Warm Weather Stresses Your Heart: Tips to Stay Cool

**By Mariko W. Harper, MD, MS, FACC**

Did you know that warm weather can put stress on your heart? When temperatures rise, the heart must work harder to keep the body cool. This isn’t great news for those living with heart disease because these individuals will have a harder time adapting, leading to a greater risk for heat stroke than their heart-healthy peers.

Additionally, when the body sweats to cool itself down, you tend to lose water and important minerals, like sodium and potassium. These minerals are necessary for muscle contraction and maintenance of fluid levels. Certain common heart medications, like diuretics, beta-blockers and calcium channel blockers, can also affect how the body responds in warm weather.

Don’t worry, though, as this doesn’t mean you or your family cannot enjoy some fun in the sun! Here are a few tips to protect yourself and your heart when the temperature starts to heat up.

Before engaging in vigorous exercise, consult with your physician

Unless you are an avid exerciser, it’s always a good idea to check with your physician before attempting vigorous exercise in the heat. You might be taking up a new sport or hobby, or perhaps it’s just been a while since you’ve had a check-up. Either way, schedule a quick appointment to get your doctor’s approval. You can also consider shaking up your workout by doing it earlier in the morning or in the evenings when it’s not as hot outside.

Drink plenty of water, even when you don’t feel thirsty

Many of us struggle to get enough water throughout the day, so it’s a good idea to find ways to help remind yourself to stay hydrated. This might mean filling up a large water bottle that you can carry around all day or setting reminders on your phone. You can also “eat your water” by enjoying fruits and vegetables like watermelon and cucumber.  

Avoid being in the sun during the hottest time of day

This one might be a no-brainer, but the best way to prevent overheating is to avoid being in the sun when it’s the hottest, typically from 10 a.m. to 2 p.m. If you must be in the sun during these hours, cover your skin with light-colored and lightweight fabrics, such as cotton, and find shade as often as you can.

Avoid alcohol and caffeine

Both alcohol and caffeine can contribute to dehydration. Stick with water and other non-caffeinated beverages.

Heat presents danger for anyone, but particularly those with heart conditions. If you have a serious heart condition such as congestive heart failure, it is best advised to limit your exposure to extremes of temperature.  If you start to feel dizzy, nauseous or disoriented, get out of the heat immediately, apply cool water to your skin and drink water to rehydrate. If you don’t start to feel better, call your doctor, or seek care immediately.

By remembering these tips and taking extra caution when outside in the sun, a summer of heart-healthy fun and fitness awaits you! If you have any concerns about your heart or overall health, there is no time better than now to reach out to your doctor prior to engaging in new activities. 

Mariko Harper, MD is board-certified in internal medicine, cardiovascular disease, nuclear cardiology and echocardiography. She practices at Virginia Mason Heart Institute. Dr. Harper specializes in general cardiology, echocardiography, nuclear cardiology and hypertrophic cardiomyopathy. 

Show Your Heart Some Love with These Five Tips

**By Mariko Harper, MD**

February is American Heart Month, a time dedicated to encouraging you to take control of your cardiovascular health. As the pandemic rages on, leaving those with poor heart health at a higher risk for developing severe illness from COVID-19, the need for education around optimizing heart health is at an all-time high.

While most of us are spending more time at home these days, there is no better time to incorporate your cardiovascular health into your self-care regimen. Here are five ways you can put your heart health first during COVID-19:

Spend time getting in tune with your cardiovascular health

Learning what your cardiovascular numbers are, such as your total cholesterol, bad and good cholesterol (LDL and HDL), blood sugar, body mass index and blood pressure, is crucial for building up your heart health. Once you know how to identify these, you can then figure out how to regularly monitor them, as well as ways to keep them under control.

We know this step can seem difficult, or be a lot to take in. Fortunately, the American Heart Association offers a myriad of resources available on its website to help, such as how to monitor your blood pressure at home, understanding what your blood pressure numbers mean and how to improve your cholesterol. Ramping up your physical activity is another way to keep your cardiovascular numbers in check.

Incorporate physical activity into your daily routine

Regular exercise has proven to have substantial benefits for heart health. Daily movement can potentially lead to lower blood pressure, stable blood sugar regulation and healthier levels of cholesterol.

Incorporating physical activity into your daily routine may be easier than you think. Whether you pick up the habit of taking leisurely strolls around the block, or decide to partake in more vigorous workout activities, any movement is good movement. Regular exercise can also provide a tremendous outlet for stress.

Find outlets to reduce stress

It’s no secret that stress levels play a large role in your overall heart health, and that higher stress levels can even make you more susceptible to heart disease. Though a number of stressors in our lives may be out of our control, especially during the pandemic, forming healthy outlets for stress can help you manage.

Finding new hobbies, or embracing old ones, is a great place to start. Maybe you’ll find that you’re secretly an art aficionado, or a master baker or chef. Or maybe yoga and quiet meditation are more up your alley.

Look out for key signs of heart trouble

While most heart health efforts are focused on prevention, it’s also important to be aware of and look out for signs of heart trouble. Though chest discomfort is the most common symptom of a heart attack, many patients don’t directly experience chest pain, but may experience an intense heaviness or pressure, rather than a sharp, stabbing pain.

Other common symptoms to be aware of include sudden shortness of breath, and aches in your arm, shoulder or jaw. Less common symptoms can include nausea, lightheadedness and breaking out in a cold sweat. If you think you or a loved one is potentially experiencing a heart attack, do not hesitate to call 911.

Don’t shy away from routine or emergent medical care

COVID-19 has brought about an absolutely devastating death toll on its own, but research shows that it is also preventing people from accessing the health care they need. Nationwide since the start of the pandemic in February, there has been an increase in deaths due to ischemic heart disease, which is caused by narrowed arteries not being able to carry enough blood to the heart.

Ignoring or delaying both emergent and routine medical care for your heart can lead to an increase in risk of major cardiovascular complications, as well as an increase in the mortality associated with COVID-19. We have robust safety protocols in place here at Virginia Mason to keep you safe during the pandemic, and highly encourage you to not ignore medical emergencies, or even pause your routine medical care.

If heart health is something that you haven’t considered much in the past, this information can be a lot to process. Think of improving cardiovascular health as part of self-care, and keep in mind that all progress is good progress.

While these tips are a great place to start for getting your heart health back on track, be sure to bring up any cardiovascular concerns with your primary care provider.

Dr.HarperMariko Harper, MD is board-certified in internal medicine, cardiovascular disease, nuclear cardiology and echocardiography. She practices at the Heart Institute at Virginia Mason. Dr. Harper specializes in general cardiology, echocardiography, nuclear cardiology and hypertrophic cardiomyopathy. 

Staying Ahead of Heart Failure: Janet’s Story

To see Janet Henry now, as a successful Human Resources executive for an international chain of stores, and gracious hostess who loves to entertain, it’s hard to realize all she has been through. In the space of one year, she experienced serious health crises: breast cancer, followed by toxic shock, followed by heart failure.

Janet.heart.failure“Many people don’t realize that heart failure is not the same as heart disease,” explains cardiologist Sara Weiss, MD. “Patients with heart disease experience atherosclerotic plaque, or hardening of the vessels which may lead to a heart attack. Heart failure happens when the heart muscle is weakened and is failing to pump consistently enough to serve the needs of the body.”

Heart failure can be caused by heart attack, alcohol abuse, or, in Janet’s case, a complication of the medication she was receiving to combat breast cancer.

When the cancer therapy began, Janet’s oncologist Nanette Robinson, MD, knew one of the biologic medications (a medicinal preparation made from living organisms and their products) would have to be monitored closely because of its possible impact on the heart. Throughout treatment, she and Dr. Weiss, communicated, overseeing Janet’s treatment to minimize, when possible, any impact on her heart. Then, in the middle of the cancer treatment, Janet contracted toxic shock which added to the stress on her heart. Soon after, she began to feel the extreme fatigue that is an indicator of heart failure.

“Because I was in the middle of cancer therapy it was difficult to understand what was causing the fatigue,” Janet remembers. “When we determined the fatigue was caused by heart failure, I began seeing Dr. Weiss weekly. She prescribed and adjusted medication strengths until we had the right dosage and I didn’t feel the fatigue anymore.

“I think I’m doing really well with the medication,” Janet adds. “My heart numbers are right where they’re supposed to be.”

“Heart failure is very treatable,” according to Dr. Weiss. “Medication and special pacemakers are the primary treatment. Patients are also encouraged to make lifestyle changes, which include eating healthy food, exercising and maintaining a healthy weight.”

Heart failure can also be experienced as shortness of breath because of fluid buildup in their lungs or abdomen. To prevent heart failure, Dr. Weiss recommends that patients work with their primary care provider to learn what their health numbers are for blood pressure, cholesterol level, body mass index and glucose level. They should also follow a plan to control existing conditions including high blood pressure and diabetes.

Janet is now cancer-free and her heart failure is under control. Along with the medical support she received, Janet credits Team Janet, her family and friends whose “tremendous support saw her through this difficult time.” Janet maintains her health with a low salt diet. She also added a new member to her family, an energetic black lab named Annie, who encourages her to walk every day.


A version of this story also appears in the Virginia Mason Health System 2018 Annual Report. 

Watchman Device Potential Alternative to Blood Thinners

People with atrial fibrillation – an abnormal, irregular heart rate – are at increased risk of stroke due to blood clots. The abnormal rhythm may cause blood to pool and form clots, mainly in a small chamber of the heart known as the left atrial appendage. To prevent these clots from forming, many atrial fibrillation patients considered at high risk for stroke are treated with blood thinning medications such as warfarin.

But there’s a catch: for many patients, taking blood thinners is problematic, due to bleeding issues or other health problems that interfere with the medication. For the right patient, a new device offers a potential alternative to long-term blood thinners. The device, called the Watchman, is a quarter-sized implant placed in the left atrial appendage of the heart. Once in place, it permanently closes off the appendage, preventing clots from escaping and causing a stroke.


Watchman Device Implant

The minimally invasive Watchman procedure is performed under general anesthesia through a catheter inserted in the groin. Patients typically leave the hospital the next day and quickly return to normal activities.

“The Watchman device is a great alternative for patients with a history of bleeding, frailty, falls, dementia or inability to maintain their target blood values on warfarin, despite their best efforts,” says Moses Mathur, MD, interventional cardiologist, Virginia Mason Heart Institute.

Patient Selection a Key to Success

While the goal of implanting the Watchman device is eliminating medications like warfarin, patients must be able to take a short course of blood thinners after the procedure until imaging tests show the appendage is permanently closed. After that, patients are transitioned to an aspirin regimen.

Other key criteria for Watchman candidates include:

  • Diagnosis of atrial fibrillation not due to a heart valve problem (such as rheumatic mitral stenosis, or presence of a mechanical heart valve)
  • Increased risk for stroke based on age and other current health conditions
  • Left atrial appendage anatomy compatible with the Watchman device
  • Ability to undergo an ultrasound scan of the heart (transesophageal echocardiogram), to ensure no existing clots are present and to examine the left atrial appendage during and after the procedure

Due to thorough patient assessments and the focus of an experienced team, Virginia Mason has an over 95 percent success rate implanting the Watchman device and eliminating long-term blood thinner regimens for patients.

“By assuming a small procedural risk up front, patients are offered the promise of being warfarin-free for the rest of their lives,” says Dr. Mathur. “And along with that comes fewer side-effects, less bleeding and less cost, year after year.”

Why the Heart Institute at Virginia Mason?

The Watchman procedure requires a heart team with expertise in structural interventional cardiology, where interventional cardiologists, electrophysiologists, imaging specialists and others work together to achieve the best outcomes for patients. This approach ensures every part of the procedure – from patient selection to post-procedure follow-up care – results in fewer complications and an optimal recovery.

Women: Don’t Ignore These Signs of Heart Attack

**By J. Susie Woo, MD, FACC**

Woman Chest PainMarysville resident Wendy Knowles never thought she was at risk for a heart attack, especially since she is only 47 and lives a healthy lifestyle.

But when she recently experienced muscle spasms in her shoulders, throbbing in her arms and jaw and a sense of something sitting on her chest, Knowles knew it was time to head to the nearest emergency department. Feeling alarm over her symptoms proved valid: She was having a heart attack and needed an emergency procedure to save her life.

Knowles was transferred to Virginia Mason. Shortly after arriving she found herself in a cardiac catheterization lab, where an angiogram showed her left anterior descending (LAD) artery was completely blocked. Knowles underwent angioplasty, a procedure in which a small balloon is inserted through an artery — in this case in Knowles’ wrist — and is inflated to open the blockage. Next, Knowles received a wire mesh stent to support the newly opened artery. Cardiac rehabilitation and a new medication regimen followed.

“When my interventional cardiologist told me that my LAD was completely blocked, which is called a ‘widow maker’ since many people suddenly die as a result, it hit me hard,” said Knowles. “Awareness and assertiveness saved my life.”

Heart attack symptoms in women

While chest discomfort is the most common heart attack symptom in women, it may not be the first. For unknown reasons, women’s symptoms tend to be more subtle or atypical.

They can include:

  • Extreme fatigue
  • Squeezing or burning in the chest
  • Severe indigestion or pressure in the lower chest or upper abdomen
  • Pain in the upper back or shoulders
  • Jaw or neck pain
  • Nausea or vomiting
  • Shortness of breath

Intense and unfamiliar symptoms and pain that worsens with exertion, but eases with rest, should be checked out immediately. A sudden, cold sweat or pronounced abdominal pressure would also be reasons for concern. For some women, heart attack symptoms may not surface at once. Instead, they can build over time, weeks or days before the heart attack becomes evident.

If you suspect a heart attack, do not hesitate to seek evaluation, even if you have never considered yourself at risk. Swift action could save your life.

Heart attack risk factors in women

Although heart attack symptoms between women and men can differ, risk factors for heart disease between the sexes are the same.

They include:

  • Diabetes
  • Smoking
  • High blood pressure
  • High cholesterol
  • Being overweight or obese
  • Lack of regular aerobic exercise
  • An unhealthy diet
  • Family history of premature coronary disease

Where a difference exists, however, is that some of these risk factors play a more significant role in the development of heart disease in women than they do in men. For example, a woman who smokes or has diabetes is at greater risk for heart disease than a man with either of these factors.

There are also specific risk factors that affect only women. Females who have high blood pressure while pregnant (preeclampsia) are at increased risk for heart disease later in life. The rate of heart disease in women also increases dramatically after menopause, when estrogen levels drop.


Make time to speak with your health care provider about your individual risk for heart disease. Review your personal and family medical history to better understand your overall risk. And if you suspect you might be having a heart attack, even if symptoms seem vague, don’t ignore them and don’t wait. Seek emergency help right away.

bellevueWoo--Joan--Susie--10Susie Woo, MD, FACC, is board certified in internal medicine, advanced heart failure and transplant cardiology. Her specialties include echocardiography, nuclear cardiology, heart failure and preventive cardiology. She practices at Virginia Mason Bellevue Medical Center and Virginia Mason Hospital and Seattle Medical Center.

High-Intensity Interval Training (HIIT): Exercise Bursts with Surprising Benefits

**By Drew Baldwin, MD, FACC**


Monitored high-intensity workouts were key in Glen Cook’s recovery.

Whether or not you’re a runner, it’s hard not to be impressed by Glen Cook’s accomplishment. The Midwest native has run the Chicago Marathon every 10 years since 1982, and he has finished faster each time.

Yet despite having been a lifelong runner, the 61-year-old Bainbridge Island resident suffered a heart attack at home in September 2016. After a three-day hospital stay, he was discharged and referred to the Virginia Mason Heart Institute’s Cardiac Rehabilitation program for outpatient care.

Once he recovered from the shock of his first major health event, Cook’s love of running and dogged determination spurred him to tell the cardiac rehabilitation staff about his dream – to run his fastest Chicago Marathon yet in 2022. For five months, he traveled to Seattle twice a week for cardiac rehab sessions. Those 36 customized sessions involved short, high-intensity aerobic workouts that were carefully monitored to ensure his safety.

The American College of Sports Medicine recommends that healthy adults should be getting at least 150 minutes of moderate physical activity throughout the week. Recent research has shown that even 10-15 minutes of vigorous exercise per day may have substantial heart-health benefits.

My usual recommendation is to get at least 10 minutes of vigorous aerobic exercise daily. In addition to that, light weightlifting, gentle stretching, and balance exercises can help to develop strength, flexibility and balance.

Few Americans achieve the amount of exercise recommended by the American College of Sports Medicine. Many report that a major barrier to regular physical activity is insufficient time. One approach to exercise that requires less time is high-intensity interval training (HIIT).

HIIT and what it involves

HIIT involves short periods of high-intensity exercise training. This is much different than the traditional long periods of steady, moderate exercise. HIIT can provide similar exercise benefits in much less time.

According to David Cowan, the exercise physiologist who supervises Virginia Mason’s Cardiac Rehabilitation program, a typical HIIT routine includes alternating bursts of intense, heart-pumping activity followed by short periods of recovery. “The recovery can either be complete rest or low-intensity effort,” said Cowan. “As long as you stick with this pattern, the chosen exercise can be whatever gets you moving – whether that’s cycling at the gym, sprinting outside, climbing stairs, or even using your own body weight for burpees and jump squats.”

A typical HIIT workout consists of performing a challenging exercise – at 80 percent to 90 percent of maximum aerobic capacity – for 30 seconds to one minute, followed by an easier exercise. That sequence is repeated, with different exercises, for 20 minutes.

Beginners can start with an easy-to-remember 10 x 1 routine: one minute of high-intensity exercise followed by one minute of recovery that is repeated 10 times.

Benefits of HIIT

The benefits of HIIT include weight loss, increased exercise capacity and overall fitness improvement. But one of the best benefits is the short amount of time required. Considering that many people cite lack of time as the main reason for not exercising on a regular basis, HIIT provides an excellent alternative to the long, boring workouts most people dislike.

Researchers around the world have conducted various studies and found HIIT to have positive effects on patients with heart conditions. In some studies, it has been shown to be more effective than continuous moderate activity at improving cardiovascular and respiratory fitness.

Forms of HITT

Interval training can be tailored for different starting levels of fitness. For instance, older adults can start HIIT with intervals of brisk walking alternated with slow walking.

A 2007 study of middle-aged and older people found that participants who trained in interval walking for at least four days per week had a reduction in blood pressure, increase in thigh muscle strength and improved peak aerobic capacity after the five-month study period. The changes seen after interval walking exceeded those seen in subjects who performed moderate-intensity continuous walking. This suggests that HIIT may do a better job at protecting against an age-related decline in fitness.

Final thoughts

Whether you want to reduce your risk for heart disease, or just improve your overall health, interval training may be an excellent option. A person who is new to HIIT should ease into it, starting with a five-minute workout three times a week then increasing the intensity and duration. If you have a health condition, always consult with your primary care provider before starting any new exercise regimen.

Drew Baldwin, MD, FACC, is board certified in Interventional Cardiology and Cardiovascular Diseases. He practices at Virginia Mason Hospital and Seattle Medical Center and Virginia Mason Federal Way Medical Center. Dr. Baldwin’s clinical expertise includes clinical cardiology, interventional cardiology, echocardiography and nuclear cardiology. He has special interest in coronary artery disease and peripheral vascular disease. Dr. Baldwin is a Mercer Island resident.

Don’t Let the Numbers Fool You: A User’s Guide to Nutrition Labels

woman comparing food labels in storeEver stood in the grocery aisle, staring at the nutrition label of a can of soup or box of cereal and tried to figure out if it was “healthy” or not? It can feel like you need an advanced degree in mathematics or chemistry to decipher all the numbers and ingredients. And that’s not even accounting for any dietary restrictions. For people with diabetes or congestive heart failure, trying to read food nutrition labels can not only be confusing, but potentially overwhelming. Fortunately, there are some things you can do to decrypt the nutrition label code.

The Nutrition Puzzle

According to Lane Hobbs, Virginia Mason registered dietitian and certified diabetes educator, food nutrition labels are not an “eat this, not that” source of information. It’s always going to show a percentage of something higher than others. What the nutrition label can do is help “put together the puzzle of your diet.” The big pieces of your dietary puzzle should be the low calorie, high vitamin and mineral types of food such as fruits, vegetables, whole grains and lean meat. The little pieces are the things that are higher in calories or fat – like butter or oil. An avocado may be higher in fat than lettuce, but that doesn’t make it unhealthy. It’s just information. Nutrition labels can help make those little pieces fit in your daily dietary puzzle.

Go Low

But you say, “I’m making spaghetti for my family for dinner – how do I know which sauce is the healthiest choice?” Lane suggests you look for foods that have lower sodium, higher fiber and lower sugar. Turns out, spaghetti sauces are high in sodium. Lane recommends that when you’re looking from label to label – like with spaghetti sauce – just pick the one with lower sodium. It’s the comparing that is helpful, not picking up an avocado and saying it has fat, I can’t eat that.

Do the Math

Checking nutrition numbers – sounds easy, right? Not necessarily. Percentages on nutrition labels are often confusing. For instance, you may think a label claiming the food has 12 percent fat means the food itself contains 12 percent fat. In actuality, that number is the estimated amount of fat a person needs during one day. Meaning if you eat a serving of that food, you would be getting 12 percent of the fat you need that whole day.

That information is particularly important when looking at high sodium foods like soup – one serving size may contain a third of the amount of sodium a person needs all day. So if you are comparing soups labels, go for the one with less sodium – or better yet, make it fresh yourself.

Familiarize Yourself

If you are on a no/low sodium diet, don’t panic when reading labels or trying to find heart healthy recipes. Sodium is natural in foods. Lane advises you to simply not add sodium to your meals. Or don’t eat as many foods that have higher amounts of sodium.

But how do you figure out a recipe’s sodium component? Get familiar with what ingredients already have a lot of salt like sausage, blue or parmesan cheese, or chicken broth. If those salty ingredients are already in the recipe, says Lane, don’t add additional salt. Looking at nutrition labels is one way you can starting learning what foods have a lot of salt.

It Gets Easier

New Food Nutrition LabelFortunately, reading nutrition labels should get easier in the future. New, simpler nutrition labels will be required in 2018. There will still be a lot of information on the labels, but the goal is to make some things more transparent, like serving size. Today one container of yogurt may actually have a serving size of two servings. Going forward, the nutrition information for that yogurt will indicate one serving size.

Another improvement coming to future nutrition labels: changing “sugar” to “added sugar.” Right now, sugar numbers on a nutrition label do not have much meaning. Milk and yogurt, for example, have sugar on the label because it’s natural – sugar is part of the dairy. In the future, however, the nutrition labels will indicate when sugar has been added to the food. Thus, skim milk won’t have added sugar while chocolate milk will.

But you don’t need to wait until 2018 to get something useful from a nutrition label. Lane suggests you just learn a little at a time, and be careful about serving size. Serving size is one of the most important things on the label.


Marianne is a Web Producer for Virginia Mason who hates to do math. She’s looking forward to food labels that don’t make her have to think as much.

Heart Failure: Proper Management Improves Quality of Life

**By Sara Weiss, MD**

HeartAccording to the American Heart Association, heart failure affects 6.5 million Americans and is projected to increase 46 percent by 2030, impacting more than 8 million people. Unfortunately, this common condition was given one of the most misleading names in medicine.

Heart failure does not mean the heart has failed and is no longer working. It simply means the heart’s pumping power is weaker than normal.

With heart failure, blood moves through the heart and body at a lesser rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body’s needs. The chambers of the heart may respond by stretching to hold more blood or by becoming stiff and thickened. This helps keep blood moving, but the heart muscle walls may eventually weaken and pump less efficiently. As a result, the kidneys may respond by retaining fluid and salt. If fluid builds up in the arms, legs, ankles, feet, lungs or other organs, the body becomes congested – thus the term “congestive heart failure.”


Heart failure may result from many health conditions that directly affect your cardiovascular system. This is why it is important to get annual checkups to lower your risk for heart health problems.

Heart failure can be prevented by early treatment of high blood pressure, coronary artery disease and valve conditions. Other less common causes of heart failure include alcohol abuse, certain kinds of chemotherapy and genetic disorders.


Heart failure can be ongoing (chronic), or your condition may start suddenly (acute).

In the early stages of heart failure, you may not have any obvious symptoms. However, if your condition progresses, your body will experience gradual changes.

Symptoms you may notice first include fatigue, swelling in lower legs, ankles and feet; and weight gain. Symptoms that indicate your condition has worsened include irregular heartbeat; a cough that develops from congested lungs; wheezing and shortness of breath, which may indicate pulmonary edema (fluid accumulation in the lungs). And symptoms that indicate a severe heart condition include rapid breathing; skin that appears blue due to lack of oxygen; fainting and chest pain that radiates through the upper body.

Remember, since chest pain that radiates through the upper body can also be a sign of a heart attack, or if you experience any of the symptoms of a severe heart condition, seek immediate medical attention.


Although not all conditions that lead to heart failure can be reversed, treatments can improve signs and symptoms of the condition, and help you live longer. For instance, lifestyle changes – such as exercising, reducing salt intake, managing stress and losing weight – can improve your quality of life.

Like the saying, “An ounce of prevention is worth a pound of cure,” one approach – and, really, the best way – to prevent heart failure is to control the conditions that cause it, such as coronary artery disease, high blood pressure, diabetes or obesity.

When to see a doctor

If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean the existing heart failure is getting worse or not responding to treatment. Contact your doctor promptly.

And if you experience any of the following, seek emergency treatment:

  • Chest pain
  • Fainting or severe weakness
  • Rapid or irregular heartbeat associated with shortness of breath, chest pain or fainting
  • Sudden, severe shortness of breath and coughing up pink, foamy mucus

Although these signs and symptoms may be due to heart failure, there are many other possible causes, including other life-threatening heart and lung conditions. As I always tell patients, don’t try to diagnose yourself. Instead, call for immediate assistance.

Treatment options

Heart failure is very treatable and usually involves the use of various medications. A cardiologist will work closely with you to find the ideal combination of medications that will help your heart work better and help with the demands of the body. Managing heart failure involves a delicate balance between taking the work load off your heart and supplying enough oxygen and nutrients to the other organs.

There are invasive treatments for advanced congestive heart failure including heart transplantation and the implantation of a pacemaker or pump that helps the heart push blood along.

Avoiding progression

In addition to compliance with medication, there are things that may help keep congestive heart failure at bay. They include:

  • Regular visits with your primary care physician and cardiologist. Congestive heart failure must be closely monitored and any changes treated promptly. You should weigh yourself weekly and report weight gain of 3 lbs. or more to your physician since it could be the result of fluid retention.
  • Dietary changes. Weight loss, even if you are slightly overweight, is imperative to prevent further damage to your heart muscle. The larger your body, the harder your already damaged heart has to work to supply much-needed oxygen and nutrients. Even moderate weight loss can greatly impact congestive heart failure management.
  • Exercise. Exercise can be a challenge due to symptoms of congestive heart failure. However, any increase in activity is helpful. Walking is a great low-impact option for patients with congestive heart failure. If weather is an issue, or if you don’t have a safe, level place to walk, try a local shopping mall. Many malls open early and even place distance markers for people who exercise there. It is a great way to meet people, have fun and stay healthy. Before starting an exercise regime, consult your doctor.
  • Avoid fluid overload. Restricting fluid intake is important. A decrease in fluid intake can reduce the amount of work the heart has to deal with.
  • Salt intake. Where there is salt, there is water. If you have a lot of sodium in your body, you will retain fluid. For this reason, avoid foods with high amounts of salt.
  • Smoking. If you smoke, stop immediately. It must be avoided at all costs since cigarette smoke carries a lot of carbon monoxide, which worsens the ability of oxygen to be carried throughout the body.
  • And lastly, stay healthy. It requires a lot of energy for your body to fight off common illnesses, like flu. So, stay current on flu and pneumonia vaccinations. Respiratory diseases may cause heart failure symptoms to worsen. So, the best approach is simply to avoid the risk.

Whether you have heart failure or not, I encourage everyone to take care of their heart to enjoy a lifetime of better health.

Dr Sara WeissSara Weiss, MD, is a board-certified cardiologist who specializes in heart failure management, echocardiography, and women and cardiovascular disease. She practices at Virginia Mason Hospital and Seattle Medical Center.

Heartburn or Heart Attack? Pay Attention to Symptoms

**By Gordon L. Kritzer, MD, FACC**

heartattackSince large meals are often part of celebrating, it’s easy to overdo it on special occasions. If you’ve just eaten a big meal and you feel a burning sensation in your chest, you might think it is heartburn, and it might be. However, there is a chance that the chest pain could be caused by reduced blood flow to your heart (angina), or an actual heart attack.

What is heartburn?

Heartburn, often called acid indigestion, is discomfort or actual pain caused by digestive acid moving into the esophagus, which carries swallowed food to your stomach.

Signs of classic heartburn are:

  • A burning sensation starting in the upper abdomen and moving up into the chest after eating, or while bending over or lying down.
  • Symptoms that awaken you from sleep, especially if you have eaten within two hours of going to bed.
  • Symptoms that are relieved by antacids.
  • Getting a sour taste in your mouth, especially when lying down.
  • A small amount of stomach contents rising up into the back of your throat (regurgitation).

Common confusion

Despite its name, heartburn is related to your esophagus, not your heart. But because the esophagus and heart are located near each other, either one can cause chest pain that sometimes radiates to your neck, throat or jaw. This is why many people mistake heartburn for angina and vice versa.

Since heartburn, angina and heart attack may feel very much alike, even experienced doctors cannot always tell the difference from your medical history and a physical exam. That is why if you go to an emergency department for chest pain, you will immediately have tests to rule out a heart attack.

What to do if you’re unsure

I often tell patients that if you burp and symptoms go away, it probably isn’t related to your heart, but to your esophagus. However, if you suddenly experience shortness of breath and sweating or persistent chest pain, then it’s likely a heart-related issue and you should call 911 immediately.

Also, call your doctor if you had an episode of unexplained chest pain that went away within a few hours. This is important because both heartburn and a developing heart attack can cause symptoms that subside after a while. The pain does not have to last a long time to be a warning sign.

Heart attack vs. sudden cardiac arrest

It is also important that people are able to recognize the difference between a heart attack and sudden cardiac arrest. When someone is having a heart attack, he or she is conscious and might complain of chest pain or other symptoms.

When a person is experiencing sudden cardiac arrest, the heart has unexpectedly stopped beating and blood is no longer pumping throughout the body or brain. The individual may lose consciousness and appear lifeless. Some victims gasp and shake as if they are having a seizure. Death can occur within minutes.

If someone is experiencing heart trouble, here are five ways to help them:

  • Call 911. Whether it is a heart attack or sudden cardiac arrest, step one is always to call 911 to report the emergency and allow emergency dispatchers to coach you through some simple, potentially lifesaving steps.
  • Ease strain on the heart. If the person is conscious and possibly suffering a heart attack, help move them into a comfortable position – half-sitting, with head and shoulders well supported and knees bent, to ease strain on the heart. Also, loosen clothing at the neck, chest and waist.
  • Have the person chew and swallow an aspirin. If the person is conscious, give them a full dose (300 mg) of aspirin. Have the person chew it slowly so it dissolves and is absorbed into the bloodstream more quickly when it reaches the stomach. Aspirin helps break down blood clots, minimizing muscle damage during a heart attack.
  • Perform cardiopulmonary resuscitation (CPR). If the person is unconscious, the next step is to start chest compressions. To do this, press down hard (about two inches deep) and fast (100-120 times per minute) on the center of the chest.
  • Look for an automated external defibrillator. These commonly found devices have clear instructions and are designed for use by the public. To use one, simply attach the pads as indicated on the machine, then it will talk you through the process. It will only deliver a shock if the patient’s condition warrants it. Leave the machine switched on at all times, and leave the pads attached – even if the patient has recovered.

Awareness is key

Learning to recognize simple heartburn and the symptoms of a serious heart condition will help you act quickly when it matters most. Knowledge is power as we become better health advocates for ourselves and for others.

Gordon L. Kritzer, MD, FACC, is a board certified cardiologist who specializes in interventional and invasive cardiology as well as cardiac rehabilitation. He practices in the Heart Institute at Virginia Mason Hospital and Seattle Medical Center (206-341-1111). For more information, watch Dr. Kritzer’s “Signs of a Heart Attack” video.


Lifelong Heart Health Requires Awareness and Action


J. Susie Woo, MD

**By J. Susie Woo, MD**

As a cardiologist, I diagnose and treat heart disease – our country’s leading cause of death – across a broad spectrum of patients. Although the goal is to always individualize treatment based on a person’s unique condition, there are commonalities everyone should be aware of and follow to achieve optimal heart health.

Knowing your risk

Although there are a handful of things everyone can and should do over the course of their lives to lower their risk of heart disease, people’s genetic makeup can place them at higher risk no matter what they do. Since medical science is proving more and more that genetics plays a role in heart disease, one of the most important steps in preventing an event, like a heart attack or stroke, is knowing whether you have a family history of cardiovascular disease.

The most relevant family history is that of your first-degree relatives: your biological parents and siblings. Early heart disease in those family members, or in more distantly related family members, are the most concerning signs of an inherited predisposition toward cardiovascular disease or sudden death.

Here is what your physician wants to know:

  • Is there any family history of heart disease, heart attack or stroke?
  • Is there any family history of high blood pressure, especially at an early age?

Most importantly, is there any history of a heart attack in a male before age 55 or a female before age 65?

Six healthy habits

Beyond knowing your family history of heart disease, people who adhere to six recommended health behaviors are about 80 percent less likely to die from heart attack or stroke than those who follow none of the actions, according to a study that included nearly 45,000 U.S. adults. However, the study also revealed that few adults follow all of these behaviors as recommended by the American Heart Association:

  • Not smoking and limiting consumption of alcohol
  • Having normal cholesterol levels
  • Eating a healthy diet
  • Having normal blood glucose
  • Being physically active
  • Having normal blood pressure

Not smoking and limiting consumption of alcohol

If you are one of the estimated 40 million Americans who still smoke, quitting as soon as possible should be your highest priority. Smokers are two to three times more likely to develop heart disease than non-smokers, but that increased risk reverses to that of a non-smoker after just three years of abstinence. Your doctor can help provide you with stop-smoking aides and information about local smoking-cessation resources.

A little alcohol can be good for your heart, but after that, the health benefits are lost and it simply results in empty calories. If you choose to drink, physicians recommend an average of no more than one drink – preferably a glass of red wine – a day for women and two drinks per day for men.

Having normal cholesterol levels

Cholesterol levels should be measured at least once every five years in everyone over age 20. More frequent screening is performed in men over age 35 and women over age 45, especially if there is a history of high cholesterol. Cholesterol levels are measured by a blood test called a lipid profile under fasting conditions. The lipid profile includes:

  • Total cholesterol
  • LDL (low-density lipoprotein, also called “bad” cholesterol)
  • HDL (high-density lipoprotein, also called “good” cholesterol)
  • Triglycerides (fats carried in the blood from the food we eat). Excess calories, alcohol or sugar in the body are converted into triglycerides and stored in fat cells throughout the body.

Results of your blood test will come in the form of numbers. It is important to know that the numbers by themselves are not enough to predict your risk of heart disease. They are, instead, one part of a larger equation that includes your age, your blood pressure, your smoking status, and whether you use blood-pressure medications. Your doctor will use this information to calculate your 10-year risk for serious cardiovascular problems. You and your doctor will then develop a strategy for reducing that risk.

High LDL cholesterol leads to atherosclerosis (build-up of cholesterol plaque) on the walls of your arteries and increases your chances of developing angina (chest pain) or heart attack. The lower your LDL cholesterol number, the lower your risk. If your LDL is 190 or more, it is considered very high and your doctor will most likely recommend a statin (medicines that can help lower cholesterol levels), in addition to healthy lifestyle choices.

You may also need to take a statin even if your LDL is below 190. After calculating your 10-year risk, your physician will recommend a percentage by which you should try to lower your LDL through diet, exercise and medication, if necessary.

When it comes to HDL cholesterol, a higher number means lower risk. This is because “good” cholesterol removes the “bad” cholesterol from your blood and keeps it from accumulating in your arteries. A statin can slightly increase your HDL, as can exercise.

Eating a healthy diet

A healthy diet is not only a key component to your heart health, it is instrumental to your overall health. A great place to start is by reducing consumption of foods that come from cows. Other heart-healthy diet changes include:

  • Substitute red meat with proteins such as fish, chicken and soy several times every week
  • Include a combined seven servings of fruits and vegetables in your diet every day
  • Eat foods made from whole grains instead of processed grains
  • Avoid non-nutritious calories and snacks, including packaged foods, fast food and sugary drinks
  • Stop eating when you are no longer hungry, instead of eating until you are full

Having normal blood glucose

Maintaining normal blood glucose levels is important to prevent diabetes and sustain heart health throughout your life. The blood test measuring a fasting blood glucose is often part of an annual physical. The amount of glucose (or “sugar,” measured in mg/dL) in your blood changes throughout the day and night, depending on when and what you have eaten, and whether or not you have exercised. Normal blood glucose levels include:

  • A normal fasting (no food for eight hours) blood sugar level of between 70 and 99 mg/dL
  • A normal blood sugar level two hours after eating of less than 140 mg/dL

Being physically active

Research has shown that people can increase their lifespan by two hours for every hour of exercise. Regular aerobic exercise is one of the best ways to get and stay healthy. Current recommendations are for you to get 30 minutes of moderate-intensity exercise at least five days a week, both for your heart and overall wellness. To maximize the heart-health benefits of your workouts:

  • Find an aerobic activity you enjoy, such as brisk walking, swimming or cycling. These activities get your heart beating and your big muscles moving
  • Work out at the same time every day so it can more easily become part of your daily routine
  • Exercise enough to break a sweat and increase your heart rate, but keep in mind that you don’t need to be out of breath to benefit
  • If you have not been exercising, start slowly with just 10 minutes of aerobic activity daily, which is still enough to reduce your risk of premature death

Having normal blood pressure

A normal blood pressure is 120 on top (systolic) and 80 on the bottom (diastolic). If your blood-pressure numbers are much higher than that, you should see your doctor and take medications if necessary. High blood pressure significantly increases your risk for a heart attack, stroke, heart failure and kidney failure.

To keep track of your blood pressure, especially if it is high or borderline high, consider purchasing a home blood-pressure monitor. Recording occasional blood-pressure measurements at home, especially after a medication or lifestyle change, is a healthy habit that can help you and your doctor get your numbers under control.

Baby steps

Lastly, it’s important to keep in mind that even small, incremental changes in these areas will have a cumulative effect and lower your risk for cardiovascular disease and stroke. Over time, repetition of these six habits will become routine and lead to a healthier lifestyle and overall sense of wellbeing.

This story originally appeared in the Bellevue Reporter.

J. Susie Woo, MD, FACC, is board certified in Internal Medicine and Cardiovascular Disease. Her specialties include echocardiography, nuclear cardiology, advanced heart failure and preventive cardiology. She practices at Virginia Mason Bellevue Medical Center and Virginia Mason Hospital & Seattle Medical Center.