The Heart

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Heart health: Are women getting incorrect treatment?

Recent research suggests that ignoring sex-specific risk factors of heart disease has resulted in women having a higher risk of dying from heart failure than men.

Two women having funShare on PinterestDifferences between men and women may mean that the latter do not receive the right treatment for heart conditions.

A review published in Nature Medicine reveals an alarming failure to successfully treat cardiometabolic disorders, such as diabetes, heart disease, and stroke, in women.

The authors urge health services to consider the biological differences between men and women when treating heart disease.

The review, by Prof. Eva Gerdts, of the University of Bergen, in Norway, and Prof. Vera Regitz-Zagrosek, of the Charité Universitätsmedizin Berlin, in Germany, compares the common risk factors for both sexes.

"Men and women have different biologies, and this results in different types of the same heart diseases. It is about time to recognize these differences."Prof. Eva GerdtsThe authors summarize the results of over 18 major studies that have explored the causal factors of heart disease in each sex.The overwhelming finding was that women are more at risk of receiving the wrong treatment because health service professionals fail to spot symptoms or risk factors that are unique to women.Obesity at the heart of itRecent research has substantiated fears that the global rise in cardiometabolic disorders is linked to obesity. Meanwhile, fresh evidence suggests that obesity and associated damage to the heart occur differently in men and women.Global figures show that obesity in women is on the rise, and as Prof. Gerdts' review explains, women store fat differently from men. The mechanisms behind this process combine to create an increased risk of type 2 diabetes and heart disease."If we see this from a life span perspective, we can see that obesity increases with age and that this trend is greater for women than men. Obesity increases the risk of having high blood pressure by a factor of three. This, in turn, increases the risk of heart disease," explains Prof. Gerdts.The estrogen advantageThe hormone estrogen works to impede metabolic syndrome by preventing connective tissue from forming in the heart. This also helps keep blood pressure stable.But the decrease in estrogen that occurs during menopause can increase the risk of arterial stiffening and subsequent disease. This helps explain an increase in hypertension among women over 60. In men, meanwhile, hypertension is more common before the age of 60.Lifestyle risks increase with ageSocioeconomic status and lifestyle factors also play a role in cardiovascular risk discrepancies.The researchers highlight the fact that, around the world, women are more likely to experience low levels of education, low income, and joblessness, and that studies have associated each of these factors with diabetes and depression — two major contributing factors for heart disease.Meanwhile, the adverse effects of unhealthful habits, such as smoking — which is on the rise in women — multiply as we age. This can lead to high blood pressure, which can cause heart failure if a person does not receive treatment. "For women, the effects of risk factors such as smoking, obesity, and high blood pressure increase after menopause," says Prof. Gerdts. What can we do?Prof. Gerdts hopes to incite action among the medical community; she calls for healthcare providers to place more emphasis on sex differences when treating cardiometabolic disorders."Heart disease remains among the most common cause of death and reduced quality of life in women. Medically speaking, we still do not know what the best treatment for heart attack or [heart] failure is in many women. It is an unacceptable situation."Prof. Eva GerdtsThe present study highlights an imbalance in available research, in an effort to pave the way for further work.The outlook is promising if we consider that cardiac arrest — which is more common in men — is now treatable and preventable. If the same resources and research were applied to the factors that put women at risk of heart failure, perhaps similarly effective interventions could be developed in the near future.In the meantime, it is important for healthcare providers to help women in high-risk groups lower their blood pressure, reduce the risk or effects of obesity, and put quitting smoking at the top of their list of 2020 goals, if necessary.
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Marathon running may reverse a risky part of the aging process

People have long been aware of the benefits of exercise. Now, a new study finds that one particular aspect of fitness — that is, training for a specific goal — may be particularly advantageous.

seniors runningShare on PinterestA new study has shown that training for and running a marathon can reverse vascular aging.

The value of goal-oriented exercise ties directly into the aging process. As a person gets older, their arteries are more likely to stiffen.

Aerobic exercise can reduce arterial stiffening, which the medical community sees as a predictor of cardiovascular events.

However, it is difficult for doctors to recommend a form of fitness that is likely to work for everyone.

Recent findings, however, suggest that training for and running a marathon could be an excellent choice for people looking to improve their cardiovascular health.

A total of 138 people running in the 2016 and 2017 London Marathons participated in the study, which appears in the Journal of the American College of Cardiology.

Training for the marathonNone of the participants had completed a marathon before, and none had any significant medical history or preexisting heart disease.They were also all running a maximum of 2 hours a week before starting the study.Just over half of the participants were female, with the average age of the group being 37 years.The researchers advised each of the runners to follow the marathon's Beginner's Training Plan, which consists of about three runs every week for 17 weeks leading up to the race.As the weeks went on, the weekly exercise became more intense.A 4 year reductionBefore the participants began their marathon training, the research team measured their blood pressure and aortic stiffness using cardiovascular magnetic resonance.The researchers calculated the biological age of each individual's aorta using their actual age and the aortic stiffness measurements from three levels of the artery.They then took the same measurements between 1 and 3 weeks after the marathon.An analysis of the average finish times of 27,000 runners suggested that the participants were running between 6 and 13 miles a week in training.Of the participants, the men took an average of 4.5 hours to complete the race while the women took 5.4 hours.When the researchers compared the measurements from before and after the race, they found that both blood pressure and aortic stiffness had reduced in the first-time marathon runners.Notably, the changes in aortic stiffness were equivalent to a 4 year decrease in vascular age.Interestingly, older male runners who were slower and had a higher baseline blood pressure gained the most from the training regimen and race.Never too late to changeSenior author Dr. Charlotte H. Manisty, who works at the Institute of Cardiovascular Science at University College London and Barts Heart Centre in London, United Kingdom, comments on the findings:"Our study shows it is possible to reverse the consequences of aging on our blood vessels with real-world exercise in just 6 months." Dr. Charlotte H. Manisty"These benefits were observed in overall healthy individuals across a broad age range," she adds, "and their marathon times are suggestive of achievable exercise training in novice participants."People with greater arterial stiffness and hypertension may benefit even more from this form of exercise, although future studies would need to test this theory.However, it is not possible to conclude that exercise alone produced the above effects.The more healthful lifestyle choices that often accompany marathon training, such as a better diet and sleeping pattern, may have had a part to play.It is also possible that some participants adopted a different training regimen to the recommended plan, meaning that further research will need to take a standardized approach.Nevertheless, the findings highlight "the importance of lifestyle modifications to slow the risks associated with aging, especially as it appears to never be too late as evidenced by our older, slower runners," Dr. Manisty states.
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Stroke: Smoking both traditional and e-cigarettes may raise risk

A team at George Mason University, Fairfax, VA, has uncovered another electronic cigarette health concern. This time, it relates to stroke risk.

young adult smoking e-cigShare on PinterestYoung adults who use e-cigarettes may put themselves at stroke risk.

In recent years, the popularity of e-cigarettes has soared.

A 2016 study found that 10.8 million adults in the United States were current e-cigarette users. It is common for people to switch from traditional cigarettes to the e-variety because they think they are a healthier option.

But newly issued health warnings have pointed to the potential risks of smoking e-cigarettes. In June 2019, the U.S. saw an outbreak of lung injuries associated with e-cigarettes.

Experts believe that vitamin E acetate — an ingredient found in some e-cigarettes containing THC — may be the link.

In December 2019, the Centers for Disease Control and Prevention (CDC) reported that more than 2,500 individuals from the U.S., Puerto Rico, and the U.S. Virgin Islands were hospitalized or died as a result of using vapes, e-cigarettes, or associated products.Recent studies, albeit small-scale, have found both benefits and risks to e-cigarettes.One study that appears in PNAS found that nicotine from e-cigarette smoke caused lung cancer in mice as well as precancerous growth in the bladder.However, a second study, appearing in the Journal of the American College of Cardiology, noted a significant improvement in vascular health within a month of a traditional smoker switching to e-cigarettes.A trend among the youngDespite their nicotine content, the variety of e-cigarette flavors available has led to the products becoming a trend among young adults. There is also a concern this habit could lead to conventional cigarette smoking.Equally worrying findings have come from a new study that appears in the American Journal of Preventive Medicine. The study found that young adults smoking both traditional and e-cigarettes face a significantly higher risk of stroke.Using data from the 2016-17 Behavior Risk Factor Surveillance System (BRFSS), the study examined smoking-related responses from a total of 161,529 people aged between 18 and 44.Just over half of the respondents were female, with 50.6% identifying as white and just under a quarter identifying as Hispanic.The team calculated the adjusted odds ratios for strokes among those who currently smoked, former smokers who now used e-cigarettes, and people who used both."It's long been known that smoking cigarettes is among the most significant risk factors for stroke," says lead investigator Tarang Parekh from George Mason University."Our study shows that young smokers who also use e-cigarettes put themselves at an even greater risk."Tarang ParekhAn important message and a 'wake-up call'The study identified that young adults who smoked both traditional and e-cigarettes were almost twice as likely to have a stroke compared with conventional cigarette smokers.This risk rose to almost three times as likely when compared with non-smokers. Results also showed there was no clear advantage to switching from traditional cigarettes to e-cigarettes.However, people using e-cigarettes who had never smoked before did not display an increased stroke risk. This may be down to factors including young age and normal heart health.This study relied on self-reported data, which is a limitation. However, the findings prove the need for large-scale, long-term studies to confirm which detrimental health effects e-cigarettes are causing and which ingredients are responsible."This is an important message for young smokers who perceive e-cigarettes as less harmful and consider them a safer alternative," Parekh states.According to Parekh, the results are "a wake-up call" for policymakers to urgently regulate e-cigarette products "to avoid economic and population health consequences.""We have begun understanding the health impact of e-cigarettes and concomitant cigarette smoking, and it's not good."Tarang Parekh
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Cardiomyopathy: What to know

Cardiomyopathy is a disease that involves a weakened heart muscle. The condition makes it difficult for the heart to pump blood throughout the body.

According to the Centers for Disease Control and Prevention (CDC), cardiomyopathy may occur in as many as 1 in 500 people, but it frequently goes undiagnosed. Cardiomyopathy can develop over time, or a person may have the disease from birth.

Keep reading to learn more about cardiomyopathy, including its symptoms, causes, and treatment.

There are a few types of cardiomyopathy, including the following:Dilateda female runner experiencing shortness of breath because of cardiomyopathyShare on PinterestA person with cardiomyopathy may experience shortness of breath and heart palpitations.

Dilated cardiomyopathy is the most common form of the disease. It typically occurs in adults between the ages of 20 and 60 years.

The disease often starts in the left ventricle, but it can eventually also affect the right ventricle.

Dilated cardiomyopathy can affect the structure and function of the atria, too.

Hypertrophic

Hypertrophic cardiomyopathy is a genetic condition in which abnormal growth of the heart muscle fibers occurs, leading to the thickening or "hypertrophy" of these fibers. The thickening makes the chambers of the heart stiff and affects blood flow. It can also increase the risk of electrical disturbances, called arrhythmias.

According to the Children's Cardiomyopathy Foundation, it is the second most common form of cardiomyopathy in children. In about one-third of affected children, diagnosis occurs before the age of 1 year.

Restrictive

Restrictive cardiomyopathy occurs when the tissues of the ventricles become rigid and cannot fill with blood properly. Eventually, it may lead to heart failure. It is more common in older adults and can result from infiltrative conditions — those involving the accumulation of abnormal substances in bodily tissues — such as amyloidosis.

Arrhythmogenic

In arrhythmogenic cardiomyopathy, fibrotic and fatty tissue replaces the healthy tissues of the right ventricle, which may cause irregular heart rhythms. In some cases, this process can also occur in the left ventricle.

According to research in the journal Circulation Research, arrhythmogenic cardiomyopathy increases the risk of sudden cardiac death, especially in young people and athletes. It is a hereditary genetic condition.

Learn more about some other types of heart disease here.

In some cases, usually mild ones, there are no symptoms of cardiomyopathy.However, as the condition progresses, a person may experience the following symptoms with varying degrees of severity:fatigueshortness of breathswelling of the legs and anklesheart palpitationsdizzinessfaintingThe cause of cardiomyopathy is not always clear, but there are some known risk factors.For example, conditions that lead to inflammation or damage of the heart can increase a person's risk of cardiomyopathy.Heart failure, which can occur as a result of a heart attack or other conditions, can also cause cardiomyopathy.Additional risk factors include:Doctors will carry out a physical exam and diagnostic tests to confirm cardiomyopathy.They are likely to use one or more of the following diagnostic tests:Chest X-ray: A chest X-ray helps determine whether the heart has become enlarged, which is a sign of certain health conditions.Electrocardiogram (EKG): An EKG measures the electrical activity of the heart, including how fast it is beating. It also shows whether the heart rhythm is regular or abnormal.Echocardiogram: An echo uses sound waves to create a moving image of the heart. It shows the shape and size of the heart.Cardiac catheterization: A catheterization checks the flow of blood through the heart's chambers.The intention of cardiomyopathy treatment is to control symptoms, slow the progression of the condition, and prevent sudden cardiac death. The type of treatment may depend on the severity of the symptoms and the form of cardiomyopathy.Usually, treatment includes a combination of the following:Lifestyle changesLifestyle changes can help reduce the severity of conditions that may have led to cardiomyopathy. More healthful lifestyle habits may also slow the progression of the disease.Lifestyle changes may include following a healthful diet, which involves limiting the intake of trans fats, saturated fats, added sugar, and salt.Read about 16 foods for a healthy heart here.Managing stress, quitting smoking, and staying physically active are also beneficial for people with cardiomyopathy.The quantity and intensity of beneficial physical activity may vary. It is essential to discuss exercise programs with a doctor or another healthcare professional before starting one.MedicationsUsually, medications are part of a cardiomyopathy treatment plan. Some types of drugs that doctors may prescribe include:Beta-blockers: Beta-blockers slow the heart rate, meaning that the heart has to work less hard.Blood thinners: Blood thinners help decrease the risk of blood clots developing.Diuretics: Diuretics remove excess fluid from the body. This fluid may accumulate when the heart does not pump efficiently.Blood pressure drugs: Angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and angiotensin receptor-neprilysin inhibitors help lower blood pressure and interrupt the stress receptors that become activated in people with cardiomyopathy.Antiarrhythmics: Antiarrhythmics are medications that prevent abnormal heart rhythms.Implanted devicesTreatment may also include different types of implanted devices. The specific device depends on the symptoms. Implanted devices include:Pacemaker: After its surgical implantation beneath the skin near the chest, a pacemaker delivers electrical impulses to the heart, causing it to beat at a normal rate.Implantable cardioverter-defibrillator: This device also delivers an electric shock to the heart when it detects an abnormal, potentially unstable heart rhythm. The electrical impulse returns the heart rhythm to normal.Left ventricle assist device (LVAD): The LVAD assists the heart in pumping blood throughout the body. When cardiomyopathy has severely weakened the heart, this device is helpful while a person is waiting for a heart transplant.Cardiac resynchronization device: This implanted device helps coordinate the contractions of the left and right ventricles of the heart to improve heart function.SurgeryWhen symptoms are severe, surgery might be an option. Some possible surgical procedures for cardiomyopathy include:Septal myectomyThis surgery treats hypertrophic cardiomyopathy with obstruction of blood flow. It involves removing part of the septum that is protruding into the left ventricle. Removing the thickened tissue improves blood flow out of the heart.Heart transplantPeople with certain forms of cardiomyopathy with advanced heart failure might be eligible for heart transplantation. However, a heart transplant is an extensive process for which not everyone qualifies.Cardiomyopathy is a serious medical condition that requires treatment.Without treatment, the disease may progress and become life threatening.Anyone who has a strong family history of cardiomyopathy or experiences one or more of the symptoms of this disease should see a doctor. An earlier diagnosis may improve a person's outlook.Cardiomyopathy is a disease that involves the weakening of the heart muscle.There are various forms of cardiomyopathy, including dilated cardiomyopathy, which is the most common.Treatment for cardiomyopathy depends on the extent of the symptoms, as well as the form of the disease.Treatment usually consists of lifestyle changes and medications. Additional treatment in more severe cases may include implanted devices or surgery.
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What to know about vasovagal syncope

The term vasovagal syncope describes fainting that occurs in response to a sudden drop in heart rate or blood pressure. The resulting lack of blood and oxygen to the brain is what causes a person to pass out.

Doctors sometimes refer to vasovagal syncope (VVS) as neurocardiogenic syncope or reflex syncope. This condition typically occurs when the body overreacts to a stimulus that induces a state of fear or emotional distress.

Other causes may include severe pain, exhaustion, or sudden changes in body posture. Some people have a predisposition to these episodes due to a health condition that affects blood pressure or the heart.

Although a person may sometimes sustain injuries as a result of passing out, VVS is generally harmless. However, a medical diagnosis is necessary to rule out more serious medical conditions.

In this article, we outline some common symptoms and causes of vasovagal syncope. We also cover the treatment options available and provide tips on how to prevent fainting episodes.

a man looking faint as he is experiencing Vasovagal syncopeShare on PinterestLightheadedness, dizziness, and weakness can be signs that a person will faint.

Some people who experience VVS do not notice any warning signs before fainting. Others may have symptoms such as:

People who experience these symptoms before fainting should lie down somewhere safe. Lying down will help the body maintain adequate blood flow to the brain, which may prevent fainting. It will also minimize the risk of a fall or injury in the event of fainting.

A person who has fainted may feel tired, lightheaded, or nauseated when they come round.

VVS occurs when the nerves that regulate heart rate and blood vessel constriction temporarily lose some of their normal regulation.Malfunctions generally occur when a stimulus, such as fear, or an abrupt change in body posture causes the blood vessels to widen suddenly. This widening leads to a sudden drop in blood pressure and a resulting lack of blood and oxygen to the brain. This lack of oxygen is what causes fainting.People may experience VVS for different reasons. Some common triggers include:fearthe sight of blood or goregetting blood drawnstanding for a long timesudden changes in posturestraining, such as during bowel movementssevere painintense exerciseexposure to heatA person who has experienced VVS may feel tired, weak, and nauseated when they come round. It is important that they rest before getting up and continuing with their day.In some cases, people may need to seek emergency medical attention after a fainting episode. Generally, medical care is only necessary for people who experience the following scenarios and symptoms:fainting while pregnantfalling from a significant heightsustaining a head injury or other severe injuryloss of consciousnesschest pain or difficulty breathingconfusion, slurred speech, or issues with vision or hearinginvoluntary movements of the bodyPeople who have previously experienced VVS should talk to their doctor if they experience any new triggers or symptoms.People should also see a doctor if they experience fainting for the first time. However, it is not always possible to diagnose VVS from a single episode of fainting.Some types of syncope can occur as a result of an underlying medical condition that requires treatment. Examples of such conditions include:Typically, doctors will begin a diagnosis of VVS with a review of the person's medical history and any other symptoms. They will also conduct a physical examination. As part of this examination, the doctor will take blood pressure readings while the person is standing, sitting, and lying down.A doctor may also attempt to rule out alternative causes of fainting using one or more tests. Examples of such tests include:Electrocardiogram (EKG), which measures electrical activity in the heart.Echocardiogram, which assesses heart motion and blood flow through the heart.Exercise stress test to evaluate heart function in response to exercise.Tilt-table test, in which the doctor will secure a person to a padded table that tilts at different angles. Various monitors detect and record heart activity, blood pressure, and oxygen levels while the table positions the person at different angles.VVS does not typically require treatment. However, a person may sometimes be slow to regain consciousness after an episode of fainting. A bystander can intervene by laying the person on their back and raising their legs in the air. Doing this may help restore blood flow to the brain, thereby helping the person regain consciousness.According to a 2016 review, there are limited treatment options for people with VVS. Doctors advise people with this condition to avoid known fainting triggers and take precautions to prevent injury when signs of imminent fainting begin.Medications are not usually necessary for VVS. However, in some circumstances, the following medications may be effective in reducing the frequency of VVS episodes:Alpha-1 adrenergic agonists: These drugs help raise blood pressure.Fludrocortisone: A type of corticosteroid that can help maintain blood pressure by increasing sodium and fluid levels in the body.Selective serotonin reuptake inhibitors (SSRIs): Antidepressant medications that may help moderate the nervous system response.However, further studies are necessary to determine the effectiveness of these and other medical treatments for VVS.VVS is not always completely preventable. However, a person may be able to reduce the number of fainting episodes that they experience.A person's doctor may provide the following recommendations for preventing VVS and the associated complications:identifying and avoiding situations that trigger fainting episodesengaging in moderate exercisedrinking plenty of fluids to maintain blood volumeconsuming a diet that is higher in saltwearing compression stockingsdiscontinuing medications that lower blood pressureimmediately sitting or lying down when feeling faintAs with prescription medications, these preventive lifestyle approaches may work for some people and not others. Various factors, such as the person's blood pressure and heart function, may determine the effectiveness of these approaches.Vasovagal syncope refers to fainting that occurs in response to a sudden drop in heart rate or blood pressure.Vasovagal syncope is usually not dangerous. However, people should seek medical attention if they faint when pregnant, experience additional symptoms, or fall and injure themselves when fainting. People should also see a doctor if they are unsure of the cause of fainting.There are no standard treatments for vasovagal syncope. Instead, treatment generally involves making certain dietary and lifestyle changes, as well as avoiding potential triggers of fainting.
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