“Women need to learn about the prevention, signs and symptoms, and treatment of heart disease just as much as men do. There is a lot of publicity about breast cancer and fear of this disease gets women to be proactive with the recommendations for surveillance and management. But coronary artery disease is still the #1 killer in women” says Christina Birch, RN, ANP, Adult Nurse Practitioner at Berkeley Cardiovascular Medical Group, Berkeley, CA. That’s why we’ve spent the week talking about the nine ways to reduce your odds of getting heart disease. Today, the final two:

8. Identify stress points and fix them When you know you’re under stress and need some down time, go for a leisurely walk, take a warm bath, or go for a massage.  Whatever you enjoy that relaxes you, find time to do it. If you don’t take care of stresses when they’re small, you could wind up with big problems to fix later on.

9.  Alcohol Consumption In the INTERHEART Study, “Regular alcohol use was defined as consumption three or more times a week.” The study suggests that “advice about alcohol use could be best customized to individuals depending on their social, cultural, and religious backgrounds and the overall effect on their health.”

Drinking too much alcohol can, over time, damage your heartand raise your blood pressure. If you drink alcohol, you should do so moderately. For women, moderate drinking means one drink per day. For men, it means two drinks per day. One drink counts as:

• 5 ounces of wine
• 12 ounces of beer
• 1½ ounces of 80-proof hard liquor

We All Need a Little Help We would also love to hear from you regarding tips and tricks you use to stay healthy. Are you using a mobile app to help you quit smoking?  Track your blood pressure?  Monitor your blood sugars?  Help plan your meals?  Please share your recommendations in the comment section below.

267,000 women die each year from heart attacks — six times as many as breast cancer. The good news is, you can tilt the odds in your favor. Click here to see the #1 and #2 things you can do. Click here to see #3 and #4. On to #5, #6 and #7:

5.  Obesity Are you overweight? Well, if you are, you’re increasing your risk for heart disease. In fact, if you have fat around your belly, that’s a major concern. That belly fat (or abdominal obesity) isn’t healthy. Measure your waist, if it’s over 35 inches, that’s a problem.

6.  Sedentary Lifestyle Ok ladies, there’s no excuse for being lazy. I know, we’re all busy and it’s so easy to make excuses, but stop being inactive and just move. Walking counts!

7.  Poor Eating Habits   Following the Mediterranean diet is a good step towards good health. Lean proteins, fresh fruits and vegetables, nuts, fish, and whole grains are good choices.

Track your fruits and vegetables.

The common Mediterranean dietary pattern consists of five characteristics:

• A high consumption of fruits, vegetables, whole-grain breads and cereals, potatoes, beans, nuts and seeds
• Olive oil as a key source of monounsaturated fat (monounsaturated fat doesn’t raise blood cholesterol levels the way saturated fat does)
• Dairy products, fish and poultry in low to moderate amounts; little red meat is eaten
• Eggs consumed zero to four times a week
• Wine in low to moderate amounts

Love Your Body, Protect Your Heart Tip: Exercise 30 minutes per day, five days per week.  Find a walking path near you.

There are nine major risk factors that impact heart disease. The good news?  There’s something you can do about each one to help prevent heart disease. Yesterday we talked about smoking and cholesterol. Today, number 3 and four on the list:

3.  High Blood Pressure (Hypertension) Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

Ideal blood pressure is less than 120/80.

4.  Diabetes Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells to give them energy. With Type 1 diabetes, your body does not make insulin. With Type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb.

Fasting blood sugar should be below 100.

Love Your Body, Protect Your Heart Tip: Learn how to take your own blood pressure and keep track of it.

Today 35 million heart-shaped boxes of chocolate will be sold. That’s nothing compared to the 8 billion, yes 8 BILLION, chalky little “Will You Be Mine” heart shaped candies that will fly off the shelf just in time to tell someone special that they are your sweetheart.

But an even more staggering number is this one — 267,000 women die each year from heart attacks — six times as many women as breast cancer.

A large study, called the INTERHEART Study, showed that there are nine major risk factors that account for heart attacks. The good news that came out of this study — heart disease is preventable.

Over the next few days, we’ll look at those nine factors and how you can love your heart and live longer.

1.  Smoking Ladies, one of the best things you can do to prevent heart disease is to put an end to smoking. According to the INTERHEART Study, even smoking one to five cigarettes daily increases your risk for a heart attack by 40 percent. Second hand smoke should be avoided. Once you decide that you really want to take an actionable step to help keep your heart healthy, that’s good news. There is help for nicotine addiction. There are smoking cessation programs that can help.

2.  High Cholesterol, High Triglycerides Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body. Your body needs some cholesterol to work properly. But if you have too much in your blood, it can stick to the walls of your arteries. This is called plaque. Plaque can narrow your arteries or even block them.

Know your total cholesterol, your LDL (lousy or bad) cholesterol and your HDL (good cholesterol). Total cholesterol needs to be below 200 mg/dL.

HDL (good) cholesterol should be above 60 mg/dL. (In the average woman, they range from 50 to 60 mg/dL. An HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease.)

LDL (lousy or bad) cholesterol should be less than 100 mg/dL.

Triglycerides should be less than 150 mg/dL.

Triglycerides are a type of fat in the bloodstream and fat tissue. Too much of this type of fat can contribute to the hardening and narrowing of your arteries. This puts you at risk of having a heart attack or stroke.

Tomorrow we’ll pick up on the list of nine things you can do to decrease your risk of heart disease. In the meantime, if you were a smoker and were able to quit, how did you do it? Did you go to a support group? Did you use an aid, such as a patch, to help you quit? Did you use a “quit smoking app?”  Was it helpful?  Please share your stories with us in the comment section below.

High blood pressure, which used to be a disease of middle age, is becoming more common in children. Once a child has high blood pressure, unless there are significant lifestyle changes, the high blood pressure continues into adulthood. This leads to an increased risk of cardiovascular disease and early adult death, even if the blood pressure is later controlled. How much better to prevent high blood pressure in the first place!

The October 19, 2004 Circulation contains a study revealing several important – and surprising – factors that influence the blood pressure of kindergarten children. As you might expect, overweight kindergarteners are more likely to have high blood pressure: healthy nutrition and plenty of active play in the toddler and preschool years can help prevent this. But you can make changes even before your baby is conceived. Both mother’s and father’s body mass index (BMI) at the first prenatal visit correlates with the baby’s blood pressure at age 5. Parents’ getting in shape seems to protect their kids. The same is true for mom’s who quit smoking. Those who continue smoking after the first prenatal visit are more likely to have young children with hypertension. Lastly, breastfeeding for 6 months or more gets kids off to healthier starts for their hearts and blood vessels (among many other things). It’s not too early to help give your child a healthy adulthood and middle age.

Heart disease remains the #1 cause of death in the United States, killing about half a million people each year. Coronary heart disease used to be thought of as a disease of the middle aged and the elderly. Over the last twenty years it has become increasingly clear that atherosclerosis – damage to the heart arteries — begins in childhood. Now is the best time to make changes.

With this in mind, the American Heart Association has established a Committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY).  I am thrilled that they have published July 2002 guidelines for cardiovascular health in children. The guidelines are also aimed at preventing diabetes, obesity, high blood pressure, and high cholesterol.

My take home message for parents is to help your kids spend at least 30 minutes a day in active play (encourage play, not exercise), to make wise food choices (including at least five servings a day of fruits and vegetables, at least six of whole grains and other complex carbohydrates, switching to low fat or nonfat dairy options after age 2, and avoiding all exposure to secondhand smoke. These are great guidelines for the whole family.

Group A strep is a common cause of illness in children. Usually the disease is as mild as strep throat, but strep can also cause serious illnesses, including toxic shock, “flesh-eating disease”, and rheumatic fever, a serious form of heart disease. Preventing rheumatic fever and other complications is one of the major reasons we treat all cases of strep with antibiotics.

But why is strep sometimes mild and sometimes so severe? Are some kids just more susceptible?

A study published in the March 26, 2002 (early online edition) of the Proceedings of the National Academy of Sciences goes a long way toward answering these questions. Scientists from the National Institute of Allergy and Infectious Diseases (NIAID) analyzed strep bacteria from 36 different rheumatic fever outbreaks. They have discovered several genes present in those strains of strep that are not present in other strains.

The genes are the blueprints for specific toxins. It appears that different subtypes of Group A strep are responsible for different degrees and locations of illness. And an interesting twist – the extra genes appear to be ‘swappable’, injected into the strep by a virus that infects the bacteria.

Dr. Greene’s Answer:

Kawasaki disease is an uncommon but important cause of fever in children. It was first noticed in Japanese children following World War II. While it is more common among the Japanese, we now know that it occurs in all racial groups, primarily in children under 5 years of age. Sometimes Kawasaki disease appears in clusters of children, suggesting that infectious organisms may trigger the condition.

Kawasaki disease is an inflammation of the child’s blood vessels. The most important blood vessels involved are those of the heart, including the coronary arteries. Kawasaki disease has become the most common cause of heart disease in children born without birth defects. If Kawasaki disease is not recognized and appropriately treated within 10 days, the risk for permanent heart damage increases. Children can die from heart problems during this illness. They can also die from heart attacks later in childhood or as young adults. Early treatment is effective in preventing this, but first Kawasaki disease must be recognized.

There is no specific blood test for Kawasaki disease. The diagnosis is based on symptoms. The disease is also called mucocutaneous lymph node syndrome because the classic symptoms are in the mucus membranes, skin, and lymph nodes. At an international symposium in Tokyo 10 years ago, expert participants agreed on a definition for Kawasaki disease (Pediatric Infectious Disease Journal 1989; 8:663):

A. Fever lasting for at least 5 days

B. Presence of any four of the following five conditions:

1. Red eyes without discharge
2. Changes of the mucus membranes of the mouth, including red throat or red and/or dry and cracked lips, or strawberry tongue (a white coat on the tongue through which swollen red bumps protrude).
3. Changes of the hands or feet, such as swelling and/or redness and/or peeling of the skin, usually beginning around the nails.
4. Rash on the trunk. May take many forms, but without blisters. Perhaps also present on the limbs or face.
5. Swollen neck lymph node or nodes.

C. Illness not explained by another known disease.

Almost all children with Kawasaki disease are quite irritable. Because blood vessels throughout the body can be affected to varying degrees, many other symptoms might or might not be seen. These include diarrhea, vomiting, abdominal pain, cough, runny nose, headache, arthritis, burning urination, mouth sores, sensitivity to light, nerve weakness, confusion, or seizures.

To make the situation more confusing, many children with true Kawasaki disease do not fulfill all of the classic criteria. We call this ‘incomplete’ or ‘atypical’ Kawasaki disease. We know that some children have it because they go on to develop the coronary artery aneurysms of classic Kawasaki disease, even though they do not have all of the other symptoms.

These cases without all of the classic diagnostic clues are most common in infants less than 1 year of age. Sadly, infants are also the ones with the highest chance of coronary artery problems, and thus the ones who need accurate diagnosis most urgently.

The good news is that Kawasaki disease usually responds dramatically to therapy with intravenous gamma globulin (IVIG) and high-dose aspirin when caught in time. Recovery is usually complete when children are treated within the first 10 days of symptoms and before the development of coronary artery aneurysms.

Dr. Greene’s Answer:

My community of San Mateo, California has enjoyed the privilege of having a crusty, lovable, brilliant pediatric cardiologist who taught physicians and parents alike about children’s hearts and the sounds they make. We have been fortunate, since the very words “heart murmur” conjure up in parents’ minds elusive fears and concerns.

When bringing an otherwise healthy son in for a routine physical exam, we expect to learn his height and weight. We anticipate that his vision and hearing and blood pressure will be checked. We assume that the doctor will confirm our observations that our son is healthy. We do not expect, however, to learn something totally new about his health. Learning about a new heart murmur at the 12-year physical can be quite disconcerting. What is a murmur?

When people hear the “lub-dub” that they think is the heart beating, they are really listening to the sounds of the valves in the heart closing. The heartbeat itself — the contraction of the heart muscle to pump out the blood — is silent. Most of the time, blood flowing through the heart is also silent.

When the turbulence of blood flowing through the heart can be heard, the person is said to have a murmur (like the murmuring of a babbling brook). Some murmurs indicate an abnormality in the structure of the valves or walls of the heart, or of the major blood vessels. These problems can be insignificant or can be quite severe. Other murmurs can arise from normal hearts, and represent no problem whatsoever.

Skilled physicians can reliably distinguish between the different types of murmurs using a very low-tech instrument — the stethoscope. By simply listening, one can learn to recognize the different classes of murmurs by their intensities, their timing, their locations, and the character of the sounds.

Functional murmurs, also called innocent murmurs, are noises made by the normal heart or its surrounding structures. At least 80% of children have functional murmurs at some point during childhood. The PPS murmur is a common innocent murmur in babies. Still’s murmur is a twanging, vibratory sound typically found during the preschool years.

The pulmonary ejection murmur, or pulmonary flow murmur of children, is the most common innocent murmur found in children 8 to 14 years of age. This quiet murmur is heard best over the upper left edge of the breastbone, and not heard well elsewhere. The noise arises from the turbulence of the blood flowing through the pulmonary artery, and peaks midway between the first and second heart sounds. The murmur is louder when the heart is pumping fast — during exercise or a fever. It is a blowing rather than vibrating noise, with a slightly grating quality. There are no clicks or extra noises. If there is any doubt as to the diagnosis, an EKG, a chest X-ray, and/or an ultrasound can distinguish it from other murmurs. Since a functional murmur is a normal noise made by normal structures, no restrictions or precautions of any kind are necessary.

Unfortunately, lingering fears have prompted many parents to become overprotective. Sometimes, the diagnosis of an innocent murmur noticeably alters personality development — unnecessarily. Parents’ anxiety can undermine a child’s self-image and self-confidence. If your son has a functional murmur, he can enter adolescence full of energy, activity, and enthusiasm. There is no reason to hold back at all!

Parents often ask me if a functional murmur will go away. I usually reply that since it is a normal noise, arising from a normal heart, it doesn’t really matter if it disappears or not. In point of fact, though, functional murmurs often do go away. This too shall pass.

Today I went to a funeral. The great man I began to describe in the first paragraph, Marvin Auerbach, M.D., was the quintessential pediatric cardiologist and pediatrician. His generosity and courage were an inspiration to many — so many that a standing-room-only crowd came to honor him. His confident assertions banished the fears of many parents whose children had functional murmurs. His expertise guided many parents whose children had something more serious.

When I first came to this community, Marv pulled me aside. “Alan,” he said, “you need to write.” He encouraged and inspired me. If it weren’t for him, I probably wouldn’t be writing to you today.

Good-bye, Marv.
Thanks.
I will always miss you.