Holy Cross Cardiovascular Blog

Exercise and Physical Activity for Older Adults: Part 5

  • Posted Jul 27, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

OK, in Part 5, you will get examples of exercises you can try. To get all of the benefits of physical activity, try all four types of exercise -- endurance, strength, balance, and flexibility.

Exercises to Try - Endurance Exercises
Endurance exercises are activities that increase your heart rate and breathing for an extended period of time. Examples are walking, jogging, swimming, raking, sweeping, dancing and playing tennis. Build up your endurance gradually, starting with as little as 5 minutes of endurance activities at a time, if you need to. Then try to build up to at least 30 minutes of moderate-intensity endurance activity on most or all days of the week. Doing less than 10 minutes at a time won't give you the desired heart and lung benefits.

Safety tips:
•    Do a little light activity, such as easy walking, before and after your endurance activities to warm up and cool down.
•    Drink liquids when doing any activity that makes you sweat.
•    Dress appropriately for the heat and cold. Dress in layers if you're outdoors so you can add or remove clothes as needed.
•    When you're out walking, watch out for low-hanging branches and uneven sidewalks.
•    Walk during the day or in well-lit areas at night and be aware of your surroundings.
•    To prevent injuries, use safety equipment such as helmets for biking.
•    Endurance activities should not make you breathe so hard that you can't talk and should not cause dizziness or chest pain.

Here are some examples of moderate endurance activities for the average older adult. Older adults who have been inactive for a long time will need to work up to these activities gradually.
•    walking briskly on a level surface
•    swimming
•    dancing
•    gardening, mowing, raking
•    cycling on a stationary bicycle
•    bicycling
•    playing tennis

These are examples of activities that are vigorous. People who have been inactive for a long time or who have certain health risks should not start out with these activities.
•    playing basketball
•    jogging
•    climbing stairs or hills
•    shoveling snow
•    brisk bicycling up hills
•    digging holes

Gradually working your way up is especially important if you have been inactive for a long time. It may take months to go from a very long-standing sedentary lifestyle to doing some of the activities suggested in this section.

When you're ready to do more, build up the amount of time you spend doing endurance activities first, then build up the difficulty of your activities. For example, gradually increase your time to 30 minutes over several days to weeks (or even months, depending on your condition) by walking longer distances. Then walk more briskly or up steeper hills.

Exercises to Try - Strength Exercises
Strength exercises build muscle, and even very small changes in muscle strength can make a real difference in your ability to perform everyday activities like carrying groceries, lifting a grandchild or getting up from a chair. The 10 muscle strengthening exercises include:
1.    wrist curls
2.    arm curls
3.    side arm raises
4.    elbow extensions
5.    chair dips
6.    seated rows with resistance band
7.    back leg raises
8.    knee curls
9.    leg straightening exercises
10.  toe stands

To do most of these strength exercises, you need to lift or push weights. You can use weights, resistance bands or common objects from your home. Or, you can use the strength-training equipment at a fitness center or gym. Start with light weights and gradually increase the amount of weight you use. Starting out with weights that are too heavy can cause injury. If you can't lift or push a weight 8 times in a row, it's too heavy for you, and you should reduce the amount of weight.

How Much, How Often?
Try to do strength exercises for all of your major muscle groups on 2 or more days per week for 30 minutes at a time, but don't exercise the same muscle group on any 2 days in a row. When using weights, take 3 seconds to lift or push a weight into place, hold the position for 1 second and take another 3 seconds to return to your starting position. Don't let the weight drop; returning it slowly is very important.

Muscle strength is progressive over time. Gradually increase the amount of weight you use to build strength. When you can do 2 sets of 10 to 15 repetitions easily, increase the amount of weight at your next session.

Safety tips:
•    Don't hold your breath during strength exercises. This could affect your blood pressure, especially if you have heart disease.
•    Use smooth, steady movements to bring weights into position. Avoid jerking or thrusting movements.
•    Breathe out as you lift or push a weight and breathe in as you relax.
•    Avoid locking the joints of your arms and legs into a strained position. To straighten your knee, tighten your thigh muscles. This will lift your kneecaps and protect them.
•    For exercises that require a chair, choose one that is sturdy and stable enough to support your weight when seated or when holding on during the exercise.

Exercises to Try - Balance Exercises
Each year, more than one-third of people age 65 or older fall. Falls and fall-related injuries, such as hip fracture, can have a serious impact on an older person's life. If you fall, it could limit your activities or make it impossible to live independently. Balance exercises, along with certain strength exercises, can help prevent falls by improving your ability to control and maintain your body's position, whether you are moving or still. The 6 exercises that follow are aimed at improving your balance and your lower body strength. They include:
1.    standing on one foot
2.    walking heel to toe
3.    balance walk
4.    back leg raises
5.    side leg raises
6.    hip extensions

You can do balance exercises almost anytime, anywhere and as often as you like, as long as you have something sturdy nearby to hold on to if you become unsteady. In the beginning, using a chair or the wall for support will help you work on your balance safely.

Balance exercises overlap with the lower body strength exercises, which also can improve your balance. Do the strength exercises -- back leg raises, side leg raises, and hip extensions -- two or more days per week, but not on any two days in a row.

Exercises to Try - Flexibility Exercises
Stretching, or flexibility, exercises are an important part of your physical activity program. They give you more freedom of movement for your physical activities and for everyday activities such as getting dressed and reaching objects on a shelf. Stretching exercises can improve your flexibility but will not improve your endurance or strength. The 12 flexibility exercises  are:
1.    neck stretch
2.    shoulder stretch
3.    shoulder and upper arm raise
4.    upper body stretch
5.    chest stretch
6.    back stretch
7.    ankle stretch
8.    back of leg stretch
9.    thigh stretch
10.  hip stretch
11.  lower back stretch
12.  calf stretch

Do each stretching exercise 3 to 5 times at each session. Slowly stretch into the desired position, as far as possible without pain and hold the stretch for 10 to 30 seconds. Relax, breathe, then repeat, trying to stretch farther.

You can progress in your stretching exercises. For example, as you become more flexible, try reaching farther, but not so far that it hurts.

Safety tips:
•    Talk with your doctor if you are unsure about a particular exercise. For example, if you've had hip or back surgery, talk with your doctor before doing lower body exercises.
•    Always warm up before stretching exercises and stretch after endurance or strength exercises. If you are doing only stretching exercises, warm up with a few minutes of easy walking first. Stretching your muscles before they are warmed up may result in injury.
•    Always remember to breathe normally while holding a stretch.
•    Stretching may feel slightly uncomfortable; for example, a mild pulling feeling is normal.
•    You are stretching too far if you feel sharp or stabbing pain, or joint pain -- while doing the stretch or even the next day. Reduce the stretch so that it doesn't hurt.
•    Never "bounce" into a stretch. Make slow, steady movements instead. Jerking into position can cause muscles to tighten, possibly causing injury.
•    Avoid "locking" your joints. Straighten your arms and legs when you stretch them, but don't hold them tightly in a straight position. Your joints should always be slightly bent while stretching.

Exercise and Physical Activity for Older Adults: Part 4

  • Posted Jul 20, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

How to Get Started - Shoes and Equipment
For many activities, you don't need any special clothing. Most often, any comfortable, loose-fitting clothes will do. However, your shoes are an important part of your physical activity routine. Remember, you're going to be wearing them a lot. Here are a few pointers to keep in mind:
•    Choose shoes that are made for the type of physical activity you want to do (walking, running, dancing, bowling, tennis).
•    Look for shoes with flat, non-skid soles, good heel support, enough room for your toes, and a cushioned arch that's not too high or too thick.
•    If tying laces is difficult, look for shoes with Velcro® fasteners.
•    Make sure your shoes fit well and provide proper support for your feet. This is especially important if you have diabetes or arthritis. Shoes should feel comfortable right from the start.
•    The size of your feet changes as you grow older so always have your feet measured before buying shoes. The best time to have your feet measured is at the end of the day when your feet are largest. Be sure new shoes feel good on your feet while you are still in the store -- uncomfortable spots will probably not get better.
•    If you have diabetes, break in new shoes gradually to avoid blisters and sore spots.
You don't need to buy special equipment to exercise. Many physical activities -- such as brisk walking, raking leaves, or taking the stairs whenever you can -- are free or low cost and do not require special equipment.

For strength training, you will often need to lift or push weights. You can use the strength-training equipment at a fitness center or gym. Or, you can use weights, resistance bands or even common objects from your home. For example, you can make your own weights from unbreakable household items.
•    Fill a plastic milk jug with sand or water and tape the opening securely closed.
•    Fill a sock with dried beans, and tie up the open end.
•    Use common grocery items, such as bags of rice, vegetable or soup cans, or bottled water.

Resistance bands are stretchy elastic bands that come in several strengths, from light to heavy. You can use them in some strength exercises instead of weights.
1.    Lay the band flat in your hand with the end toward your pinky finger.
2.    Wrap the long end of the band around the back of your hand.
3.    Grasp firmly.

If you are a beginner, try exercising without the band until you are comfortable, then add the band. Choose a light band if you are just starting to exercise, and move on to a stronger band when you can do 2 sets of 10 to 15 repetitions easily.

Hold on to the band tightly (some bands have handles), or wrap it around your hand or foot to keep it from slipping and causing possible injury. Do the exercises in a slow, controlled manner, and don't let the band snap back.

Step counters, also called pedometers, can help you keep track of your endurance activity, set goals and measure progress. Most inactive people get fewer than 5,000 steps a day, and some very inactive people get only 2,000 steps a day.

Wear the step counter for a few days to see how you're doing. If you get:
•    Fewer than 5,000 steps a day, gradually try to add 3,000 to 4,000 more steps a day.
•    About 8,000 steps a day, you're probably meeting the recommended activity target.
•    10,000 or more steps a day, you can be confident that you're getting an adequate amount of endurance activity.
•    10,000 steps a day comfortably, try for 15,000 steps a day, which would put you in the high-activity group.

Exercise and Physical Activity for Older Adults: Part 3

  • Posted Jul 13, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

How to Get Started - Choosing Your Activities

Health experts say that older adults should be active every day to maintain their health, whether through physical activity or regular exercise. When thinking about ways to be active, consider doing exercises that you can fit into your daily life. Choose activities that appeal to you and that suit your lifestyle, budget, and health.

Find activities you truly enjoy. If you prefer individual activities, try swimming, gardening or walking. Dancing or playing tennis may be for you if you enjoy two-person activities. If group activities appeal to you, try a sport such as basketball or join an exercise class. Some people find that going to a gym regularly or working with a fitness trainer helps them stay motivated.

Finding the Time

There are a number of ways to fit exercise and physical activity into your schedule. For example, you can be active in short spurts throughout the day, or you can set aside specific times of the day on specific days of the week to exercise. Another way is to combine physical activity with a task that's already part of your day, such as walking the dog or doing household chores. You could also check out an exercise video from the library or use the fitness center at a local senior center.

Look for activities that are in line with your budget. Many physical activities -- such as brisk walking, raking leaves, or taking the stairs whenever you can -- are free or low cost and do not require special equipment.

Considering Your Health

Of course, you should consider your health when deciding which activities you would like to do. You may want to talk with your doctor if you aren't used to energetic activity, and you want to start a vigorous exercise program or significantly increase your physical activity. You also should talk with your doctor if you recently underwent hip or back surgery or if you have uncontrolled health problems or chronic conditions such as diabetes, heart disease or arthritis. Doctors rarely tell people not to exercise, but they may have certain safety tips for those who have these conditions.

Choosing the Types of Exercises

Most people tend to focus on one type of exercise or activity and think they're doing enough. Consider adding variety into your activity routine. Try to choose activities that include all four types of exercise -- endurance, strength, flexibility and balance -- because each type has different benefits. Doing one kind also can improve your ability to do the others. In addition, variety helps reduce boredom and risk of injury.

Examples of physical activities that build endurance include:
•    brisk walking
•    yard work (mowing, raking)
•    dancing
•    aerobics classes
•    jogging
•    swimming, water exercises
•    biking
•    climbing stairs or hills
•    playing tennis
•    playing basketball

Examples of physical activities that build strength include:
•    lifting weights
•    using a resistance band
•    Pilates

Examples of physical activities that improve balance include:
•    standing on one foot
•    heel-to-toe walk
•    Tai Chi

Examples of physical activities that increase flexibility include:
•    shoulder and upper arm stretch
•    calf stretch
•    yoga

Try to do at least 30 minutes of moderate-intensity endurance activity on most, or all, days of the week. If you don't have 30 minutes in your daily routine to be active, look for three 10-minute periods. Getting this amount every day is best, but doing anything is better than doing nothing at all. When you do strength exercises, try to do them for all of your major muscle groups on 2 or more days a week for 30-minute sessions each, but don't do strength exercises of the same muscle group 2 days in a row.

If you're not used to exercising, you may want to work with a personal fitness trainer. One of the best ways to find a personal trainer is to get a referral from someone you know who has a great trainer. Ask your friends, family or your health care provider. You also can check with a local health club or senior center. Once you have a couple of names, here are a few questions to help you pick the right person. If you can answer YES to most of these questions, you're probably on the right track.

Education and Experience of the Trainer
•    Does the trainer have a certification from an accredited organization?
•    Does the trainer have education or experience in exercise science, aging and program design?
•    Does the trainer have at least 2 years of experience, including experience training people your age?
•    Will the trainer be able to develop an exercise program based on your goals, abilities and health?
•    Has the trainer worked with people with your medical conditions?
•    Does the trainer know how to personalize your exercises based on medications you take?

Personality of the Trainer
•    Did the trainer listen carefully to you and answer your questions?
•    Does the trainer have a sense of humor and a personality that you like?

Business Practices of the Trainer
•    Has the trainer told you what to expect from the sessions?
•    Are the costs of the sessions and the cancellation policy clearly stated?
•    Is the trainer insured or bonded?
•    Will the trainer give you a list of clients so you can check references?

There are so many ways to stay active. No matter what your age, you can find activities that meet your fitness level, physical abilities and needs.

Exercise and Physical Activity for Older Adults: Part 2

  • Posted Jul 06, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

Older Male in Pool with Foam WeightsHow to Get Started - Setting Your Goals Many people find that having a firm goal in mind motivates them to move ahead on a project. Following these steps will help you achieve the goal of making exercise a part of your everyday life:
1.    Identify your starting point.
2.    Figure out your current fitness level.
3.    Set short-term goals.
4.    Set long-term goals.
5.    Write a plan if you need to.

Goals are most useful when they are specific, realistic and important to you. Consider both short- and long-term goals. Your success depends on setting goals that really matter to you. Write down your goals, put them where you can see them and review them regularly.

Short-Term Goals
If you’re already active, think of short-term goals to increase your level of physical activity. For example, over the next week or two, you may want to move gradually from walking to jogging, increase the amount of weight you lift or try a new kind of physical activity. No matter what your starting point, reaching your short-term goals will make you feel good and give you confidence to progress toward your long-term goals.

Long-Term Goals
After you write down your short-term goals, you can go on to identify your long-term goals. Focus on where you want to be in 6 months, a year or 2 years from now. Long-term goals also should be realistic, personal and important to you. Here are a few examples:
•    By this time next year, I will swim a mile three times a week.
•    Next summer, I will be able to play ball with my grandchildren.
•    In 6 months, I will have my blood pressure under control by increasing my physical activity and following my doctor's advice.

Exercise Plan
Regularly review and update your plan and long-term goals so that you can build on your success. Some people find that writing an exercise and physical activity plan helps them keep their promise to be active. See if this works for you. Be sure the plan is realistic for you to do, especially as you gain experience in how to be active. You might even make a contract with a friend or family member to carry out your plan. Involving another person can help you keep your commitment. Make your plan specific and grounded in your goals. For each exercise or activity you choose, include:
•    What kind of activity you plan to do
•    Why you want to do it
•    When you will do it
•    Where you will do it

Exercise and Physical Activity for Older Adults: Part 1

  • Posted Jun 29, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

In previous blogs, I have discussed the importance and benefits of exercising. Being physically active can help you stay strong and fit enough to keep doing the things you like to do as you get older. Making exercise and physical activity a regular part of your life can improve your health and help you maintain your independence as you age. Although exercise and physical activity are among the healthiest things you can do for yourself, some older adults are reluctant to exercise. Some are afraid that exercise will be too hard or that physical activity will harm them. Others might think they have to join a gym or have special equipment. Yet, studies show that "taking it easy" is risky. In this series of blogs, I will discuss important issues for the older individual to address when considering an exercise program.

These sections are all about getting organized. They offers tips for exercising safely, setting short- and long-term goals, choosing activities and fitting them into your daily life, and managing some of the practical things, such as wearing the right shoes, working with a personal trainer, and using equipment. There are many ways to stay active, and regardless of your age, you can find activities that meet your fitness level, physical abilities and needs.

How to Get Started - Safety First
Most older adults, regardless of age or condition, will do just fine increasing their physical activity to a moderate level. However, if you haven't been active for a long time, it's important to start out at a low level of effort and work your way up slowly. Also, if you are at high risk for any chronic diseases -- such as heart disease or diabetes, if you smoke or are obese -- you should check first with your doctor before becoming more physically active.

Other reasons to check with your doctor before you exercise include
•    any new, undiagnosed symptom
•    chest pain
•    irregular, rapid or fluttery heart beat
•    severe shortness of breath

Check with your doctor if you have
•    ongoing, significant and undiagnosed weight loss.
•    infections, like pneumonia, accompanied by fever which can cause rapid heart beat and dehydration.
•    an acute blood clot
•    a hernia that is causing symptoms such as pain and discomfort.

Check with your doctor if you have
•    foot or ankle sores that won't heal.
•    persistent pain or problems walking after a fall -- you might have a fracture and not know it.
•    eye conditions such as bleeding in the retina or a detached retina. Also consult your doctor after a cataract removal, lens implant or after laser treatment or other eye surgery.
•    a weakening in the wall of the heart's major outgoing blood vessel called an abdominal aortic aneurysm.
•    a narrowing of one of the heart's valves called critical aortic stenosis.
•    joint swelling

If you have had hip repair or replacement
•    check with your doctor before doing lower-body exercises.
•    don't cross your legs.
•    don't bend your hips farther than a 90-degree angle.
•    avoid locking the joints in your legs into a strained position.

Your activity level is an important topic to discuss with your doctor as part of your ongoing preventive health care. Talk about exercise at least once a year if your health is stable and more often if your health is getting better or worse over time so that you can adjust your exercise program. Your doctor can help you choose activities that are best for you and reduce any risks.

When you exercise, it is important to do it safely. Follow these tips to avoid injury.
•    When starting an exercise program, begin slowly with low-intensity exercises.
•    Wait at least 2 hours after eating a large meal before doing strenuous exercise.
•    Wear appropriate shoes for your activity and comfortable, loose-fitting clothing that allows you to move freely but won't catch on other objects.
•    Warm up with low-intensity exercises at the beginning of each exercise session.
•    Drink water before, during and after your exercise session.
•    When exercising outdoors, pay attention to your surroundings -- consider possible traffic hazards, the weather, uneven walking surfaces, and strangers.

Stop exercising if you:
•    Have pain or pressure in your chest, neck, shoulder or arm
•    Feel dizzy or sick to your stomach
•    Break out in a cold sweat
•    Have muscle cramps
•    Feel severe pain in joints, feet, ankles or legs

The Food Pyramid is Gone

  • Posted Jun 22, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

The 20 year old food pyramid is now history thanks to the efforts of the US Department of Agriculture amid the obesity epidemic from which this country is presently suffering. This new symbol will be seen everywhere in the near future: restaurants, schools, grocery stores, workplaces, you name it. This new icon is aimed at boosting awareness of new federal dietary guidelines issued in January.

The new icon resembles a pie chart or pizza and is sliced into four wedges to illustrate the amounts of each food group including fruits, vegetables, grains and protein. You will find that half of the plate is covered with fruits and vegetables. There is also a smaller circle next to the plate which represents dairy products, such as a glass of low-fat milk.

Now, for what our government is recommending, the USDA has developed six steps to healthy eating to be released along with the new food plate icon:

•    Make half your plate fruits and vegetables. We have known for some time that eating more of these foods can save your life and your risk of fatal cardiovascular disease decreases by four percent. Eating more fruits and vegetables help you lose weight.
•   Avoid supersized portions. One simple trick that helps with portion control is to use smaller plates. Use 8-inch rather than 12-inch plates.
•    Enjoy tasty meals, but eat less.
•    Switch to low-fat or fat-free dairy products. You still get the calcium and vitamin D (in fortified products).
•    Read labels and pick foods with less sodium.
•    Drink more water and less sweet drinks. Sugary beverages make you gain weight and increase your risk of getting heart disease and diabetes type 2 (2 sugary drinks increase diabetes risk by 26%).

Holy Cross Hospital Introduces Advanced Interventional Cardiac Imaging

  • Posted Jun 13, 2011
  • By Holy Cross Administrator

Heart disease is one of our nation’s most common health problems—the leading cause of death for Americans age 35 and older. Introducing advancements in the medical technology used to diagnose and treat this condition is more critical than ever before at Holy Cross Hospital. In an effort to help its physicians provide faster and more efficient cardiac care to South Florida area residents, Holy Cross has opened a new state-of-the-art EPS (Electrophysiology Studies) lab from Philips. Holy Cross is able to conduct minimally invasive procedures on the new system to treat a wide range of clinical problems including atrial fibrillation -- a leading cause of heart disorders in theU.S. These catheter-based procedures may reduce the risks and recovery time found in traditional surgical approaches. The benefits of catheter-based interventions include shorter hospital stays, reduced recovery time without the pain of a large incision, and less visible surgical scarring. These procedures can be performed on both the heart and peripheral blood vessels. Specifically, Holy Cross will use the Allura Xper FD10 X-ray system from Philips. This fully digital system enables physicians to capture and view detailed images of a patient’s heart structure, thereby facilitating faster and more accurate diagnosis and treatment of cardiac disease. Additionally, the system: ·     Exposes patients to less radiation during the procedures than some other systems. ·     Enables a physician to have better patient access during an exam due to the system’s compact design. ·     The Allura’s digital Philips Flat Detector helps to provide outstanding image quality, with less distortion than older imaging technologies. The Flat Detector helps to enhance diagnostic confidence and promotes better visualization during interventional procedures. “Interventional X-ray technology is a vital component in the future of medicine,” said Richard Fabian, Vice President, Diagnostic Imaging, Philips Medical Systems, North America. “We’re happy that the Philips Allura system is helping to bring a new level of quality and detail to the images that physicians at Holy Cross are using to promote alternatives to major surgery.” This flexible system can be used for procedures such as electrophysiology studies, ablations, pacemaker and defibrillator implants. Holy Cross performs hundreds of these types of procedures per year. “Both our patients and clinicians can benefit from the speed and outstanding image accuracy of this new  X-ray system,” explained Rishi Anand, MD, Medical Director of the EPS Lab. “It will allow our physicians to complete a variety of diagnostic and interventional procedures faster, and that means the patient is off the table and on their way to recovery and discharge much sooner.”

Heart Attack Signs in Women (for Women)

  • Posted Jun 08, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

Older Woman on BeachWomen do need to pay attention to symptoms that maybe related to heart disease, and they need to be able to discern how it is different from stress related disorders and G.I. disorders. What are the signs of a heart attack? Most people think it is the Hollywood version where the person grabs their chest and falls over. The truth of the matter is that many heart attacks start with vague and subtle symptoms that may come and go. Women with coronary artery disease may not receive the same level of quality care as men, according to research. Hospitals participating in the American Heart Association's Get With The Guidelines Program have significantly improved the quality of cardiovascular care for women of all ages within a year of the program's implementation.

Symptoms of Heart Disease
It is vital to learn the symptoms of heart disease:

• Chest discomfort - Lasting greater than 5 minutes. Can range from severe pain to a squeezing pressure or heartburn sensation. This discomfort will often spread to one or both arms, the back, jaw and stomach.
• Shortness of breath - Can occur at the same time as chest discomfort or by itself.
• Palpitations - Awareness of your heartbeat. Described as a flip-flopping or skip heartbeat.
• Nausea
• Sweating - Cool and clammy skin.
• Anxiety - A sense of doom or something wrong.
• Fatigue - A new onset of fatigue not associated with lack of sleep.
• Women are less likely to recognize they have heart disease and will often present with less typical symptoms, such as: new episodes of fatigue, insomnia, indigestion and anxious feeling. Listen to your body and be an advocate of yourself. Be aware and discuss changes and new pains with your doctor. Your intuition and feelings can also be a symptom. Be persistent.

Do you often experience leg pain or just feel like you're getting old?
• Do you have leg pain when you walk?
• Does the pain stop when you stand still?
• Are you over 50?
• Are you a smoker?
• Are you overweight?
• Are you diabetic? If you answered yes to two or more of these questions, you really need to consult your physician.

Signs and Symptoms of a Heart Attack
If you, or a loved one, experience any of the following symptoms, get medical attention immediately:
• Pain, squeezing, fullness, or pressure in the center of the chest that last more than a few minutes or goes away and returns.
• Pain that moves to the shoulders, neck, or arms.
• Chest discomfort accompanied by lightheadedness, fainting, sweating, fatigue, nausea, or shortness of breath. Fatigue, nausea, and shortness of breath are especially common in women.

Some less common symptoms are:
• Unusual chest, stomach or abdominal pain
• Nausea or dizziness (without chest pain)
• Shortness of breath and difficulty breathing without chest pain
• Anxiety, weakness or fatigue for no apparent reason
• Heart palpitations, breaking out in a call sweat, or paleness

Gastric Bypass Not Just For Weight Reduction

  • Posted Jun 06, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

Configuration of gastric bypass

A new study from Dr. Blandine Laferrere (St. Luke’s Hospital, Ney York, NY), published in the April 2011 issue of Science Translational Medicine, reported that gastric-bypass surgery may provide benefits to patients with diabetes (type 2) beyond the benefits usually attributed to weight loss.

The report found that several amino acids -- and specifically plasma, branched-chain amino acids (BCAAs) and its metabolites -- decreased in the gastric bypass surgery group but not in a similar group of patients who lost the same amount of weight (about 20 pounds) with standard diet alone. It has been postulated that these amino acids are associated with insulin resistance and the rapid decline of diabetes seen in many diabetic patients post gastric-bypass may be related to the pronounced changes in BCAAs or other metabolites and not the weight loss alone.

Future studies will hopefully further characterize the mechanisms involved in these metabolic changes and will seek to understand whether the specific metabolic signature of gastric-bypass surgery somehow alters glucose homeostasis. This type of information may open new doors to the understanding and management of diabetes mellitus with the hope that we see improvements in insulin sensitivity on affected patients.


Safety of ADHD Drugs

  • Posted Jun 01, 2011
  • Vicente Font, MD, FACP, FCCP, FACC

For a long time, there has always been a concern that there might be a cardiovascular risk associated with attention deficit hyperactivity disorder (ADHD) medications. These drugs can increase blood pressure and heart rate, and there have been reports of cardiovascular events in kids getting ADHD medication. A new report was published online May 16 in Pediatrics. This large observational cohort study, funded by Shire, a manufacturer of ADHD medications found that children and adolescents who take medication for ADHD are not at increased risk for cardiovascular events and death. Using 2 administrative databases, the researchers identified 241,417 children 3 to 17 years old with a prescription for an amphetamine, atomoxetine, or methylphenidate and matched each of them with up to 4 nonusers of ADHD medications (n = 965,668). Specific outcomes included sudden cardiac death, myocardial infarction (MI), stroke and cardiac arrhythmias. Median follow-up time was 135 days in ADHD users and 609 days in nonusers. The incidence of all these events was "very low" in both groups, the researchers report. There were 28 deaths in the group exposed to ADHD medications (incidence 1.79 per 10,000 person-years) and 607 in the control group (incidence 3.00 per 10,000 person-years). There were no validated cases of MI or stroke in the exposed group and 11 cases in the unexposed group. They found no statistically significant difference between incident users and nonusers in the rate of sudden death or ventricular arrhythmia or death from any cause. The study is reassuring, and we can conclude that there is no evidence of an “epidemic” of cardiac problems in kids who take these medications. Although this study is limited by its design (it is observational and “non-experimental”), it suggests that the prevalence of cardiac events among these kids is not higher than the population controls. A study on cardiovascular risks of ADHD medications in children sponsored by the US Food and Drug Administration and the Agency for Healthcare Research and Quality are due to be released soon.


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