Operations for the Howard County Department of Fire and Rescue Services

I don’t smoke. I am not overweight. I exercise regularly and eat pretty healthy. But on April 26, 2015 at the age of 46, my heart stopped.

 

See Jimmy Brothers’ Story

It was a Sunday, and I woke up feeling like I was getting a cold. Not sure I can describe it exactly—I just didn’t feel well. I took some cold medicine and headed out with my family to coach my daughter’s lacrosse game.

On the way home from the game, the elephant arrived and was sitting on my chest. The pain was crushing and shooting down my arm. I was sweating and nauseated. As the Battalion Chief in EMS Operations for the Howard County Department of Fire and Rescue Services (HCDFRS), I knew the symptoms. I was having a heart attack.

My wife was driving, and I realized we were so close to the Elkridge Fire Station. I told her to call to see if the ambulance was there, which, thank goodness, it was. The ambulance crew was waiting outside when we pulled up to the station. I took two steps out of the car and collapsed onto the gurney as they attached a 12-lead EKG to get a reading of my heart. As they hit ‘send’ on the unit to transmit my EKG to Howard County General Hospital, my heart stopped.

I don’t remember going unconscious. The paramedics, one who I had trained, did high performance CPR and shocked my heart back into rhythm.

When my wife Becky arrived at the HCGH Emergency Department, I was already headed to the cardiac catheterization lab where they were waiting for me. The cardiac catheterization showed a 100 percent blockage in the left anterior descending (LAD) artery—a condition sometimes referred to as ‘the widow maker.’ I was given a clot-dissolving medication and a stent was inserted to hold the artery open.

The irony of my story is that, in my role with HCDFRS, I had worked with HCGH to bring much of the cardiac technology and protocols to the county—a system that nearly 10 years later saved my life.

As a part of this unique partnership, paramedics are provided with advanced cardiac training at the HCDFRS Education & Training Section by HCGH cardiologists. In addition, HCDFRS ambulances are equipped with technology that can wirelessly transmit EKG data to HCGH cardiologists and emergency physicians in real time. In the event of a diagnosed heart attack, like I had, the hospital can assemble the cardiac catheterization team before the patient arrives—saving valuable time and, in turn, heart muscle. The gold standard of time to open an artery (often referred to as door-to-balloon time) is no more than 90 minutes from the time the patient enters the hospital’s door. My time was only 38 minutes because I recognized the signs and got help quickly.

The earlier that lifesaving care can be started, the less time the heart muscle is deprived of blood and oxygen which causes the heart to work harder, possibly leading to dangerous cardiac rhythms as was the case with me. This is often followed by cardiac arrest.

Once the heart stops beating, there is only a matter of minutes to get it started again.

Fortunately, my heart attack didn’t leave Becky a widow, but I do have some heart damage. I attended HCGH cardiac rehabilitation for several months and am feeling good.

I encourage everyone to learn CPR so that, if a loved one has a heart attack, you know what to do. If you know CPR, download this free app and follow HCDFRS so you can be notified if someone near your location in Howard County is having a cardiac emergency. The app also will alert you of Automated External Defibrillators (AEDs) close by.

Most important, call 911 if you think you or a loved one is having a heart attack so you can receive emergency cardiac care quickly. Do not wait, and do not drive to the hospital.

James Brothers is the Battalion Chief in EMS Operations for Howard County Department of Fire and Rescue Services (HCDFRS).

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Like ham and eggs or sunshine and summer, with winter comes snow and shoveling the white stuff. Snow shoveling can be a good source of aerobic exercise, but it doesn’t come without risks. Improper shoveling can cause injuries to your back and shoulders. And the American Heart Association says the risk of heart attack can increase while shoveling since cold temperatures and physical labor make the heart work harder. This may be partially due to the sudden demands that snow shoveling puts on the heart, especially for those who live a fairly sedentary lifestyle.

Take note: if you are at risk for heart attack, you need to take special precautions. The National Safety Council and the National Institutes of Health recommend the following tips for safe snow shoveling:

 

  • snow shoveling tips
    [Credit: pavelgr/Thinkstock] Protect your heart if at risk for a heart attack: you recently had one and/or coronary stents, heart disease history, high blood pressure or cholesterol, smoker, sedentary lifestyle. Get your doctor’s permission beforehand. Take frequent breaks and pace yourself.
  • snow shoveling tips
    [© Robeo | Dreamstime.com] Call 911 if you have: chest tightness or pain, pain in your jaw or pain radiating down your arm. Experts recommend calling an ambulance versus driving to the hospital. Specially-trained emergency teams can assess your condition, stabilize you and activate a treatment team.
  • snow shoveling tips
    [© Dolgachov | Dreamstime.com] Avoid injury while shoveling. Don’t lift too much snow, use a smaller shovel or partially fill a larger one. Bend from the knees with a straight back and sit into the motion; avoid twisting movements. Listen to your body and stop if you feel pain.
  • snow shoveling tips
    [© Eurobanks | Dreamstime.com] Shovel snow when it’s fresh. It’s easier to move than when it’s wet and packed. Push the snow rather than always lifting.
  • snow shoveling tips
    [© Maszas| Dreamstime.com] Ears, nose, hands and feet need extra protection and are at risk for frostbite after as little as 10 minutes in sub-freezing temperatures. Dress in layers that can be removed as needed. Protect your face, since cold air makes working and breathing harder and adds strain on your body.
  • snow shoveling tips
    [© Ocusfocus| Dreamstime.com] Drink plenty of water. Dehydration is as serious in the winter as in the summer. Also, avoid eating before you shovel.
  • snow shoveling tips
    [© Scukrov | Dreamstime.com] Avoid caffeine and nicotine as they are stimulants that can increase your heart rate and cause your blood vessels to constrict, putting extra stress on the heart. Too much caffeine, alcohol or sugary drinks can all cause dehydration.
  • snow shoveling tips
    [© Pojoslaw| Dreamstime.com] Warm up before you start by marching in place or walking for a few minutes. Stretch your arm and leg muscles after you’ve warmed up. Warm muscles are less likely to be injured.

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pain relievers

Acetaminophen or aspirin are safer alternatives to manage pain than relying on ones like ibuprofen and naproxen, which can increase the risk of heart attack or stroke. [© Monkey Business Images | Dreamstime.com]

The U.S. Food and Drug Administration (FDA) recently announced it is “strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs)­—including ibuprofen, naproxen, diclofenac, and celecoxib as well as others—increase the chance of heart attack or stroke. The risk of heart attack and stroke with NSAIDs, both of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of prescription drug labels.”

We knew that long-term use of NSAIDs increased the risk of heart disease and stroke, but this new study discovered that short-term use could also pose a significant threat. This warning is especially important for high-risk groups that include males over age 50, females over age 60 and those who have high-risk factors of developing coronary artery disease such as diabetes, high blood pressure, high cholesterol, smoking or obesity.

For my patients with diagnosed coronary artery disease, a stent, history of a heart attack or bypass surgery who are suffering from a headache, arthritis or backache, I recommend that they take NSAIDs for no more than a few days. If you are a high-risk cardiac patient, but have not had a cardiac event, you can take NSAIDs for a few weeks but no longer.

If you want to avoid the risks associated with NSAIDs, Tylenol (acetaminophen) or aspirin are safer alternatives to manage pain. If you have concerns, you should call your doctor to discuss your risk of taking NSAIDs versus the benefit they may have in treating your pain.

If you are taking NSAIDs and experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of your body or slurred speech, call 911.

 


According to the FDA, new prescription NSAID labels will be revised to reflect the following information:

  • The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID.
  • The risk may increase with longer use of the NSAID. The risk appears greater at higher doses.
  • It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
  • NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
  • In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
  • Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
  • There is an increased risk of heart failure with NSAID use.
Keith Freidman, M.D., is a cardiologist with Cardiovascular Specialists of Central Maryland in Columbia.

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