How To Choose a Cardiac Rehab Program

Cardiac rehab programs vary in the types of services they offer and
     emphasize. Choose one that makes exercise training a priority.
     Studies show that people who participate in an exercise-based
     program are less likely to have a future heart attack or major heart
     surgery, and are less apt to die of any heart-related cause than those
     who don’t join a program that emphasizes exercise. When choosing
     a cardiac rehab program, also look for one that:

       ¦   Offers a wide range of services, including education and
           counseling.
       ¦   Offers services at a time and place that are convenient for you.
       ¦   Offers services that meet your specific needs and preferences.
           For example, if you’re overweight, look for a plan that provides
           help for weight loss.
       ¦   Is supervised by a team of health care professionals.
       ¦   Is affordable. Your insurance may cover the cost of some
           cardiac rehab services, but not others. Find out what will be
           covered and for how long, so you’ll know from the start what
           your out-of-pocket costs will be.

     What You’ll Do in a Cardiac Rehab Program
     Get moving. E x e rcise training will help you learn to safely participate
     in physical activity, strengthen your muscles, and improve your
     stamina. If you’ve recently gotten out of the hospital, you may be
     worried that exercise will bring on another heart attack or other
     heart crisis. In fact, physical activity can help prevent future heart
     problems. Your rehab team will help you develop a program that is
     safe and effective for you.

     Some programs make use of equipment such as a treadmill for
     walking, stationary bikes, and light weights, and you’ll be shown
     how to use this equipment to get the most benefit. Other programs
     offer low-impact aerobics classes and other group exercise activities.
     In most programs, your heart rate and blood pressure will be moni-
     tored while you move. As your heart and body become stronger,
     you will gradually increase your physical activity. Eventually, after
     you become familiar with the program, you can continue it at a
     fitness center or at home.

Learn new heart healthy habits. In your cardiac rehab program,

you’ll also learn about controlling your personal risk factors for heart

attack and other heart complications, and how to create new, healthier

habits. Controlling risk factors is a very important part of your re c o v-

ery process. Depending on your personal needs, you may learn to:

   ¦   Quit smoking if you’re a smoker.

   ¦   Manage related health conditions such as diabetes and high

       blood pressure.

   ¦   Eat a healthy, low-saturated fat, low-cholesterol diet.

   ¦   Control your weight.

   ¦   Manage stress.

For more information on controlling risk factors, see the sections of

this guidebook on “Major Risk Factors” and “What Else Affects

Heart Disease?” on pages 13 and 31 respectively.

Get counseling and sup-

port. A good cardiac

rehab program will help

you learn to cope with

the challenges of adjust-

ing to a new lifestyle,

as well as address any

concerns you may

have about the future.

You’ll also be offered

help in dealing with the

emotional ups and downs

that many people experi-

ence following a heart

attack or heart surgery.

Many programs offer

classes in stress man-

agement, as well

individual counseling,

group support, or

both.

Blood Pressure: How High Is High?

Blood Pressure:
   How High Is High?

Your blood pressure category is determined by the higher number
   of either your systolic or your diastolic measurement. For example,
   if your systolic number is 115 but your diastolic number is 85, your
   category is prehypertension.

                                             Systolic                             Diastolic
   Normal blood pressure        Less than 120     and    Less than 80

   Prehypertension                  120–139           or         80–89

   High blood pressure          140 or higher     or     90 or higher




Blood Pressure
But you can take action to control high blood pressure, and thereby
avoid many life-threatening disorders.

Your health care provider should check your blood pressure on
several different days before deciding whether it is too high. Blood
pressure is considered high when it stays at or above 140/90 over a
period of time. However, if you have diabetes, it is important to
keep your blood pressure below 130/80.

For those with heart disease, it is especially important to control
blood pressure to reduce the risks of stroke and heart attack. Even
if you don’t have high blood pressure, it is important to avoid
developing prehypertension, a condition that increases your risk
for high blood pressure.

Be aware, too, that a high systolic blood pressure level (first number)
     is dangerous. If your systolic blood pressure is 140 or higher (or
     130 or higher if you have diabetes), you are more likely to develop
     heart disease complications and other problems even if your
     diastolic blood pressure (second number) is in the normal range.
     High systolic blood pressure is high blood pressure. If you have this
     condition, you will need to take steps to control it. High blood
     pressure can be controlled in two ways: by changing your lifestyle
     and by taking medication.

     Changing your lifestyle. If your blood pressure is not too high, you
     may be able to control it entirely by losing weight if you are over-
     weight, getting regular physical activity, limiting the salt in your
     food, cutting down on alcohol, and changing your eating habits.
     A special eating plan called DASH can help to lower blood pressure.
     DASH stands for Dietary Approaches to Stop Hypertension. The
     DASH eating plan emphasizes fruits, vegetables, whole-grain foods,
     and low-fat dairy products. It is rich in magnesium, potassium, cal-
     cium, protein, and fiber, but low in saturated fat, trans fat, total fat,
     and cholesterol. (Trans fat is a harmful type of dietary fat that
     forms when vegetable oil is hardened.) The diet also limits red meat,
     sweets, and sugar-containing beverages.

                                           If you follow the DASH eating
                                             plan and also consume less
                                              sodium, you are likely to
                                              reduce your blood pressure
                                              even more . Sodium is a sub-
                                             stance that affects blood pres-
                                            sure. It is the main ingredient
                                                in salt and is found in many
                                                          processed foods,
                                                              such as soups,
                                                             convenience
                                                            meals, some
                                                            breads and cere-
                                                            als, and salted
                                                              snacks. For
                                                               more on the
                                                                DASH eating

You and Your Doctor: A Healthy Partnership

You and Your Doctor: A Healthy Partnership

Your doctor can be an important partner in helping you manage h e a rt disease. He or she may already have spoken with you about your heart disease risk factors, but if not, be sure to ask about how to control all of them to help prevent future problems . H e re are some tips for establishing good, clear communication with your doctor.

Speak up. Tell your doctor that you want to keep your heart disease from getting worse and would like help in achieving that goal. Ask questions about your chances of having a first heart attack or a repeat heart attack, your risk of other heart complications, and ways to lower those risks. If you haven’t done so already, ask for tests that will determine your personal risk factors.

Be open. When your doctor asks you questions, answer them as honestly and fully as you can. While certain topics may seem quite personal, 

                           Keep it simple. If you don’t understand something your doctor says, ask for an explanation in plain language. Be especially sure you understand how to make the lifestyle changes your doctor recommends, as well as why and how to take each medication you’re given. If you’re worried about understanding what the doctor says, or if you have trouble hearing, bring a friend or relative with you to your appointment. You may want to ask that person to write down the doctor’s instructions for you.


                           Major Risk Factors

A strong partnership with your doctor is an important first step in managing heart disease. But to make a lasting difference, you’ll also need to learn more about the kinds of habits and conditions that can worsen heart disease and what you can do about them. What follows is a guide to major risk factors for heart disease, heart attack, and other heart problems, and steps you can take to control or eliminate them.

Smoking

Smoking is the “leading cause of preventable death and disease in the United States,” according to the Centers for Disease Control and Prevention. If you have heart disease and continue to smoke, your risk of having a heart attack is very high. If you live or work with others, your “secondhand” smoke can cause them numerous health problems, including a higher risk of heart attack—even if they don’t smoke themselves. By the same token, if you have heart disease and live or work with someone who smokes, your own risk of heart attack goes up considerably.

Smoking puts stress on the heart in many ways. The nicotine in

cigarettes constricts the coronary arteries, which raises blood pre s s u re and forces the heart to work hard e r. Smoking also raises carbon monoxide levels and reduces oxygen levels in the blood. I t ’s a double w h a m m y : Smoking both increases the heart ’s need for oxygen and restricts the amount of oxygen it receives .

There is simply no safe way to smoke. Low-tar and low-nicotine cigarettes do not lessen the risks of a heart attack. The only safe and healthful course is not to smoke at all.

The good news is that quitting smoking will immediately and significantly reduce your risk of further heart disease complications. After a few days, once nicotine and carbon monoxide are cleared from your b o d y, your blood pre s s u re will go down and the levels of oxygen and carbon monoxide in your blood can re t u rn to norm a l . Within 1 year after quitting, your blood flow and breathing will be improved and your coughing and shortness of breath will be reduced .

          

Getting Tested for Heart Disease

You may be reading this book because you think you might have heart disease but aren’t yet sure. Keep in mind that heart disease doesn’t always announce itself with symptoms. That means you could have heart disease and still feel perfectly fine. The best course is to talk with your doctor about your personal degree of heart disease risk and about whether getting tested is a good idea.

Most screening tests for heart disease are done outside of the body and are painless. After taking a careful medical history and doing a physical examination, your doctor may give you one or more of the following tests:

Electrocardiogram (ECG or EKG) makes a graph of the heart’s electrical activity as it beats. This test can show abnormal heartbeats, heart muscle damage, blood flow problems in the coronary arteries, and heart enlargement.

Stress test (or treadmill test or exercise ECG) re c o rds the heart ’s electrical activity during exercise, usually on a treadmill or exercise bike. If you are unable to exercise due to arthritis or another health condition, a stress test can be done without exercise . Instead, you can take a medicine that increases blood flow to the h e a rt muscle and shows whether there are any problems in that flow.

Nuclear scan (or thallium stress test) shows the working of the heart muscle as blood flows through the heart . A small amount of radioactive material is injected into a vein, usually in the arm, and a camera records how much is taken up by the heart muscle.

Echocardiographic changes sound waves into pictures that show the heart’s size, shape, and movement. The sound waves also can be u s e d to see how much blood is pumped out by the heart when it contracts.

Coronary angiography (or angiogram or arteriography) shows an x ray of blood flow problems and blockages in the coronary arteries. A thin, flexible tube called a catheter is threaded through an artery of an arm or leg up into the heart. A dye is then injected into the tube, allowing the heart and blood vessels to be filmed as the heart pumps. The picture is called an angiogram or arteriogram.

Ventriculogram is frequently a part of the x-ray dye test described before. It is used to get a picture of the heart’s main pumping chamber, typically the left ventricle.

Intracoronary ultrasound uses a catheter that measures blood flow. It creates a picture of the coronary arteries that shows the thickness and other features of the artery wall. This lets the doctor see blood flow and any blockages.

In addition, several new, highly sensitive screening tests have been developed. Ask your doctor about these tests:

Carotid doppler ultrasound uses sound waves to detect blockages and narrowing of the carotid artery in the neck, both of which can signal an increased risk for heart attack or stroke.

Electron-beam computed tomography is a superfast scan that provides a snapshot of the calcium buildup in your coronary arteries.

Heart Disease A Wakeup Call

If you have heart disease, you may understandably hope that it’s only a temporary ailment, one that can be cured with medicine or surgery. But heart disease is a lifelong condition: Once you have it, you’ll always have it. It’s true that procedures such as angioplasty and bypass surgery can help blood and oxygen flow more easily through the coronary arteries that lead to the heart. But the arteries remain damaged, which means that you’re more likely to have a heart attack. It is sobering, yet important, to realize that the condition of your blood vessels will steadily worsen unless you make changes in your daily habits. Many people die of complications from heart disease, or become permanently disabled. That’s why it is so vital to take action to control this serious condition.


The good news is that you can control heart disease. There is much you can do to manage your heart condition, reduce your risk of a first or repeat heart attack, and improve your chances of living a long, rewarding life. The sooner you get started, the better your chances of avoiding further heart problems, feeling better, and staying well. So use this handbook to find out more about your own heart condition and what you can do to improve it. You have the power to make a positive difference in your heart health—and you can start making that difference today.

What Is Heart Disease?

Coronary heart disease is the main form of heart disease. It occurs when the coronary arteries, which supply blood to the heart muscle, become hardened and narrowed due to a buildup of plaque on the arteries’ inner walls. Plaque is the accumulation of cholesterol, fat, and other substances. As plaque continues to build up in the arteries, blood flow to the heart is reduced.

Coronary heart disease—often simply called heart disease—can lead to a heart attack. A heart attack happens when a cholesterol-rich plaque bursts and releases its contents into the bloodstream. This causes a blood clot to form over the plaque, totally blocking blood flow through the artery and preventing vital oxygen and nutrients from getting to the heart. A heart attack can cause permanent damage to the heart muscle.

Heart disease includes a number of other serious conditions, including: 

Angina. More than 6 million Americans live with angina, which is chest pain or discomfort that occurs when the heart muscle is not getting enough blood. The inadequate blood flow is caused by narrowed coronary arteries, due to an accumulation of plaque. A bout of angina is not a heart attack, but it means that you’re more likely to have a heart attack than someone who doesn’t have angina. There are two kinds of angina:

Stable angina has a recognizable pattern. It may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion. Stable angina pain is generally brought on by some kind of exertion or strain (such as climbing stairs or experiencing emotional stress), and it is usually relieved by rest or medicine.

Unstable angina is more serious than stable angina. Occurring at any time, unstable angina often reflects a change in a previously stable pattern of angina. Episodes of unstable angina are usually more f requent, painful, and longer lasting than bouts of stable angina, and a re less often relieved by rest or medicine. Unstable angina is a sign that you may have a heart attack very soon. The symptoms are the same as if you are having a heart attack. (See page 46 for heart attack warning signs.) If you have any of these symptoms, you should call 9–1–1 right away so that you can get immediate treatment.

Congestive heart failure. Congestive heart failure is a life-threatening condition in which the heart cannot pump enough blood to supply the body’s needs. Affecting nearly 5 million Americans, heart failure occurs when excess fluid collects in the body as a result of heart weakness or injury. This condition leads to a buildup of fluid in the lungs, causing swelling of the feet, tiredness, weakness, and breathing difficulties.

High blood pressure is the leading cause of congestive heart failure in the United States. Heart disease and diabetes are also major underlying causes of heart failure. People who have had a heart attack are at high risk of developing this condition.

 Arrhythmias are problems that affect the electrical system of the heart muscle, producing abnormal heart arrhythmias . Many factors can contribute to arrh y t hm i a s , including heart disease, high blood pre s s u re, diabetes , smoking, heavy alcohol use, an electrolyte imbalance, drug abuse, and stress ..

Your Help Can Change A Life.

Your Help Can Change A Life.

Hi, I’m Kevin McGill and this is my story. Not long ago my life was quite normal. I had dreams and ambitions about my future and strived to make them happen. But suddenly everything changed. I was diagnosed with cardiomyopathy and triple cardiovascular disease. My whole world collapsed…

Trying To Overcome The Obstacles.

Since, I haven’t been able to work for a while, money has been short. If that wasn’t enough, my old truck died and I now have no means of transportation. Getting to and from doctor appointments and the drug store has been a real struggle, since there is no public transportation that I can use, and the closest drug store is almost an hour in walking distance.

A Small Donation Can Have A Huge Impact.

Given the chance, I plan on buying a cheap used car that will help me visit my doctor, the drug store and the local grocery store. Due to my condition, I require constant medical attention, but don’t have a way to get there. Your invaluable support and generous donations can fill my life with hope again. If you share my belief that everyone deserves a chance to live with dignity, you can make my dream come true.

Challenges Make Life Difficult, But OvercomingThem Makes Life Meaningful.

my gofundme page click anywhere on article

Hello my name is kevin and I am disabled with diabetes and heart disease , I just recently lost my car because it finally gave out due to high millage and I need a way to the doctors every week , I will use the donation money to buy a descent car, I am not asking for a brand new car just something really dependable that can get me back and forth from my doctors appointments this means a lot to me because without my condition being monitored they can not make the adjustments necessary to my heart disease and I will be so grateful if someone can help me out because to me getting to the doctors and getting my meds the only reason I'm still alive.

Cardiovascular Disease & Diabetes

The following statistics speak loud and clear that there is a strong correlation between cardiovascular disease (CVD) and diabetes.

• At least 68 percent of people age 65 or older with diabetes die from some form of heart disease; and 16% die of stroke.
• Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes.
• The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.
   

Why are people with diabetes at increased risk for CVD?

Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. That's because people with diabetes, particularly type 2 diabetes, may have the following conditions that contribute to their risk for developing cardiovascular disease.

• High blood pressure (hypertension)
  High blood pressure has long been recognized as a major risk factor for cardiovascular disease. Studies report a positive association between hypertension and insulin resistance. When patients have both hypertension and diabetes, which is a common combination, their risk for cardiovascular disease doubles.
• Abnormal cholesterol and high triglycerides
  Patients with diabetes often have unhealthy cholesterol levels including high LDL ("bad") cholesterol, low HDL ("good") cholesterol, and high triglycerides. This triad of poor lipid counts often occurs in patients with premature coronary heart disease. It is also characteristic of a lipid disorder associated with insulin resistance called atherogenic dyslipidemia, or diabetic dyslipidemia in those patients with diabetes. Learn more about cholesterol abnormalities as they relate to diabetes.
• Obesity
  Obesity is a major risk factor for cardiovascular disease and has been strongly associated with insulin resistance. Weight loss can improve cardiovascular risk, decrease insulin concentration and increase insulin sensitivity. Obesity and insulin resistance also have been associated with other risk factors, including high blood pressure.
• Lack of physical activity
  Physical inactivity is another modifiable major risk factor for insulin resistance and cardiovascular disease. Exercising and losing weight can prevent or delay the onset of type 2 diabetes, reduce blood pressure and help reduce the risk for heart attack and stroke. It's likely that any type of moderate and/or vigorous intensity, aerobic physical activity—whether sports, household work, gardening or work-related physical activity—is similarly beneficial. For overall cardiovascular health, the American Heart Association recommends:
  
   – At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150
  
  OR
  –At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate-and vigorous-intensity aerobic activity
  
  AND
  
  –Moderate-to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.
   
• Poorly controlled blood sugars (too high) or out of normal rangeDiabetes can cause blood sugar to rise to dangerous levels. Medications may be needed to manage blood sugar.
• Smoking
  Smoking puts individuals, whether or not they have diabetes, at higher risk for heart disease and stroke. Learn how to kick the habit.
   

Individuals with insulin resistance or diabetes in combination with one or more of these risk factors are at even greater risk of heart disease or stroke. However, by managing their risk factors,  patients with diabetes may avoid or delay the development of heart and blood vessel disease. Your health care provider will do periodic testing to assess whether you have developed any of these risk factors associated with cardiovascular disease.

The Pains of Sleep

Ere on my bed my limbs I lay,

It hath not been my use to pray

With moving lips or bended knees;

But silently, by slow degrees,

My spirit I to Love compose,

In humble trust mine eye-lids close,

With reverential resignation

No wish conceived, no thought exprest,

Only a sense of supplication;

A sense o'er all my soul imprest

That I am weak, yet not unblest,

Since in me, round me, every where

Eternal strength and Wisdom are.

But yester-night I prayed aloud

In anguish and in agony,

Up-starting from the fiendish crowd

Of shapes and thoughts that tortured me:

A lurid light, a trampling throng,

Sense of intolerable wrong,

And whom I scorned, those only strong!

Thirst of revenge, the powerless will

Still baffled, and yet burning still!

Desire with loathing strangely mixed

On wild or hateful objects fixed.

Fantastic passions! maddening brawl!

And shame and terror over all!

Deeds to be hid which were not hid,

Which all confused I could not know

Whether I suffered, or I did:

For all seemed guilt, remorse or woe,

My own or others still the same

Life-stifling fear, soul-stifling shame.

So two nights passed: the night's dismay

Saddened and stunned the coming day.

Sleep, the wide blessing, seemed to me

Distemper's worst calamity.

The third night, when my own loud scream

Had waked me from the fiendish dream,

O'ercome with sufferings strange and wild,

I wept as I had been a child;

And having thus by tears subdued

My anguish to a milder mood,

Such punishments, I said, were due

To natures deepliest stained with sin,—

For aye entempesting anew

The unfathomable hell within,

The horror of their deeds to view,

To know and loathe, yet wish and do!

Such griefs with such men well agree,

But wherefore, wherefore fall on me?

To be loved is all I need,

And whom I love, I love indeed.

By Samuel Taylor Coleridge

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Almost well again :) test results

Transthoracic Echocardiography Report (TTE)

Demographics

Patient MCGILL KEVIN Gender Male
Name CORTEZ

MR ****** Race Caucasian

Account  ********* Room # 0000

Corporate DOS 07/05/2016
ID

Accession # ******* Referring Physician Jerry Champ MD

DOB 08/19/1975 Sonographer Jarobvey Matthews RVT,
RDCS

Age 40 year(s) Interpreting Jerry Champ MD
Physician

Ordering Physician Jerry Champ MD

Procedure

Type of Study

TTE procedure:ECHOCARDIOGRAM WITH DOPPLER \T\ COLOR FLOW.

Procedure Date
Date: 07/05/2016 Start: 02:01 PM End: 02:33 PM

Study Location: AnMed Health Cardiovascular Diagnostics Center OP
Technical Quality: Fair visualization

Indications:Cardiomyopathy, ischemic and Shortness of breath.

Patient Status: Routine

Height: 69 inches Weight: 165 pounds BSA: 1.9 m\S\2 BMI: 24.37 kg/m\S\2

Rhythm: Normal Sinus Rhythm with occasional PVCs HR: 72 bpm BP: 118/76 mmHg

M-Mode Measurements (cm)

LVIDd: 5.81 cm LVIDs: 5.06 cm
IVSd: 0.78 cm
LVPWd: 0.78 cm AO Root Dimension: 3.2 cm
Rt. Vent. Dimension: 2.85 cm LA: 4.1 cm
LVOT: 2.3 cm

Findings

Mitral Valve
Structurally normal mitral valve. No evidence of mitral valve stenosis.
There is trivial mitral regurgitation. No valvular masses or vegetations
are seen on the mitral valve.

Aortic Valve
The aortic valve is trileaflet with no thickening and normal function.
There is no significant stenosis or regurgitation. No valvular masses or
vegetations are seen on the aortic valve.

Tricuspid Valve
Tricuspid valve is normal in appearance and function. No evidence of
tricuspid stenosis. There is trivial tricuspid regurgitation. No valvular
masses or vegetations are seen on the tricuspid valve.
Estimated RV systolic pressure is 27 mmHg.

Pulmonic Valve
The pulmonic valve was not well visualized.
No evidence of any pulmonic regurgitation.
No evidence of pulmonic valve stenosis.

Left Atrium
The left atrium is mildly dilated. No left atrial mass or thrombus is
identified.
No color flow is seen across the interatrial septum.

Left Ventricle
The left ventricle is mildly enlarged. Normal left ventricular wall
thickness. Left ventricular systolic function is moderately diminished.
Ejection fraction is estimated at 30-35%. The apex is akinetic. No
evidence of left ventricular mass or thrombus noted. No evidence of
ventricular septal defect.

Right Atrium
The right atrium is normal in size and function. No right atrial mass or
thrombus identified. No color flow is seen across the interatrial septum.

Right Ventricle
The right ventricular systolic function is normal. The right ventricular
dimensions and wall thickness are normal.

Pericardial Effusion
The pericardium is normal without pericardial effusion.

Pleural Effusion
No evidence of pleural effusion.

Vessels
Aortic root dimensions and IVC dimensions are normal.

Conclusions

Summary
MODERATE LV SYSTOLIC DYSFUNCTION WITH SEGMENTAL WALL MOTION ABNORMALITIES.
MILD LEFT ATRIAL ENLARGEMENT.
MILD LV DIASTOLIC DYSFUNCTION.
NO SIGNIFICANT VALVULAR ABNORMALITIES NOTED.

Signature

----------------------------------------------------------------
Electronically signed by Jerry Champ MD (Interpreting
physician) on 07/05/2016 at 04:31 PM
----------------------------------------------------------------

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