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. 

Am I Having a Heart Attack? What to Expect in the Emergency Department

**By Julianna T. Yu, MD, FACEP**

As an emergency medicine physician, I am trained to prepare for every potential scenario. Conversely, most people do not plan ahead prior to coming to an emergency department for an urgent medical condition. A few simple, proactive steps can help ensure you receive the best care in an urgent situation, especially for any suspected heart-related concern.

ER stretcher
How do I tell if it’s a heart attack? 

For many people, it is not always clear when to seek emergency care. Heart attack symptoms are not always obvious. According to current American Heart Association guidelines, most heart attacks that warrant immediate medical attention involve:

  • Discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Cold sweat, nausea or lightheadedness.

If you have any of these symptoms, call 911 immediately.

What to bring to an emergency department

Ideally, create a personal health file in advance and update it regularly. It should fit into a wallet or purse and include:

  • Chronic health conditions and previous surgeries
  • Results of recent medical tests
  • Medication allergies
  • List of current medications, vitamins or herbal supplements
  • Names and contact information for your doctors, family and friends who may need to be alerted in the event of an emergency health issue
  • Advance directives

What to expect when you arrive at an emergency department

Emergency departments operate on a triage basis, which means team members treat the most serious illnesses or injuries first. If you are brought to an emergency department with a suspected cardiovascular condition, such as heart attack or stroke, you will be rapidly evaluated and treated. A team of clinicians – emergency medicine physicians and nurses – will work as a team to take your medical history and do a physical exam, confirm your diagnosis, relieve your symptoms and consult with appropriate specialists.

Depending on your symptoms and diagnosis, you may receive one or more of the following:

  • Intravenous (IV) fluids
  • Electrocardiogram (EKG or ECG)
  • Blood tests
  • Oxygen
  • Medications
  • Consultation with a cardiologist

A heart attack occurs when there is a blood vessel blockage that reduces blood and oxygen flow to the heart muscle. Rapid treatment by an experienced team is especially important because the longer an artery is blocked, the greater the chance of permanent damage to the heart muscle.

A little prevention can go a long way

The best way to avoid an emergency department visit for a cardiac condition is to reduce your risk factors for heart disease. I strongly encourage you to make some time soon to review your cardiac risk factors with your doctor. Your chances of having a heart attack are lower if you:

  • Treat high blood pressure and diabetes
  • Lower high cholesterol
  • Maintain ideal body weight
  • Exercise regularly (30 minutes of moderate intensity aerobic activity at least five days per week, under the supervision of your doctor)
  • Stop smoking
  • Reduce stress
  • Eat a well-balanced diet high in fruits and vegetables

To calculate your personal heart attack risk, visit heart.org/gglRisk/main_en_US.html.

After meeting with your doctor, I recommend creating your personal health file and carrying it with you whenever you leave home.

I hope this information will help improve your heart health and assist you in becoming a more informed health care consumer.

Julianna T. Yu, MD, FACEP, is board certified in Emergency Medicine and medical director of the Emergency Department at Virginia Mason, located at the intersection of Spring Street and Boren Avenue (1010 Spring St.) on First Hill in Seattle. 

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.

What is Broken Heart Syndrome?

Broken HeartOf all the times I’ve suffered the emotional pain of romantic failure, it has been a comfort knowing I couldn’t die from a broken heart. But, as it turns out, the pain of losing a loved one can cause physical symptoms, much like a heart attack, that can be life threatening. It’s called broken heart syndrome, and I asked Connie Keibler, ARNP, of the Heart Institute at Virginia Mason, to answer a few questions about the condition.

What is broken heart syndrome? Is it the same as a heart attack?
Keibler: Broken heart syndrome feels like a heart attack and causes temporary, reversible heart failure. Although the symptoms are similar to a heart attack, patients do not have obstructive coronary artery disease, and they do not have permanent heart damage. In fact, this condition reverses in just a couple weeks or months. However, broken heart syndrome can be fatal, causing severe heart failure, low blood pressure, cardiogenic shock, and life threatening heart rhythm abnormalities or arrhythmias.

Why is it called broken heart syndrome?
Keibler: The condition usually follows intense emotional or physical stress, and symptoms typically begin minutes to hours after someone is exposed to severe, unexpected stress. It is believed the heart muscle is overwhelmed by a massive amount of stress hormones, adrenaline and epinephrine, that result from exposure and response to the stressor. Broken heart syndrome is known by other names: stress cardiomyopathy, stress-induced cardiomyopathy, apical ballooning syndrome and Takotsubo cardiomyopathy.

Why does it happen?
Keibler: Science is attempting to understand the exact pathophysiological process. Preceding clinical stressors have been identified as a sudden illness, asthma attack, death of a loved one, fear or anger. Patients who present with broken heart syndrome have symptoms and clinical findings that mimic a heart attack or myocardial infarction. They complain of chest pain, shortness of breath, have symptoms of congestive heart failure, and often have very low blood pressure. Clinically there will be EKG changes suggesting an acute coronary syndrome. When the patient is taken for a coronary angiography, the coronary arteries are found to be free of disease, but there is severe heart muscle weakness (cardiomyopathy).

Is it similar to a panic attack?
Keibler: No, it really is not. A panic attack causes similar physiologic symptoms experienced with a response to a perceived stress. Panic attacks do not cause the physical damage to the heart muscle, as we see in broken heart syndrome or stress cardiomyopathy.

Who is at risk? Can anyone get broken heart syndrome?
Keibler: Broken heart syndrome is diagnosed in 1.7 to 2.2 percent of patients presenting with acute coronary syndrome. It is very difficult to predict risk. We know that most patients do not have a previous history of heart disease, and we know that it primarily affects women. The average age is 60, and the vast majority of patients are post-menopausal women. This syndrome has been observed in young women and men, but is far less common.

Why do more women than men experience broken heart syndrome?
Keibler: We really do not know. Further research will be necessary to help explain this phenomenon.

How do you prevent it?
Keibler: It is difficult to predict who is at risk. Therefore it is difficult to prevent this rare condition. Once discovered or experienced, there is a chance of recurrence. It is recommended that patients stay on long-term treatment with beta blockers or similar medications to help prevent the damaging effects of stress hormones. It seems imperative that we all should strive to manage stress in our lives. Many stressors are not avoidable, but we can grow in our ability to respond to stress in healthier ways.

What should you do if you think you’re experiencing broken heart syndrome?
Keibler: You should seek medical attention immediately. Call 911 and get to an emergency room. It is reassuring that this condition is reversible, but it can be life threatening. Patients will require hemodynamic support and medical management, along with monitoring and treatment of arrhythmias during the acute phase. After recovery, the long term prognosis is excellent.