ASK THE DOCTOR: Heart to Heart
The heart is a muscle. It has four houses, called chambers — which in Greek or Latin refers to something with an arch over it, and in French refers to a private room.
In these rooms, we supposedly keep our innermost secrets. Each chamber has a door, called valves, which on their best behavior neatly open and close to let blood in and out. The two rooms on the right receive blood that needs more oxygen, and thus send the blood over to the lungs for recharging. The two left rooms then take that oxygenated blood and send it forcefully out to all of our vital organs, including the heart, which gets the oxygen-rich blood through pipes called coronary arteries.
The chambers’ reliable electrical system keeps the heart muscle moving, creating 2-3 billion heartbeats in an average human lifespan. It’s no wonder the heart has become the stuff of poetry, philosophy, religion and the place we often first feel things — palpitations of love, fear and excitement.
Some people are born with the house already needing repairs, for which we have amazing pediatric cardiac surgeons. Others have the bad luck of breakdowns later in life, and cardiologists serve as expert plumbers and electricians, sometimes literally holding a life in their hands.
My father had his first heart attack at 42, a genetic gift he shared with many of his brothers. Surgeons installed balloons to pop open arteries and, later, bypass grafts, where pipes from other parts of the body are recruited to bring the good blood to an oxygen-thirsty heart. He received one of the first stents at Mayo Clinic by the larger-than-life Dr. David R. Holmes, who was one of my inspirations to become a doctor. Ultimately, my father received a new heart altogether. He was still himself with a new heart, though perhaps slightly more tender in the knowledge of where that gift came from and someone else’s grief behind it.
We love cardiologists and surgeons, but it is best to avoid needing their care in the first place, if possible. A Google search will give you all sorts of advice on heart health, some maybe good, a lot questionable and some just goofy. We know our life choices can affect our health and particularly the heart, but it is not only that. Genetics, gender, age, environment and life stressors impact our heart health as well.
These things we cannot control, so let’s focus on what we can. If you smoke and stop smoking right now, you’ve done more to protect your heart than anything a doctor can ever do for you. Another low-hanging fruit is exercise. If you are starting from the couch, just try walking for 30 minutes a day, increasing in whatever increments you can manage. Over the years, scientists have tried to name the holy grail amount of exercise for best heart health. I would say some is better than none, and if you can work up to an hour a day where you are a little out of breath, still able to chat with your friend but not in compound sentences, you are a champion. If you can’t walk, seated exercise or pool exercise is great.
Diet earns its own paragraph. This is another realm that has seen multiple fads over the years. Those with established coronary artery disease (blocked pipes in the house of the heart) would benefit from close attention to what they allow in their body. Though I grew up in the Midwest in the 1970s and ’80s, we had a low-fat, low-processed diet, made by my mother, an RN, to try to keep my father around a bit longer. If you don’t have heart disease, close attention to diet can reduce your risk of getting it. The author Michael Pollan wrote in “In Defense of Food: An Eater’s Manifesto” that people should “eat food, not too much, mostly plants.”
Instead of over-thinking or buying too much into any one diet, the idea is to first identify what is “food.” If it has a label, it might not be the best for you, but if the label is filled with incomprehensible words that your great-grandma would not recognize as edible, try to put it back on its shelf. Pollan points out that good nutrition exists on the periphery of supermarket aisles. The over-processed stuff that can harm our health tends to reside in the middle aisles.
Other factors partly in our control include blood pressure and cholesterol. If your doctor has checked your cholesterol, they will likely plug the numbers into a 10-year cardiovascular risk calculation that includes your blood pressure, to decide whether a medicine to lower cholesterol might be of benefit. Many people will need at least one medicine for ideal blood pressure control (below 120 over 80). Use of medicine and which ones are best for you is a shared decision with your doctor. But we know that lower blood pressure over time significantly reduces your risk of heart attack, heart failure and strokes.
Blood sugar level similarly affects cardiovascular risk, which is one reason why we recommend controlling diabetes, another common diagnosis. When you are aiming for a good average blood sugar over time (A1C), it is in service to your heart house, up there in your chest, keeping you alive.
We put our hands on our heart when we show respect, when we feel emotional, when we want to say thank you for kindnesses. I invite you to put your hand to your heart now, which for most of us is up in the left chest (dextrocardia — being right-hearted — is a thing I’ve seen a few times in my career!), and pledge that you will take care of it, thank it for being so consistent in its hard work, and give yourself some grace. Being human, some days we don’t help our hearts to thrive, but just keep trying, one beat at a time.
Dr. Jennifer Heidmann is medical director and primary care provider at Redwood Coast PACE (707-443-9747). This column should not be taken as medical advice.
Ask your medical provider if you have health questions. Send comments to SN@humsenior.org.
