- There are a number of conditions that affect the heart
- Cardiac Rehabilitation includes exercise and heart healthy education that can help your loved one if they are recovering from a heart attack, heart failure, heart surgery, or have other heart conditions.
- To switch your loved one to a more heart-healthy diet, help them reduce foods that are high in sodium, fat and sugar, and encourage them to eat foods rich in whole grains fruits & vegetables
- If your loved one suffers from heart disease, it’s important to monitor their key health factors such as heart rate, blood pressure, cholesterol, swelling, sleep and weight
- Always be on the lookout for new chest discomfort, fatigue, dizziness, lightheadedness, shortness of breath or other trouble breathing
What is Heart Disease?
Heart Disease refers to a range of conditions affecting the heart, including:
- Coronary Artery Disease - Refers to blockage of the blood vessels that supply oxygen and nutrients to the heart muscle. Coronary artery disease causes angina (chest pain) and heart attacks.
- Heart Failure – There are two types:
- Systolic – Heart failure due to weakness in the heart's muscle strength when pumping blood.
- Diastolic – Heart failure due to excessive stiffness of the heart muscle. The heart doesn't relax enough to fill with enough blood before it pumps blood to the body.
In both types of heart failure, the heart can't pump enough blood to the body's tissues. This results in:
- Poor oxygen and nutrient delivery to tissues
- Backup of fluid into the lungs and lower legs
- Fatigue, shortness of breath, and damage to body tissues.
- Hypertrophic Cardiomyopathy (HCM) – Refers to when the heart muscle thickens and doesn't function properly. Hypertension, obstruction in blood flow due to heart valve problems, or genetic disorders can cause HCM.
- Valvular Heart Disease - Refers to a disease of valves that control blood flow through the heart's four separate chambers. It can cause numerous problems, including heart failure, damage to the heart muscle, and circulatory collapse (loss of blood pressure and consciousness).
- Infections of the Heart – Infections can affect the heart muscle, heart valves, inner lining of the heart, or lining around the outside of the heart.
- Hypertension (High Blood Pressure) is associated with most of the conditions noted above.
Cardiac Rehabilitation can help your loved one if they are recovering from a heart attack, heart failure, heart surgery, or have other heart conditions. Includes:
- Exercise Counseling and Training: In Cardiac Rehab, your loved one will learn how to exercise and do other activities in healthy ways that promote heart health.
- Education for Heart-Healthy Living: A key element of cardiac rehab is educating your loved one on how they can manage their risk factors, and live a healthy lifestyle. For example, they'll learn how to make heart-healthy nutrition choices and quit smoking.
- Counseling to Reduce Stress: Stress hurts your heart. This part of cardiac rehab is to help your loved one identify and tackle everyday sources of stress.
Help with Lifestyle Changes
Heart disease results from genetics and lifestyle choices. Unfortunately, none of us can change our genes. However, we can make lifestyle choices that decrease heart disease risk and help treat heart disease if it's already present.
Many of the above types of heart disease develop gradually over a long time. Although you can't change years of lifestyle choices your senior has already made, it's never too late to start with healthy ones! Even if past lifestyle changes have already affected the heart, good future lifestyle choices may prevent further damage and prevent worsening symptoms.
Here are some potentially powerful lifestyle changes and modifications that may alter the risk or course of heart disease.
- Be vigilant about salt (sodium) intake. The recommended amount of daily salt intake depends on each person’s particular health conditions. Check with the doctor for your senior’s specific recommended daily sodium intake.
- Prepare foods low in fat and sugar, and rich in whole grains, vegetables, and fruits. This has a lot of health benefits, not just for the heart.
- Experiment with healthier cooking methods, such as baking, steaming, and broiling
- Avoid processed foods that are high in salt, fat, or sugars. Read the labels whenever you buy canned or packaged products.
- Limit alcohol intake
- Try to maintain a healthy weight
- If your loved one has a heart or other medical condition that warrants meeting with a nutritionist or dietitian, these meetings are an excellent opportunity to reinforce your knowledge and understanding of the above points.
- Encourage a level of exercise that your loved one can perform
- Review with the doctor or other appropriate medical professional which activities are safe for your senior and are most likely to result in the highest benefit. Considerations include other conditions that could make certain exercises inappropriate; examples include arthritis, specific medications, and balance problems.
- Don’t make assumptions about which exercises are safe for your senior. An appropriate health care professional can take into account many factors you might not be aware of.
- Suggest fun activities that promote exercise so that it doesn't feel like a chore.
- Smoking is damaging to the cardiovascular system (and almost everything else in the body too!).
- Continuing to smoke increases the chances of many types of heart disease (and many other diseases too!).
Monitor your loved one's heart condition and keep a log of certain factors on a chart or in a diary so you can have a strong sense of what falls within their range of "normal." Some good things to log at reasonable intervals or as recommended by a medical professional include:
- Heart Rate: Know what range is normal for your loved one. Notify the doctor if rates are significantly higher or lower than usual.
- Have a cuff on the device that’s the right size.
- Know what blood pressure range is normal for your loved one.
- Usually, the doctor will compare readings from a home blood pressure device to readings taken in the office. The doctor will need to decide whether the home blood pressure machine is accurate.
- Notify the doctor if your senior’s blood pressure is significantly higher or lower than usual.
- Level of Dyspnea: Dyspnea means difficult or labored breathing, or shortness of breath. Promptly report significant new or worsening dyspnea.
- Degree of Fatigue and Vigor
- Amount of Swelling in Their Lower Legs or Ankles: Increased swelling or fluid retention may indicate heart failure or other disease of the heart or lungs.
- Ask them how they slept the previous night
- Did they feel shortness of breath when lying down? (Can be a sign of heart failure)
- Did they wake up at all in the night due to shortness of breath? (Can be a sign of heart failure or lung disease)
- Many people are first alerted to worsening heart failure when they notice a weight gain of more than two or three pounds in a 24-48 hour period or more than three to five pounds in a week.
- It's a good idea to track weight and check in with the doctor if you notice sudden changes. In a senior with heart failure or any other disease that causes fluid retention, it's a good idea to perform daily weights.
NOTE: Always be on the lookout for new chest discomfort, fatigue, dizziness, lightheadedness, shortness of breath or other trouble breathing, change in activity or exercise tolerance, rapid weight gain, palpitations, changes in alertness, or other mental functioning changes. These could signal the need for urgent treatment of lung or heart problems.
When to Get Help
It's important to know which symptoms are potential causes for alarm and which are less so. Here are some tips to help you make the call of which it is.
Call the doctor if your loved one:
- Feels shorter of breath than at baseline.
- Has new or worsening shortness of breath when they lie down, or an hour or two after falling asleep.
- Is wheezing and having trouble breathing.
- Has a cough that does not go away. It may be dry and hacking, or it may sound wet. They may bring up pink, foamy spit.
- Is coughing up blood or frothy pink material.
Call the doctor if your loved one:
- Has chest discomfort (pressure or pain)
- Complains of palpitations (a sensation of beating or pounding in the chest)
- Has a pulse or heartbeat that gets very slow or very fast, or it’s not regular
- Traditionally, normal pulse rate was considered between 60 and 100 beats per minute; however, these numbers may not be appropriate or relevant for your senior's particular condition. Discuss with the doctor.
- Has a blood pressure readnig that is significantly lower or higher than their baseline
- Has nexplained nausea or vomiting, especially with chest pain (but even if there is no chest pain)
NOTE: Be aware that people with diabetes, women, and the elderly are well-known to have heart attacks without the typical warnings of chest pain and pressure.
Call the doctor if:
- Your loved one complains of lightheadedness or feels they might pass out
- Their mental status or alertness appears altered
Concerning Physical Changes
Call the doctor if your loved one:
- Is more tired or weak than at baseline and without an alternative apparent benign reason
- Has swelling in their feet, ankles, or legs
- Has gained or lost weight quickly
- Has coolness, whiteness, or bluish/purplish fingers, toes, or lips
- Has an unexplained fever, chills, or sweats
- Has unexplained pain going down the left arm, or in the neck or jaw
- Has pain and tenderness in their belly
- Has to urinate a lot, particularly at night
- Has symptoms you think might be from one of their medicines
Always call 911 if your loved one experiences significantly worsening dyspnea, chest pain or discomfort, severe lightheadedness, syncope (losing consciousness and collapsing), or any other symptom that is sudden and alarming.
**NOTE: If there's any question about whether to make the call (to the doctor's office or 911), go ahead and do it. Indecisively wavering back and forth can waste precious time that might be critical.
Stephen Engle is a United States-trained physician (M.D.) and Diplomate of the American Board of Internal Medicine who is board-certified in internal medicine. He has experience as a medical director in administrative medicine with the largest private payer in the US, as well as experience in internal medicine at all levels (clinic, urgent care, emergency room, inpatient general and intensive care, clinical consultative medicine, and peer review.)
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