Guide to living a better, more comfortable life



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Do

    • Warm-up with easy stretching exercises before beginning your workout.


    • Start at low levels of exercise and progress slowly to longer routines.

    • Pick a spot to exercise where you can stretch and be comfortable.

    • Do exercise you enjoy or can learn to enjoy.

    • Join an exercise class with people you like.

    • Vary your workout to avoid overworking the same muscles and joints.

    • Walk, swim, or bike when the weather permits.

    • Consult your doctor first about the advisability of jogging.

    • Use exercise as a way to control stress. When you are anxious or upset, take a “break” and exercise!



Don’t


    • Exercise if it causes chest pain, dizziness or lightheadedness.

    • Exercise shortly after eating.

    • Exercise when it’s too hot or humid or when you don’t feel well.

    • Exercise if it requires you to hold your breath, grunt, or bear down (for example, lifting heavy weights or doing “chin-ups” on a bar if you aren’t used to it).

    • Engage in exercises that demand sudden bursts of energy or in contact or competitive sports unless specifically approved by your doctor.



  • I’m really worried!


What should I do?

It is not uncommon to be upset, depressed and even angry about your symptoms or illness (if one is found). But remember, there are many many individuals with similar problems and a negative or defeated outlook never helps. Try not to let the problem “get you down.” The importance of your attitude cannot be underestimated - it often determines how you feel. Worrying just wastes teime and it doesn’t make you feel any better. Channeling “worry energy” into better ways to accomplish daily activities and responsibilities will be more productive as well as satisfying. It will ease some of the emotional stress. Some things that you can do to reduce your emotional stress include:



    • Sharing your fears and worries with your family, loved ones and close friends. This truly helps to share the “burden.”

    • Learn the ways to control your symptoms from your doctor and follow through on them (diet changes, exercise program, rest, medications).

    • As about any self-help groups available at many medical centers.

    • Consider counseling if you just can’t seem to go beyond a certain point and your troubled.

Most patients with irregular heart rhythms are not limited from activities at work or play. Certainly however, fears of physical limitations, “fear of what’s next” and other anxieties are present and need to be recognized. Realize that financial worries including concern about medical costs and earning a living are common to all of us when we become ill. Fears about limitations of physical activity and dependence on others also are common and should be openly discussed in order to make them more manageable.


Even if you have been told that you have a serious arrhythmia problem, it is important to recognize that you can deal with it better if you learn as much as possible. Talk to your doctor or nurse about any specific problems you may have and learn as much as possible about staying healthy and enjoying life.


Diet, caffeine, alcohol and nicotine

  • Habits “dear to your heart” may be harming your heart

Almost any abnormal heart rhythms are less troublesome and serious in the presence of an otherwise healthy heart. It is therefore extremely important that we try to keep our heart healthy in every way possible. Here are some suggestions with regard to diet, caffeine, alcohol and nicotine.


Diet:

Healthy eating can protect your heart (and other vital organs) by protecting the arteries from the early build-up of plaque and hardening and by keeping the correct balance of essential nutrients. Reducing your intake of fat (especially saturated fat) and cholesterol will help reduce the calories you take in as well as provide a lower risk of developing heart disease.

Overeating and being overweight are major contributors to heart disese today. Overweight individuals are more likely to have high blood pressure, high blood cholesterol and other fats (triglycerides), heart disease, stroke and diabetes. Weight reduction can result in significant improvements in the way you feel. If you are overweight and are trying to lose weight, here are some helpful hints to consider:

(Remember any weight loss program should be reviewed with your physician to be sure its safe and right for you!)



    • Start with a realistic plan. Your doctor may recommend a dietician or nutritionist who will work with you to tailor a well-balanced meal plan that suits your taste.

    • Eat smaller meals more often, including varieties of vegetables, fruits and grains.

    • Keep portion sizes down.

    • Eliminate high caloric snacks. These include candies, soft drinks high in sugar content and potato chips etc. high in saturated fats.

    • Always avoid excess alcohol. It’s best to check with your doctor regarding any amount.

    • Reduce fats in your diet. They are not only high in calories but also increase blood cholesterol.

    • Substitute fish and poultry (without the skin) for red meats.

    • Broil, poach or bake- don’t fry (especially in saturated fats).

    • Substitute reduced calorie mayonnaise and salad dressings, use low fat cottage cheese or yogurt rather than heavy creams.

The first hurdle is the hardest, but after losing a little weight you’ll feel better about yourself and your health. The more you lose, the closer you get to your ideal weight, the more you’ll benefit- especially if you have high blood pressure, cholesterol or sugar, since these will almost always show improvement.

The patient with abnormal heart rhythms may be more sensitive to certain dietary changes and it is well known that some diets are particular problems. It is clear that some diets (especially the severe “Fad” diets called “liquid protein diets) have produced dangerous imbalances in the body’s minerals (especially potassium and magnesium). This has resulted in dangerous new abnormal heart rhythms in some individuals with catastrophic results. To avoid any mishaps, before embarking on a new diet, ask your physician if its appropriate for you.

Caffeine

Caffeine is a mild stimulant. It makes breathing more rapid, our heart beat faster and stronger and our nervous system react more quickly. We become more alert and responsive. There is often a slight rise in blood pressure.


It should come as no surprise, then, that caffeine is a common cause of palpitations. In addition to making the heart speed up (sinus tachycardia), it can trigger so-called “extra-beats” or “premature beats” from the top and bottom chambers of the heart.
A common story…

Consider the busy secretary who has easy access to coffee at the office and begins to get even busier from time to time missing lunch and having an extra cup of coffee in its place or hoping that an extra cup of coffee will provide the “pick-me-up” necessary to get through a long and “boring” afternoon. The increased caffeine may result in palpitations along with bothersome side effects (see below). When this occurs the best advice is to gradually but steadily reduce and eliminate the sources of caffeine. To stop abruptly is not recommended because symptoms of caffeine-withdrawal may appear (anxiety, headache, dizziness, irritability, nausea, stuffy nose).




  • Side effects of caffeine include:




    • stomach upset (bloating, nausea, diarrhea, discomfort)

    • nervousness, jitters, tremors (shaking), irritability

    • sleeplessness (insomnia)

    • fast or irregular heartbeat (arrhythmia and/or palpitations)

    • headache, ringing in ears, seeing flashes of zig-zag lights

    • dizziness

Because caffeine is so readily available it’s easy to lose track of just how much caffeine we’re getting.



  • Sources of caffeine include:



The best advice is to gradually but steadily reduce and eliminate the sources of caffeine. To stop abruptly is not recommended because symptoms of caffeine-withdrawal may appear (anxiety, headache, dizziness, irritability, nausea, stuffy nose).


Alcohol.



Consider the effects of alcohol on your heart. Alcohol has been shown to stimulate the nervous system and lead to increased blood levels of adrenaline. If excessive or we are sensitive to it, daily alcohol can lead to high blood pressure, heart muscle damage and arrhythmias.
For many people, alcohol causes palpitations. Like caffeine, alcohol makes the heart speed up (sinus tachycardia) and in many of us will trigger so-called “extra beats” or “premature beats” from the top and bottom chambers of the heart.

A common story…

A person has just been to a party for a “big occasion” and clearly has had “more alcohol to drink” than usual. Although he noticed his heart racing he didn’t think of it as abnormal after sitting down for some 20 minutes, “even after resting his heart was still racing.” He also felt tired, a little weak and when he got up quickly he felt lightheaded. His friends brought him to an emergency room where and electrocardiogream (ECG) revealed he had an abrnormal fast rhythm of the heart (tachycardia). In this instance it was from the upper chamber (atrial ) and may have been one of several types.

Generally, the effects of alcohol are temporary. However, alcohol can damage heart muscle in much the same way as a virus does, and in some patients irregular rhythms of the heart can be both serious and permanent. It is prudent from a health stand point to avoid more than two ounces of alcohol a day.

Nicotine.

Consider the effects of smoking on your heart. Nicotine absorbed from inhaled smoke (or chewed tobacco) makes more work for your heart. It causes blood vessels to constrict (become narrower). It increases your heart rate and blood pressure and can stimulate abnormal heart rhythms (arrhythmias). In addition, smoking directly contributes to long-term and irreversible heart, lung and vascular problems, including lung cancer. Tobacco in any form should be avoided.



Medications for the TOP of the heart

  • Digoxin: One of the oldest drugs, and still commonly used today

Digoxine (pronounced “di-jox’in”) is one of the medications most frequently prescribed in the USA for patients over age 65. It is used widely by doctors for two reasons: it slows the rate of some of the common fast abnormal heart rhythms and it can improve the strength of contraction of weakened heart muscles. Digoxin is used almost exclusively for control of abnormal rhythms from the “top” and “middle” of the heart (atrium and AV junction). It works by delaying or blocking some of the many fast electrical impulses from the top of the heart as they go through the middle of the heart.

Digoxin is not generally used if the heart rate is already slow enough. Patients starting on digoxin often monitor their heart rate before each dose in order to avoid slowing the heart rate excessively.

The dose of digoxin depends on your individual needs and is carefully selected by your doctor. Any change in dosage must be reviewed and approved by your physician. Too much digoxin is dangerous, while too little may not provide any benefit. It must be taken exactly as directed because even small changes in daily dose may produce side effects (see below).
Do not skip a dose just because you’re feeling well. Never take more than your doctor orders. If you miss a dose, don’t take it later when you remember it, or double up on the next dose without asking your doctor’s advice. Furthermore, don’t take non-prescription medications without your doctor’s approval, because some of them may interfere with the action of digoxin.
Call your doctor if you have any of these side effects:


    • Loss of appetite

    • Nausea, vomiting, diarrhea

    • Stomach or abdominal pain

    • Weakness, fatigue

    • Unusual tiredness or weakness

    • Changes in pulse rate: slow, irregular or rapid

    • Changes in vision (blurred, blind spots, twinkling, yellow tints or halos around lights)

    • Dizziness, headache, confusion, mental depression, fainting


  • Beta blockers: Drugs that reduce heart excitement

Beta blockers are drugs that interfere with the action of our nervous system on our heart. During physical or emotional stress, increased adrenaline produced by the body causes our heart rate and blood pressure to rise and may at times even produce irregularities in heart rhythm (arrhythmia). Adrenaline (a hormone) does this by stimulating tiny surface structures on the heart cells called receptors, where drugs or hormones “lock in” and cause changes to occur. Drugs that attach to receptors and block adrenaline from acting are called “beta blockers” because the receptors on the heart are known as “beta” receptors (beta is the Greek letter “”).

Beta blockers can be used to slow the heart rate. They slow the natural pacemaker of the heart (SA node) and delay or block some of the electrical impulses as they pass through the middle of the heart (AV junction). Beta blockers may decrease episodes of abnormal rhythms from the top of the heart.
Typical effects of beta blockers


  • A slower heart rate (pulse rate)

  • A lower blood pressure

  • Under emotional or physical stress, a smaller rise in blood pressure and heart rate than would occur without drug treatment


Generic or chemical names of beta blockers available in the US

Timolol

Carteolol

Nadolol

Propranolol



Betaxolol

Penbutolol

Metaprolol

Acebutolol

Atenolol

Pindolol



Common side effects of beta blockers

  • Wheezing or worsened asthma

  • Shortness of breath

  • Slow heart rate (fatigue, weakness)

  • Low blood pressure (lightheadedness, fainting)

  • Cold hands and feet

  • Depression

  • Abdominal discomfort, nausea, diarrhea or constipation

  • Impotence



  • Calcium channel blockers: *Helping to slow the abnormally fast heart

Only two of the many calcium channel blockers available today have actions that are used to treat abnormal rhythms of the heart: verapamil and diltiazem.

These drugs can slow the heart rate by slowing the natural pacemaker (SA node) and delay or block some of the electrical impulses as they pass through the middle of the heart (AV junction). They may decrease episodes of abnormal rhythms from the top of the heart and can keep the heart rate slower and more controlled even when irregular rhythms cannot be totally eliminated.

Combinations of digoxin, beta blockers and calcium channel blockers may be prescribed by your doctor, usually to get better control of difficult arrhythmias. If this occurs, it is important to follow instructions carefully, since a change in one medication will affect the action of another.
Common side effects of verapamil and diltiazem


  • Slow heart rate (fatigue, weakness)

  • Low blood pressure (lightheadedness, fainting)

  • Constipation or abdominal discomfort

  • Headache

  • Ankle swelling (edema)

  • Malaise (tiredness)

*Although “calcium” is in the name, these drugs do not interfere with calcium supplements taken at usual doses and have no effect on calcium in bone. These drugs affect only the small amounts of free calcium that pass into and out of cells-primarily those of the heart and blood vessels.





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