Cardiovascular Health

Cardiovascular = Cardio means the heart, Vascular means the blood vessels

Your heart is a muscle that pumps blood to all parts of the body. Blood vessels are the tubes that transport blood throughout the body. The blood provides your body with the oxygen and nourishment it needs to function.

Cardiovascular disease

Cardiovascular disease (CVD) comprises all diseases of the heart and blood vessels, and includes:

• heart attack;
• angina;
• stroke; and
• peripheral vascular disease.

Cardiovascular diseases are mainly caused by a damaged blood supply to the heart, brain and legs, and share a number of risk factors. The main underlying problem is artherosclerosis, a process that clogs blood supply vessels with deposits of fat, cholesterol and other substances.

Cardiovascular disease is the leading cause of death in Australia claiming the lives of more than one in three Australians.

What causes cardiovascular disease?

The main cause of CVD is a build up of deposits containing cholesterol in the inner lining of the heart’s arteries. This can clog the arteries and reduce blood flow to the heart muscle – known as atherosclerosis. Blood flow becomes more and more restricted as the artery continues to narrow.

Atherosclerosis is especially common in people who have a family history of the disease, and/or who smoke, have high blood pressure, are overweight, are diabetic, or have higher than normal levels of cholesterol in their blood.  It is more common in men over the age of 45 and is equally common in both sexes over the age of about 70.

Many Australians have high blood cholesterol levels due to a diet high in fat – making this ‘clogging process’ fairly common.

Clogging can start in childhood and by middle age it is often well advanced. Generally, the first sign of this occurring is when a heart attack or other problem strikes.

Atherosclerosis is most serious when it affects the blood supply to the heart causing heart attack or angina, or to the brain, which can lead to a stroke.

Heart attack

A heart attack occurs when a narrowed coronary artery is suddenly completely blocked by a blood clot. Blood supplied to the heart by this artery is cut off and the affected part of the heart muscle starts to die. This usually causes severe and continuing chest pain or discomfort, but also may present as increased shortness of breath, confusion or deterioration in function with no, or minimal pain.

Suspected heart attacks must be handled as a life-threatening medical emergency to be treated in a hospital.

Heart attacks are also called myocardial infarction or coronary thrombosis.

The warning signs:

• squeezing, discomfort or pain in the centre of the chest or behind the breastbone lasting more than 10-15 minutes – may be severe, moderate or even mild; and
• pain may spread to the neck and throat, jaw, shoulders, back, either or both arms and into the wrist and hands.

These may be accompanied by:

• sweating, shortness of breath, dizziness or light headedness;
• a chocking sensation in the throat; the arms may feel heavy or useless;
• a sick feeling in the stomach and vomiting; and/or
• palpitations (abnormal heart rhythms felt in the chest).

Sudden pain or discomfort in the chest can be frightening – not just for the person experiencing it, but for family, friends or workmates who are present as well. It is natural for all involved to ‘hope’ it is something else – like indigestion, or a pulled chest muscle – and delay taking action.

It is important to call for an ambulance if a person is experiencing any of these symptoms.

Suspected heart attack?

• Act now - ask questions later
• Get to a hospital fast

Delay can be fatal

Dial 000

• Ask for the ambulance service.
• Report a possible heart attack.

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Angina

Angina is a pain or feeling of discomfort in the chest - it is not a heart attack. It occurs when the heart muscle has to function without enough oxygen, and is usually felt in the centre of the chest.

However as with a heart attack, angina is caused mainly by narrowed coronary (heart) arteries, but the inadequate blood supply is temporary and no heart damage occurs. Unlike a heart attack, a blood clot does not form.

When a patient with narrowed arteries (atherosclerosis) runs, or walks quickly uphill or up stairs, or gets very angry or very excited, the heart works harder and needs more oxygen.  However, the narrowed coronary arteries may not be able to deliver the blood flow required to supply this oxygen. The heart becomes short of oxygen and pain occurs. This pain is similar to the pain of a heart attack, but generally goes away when the person stops doing whatever caused the pain.

Special tablets or sprays are often needed, but mostly the heart pain settles as soon as the exertion stops.

People can have angina for years without having a heart attack but if angina becomes more frequent or occurs with less exertion see your doctor immediately as further treatment is needed urgently.

If you have angina you should see your doctor or go to hospital straight away if:

• you believe it is the first time you are suffering the condition;
• you are on medication for angina, but it is getting more severe or  frequent than normal;
• the chest pain doesn’t go away with normal angina medications;
• the chest pain comes on during resting; and
• the angina doesn’t get better with rest. In this case it may be progressing to a heart attack.

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Stroke

What is a stroke?

A stroke occurs when a blood vessel supplying the brain becomes blocked or bursts. As a result, brain cells may be damaged.

Different areas of the brain control functions of the body such as movement, speech, hearing and sight. Damage to these areas will affect the functions they control.
Paralysis of parts of the body, or speech problems are common after a stroke, but many people make a good recovery because other areas of the brain take over.

How a stroke occurs

The most common type of stroke occurs because of a build up of deposits containing cholesterol on the linings of the arteries supplying the brain. This can clog the arteries and reduce blood flow. A clot may form at the point where the artery to the brain has been narrowed.

A smaller sub-group of strokes occur when small vessels within the brain burst, causing an area of bleeding (haemorrhage).

TIA – a vital warning sign

Mini-strokes or a transient ischaemic attack (TIA) have the same symptoms as a stroke but are temporary and do not damage the brain long term.  TIAs are caused by the clot causing a temporary cut in the blood supply to the brain.

TIAs must not be ignored because they are an important warning sign that a stroke may occur in the future.

What are my chances of having a stroke?

The risks are great if you:

• have high blood pressure;
• smoke;
• drink heavily, or ‘binge’ drink;
• are elderly;
• have heart disease or diabetes; or
• have had a stroke or TIA previously

STROKE ALERT

A stroke is a life-threatening emergency.
If you or someone you are with suddenly have any of the following symptoms, get straight to the hospital:

• a numb or weak feeling in the face, arm or leg;
• trouble speaking or understanding;
• unexplained dizziness;
• blurred or poor vision; or
• loss of balance, confusion.

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Peripheral vascular disease

What is peripheral vascular disease?

Peripheral vascular disease means narrowing of the inside (lumen) of the arteries in the legs, causing a reduction in blood flow. It is more common and more severe in people with diabetes, but can occur in individuals without diabetes.  Smoking can make peripheral vascular disease much worse.

In diabetic peripheral vascular disease it is a blockage of the larger arteries in the thigh and leg that cause many problems. This can affect both legs, but is generally more severe on one side.

What problems are caused by peripheral vascular disease?

In mild cases, peripheral vascular disease can show no symptoms. However, as blood supply is progressively blocked, it can cause claudication, rest pain, vascular ulceration and gangrene.

• Claudication – the development of pain in the calf after walking for a distance, up an incline or up stairs. The distance you can walk before such pain occurs is referred to as ‘claudication distance’.  

The leg and foot look and feel normal as long as you are resting. As the claudication distance becomes shorter and shorter (i.e. the onset of pain is quicker), physical activities become more and more restricted.

Giving up smoking is very important to stop claudication from worsening. Regular exercise by walking through the pain threshold can sometimes increase the claudication distance.

• Rest pain – pain in the foot even when not walking. This is distressing and difficult to get relief from. Quitting smoking can stop peripheral vascular disease reaching this stage.

This is a more severe stage of peripheral vascular disease than claudication. The affected foot looks purplish in colour and feels cold to touch.

• Vascular ulceration – when wounds of someone with severe vascular disease heal poorly because of inadequate blood supply. Therefore minor trauma or pressure often leads to ulceration - called a vascular ulcer. The ulcer tends to be situated on the edge of the foot or toes because blood supply is the poorest at these sites. Vascular ulcers are usually painful.

You are at risk for vascular ulceration if:

• you have had a foot ulcer before;
• your doctor has diagnosed poor circulation in the feet ;
• you have misshaped feet e.g. clawed toes or bunions;
• you have claudication or rest pain; or
• you do not follow advice to protect your feet with good footwear and hygiene.

• Gangrene – the gradual destruction of living tissue, due to an obstruction in the supply of blood and oxygen to this area of the body. Gangrene generally affects the extremities of the hands and feet.

In the initial stages of gangrene, the affected area is extremely painful to touch. This area then becomes dry and wrinkled, with distinct colour changes occurring. The skin becomes dark brown at first and as the tissue continues to die, turns a dark purplish-blue and then completely black.

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How to have a healthy heart

Your heart needs care for life. As well as taking positive steps to reduce your risk factors, having a healthy heart means living and enjoying a healthy lifestyle and making this part of your everyday life.

By following the information outlined in this section, you can reduce your risk of developing cardiovascular disease. If you already have cardiovascular disease – then all the more reason to follow a healthy lifestyle and slow the artery blocking process. Actions you take now can still make a difference.

Preventing cardiovascular disease

Step 1: Be a non-smoker

There is no ‘safe’ level of smoking. Every cigarette is doing you damage.

Within seconds of lighting up, thousands of chemicals enter your bloodstream. Some of them damage the lining of your arteries making your artery walls sticky and causing them to collect tiny fat particles floating in the bloodstream.

It is never too late to benefit from giving up smoking!
Your risk for heart disease drops quickly after you quit.  

Step 2: Eat a diet low in saturated fats

A diet low in saturated fats (found in meat, full-cream dairy products like butter, cream and cheese) helps to keep your blood cholesterol and weight down. If you are overweight, losing a few kilos can also improve your blood pressure and blood cholesterol levels.

Cholesterol is a fatty substance made mainly by the liver but also coming from the foods we eat. Our bodies need it in small amounts, but too much in the blood causes the arteries to block – which leads to cardiovascular disease.  Generally, the lower your blood cholesterol, the lower your risk for cardiovascular disease.

Step 3: Keep a check on your blood pressure and make sure it is controlled

Q:      What is blood pressure?

A:        Blood pressure is the pressure of the blood in the arteries as the heart pumps it around the body.

Q:      How is blood pressure measured?

A:        Blood pressure is recorded as two numbers, e.g. 120/80. The first number indicates the pressure in your arteries as your heart squeezes out blood during each beat. It is called the ‘systolic blood pressure’. The second number indicates the pressure as your heart relaxes before the next beat. It is best to measure blood pressure when you are relaxed and sitting or lying down.

Q:      What is high blood pressure?

A:         Normal: Less than 130/85
            Borderline: Between 140/95 and 160/95
            High: Greater than 160/95

NOTE: Because high blood pressure usually has NO symptoms until it has already caused serious disease have your doctor check your blood pressure regularly. 

Why does having high blood pressure matter?

High blood pressure means the pressure of  the blood in your arteries is too high. This puts a strain on your heart because it has to work harder to pump blood around your body. If blood pressure remains high it increases your risk of developing serious problems like heart attack, stroke, heart failure or kidney disease. 

If you have high blood pressure, your doctor will suggest you:

• lose any extra weight;
• cut your alcohol consumption to two drinks a day or less;
• start regular exercise; and
• eat less salt.

Your doctor may also prescribe tablets to control your blood pressure. It is very important to:

• take them regularly;
• be aware that certain blood pressure tablets may interact negatively with other prescription and over the counter drugs;
• watch for side effects such as dizziness, especially when standing up. This may be worse during hot weather or if you do not drink enough fluids; and
• talk to your doctor if you have any worries about your blood pressure tablets.

As for any medication, be sure you are aware of:
• what you are taking; • why you are taking it;
• common side effects; and
• interactions with other prescription and non-prescription medications, food and alcohol. 

Your doctor may suggest further tests to find out how seriously your arteries are affected and may also refer you to a heart specialist (cardiologist).

You may need:

• an electrocardiogram (ECG);
• an exercise stress test;
• nuclear medicine tests; or
• a coronary angiography.

Step 4: Exercise regularly

The more active you are the better for your heart health generally. But you don’t have to puff and sweat to benefit. Regular moderate physical activity, such as walking, brings the same benefits.

By exercising regularly and moderately, you will:

• feel more confident, happy and relaxed;
• control your weight better;
• have a healthier blood cholesterol level;
• have lower blood pressure; and
• have stronger bones (less chance of osteoporosis).

Try to enjoy 30 minutes of moderate physical activity (such as walking) on most days of the week.

You can accumulate your 30 minutes by taking 10 minutes three times each day.

It is the amount of energy you use when exercising that counts most – not how you use it up or how quickly.

Some tips for making exercise more enjoyable:

• Do activities you enjoy. Walking, gardening, cycling or swimming are all good forms of exercise.
• Try to make exercise part of your day.
• Start at a low level and build up slowly over time.
• Don’t overdo it.
• Choose suitable clothing and footwear.
• Exercise with a friend (human or animal).

Do NOT exercise:

• if the weather is very hot, humid or cold;
• straight after meals or alcohol; or
• if you don’t feel well.

See your doctor first if:

you’re a man over the age of 35 or a woman over 45 and:

• you smoke;
• have high blood pressure;
• have high cholesterol;
• are very overweight;
• exercise causes pain in your chest;
• moderate exercise makes you very breathless; or
• you think you have heart disease

OR

• you have been inactive and want to begin vigorous exercise.

Step 5: Know your family history

If you have a family history of cardiovascular disease, discuss this with your doctor.