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Journey To Recovery & Wellness Heart & Vascular Center

Understanding Your Heart and Common Heart Conditions Heart & Vascular Center

Heart Anatomy Aorta

Right Atrium

Pulmonary Artery

Left Atrium

Left Ventricle

Right Ventricle


Coronary Arteries

Understanding Your Heart and Common Heart Conditions


n this section, you will learn how the heart works and the important role played by the coronary arteries, valves and electrical system of the heart. You also will receive some basic information about irregular heartbeats, coronary artery disease, angina (chest pain) and heart attacks.

How the Heart Works The heart is a muscle about the size of an adult male fist. Its job is to pump blood to all parts of the body. The heart is made up of four chambers that hold and pump blood. The top two chambers are the right atrium and left atrium. The atria collect blood returning to the heart from the veins. The atria then release the blood into the bottom chambers through valves. Heart valves act as one-way doors to separate the chambers and keep the blood moving forward. The bottom two chambers are called the right ventricle and left ventricle. A wall (septum) separates the two right chambers from the two left chambers. Because of this, you may hear your heart described as two pumps, the “right heart” and the “left heart.” When the ventricles contract, they force blood out of the heart to different parts of the body. The heart is surrounded by a tough protective sac called the pericardium.

In an average lifetime, the heart beats more than two and a half billion times. The fist-sized organ beats 100,000 times per day, pumping five or six quarts of blood each minute, or about 2,000 gallons per day.

Valve Conditions There are four heart valves that act as oneway doors to keep blood moving in the right direction through the heart. Valve disease occurs when a valve doesn’t work the way it should. If a valve doesn’t close all the way, blood may leak backward. This is called regurgitation or insufficiency. If a valve doesn’t open all the way, less blood moves through the opening. This is called stenosis. Valve problems cause the heart to work harder to pump the same amount of blood. Fluid may back up in the lungs or body and can cause swelling, shortness of breath and dizziness.

Septal Defects The atrial septum is a wall of tissue that separates the upper chambers of the heart. An atrial septal defect (ASD) is a hole or opening in this wall that fails to close during the body’s development before birth. The ventricular septum divides the two lower chambers (ventricles) of the heart. A ventricular septal defect (VSD) is an opening that can be caused by a birth defect or by an extensive heart attack. If the hole in the septum is large enough to cause problems in pressure between two heart chambers, surgery may be needed. During surgery, the hole is covered by a patch or simply closed by sewing the edges of the opening together. Some holes particularly ASDs, can be closed with a plug that is delivered by a catheter.

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Understanding Your Heart and Common Heart Conditions The Heart’s Electrical System The heart’s pumping action is controlled by an electrical system that sends out impulses, or signals. An electrical signal starts in the right atrium in the sinus node. The sinus node tells the top of the heart (atria) when and how fast to pump. It is the “pacemaker” of the heart. The signal then is sent to the AV node in the middle of the heart. The AV node holds the signal until the bottom chambers of the heart (ventricles) are filled with blood. It then sends the signal to the ventricles and tells them when to pump the blood out to the body.

The Heart’s Electrical Pathway 1. sinus node 2. right atrium 3. left atrium 4. AV node 5. impulses spread through ventricles 6. right ventricle 7. left ventricle



1 2

5 7 6

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Understanding Your Heart and Common Heart Conditions Irregular Heartbeat (Cardiac Arrhythmia) Irregular heartbeat, or cardiac arrhythmia, is a problem with your heart rhythm. The heart may beat too fast or too slowly, or may skip beats. You may feel palpitations: a rapid heart rate, skipped beats, thumping or pounding in your chest. Cardiac arrhythmias may make you feel anxious, nervous, dizzy, faint or short of breath. Cardiac arrhythmias often are controlled with medications. Your doctor may want to do tests, however, to determine other treatments. Premature Ventricular Beats (PVCs) Premature ventricular beats, or PVCs, is a problem where the heart has extra beats. PVCs can occur after a heart attack or may have no known cause. PVCs occur in the ventricles, the lower chambers of the heart, and may feel like skipped beats or extra beats. After a heart attack, PVCs may stop after the heart begins to heal. If the PVCs continue or are causing problems, your doctor may prescribe medication. Ventricular Fibrillation (V-fib) Ventricular fibrillation, or V-fib, is a lifethreatening arrhythmia. It comes on suddenly with chest pressure, shortness of breath and fainting. It also is known as “sudden death,” because it is often fatal. V-fib requires rapid defibrillation or shock treatment within minutes to restore a normal heart rhythm. You may have noticed automatic external defibrillators (AED) in public places. They are used to administer shock treatment. If you are at risk for V-fib, your doctor may recommend an internal cardiac defibrillator (ICD) and/or medication.

Atrial Fibrillation (A-fib) Atrial fibrillation, or A-fib, is a problem with your heart rhythm. Symptoms of A-fib include palpitations, weakness, tiredness, shortness of breath, chest pain or tightness, dizziness or fainting. A-fib is rarely life-threatening. It can occur following a heart attack or heart surgery, with high blood pressure or thyroid problems, or it may have no known cause. A-fib is very common, affecting people of all ages. It can lead to other problems such as stroke or heart failure. However, these problems can be avoided if the condition is managed. A-fib occurs in the upper chambers (atria) of the heart. The cells in the atria send out extra signals, making the atria beat very quickly and unevenly. Sometimes the atria beat so fast that they may quiver instead of contracting. If the atria don’t contract, they can’t move enough blood into the ventricles. Blood that isn’t moving can easily form into clots. These clots can then move to other parts of the body causing serious health problems such as stroke. Your doctor may prescribe tests that will help diagnose your A-fib. These tests may include EKG, echocardiogram or electrophysiology studies (EPS). A-fib often is controlled with medications. The three most common medications that are used to slow down the speed of the heart rate are digoxin, calcium channel blockers and beta blockers. You also may be given medication to prevent clots from forming in the atria. These medications are called anticoagulants. The most common anticoagulant is called Coumadin® (warfarin). When medications don’t work sometimes the abnormal tissue is ablated or destroyed with heat or cold. This can be done with a catheter or doing heart surgery.

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Understanding Your Heart and Common Heart Conditions Coronary Artery Disease

Coronary Arteries The coronary arteries lie on the outside surface of the heart. The right coronary artery (RCA) supplies blood to the right side of the heart. The left coronary artery starts as the left main artery and divides into the left anterior descending (LAD) and circumflex (Cx) arteries. The left coronary artery supplies blood to the left side of the heart. Coronary arteries are about the size of cooked spaghetti. Many smaller branches lead from these main arteries. The heart gets its blood supply from the coronary arteries. Blood is pumped from the left ventricle into the aorta, a large artery coming off of the left ventricle. The aorta supplies blood to the arteries of the heart as well as to the rest of the body. Problems occur if the left ventricle is damaged and cannot pump enough blood to the coronary arteries. If blockages in the coronary arteries prevent blood from flowing smoothly, the heart muscle may not receive enough oxygen and nutrients to pump blood as it should.

The inside of a coronary artery has a smooth lining through which blood easily flows. Coronary artery disease starts when the lining of the coronary artery is damaged. This often is due to a risk factor, such as smoking, hypertension or diabetes. A plaque deposit (a fatty material composed of cholesterol and other abnormal cells) forms between layers of the artery wall. This buildup, called atherosclerosis, causes the arteries to become stiff and slows the flow of blood to the heart muscle. Over time, buildup of stable plaque can clog the artery and cause a partial or total blockage. Another way a coronary artery blockage can occur is when a plaque deposit becomes inflamed and unstable and actually ruptures inside the artery (see figure below). A rupture can narrow the artery even more and can cause a blood clot to form. If the blood clot is large enough, it will cut off blood flow immediately, and severe chest pain or a heart attack will result. If the heart muscle does not receive enough blood and oxygen, it is called ischemia. A symptom of ischemia is chest pain, called angina.

Plaque formation occurs when the lining of the artery becomes damaged and allows abnormal cells and fatty deposits to form between layers of the artery wall. Progression of plaque narrows the channel where blood flows. Plaque deposits can sometimes rupture if they become inflamed or unstable. A rupture can cause a blood clot to form in the narrowed area. A blood clot (thrombus) can block the artery’s flow of blood, causing severe angina and a heart attack.

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Understanding Your Heart and Common Heart Conditions –

Angina Angina is not a disease but is a symptom of heart trouble. It is a pain or discomfort that happens when part of the heart muscle is not getting enough blood. It is usually brief, lasting just a few minutes. You may have pressure, tightness or pain in your chest, arms, shoulder, neck, jaw or upper back, or have stomach indigestion. Angina discomfort often is temporary. It usually occurs during physical activity, after eating a heavy meal, after being outside when the temperature is below 32° F or above 80° F or during emotional situations. When angina occurs: – 1––˜nx–˜\D– 2˜_ÂŁ_Â˜ÂŚ}–\_Â?–_Â?– –Â?_Tk–ŒnÂĄÂ?– heart is not getting enough oxygen. – 1–DÂ?˜} – 1–– M–˜\D–x _k–;nDÂ?–kn˜–Tn– ¤ Œ–_k– one to two minutes, place a nitroglycerin tablet under your tongue and sit down.


1–– M–˜\D–x _k–;nDÂ?–kn˜–Tn– ¤ Œ–_k–NÂŁD– minutes, take another nitroglycerin. 1–– M–˜\D–x _k–Â?˜_bb–;nDÂ?kŠ˜–Tn– ¤ ÂŚ8–2 bb– 911, take another nitroglycerin and one uncoated aspirin. The aspirin acts as a blood thinner.

Ways to avoid angina include: – 1– ˜–Â?f bb8–MÂ?D‚¥Dk˜–fD bÂ?} – 1––£n_;–\D £Œ–DÂĽDÂ?2_Â?D–nÂ?–x\ÂŚÂ?_2 b– activity for one hour after eating. – 1––\D2a–ŒnÂĄÂ?–\D Â?˜–Â? ˜D–;ÂĄÂ?_kT– 2˜_ÂŁ_Â˜ÂŚÂ– and do not exceed 20 beats above resting. – 1––n–kn˜–Â?˜ Œ–nÂĄÂ˜Â–MnÂ?–bnkT–xDÂ?_n;Â?–_k– very hot or very cold temperatures (above 80° F, below 32° F or high humidity). – 1–£n_;–\nÂ˜Â–Â˜ÂĄ(Â?– k;–Â? ÂĄk Â?} – 1– k TD–Â?˜Â?DÂ?Â?} – 1–– aD–ŒnÂĄÂ?–fD;_2 ˜_nkÂ?– Â?– prescribed by your doctor.


Heart Attack

Symptoms may occur with or without activity and do not stop with rest.

Symptoms may occur with or without activity and do not stop with rest.

Chest tightness, pressure, burning - with or without pain - may go to arms or back.

Chest tightness, pressure, burning - with or without pain - may go to arms or back.

Shortness of breath, extreme tiredness, dizziness, nausea, sweating, heartburn.

Shortness of breath, extreme tiredness, dizziness, nausea, sweating, heartburn.

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Understanding Your Heart and Common Heart Conditions WHERE ANGINA DISCOMFORT CAN OCCUR

Heart Attack (Acute Myocardial Infarction) A heart attack occurs when a blood vessel (coronary artery) that feeds the heart becomes blocked and cuts off blood flow to the heart muscle (myocardium). This blockage can occur from either fatty deposits (plaque), a spasm in the blood vessel or a clot. A heart attack damages the heart muscle. The damage may be slight or extensive, depending on which blood vessel was blocked and how long the blood flow was cut off to the muscle. Observance of certain lab results and changes in your EKG over 24

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to 48 hours will diagnose a heart attack. Your doctor may recommend additional lab work and cardiac testing to determine if further treatment is needed. Your doctor also will prescribe medicines to help reduce your heart’s workload, to help the arteries heal and to improve blood flow. Most patients will have a cardiac catheterization to determine which artery is blocked and have added procedures such as angioplasty, a stent placement or possibly surgery. During your hospital stay, your health team will monitor you closely, watching for any complications. If they occur, it is usually within a few days after a heart attack.

Understanding Your Heart and Common Heart Conditions Common complications are: – – –

1– D ˜–\¦˜\f–xn(bDf 1–– D ˜–x¡fx_kT–xn(bDf– or heart failure 1–– kP ff ˜_nk– n– ¤Dbb_kT– the heart (pericarditis)


The heart muscle heals slowly. Scar tissue forms where the heart muscle fibers were damaged and this new tissue may not contract as well as the original tissue. The healthy heart muscle near the scarred area has to work harder and, over time, tiny new blood vessels grow from the nearby arteries to carry blood to and around the damaged muscle. These little “natural bypasses” are called collateral circulation. Before going home, you and your loved ones will receive detailed information about your medications, your cardiac risk factors, your activity progression at home. You will be instructed when to follow up with your doctor and begin the outpatient cardiac rehabilitation program (see “Lifestyle Changes for a Healthier Heart” section).

Managing Your Care at Home

that are easy and enjoyable such as playing games, watching movies, reading and just talking. Most people do not return to work until after they have a follow-up visit with the doctor and start a cardiac rehabilitation program. Use your progressive walking program (see page 8) to guide you with your daily walking and refer to the “Exercising for a Healthier Heart” section in this binder for further guidelines. Remember, this lower level of activity is temporary. It is common for you (and your partner) to feel a wide range of emotions after experiencing a heart attack. Limiting your activities, being out of your normal routine and becoming bored can affect the way you feel. At times, you may find yourself feeling tearful and depressed or you may feel overwhelmed with thankfulness and gratitude. Other common feelings are anger with yourself and those closest to you, discouragement when you don’t think you are improving as fast as you should or just being quietly scared that it will happen again. Express your feelings. Sharing with others can make the road to recovery a lot less bumpy.

The healing process has begun. Going home is a welcoming thought, but fears and concerns can accompany it. This is normal. After all, you were monitored closely for several days at the hospital and now you will be managing on your own. Your goals for the first two weeks are to follow the going home instructions, walk daily as prescribed and relax. Remember, your body is adjusting to a new health condition and to new medications that may make you feel more tired than usual. Sit down, put your feet up and take a nap if you are tired. Listen to your body. This is the time to let others help you. Do activities

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Understanding Your Heart and Common Heart Conditions Returning to sexual activity may be a concern of yours. You may not feel any desire for sexual activity at first, or you may worry it will trigger another heart attack. Actually, your risk for another heart attack during sex is low. Ask your doctor when you can return to sexual activity. In most cases, you can resume when you are able to climb two flights of stairs without chest pain, shortness of breath or an irregular heart rate. Meanwhile, showing affection with hugs, caresses and kisses is a good way to get back in touch with your partner. Having a heart attack is a life-changing event. It is a time to become aware of what risk factors caused the problem and to make appropriate lifestyle changes (see section on

“Lifestyle Changes for a Healthier Heart”). Your doctors and a cardiac rehabilitation program will guide you on this new journey to wellness.

Progressive Walking Program Your nurse educator will explain a walking program to you before you leave the hospital. You should begin your walking program the day after you come home from the hospital. Use the walking schedule below to chart your progress. If you are walking outdoors avoid extreme temperatures and walk on level ground, avoiding hills and grades. Please refer to the section on “Exercising for a Healthier Heart” for more guidelines.


Time 3 to 5 minutes, ________ times a day 6 to 10 minutes, _______ times a day 12 to 15 minutes, ______ times a day 18 to 20 minutes, ______ times a day 25 minutes, once a day 30 minutes, once a day

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Cardiac Testing

Heart & Vascular Center

Cardiac Testing


he following is a list of cardiac tests that your doctor may order while you are in the hospital. During any of these tests, if you feel any unusual symptoms, such as chest pain, dizziness or shortness of breath, let your technician know. After your test is finished, your doctor will review your results with you and decide if any further tests or treatments are needed.

Electrocardiogram (EKG) An electrocardiogram is a test that measures heart rate and rhythm. It also can measure the type of heartbeat that you are having. It can spot possible blockages and show if you are having or have had a heart attack. The test is painless and only takes a few minutes to perform. You will need to relax, lie on your back (if able) and tell the technician if you are having any discomfort. An EKG technician will apply small electrodes (sticky pads) on your chest, legs and arms. You will lie still, and the EKG machine will print a copy of your EKG. No special preparation is needed for this test.

Signal Average EKG This also is an electrocardiogram but may take a little longer for the EKG technician to perform. This test gives more detailed information regarding your heart rate and EKG pattern than a regular EKG. No special preparation is needed for this test.

Holter Monitor (24 or 48 hour) A Holter monitor is a test that can measure heart rate, rhythm and type of heartbeat by recording your heart’s electrical pattern over a period of 24 to 48 hours. This test can help by showing any abnormal rhythms, heart rate or missed beats (palpitations). An EKG technician will apply small electrodes on your chest after cleaning your skin with alcohol pads.

Men may have some chest hair shaved. The electrodes are connected to a small recorder that you carry with you during the test. No special preparation is needed for this test. Do not take a bath or shower while wearing this monitor, as this could harm the test results. You may be given a diary to write down any symptoms that you have while wearing the monitor.

Echocardiogram (Echo) An echocardiogram (echo) uses sound waves to make a moving picture of your heart. This test will help evaluate the blood flow, valve movement and pumping action of your heart. You will lie quietly on a bed and the technician will perform the test. Gel will be applied to your chest, and the technician will gently guide a small probe (looks like a microphone) over your chest to obtain pictures. You may feel slight pressure on your chest as the technician moves the probe. No special preparation is needed for this test.

Treadmill (Stress Test) The treadmill test evaluates what your heart does during activity and if enough oxygen is getting to your heart muscle during exercise. Heart rate, rhythm and blood pressure are monitored during the entire test. EKG electrodes (sticky pads) are placed on your chest, and a blood pressure cuff is wrapped around one of your arms. You will

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Cardiac Testing be asked to walk on a treadmill. As you do, the speed and slope will increase. You will probably walk less than 15 minutes, but the total length of the test may be longer.

Preparation for a stress test: – –

– – –

1––nfD–nM–¦n¡–fD;_2 ˜_nk–f ¦–(D– restricted before your test. 1––n–kn˜–D ˜–Mnn;–n–;_ka–(D£D TD– that contain caffeine, even if they say “caffeine-free.” Caffeine is found in chocolate, tea, coffee and soda. 1––n¡–Mnn;–¤_bb–(D–D˜_2˜D;– before the test. 1–D –˜¡;¦–¤ ba_kT–\nD} 1––_2¡– k¦–2nk2Dk–¤_˜\–˜\D–k¡D– or doctor performing your test.

During and After the Test: –


1–– D˜–¦n¡–;n2˜n–n–k¡D–akn¤–_M–¦n¡– are having chest pain, dizziness or other symptoms. 1––k2D–¦n¡–\ £D–Nk_\D;–¤ ba_kT8– your EKG and blood pressure will be checked for several more minutes while you are resting.

Pharmacological (Drug) Stress Test If you and your doctor have decided that you are unable to walk for a regular treadmill test, you will lie on a bed in the stress lab. You will receive an IV and be given medication. The medication will raise your heart rate, similar to exercise. Your heart rate, rhythm and blood pressure will be monitored throughout the test. It is important to let your doctor or nurse know if you are having any symptoms, such as chest pain, dizziness or shortness of breath.

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You may or may not be able to take all of your medications before the test. There will be food restrictions and no caffeine for 24 hours.

Isotope Stress Test An IV is started in your arm before your treadmill stress test. A chemical called an isotope (radioactive substance) will be put in the IV during the test. The isotope sticks to your blood cells and will help show images of your heart and how much blood gets into your heart muscle. At the end of your stress test, you will be taken to the Nuclear Medicine department to scan pictures of your heart muscle. You will lie quietly on a stretcher, with a camera overhead. You may be scanned twice with this procedure, in the same day or two days in a row. If a shadow is seen on your heart muscle picture, it means no blood went to that part of the muscle. The scan will give your doctor additional information concerning your heart. You may not be able to take all of your medications before the test. There will be food restrictions and no caffeine for 24 hours.

Stress Echocardiogram (Stress Echo) This test combines a stress test procedure and an echocardiogram. An echo is performed before and after your stress test. An echo test uses sound waves that show your heart’s activity at rest and after exercise. In addition to the stress test, this will help your doctor see if there are any changes in your heart muscle after exercise. Your doctor will decide if your heart is getting enough oxygen and if the heart valves are working properly.

Cardiac Testing You will have some restrictions with medications, food and caffeine before this test.



Dobutamine Stress Echo This test combines a pharmacological (drug) stress test and an echocardiogram. The medication will cause your heart muscle to pump faster, similar to exercise. If you and your doctor have decided that you are unable to walk for a regular treadmill test, you will lie on a bed in the stress lab. You will receive an IV and be given medication. An echo test is performed before the IV is started, as well as after the medication is given. This will help your doctor see if there are any changes in your heart muscle and if your heart is getting enough oxygen. You will have some restrictions with medications, food and caffeine before this test.

Transesophageal Echo (TEE) This test is a more detailed echocardiogram. You will have an IV started and lie in a hospital bed. Your throat is sprayed and will be numb. A mild sedative is given and you may sleep through this test. Your doctor will gently put a small, flexible, lubricated tube into your mouth and down your esophagus (swallowing pipe). You’ll be able to breathe normally. The end of this tube has a small probe that can provide echo images. The tube can be moved around slightly to see your heart at different angles. You should feel little or no discomfort with this procedure. Your heart rate, blood pressure and breathing will be monitored during this test.

Preparation for a TEE: –

1––n–kn˜–D ˜–n–;_ka– M˜D–f_;k_T\˜–˜\D– night before the test.




1––n¡–f ¦–˜ aD–¦n¡–DT¡b –fD;_2_kD– with a small amount of water (1/4 cup or less) before the test. 1–– M–¦n¡–\ £D–;Dk˜¡D8–˜\D¦– D–Dfn£D;– before the test is started. The nurse will help you with them after you are awake. 1–– M–¦n¡–\ £D–bDDx– xkD –xbD D–(_kT– CPAP machine tubing and mask. Please put your name on the CPAP machine. 1––n¡–¤_bb–kn˜–(D– bbn¤D;–˜n–D ˜–n–;_ka– until the medicine used to numb your throat wears off. This usually takes 30 to 60 minutes. 1––n¡–may not drive yourself home after your test. Before coming for your test, arrange for someone to take you home afterwards.

Tilt Table The tilt table test checks if changes in your body position affect your blood pressure. This test often is given to people who have fainted and may bring back fainting symptoms. – 1––n¡– \D ˜–  ˜D– k;– (bnn;– xD¡D– D– monitored for any changes. An IV will be started, and you may receive additional medication during the test. – 1––n¡– D–xb 2D;–nk– –˜ (bD–˜\ ˜–_–bn¤b¦– tilted upward, and you will be upright for part of the test. You are held securely in place by large, seatbelt-like straps on the table. – 1––n¡–¤_bb–\ £D–Mnn;8–2 MMD_kD– k;–xn_(b¦– medication restrictions before this test.

Cardiac Catheterization A cardiac catheterization (coronary angiogram) is a special test done by a cardiologist to show if the arteries that feed your heart f¡2bD– \ £D– k¦– (bn2a TD}– zDD– ‡k;Dstanding Your Heart” for a description of Heart & Vascular Center 3

Cardiac Testing coronary arteries.) A soft, hollow tube is threaded up to the heart through an artery in your leg or arm. The catheter carries dye that is released in a coronary artery so X-ray pictures Stents can be taken to reveal areas that are clogged or narrowed. The doctor can see, on an X-ray screen, the exact spot where the artery is blocked.


The doctor also will be able to measure:


– –



1–xÂ?DÂ?Â?ÂĄÂ?DÂ?–_kÂ?_;D–˜\D–\D Â?˜} 1––\n¤–¤Dbb–˜\D–£ bÂŁDÂ?–nM–ŒnÂĄÂ?–\D Â?˜– Â?D– working. 1––\n¤–¤Dbb–˜\D–fÂĄÂ?2bD–nM–ŒnÂĄÂ?–\D Â?˜– contracts and pumps. This is called an ejection fraction. A normal ejection fraction is 50 percent to 70 percent.

During your procedure, you will: –




Before your cardiac catheterization procedure, you will: – – – – – –

1––kDD;–˜n–kn˜_MŒ–ŒnÂĄÂ?–x\ÂŚÂ?_2_ k–nÂ?–kÂĄÂ?Â?D– _M–Œn¥– Â?D– bbDÂ?T_2–˜n–Â?\DbbNÂ?\–nÂ?–_n;_kD} 1––kn˜–D ˜–nÂ?–;Â?_ka– kÂŚÂ˜\_kT– M˜DÂ?–f_;– night, except for your medications with a small sip of water. 1––DfxÂ˜ÂŚÂ–ÂŚnÂĄÂ?–(b ;;DÂ?–(DMnÂ?D–Œn¥–bD ÂŁD– your room or holding area. 1––(D– Â?aD;–˜n–Â?_Tk– –2nkÂ?Dk˜–MnÂ?f–˜\ ˜– lets us know that you understand the xÂ?n2D;ÂĄÂ?D– k;–˜\D–Â?_Â?aÂ?– k;–(DkDN˜Â?} 1––\ ÂŁD–(bnn;–¤nÂ?a–;Â? ¤k– k;–ŒnÂĄÂ?– medical history checked by the staff admitting you. 1––(D–T_ÂŁDk– k– Â?x_Â?_k–_M–Œn¥–\ ÂŁD–kn˜– already taken one.

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1––(D–˜ aDk–˜n–˜\D–xÂ?n2D;ÂĄÂ?D–Â?nnf8–¤\DÂ?D– two to three staff members will be working for you.

– –

1––(D–xb 2D;–nk– –\D Â?˜–fnk_˜nÂ?8–\ ÂŁD– – 2b_x–xb 2D;–nk–ŒnÂĄÂ?–NkTDÂ?–nÂ?–˜nD–˜n–Â?D ;– the level of oxygen in your blood and a blood pressure cuff placed on your arm that will inate automatically. 1––\ ÂŁD–˜\D–\ _Â?–Â?\ ÂŁD;– ˜–˜\D– Â?D –¤\DÂ?D– the doctor will be working. This area could be the groin or arm. The groin is the most common site. 1––\ ÂŁD–˜\_Â?– Â?D –2bD kD;–¤_˜\– –Â?xD2_ b– soap and covered with a sterile sheet. 1––(D– Â?aD;–˜n–aDDx–ŒnÂĄÂ?– Â?fÂ?–¥k;DÂ?–˜\D– sheet and not to bend or move your legs. 1––(D–T_ÂŁDk–fD;_2_kD–˜\Â?nÂĄT\–ŒnÂĄÂ?– –˜n– help you relax. You may become very sleepy. 1––(D–T_ÂŁDk– –bn2 b– kDÂ?˜\D˜_2–zkÂĄf(_kT– medicine) by the doctor to numb the area where he or she will be putting 2 ˜\D˜DÂ?Â?–_k˜n–˜\D– Â?˜DÂ?ÂŚ}–k2D–˜\D– medicine takes effect, you should not feel any pain. You may feel dull pressure where the doctor is working with the catheters. The doctor will inject dye into the coronary arteries, once the catheters are in place. The doctor will be able to see any blockages on the X-ray screen. 1––MDDb–¤ Â?f– bb–nÂŁDÂ?–MÂ?nf–˜\D–;ÂŚD}–\_Â?– feeling will only last for 10 seconds. 1––kn˜–MDDb–˜\D–2 ˜\D˜DÂ?–(D2 ÂĄÂ?D–Œn¥–;n– not have nerve endings in the coronary arteries.

If your coronary arteries are normal, you will not need further treatment. If blockages are found, your doctor may recommend that

Cardiac Testing you have an angioplasty or a stent procedure to open the blockages. These procedures often can be performed at the time of the angiogram. The doctor also may recommend coronary artery bypass surgery and/or medical treatment for blockages found.

– –

After your cardiac catheterization procedure, you will: – – – –

– –

1–(D–fn£D;–˜n– –D2n£D¦– D } 1––(D–xb 2D;–nk– –\D ˜–fnk_˜n8– ¡˜nf ˜_2– blood pressure cuff and oxygen monitor z –NkTD–2b_x{} 1–(D– aD;–˜n–Dfx˜¦–¦n¡–(b ;;D} 1––\ £D–˜\D–2 ˜\D˜D–Dfn£D;–Mnf–˜\D– ˜D¦– k;–\ £D–Nf–xD¡D– xxb_D;– for 10 to 20 minutes. This is to prevent bleeding. 1––\ £D–¦n¡–(bnn;–xD¡D– k;–x¡bD–_k– your feet checked by a nurse every 15 f_k¡˜D–Mn–˜\D–N˜–\n¡} 1––\ £D– –( k; TD– xxb_D;–˜n–˜\D–_kD˜_nk– site. You may have a closure device at the site where the doctor did the procedure if the artery is big enough

– – – – – –

and the doctor thinks it is appropriate. You will be given written information on this. 1––kDD;–˜n–˜Dbb–˜\D–˜ MM–_T\˜– ¤ ¦–_M–¦n¡– feel a warm, wet feeling at the catheter site; you could be bleeding. 1––(D–nk–(D;–D˜–Mn–Mn¡–˜n–_¥–\n¡}– M– – closure device is used, bed rest will be only one to two hours. 1––kDD;–˜n–;_ka– –bn˜–nM–P¡_;–˜n–\Dbx– flush the dye out of your body. 1––kDD;–˜n–x¡˜–¦n¡–\ k;–n£D–˜\D–( k; TD– k;–xD–Nfb¦–_M–¦n¡–kDD;–˜n–2n¡T\–n– sneeze. 1––xn_(b¦–\ £D– –(¡_D– ˜–˜\D–_˜D’–˜\_–_– normal. 1––xn_(b¦–MDDb– –b¡fx– ˜–˜\D–_˜D}– M–˜\D– lump is walnut size or bigger, let the nurse know. 1–\ £D–x _k–fD;_2_kD– £ _b (bD} 1––Tn–( 2a–˜n–¦n¡–nnf}–˜–˜\D–˜_fD– of discharge, you will be given instructions for what to do when you go home: eating, activities, care of the catheter site, medications, etc.

Heart & Vascular Center 5

Cardiac Testing NOTES

6 Heart & Vascular Center

Lifestyle Changes for a Healthier Heart

Heart & Vascular Center

Lifestyle Changes for a Healthier Heart


ou cannot change your genetics, but you can make lifestyle choices that will help your heart to be stronger and healthier. The following pages will help you to evaluate your controllable risk factors and to take steps to reduce those risk factors in your life. You also will learn about our Cardiac Rehabilitation program, which is designed to put you back on the path to recovery and wellness.

Risk Factor Assessment Risk factors are those things that helped create your heart disease. You cannot change risk factors such as age, sex, heredity and race. There are risk factors that you can change, however. Making changes to reduce these risk factors can help keep your heart problem from getting worse. Complete this assessment with your nurse or doctor.

1. Are you currently a smoker?



2. Is your LDL greater than 100, HDL less than 40 or triglycerides over 150?



3. Have you ever been told you had high blood pressure?



4. Do you exercise more than 30 minutes a day, three times a week?



5. Do you have diabetes or metabolic syndrome?



packs per day x Total LDL


Triglycerides HDL

Frequency Type Does it make you sweat?

Family member(s) 6. Do you have a family history of heart disease, age 55 or younger?



7. Are you overweight?



8. How would you rank your daily stress level? 9. Do you drink alcohol?



10. Do you have chronic depression?



Weight Height Body Mass Index (see chart on page 7) Low 1 2 3 4

High 5

How many drinks per day?

The more times you answered “yes,� the higher your risk for heart disease.

Heart & Vascular Center 1

Lifestyle Changes for a Healthier Heart Reducing Risk Factors


Take charge of controllable risk factors: – 1–˜nx–˜n( 22n–¥Â?D} – 1–D;ÂĄ2D–\_T\–2\nbDÂ?˜DÂ?nb} – 1–nk˜Â?nb–\_T\–(bnn;–xÂ?DÂ?Â?ÂĄÂ?D} – 1–– k TD–;_ (D˜DÂ?– k;–fD˜ (nb_2– syndrome. – 1– nÂ?D–DÂĽ2DÂ?Â?–¤D_T\˜} – 1–ÂĽDÂ?2_Â?D} – 1– k TD–Â?˜Â?DÂ?Â?} – 1– _f_˜– b2n\nb–_k˜ aD}

Stop Tobacco Use Tobacco use is the number one preventable risk factor for heart disease. This includes cigarette, cigar and pipe smoking, snuff and chewing tobacco. Quitting is the best thing you can do for the health of your arteries. fna_kT–2 k–2 ÂĄÂ?D–˜\D–\D Â?˜–˜n–¤nÂ?a–\ Â?;DÂ?– to supply oxygen to your body. It also increases your heart rate and blood pressure. The harmful effects of tobacco use include: – 1––(Â?D a_kT–;n¤k–˜\D–b_k_kT–nM–˜\D– coronary arteries. Once an artery b_k_kT–_Â?–; f TD;8–2\nbDÂ?˜DÂ?nb–z  {– and other substances stick like glue to the artery wall and cause blockage. – 1––Â?x Â?fÂ?– k;–2nk˜Â? 2˜_nkÂ?–_k–˜\D– Â?˜DÂ?ÂŚ8– which cut off the blood supply to the heart muscle. Nicotine, a drug found in tobacco, causes blood clots to form. – 1––_k\ b_kT–2 Â?(nk–fnknÂĽ_;D8– –xn_Â?nk– created by smoke. This takes the place of oxygen in the blood, which decreases the amount of oxygen reaching the heart muscle.

– –

– – –

Tips for Quitting –

1–– aD– –NÂ?f–;D2_Â?_nk–˜n–‚¥_˜– k;– ;D2_;D–nk– –; ˜D–Œn¥–¤_bb–‚¥_˜}

2 Heart & Vascular Center

1––nkÂ?_;DÂ?–˜\D–;_MMDÂ?Dk˜–2DÂ?Â? ˜_nk– _;Â?– ÂŁ _b (bD7–q{–k_2n˜_kD–Â?Dxb 2DfDk˜– therapies such as nicotine patches, lozenges, gum, spray and inhalers. Most can be found over the counter at your drug store. It is important not to use tobacco products when using ˜\DÂ?D– _;Â?}–Â&#x;{–knk^k_2n˜_kD–fD;_2_kD– z(ÂĄxÂ?nx_nk–\ÂŚ;Â?n2\bnÂ?_;D{8–¤\_2\– is available by prescription from your doctor. It is an antidepressant that can help reduce withdrawal Â?ÂŚfx˜nfÂ?– k;–˜\D–¥Â?TD–˜n–Â?fnaD}–š{– alternative therapies such as hypnosis, 2ÂĄxÂĄk2Â˜ÂĄÂ?D8–Â?Db ÂĽ ˜_nk–˜D2\k_‚¥DÂ?– and tobacco cessation classes for behavioral change. Contact the TriHealth Fitness & Health Pavilion, zOqš{–lEO^ŠlŠŠ8–nÂ?– –bn2 b–2\ x˜DÂ?– nM–˜\D–fDÂ?_2 k– ÂĄkT–Â?Â?n2_ ˜_nk8– fDÂ?_2 k– k2DÂ?–n2_DÂ˜ÂŚÂ–nÂ?–fDÂ?_2 k– Heart Association. 1–– aD– –b_Â?˜–nM–˜\D–Â?D Â?nkÂ?–¤\Œ–Œn¥– Â?D– ‚¥_˜˜_kT}–D ;–˜\D–b_Â?˜–¤\Dk–Œn¥–MDDb– like smoking. 1–– ;Dk˜_MŒ–; _bŒ–Â?nÂĄÂ˜_kDÂ?–˜\ ˜–˜Â?_TTDÂ?– your desire to light up (drinking coffee, driving to work, stressful situations, being around others who Â?fnaD{}–D–2Â?D ˜_ÂŁD– k;–;DÂŁDbnx– kD¤–Â?nÂĄÂ˜_kDÂ?}–ÂĄ(Â?˜_Â˜ÂĄÂ˜D–2 Â?Â?n˜–nÂ?– celery sticks, gum or hard candies, toothpicks, a popsicle, a bottle of water or brush your teeth when you feel the urge to smoke. 1––Â?Œ–DÂĽDÂ?2_Â?D– Â?– –TÂ?D ˜– b˜DÂ?k ˜_ÂŁD– to smoking. 1––D¤ Â?;–ŒnÂĄÂ?Â?DbM–¤_˜\–˜\D–fnkDŒ– you save. 1––_k;– –(ÂĄ;;Œ–nÂ?–MÂ?_Dk;–¤\n–¤_bb–‚¥_˜– ¤_˜\–ŒnÂĄ}–Dbb–xDnxbD–Œn¥–\ ÂŁD–‚¥_˜8– because the more you say it the more real it will be for you.

Lifestyle Changes for a Healthier Heart You may feel discomfort and withdrawal symptoms as your body rids itself of nicotine. The ยยฆfxย˜nfยย–ยค_bbย–x ยยย–_kย–ย˜\ยDDย–ย˜nย–NยฃDย–; ยฆย}ย–ย ยฃ_kTยย–f ยฆย–b ยย˜ย–bnkTDย8ย–ยnย–ยย˜ ยฆย– 2ย˜_ยฃDย–ย˜nย–;_ยย˜ย 2ย˜ย– ยฆnยกยยDbMย– k;ย–nยฃDย2nfDย–ย˜\Df}ย–ยฃDkย–_Mย–ยฆnยกยŠยฃDย–ย˜ย_D;ย–ย˜nย–ย‚ยก_ย˜ย–(DMnยD8ย–;nkยŠย˜ย–T_ยฃDย–ยกx}ย– kยฆย–ยfnaDยยย– ย˜ยยฆย–ย‚ยก_ย˜ย˜_kTย–Mnยกยย–ย˜nย–NยฃDย–ย˜_fDยย–(DMnยDย–ย˜\Dยฆย–ยยก22DD;}

What happens after you quit smoking?

20 minutes

1 year

1ย–bnn;ย–xยDยยยกยDย–;ยnxยย–ย˜nย–knยf b 1ย–ยกbยDย–ย ย˜Dย–;ยnxยย–ย˜nย–knยf b 1ย–ย–n;ยฆย–ย˜DfxDย ย˜ยกยDย–nMย–\ k;ยย– k;ย–MDDย˜ย– increases to normal

1ย–ย–ยฅ2Dยยย–ย_ยaย–nMย–2nยnk ยยฆย–\D ยย˜ย–;_ยD ยDย– is half that of a smoker

8 hours 1ย–ย– ย(nkย–fnknยฅ_;Dย–bDยฃDbย–_kย–(bnn;ย– drops to normal 1ย–ยฅยฆTDkย–bDยฃDbย–_kย–(bnn;ย–_k2ยD ยDยย–ย˜nย–knยf b

24 hours

5 years 1ย–ย– ยกkTย–2 k2Dยย–;D ย˜\ย–ย ย˜Dย–Mnยย–ย˜\Dย– ยฃDย TDย– MnยfDยย–ยfnaDยย–znkDย–x 2aย– ย–; ยฆ{ย–;D2ยD ยDยย– by almost half 1ย–ย–ย˜ยnaDย–ย_ยaย–_ยย–ยD;ยก2D;ย–ย˜nย–ย˜\ ย˜ย–nMย– ย–knk^ ยfnaDยย–NยฃDย–ย˜nย–qOย–ยฆD ยยย– Mย˜Dยย–ย‚ยก_ย˜ย˜_kT 1ย–ย–_ยaย–nMย–2 k2Dยย–nMย–ย˜\Dย–fnยกย˜\8ย–ย˜\ยn ย˜ย– k;ย– Dยnx\ Tยกยย–_ยย–\ bMย–ย˜\ ย˜ย–nMย– ย–ยfnaDยยŠย

1ย–\ k2Dย–nMย–\D ยย˜ย– ย˜ย˜ 2aย–;D2ยD ยDย

10 years 48 hours 1ย–DยยฃDย–Dk;_kTยย–ยย˜ ยย˜ย–ยDTDkDย ย˜_kT 1ย–(_b_ย˜ยฆย–ย˜nย–ยfDbbย– k;ย–ย˜ ยย˜Dย–_fxยnยฃDย

2 weeks to 3 months 1ย–_ย2ยกb ย˜_nkย–_fxยnยฃDย 1ย– ba_kTย–(D2nfDยย–D ย_Dย 1ย– ยกkTย–Mยกk2ย˜_nkย–_k2ยD ยDยย–ยกxย–ย˜nย–ยšยฉย–xDย2Dkย˜

1 to 9 months 1ย–ย–nยกT\_kT8ย–ย_kยกยย–2nkTDยย˜_nk8ย–M ย˜_TยกDย– k;ย– shortness of breath decrease 1ย–ย–_b_ ย–zNkD8ย–2bD k_kTย–\ _ยย{ย–ยDTยnยคย–_kย–bยกkTย8ย– increasing their ability to handle mucus, clean the lungs and reduce infection

1ย–ย– ยกkTย–2 k2Dยย–;D ย˜\ย–ย ย˜Dย–_ยย–ย_f_b ยย–ย˜nย– ย˜\ ย˜ย–nMย– ย–knk^ยfnaDย 1ย–ยD2 k2Dยnยกยย–2Dbbยย– ยDย–ยDxb 2D; 1ย–ย–_ยaย–nMย–2 k2Dยย–nMย–ย˜\Dย–fnยกย˜\8ย–ย˜\ยn ย˜8ย– esophagus, bladder, kidney, cervix and pancreas decreases

15 years 1ย–ย–_ยaย–nMย–2nยnk ยยฆย–\D ยย˜ย–;_ยD ยDย–_ยย–ย˜\ ย˜ย– nMย– ย–knk^ยfnaDย Sources: American Cancer Society; Centers for Disease Control All bene๏ฌts are lost by smoking just one cigarette a day, according to the American Cancer Society.

Heart & Vascular Center 3

Lifestyle Changes for a Healthier Heart Reduce High Cholesterol High blood cholesterol also is a major risk factor that causes heart disease. Cholesterol can build up in the coronary arteries and cause blockages. The best ways to lower your cholesterol levels are to lower the amount of fat in your diet, exercise on a regular basis and take your medicines as prescribed. Reducing your cholesterol is one of the most controllable risk factors. Cholesterol _Â?– – k Â˜ÂĄÂ? b8– M ˜^b_aD– Â?ÂĄ(^ stance made in the liver. Your body makes EŠ– xDÂ?2Dk˜– nM– ˜\D– 2\nbDÂ?˜DÂ?nb– _˜– kDD;Â?8– Â?n– _˜– ;nDÂ?kŠ˜–Â?D‚¥_Â?D–fÂĄ2\–MÂ?nf–˜\D–Mnn;–Œn¥–D ˜} There are two types of cholesterol. nn;–2\nbDÂ?˜DÂ?nb8–2 bbD;–  –z\_T\^;DkÂ?_Â˜ÂŚÂ– b_xnxÂ?n˜D_k{8–;nDÂ?–˜¤n–˜\_kTÂ?7–\DbxÂ?–Â?DfnÂŁD– bad cholesterol from your blood and helps your body heal when injured or damaged.  – xÂ?DÂŁDk˜Â?– xb ‚¥D– MÂ?nf– (ÂĄ_b;_kT– ÂĄx– _k– the arteries. –  ;–2\nbDÂ?˜DÂ?nb8–2 bbD;–  –zbn¤^;DkÂ?_Â˜ÂŚÂ– b_xnxÂ?n˜D_k{8–_Â?–Â?˜_2aŒ– k;–¤_bb–(ÂĄ_b;–¥x–nk– damaged heart arteries, slowly blocking off the artery.

Ideal Blood Levels* according to the American Heart Association Cholesterol

below 200


below 150


above 40 (men) above 50 (women)


below 100 (high risk) below 130 (medium and low risk)

*Recent studies indicate that cholesterol levels may need to be lower than these guidelines suggest. Check with your doctor about the level that is right for you.

Your doctor can calculate your risk of heart ;_�D �D^bn¤8–fD;_¥f–n�–\_T\}– M–Œn¥– b�D ;Œ–

4 Heart & Vascular Center

\ ÂŁD– \D Â?˜– ;_Â?D Â?D– nÂ?– _M– ÂŚn¥Š£D– \ ;– – \D Â?˜– procedure, you are considered high risk. D˜\n;Â?– ˜n– _k2Â?D Â?D–  – k;– bn¤DÂ?–  – and triglycerides: – q}–˜nx–˜n( 22n–¥Â?D} – Â&#x;}– nÂ?D–¤D_T\˜} – š}–ÂĽDÂ?2_Â?D–Â?DTÂĄb Â?bÂŚ} 4. Manage stress. – O}– ˜– –\D Â?˜^\D b˜\Œ–;_D˜} 6. Take medicines as ordered by your doctor.

Control High Blood Pressure (Hypertension) (nÂĄÂ˜Â–OŠ–f_bb_nk–fDÂ?_2 kÂ?–\ ÂŁD–\_T\–(bnn;– pressure. Many people do not know that they have high blood pressure because there are usually no symptoms. That is why it is called the “silent killer.â€? Untreated high blood pressure can lead to coronary artery disease, stroke, heart attack, heart failure, kidney failure, blindness and other medical problems. – bnn;– xÂ?DÂ?Â?ÂĄÂ?D– _Â?– ˜\D– MnÂ?2D– nM– (bnn;– xÂĄÂ?\_kT– T _kÂ?˜– ˜\D– Â?˜DÂ?Œ– ¤ bbÂ?}– bnn;– pressure is recorded in two numbers. The NÂ?Â?˜– kÂĄf(DÂ?– _Â?– ˜\D– Â?ÂŚÂ?˜nb_2– xÂ?DÂ?Â?ÂĄÂ?D8– nÂ?– ˜\D– pressure in your arteries when blood is pumped into them. The second number is the diastolic pressure, or the pressure in your arteries when your heart rests between beats.

Lifestyle Changes for a Healthier Heart Your blood pressure is determined by taking the average of three or more readings at three different times. A normal blood pressure for –\D b˜\Œ– ;ÂĄb˜–_Â?–bDÂ?Â?–˜\ k–qÂ&#x;Š•EŠ} A blood pressure always greater than qšO•EO– _Â?– 2 bbD;– \_T\– (bnn;– xÂ?DÂ?Â?ÂĄÂ?D8– nÂ?– hypertension. A person with diabetes should \ ÂŁD– –(bnn;–xÂ?DÂ?Â?ÂĄÂ?D–¥k;DÂ?–qÂ&#x;Š•EŠ}– kŒ– of the steps to help lower your blood pres^ sure also help improve your total health. Here are some things you can do to help lower your blood pressure. – – – – – – –

1–˜nx–˜n( 22n–¥Â?D} 1–ÂĽDÂ?2_Â?D–šŠ–f_kÂĄÂ˜DÂ?– –; ÂŚ} 1–– ˜–\D b˜\Œ–Mnn;Â?– k;–b_f_˜–˜\D– fnÂĄk˜– of salt you eat. 1––nk˜Â?nb–ŒnÂĄÂ?–¤D_T\˜–^–MnÂ?–DÂŁDÂ?Œ–xnÂĄk;– you gain, you add four pounds of pressure against the heart. 1–– _f_˜– b2n\nb–˜n–nkD–˜n–˜¤n– servings per day. 1–– _f_˜–2 MMD_kD–˜n–nkD–˜n–˜¤n– cups per day. 1–– aD–ŒnÂĄÂ?–fD;_2_kD– ˜–˜\D–Â? fD–˜_fD– every day.

little or no insulin, or the body does not respond to the insulin that is made. No matter what the cause, glucose builds up in the blood. High blood sugar acts like sand paper and causes the walls of the arteries to become rough. It also causes bad 2\nbDÂ?˜DÂ?nb– z  {– ˜n– (ÂĄ_b;– ÂĄx– _k– ˜\D– ¤ bbÂ?– of an artery and make it more narrow. This slows blood ow to your body, including your heart. Heart disease may then occur. Controlling your blood sugar can help slow or prevent this damage. A diagnosis of diabetes is made if you have two fasting blood sugars of 126 mg or fnÂ?D}– – Â? k;nf– (bnn;– Â?ÂĄT Â?– nM– Â&#x;ŠŠ– fT– nÂ?– more also is proof of diabetes.

Manage Diabetes and Metabolic Syndrome Diabetes \Dk– ÂŚn¥– \ ÂŁD– ;_ (D˜DÂ?8– ÂŚnÂĄÂ?– (n;Œ– ;nDÂ?– not do a good job of using the food you eat. This is because it has a problem breaking down carbohydrates. Most of what you eat needs to be broken down into simple sugar, 2 bbD;– TbÂĄ2nÂ?D}– bÂĄ2nÂ?D– _Â?– ˜\D– (n;ŒŠÂ?– f _k– energy source. For glucose to get into your cells, it needs insulin (a hormone made by ˜\D–x k2Â?D Â?{}–DnxbD–¤_˜\–;_ (D˜DÂ?–xÂ?n;ÂĄ2D–

Heart & Vascular Center 5

Lifestyle Changes for a Healthier Heart Metabolic Syndrome

Lose Excess Weight

Metabolic syndrome is a collection of health risks that increases your chance of developing heart disease, stroke and diabetes. Your pancreas makes enough insulin but your body may have trouble using it. Treatment includes diet and exercise. You also may need to take medicine. If you have at least ˜\DD– nM– ˜\D– N£D– Mnbbn¤_kT– 2nk;_˜_nk8– ¦n¡– have metabolic syndrome.

Obesity is linked to many diseases that put you at risk for heart disease, diabetes, high cholesterol and high blood pressure. Your heart must work harder to supply blood to the extra weight. The secret to weight loss is to eat or drink fewer calories than you burn. _D˜– k;– D¥D2_D– 2 k– \Dbx– ¦n¡– ;n– ˜\_}– M– ¦n¡– D–n£D¤D_T\˜8–`¡˜– –q©–xD2Dk˜–¤D_T\˜– loss will help your heart.

Indicators of Metabolic Syndrome

Other good reasons for losing weight: – 1––D_kT–n£D¤D_T\˜–˜ aD–˜\DD–¦D – from your life. – 1––D_kT–n(DD–˜ aD– ¤ ¦–_¥–˜n–D£Dk– years of your life. – 1––(D_˜¦–xb¡–fna_kT–˜ aD– ¤ ¦– 15 years.

– – – – – – –

1–Dk˜ b–n(D_˜¦7 ^––¤ _˜–2_2¡fMDDk2D–n£D– R©–_k2\D–Mn–fDk ^––¤ _˜–2_2¡fMDDk2D–n£D– 35 inches for women 1–_Tb¦2D_;D7– (n£D–qO© 1––  7–(Dbn¤–R©–Mn–fDk (Dbn¤–O©–Mn–¤nfDk 1–––n£D–qš©•EO8–n–˜ a_kT–(bnn;– pressure medicine 1–– ˜_kT–(bnn;–¡T –zTb¡2nD{–TD ˜D– ˜\ k–q©©8–n–¦xD–Ÿ–;_ (D˜D

6 Heart & Vascular Center

Lifestyle Changes for a Healthier Heart Determine if You Have Abdominal Obesity One way to determine if you have central or abdominal obesity is to measure your waist measurement in inches across your Â?˜nf 2\}–nfDk–¤_˜\– –¤ _Â?˜–fD Â?ÂĄÂ?DfDk˜– of 35 inches or bigger, or men with a waist fD Â?ÂĄÂ?DfDk˜– nM– RŠ– _k2\DÂ?– nÂ?– (_TTDÂ?8– \ ÂŁD– 2Dk˜Â? b– n(DÂ?_Â˜ÂŚ}– – n;Œ–  Â?Â?– k;D¼– z {– calculation also is used to determine total (n;Œ–M ˜}–DD–˜\D–2\ Â?˜–(Dbn¤}

 – _Â?– Â?– 22ÂĄÂ? ˜D– Â?– ¤ _Â?˜– 2_Â?2ÂĄfMDÂ?Dk2D– in assessing risk of disease. Research shows ˜\ ˜– Â?– –xDÂ?Â?nkŠÂ?– –nÂ?–¤ _Â?˜–2_Â?2ÂĄfMDÂ?Dk2D– increases, so does insulin resistance as well as triglycerides and higher blood sugar concentration in the blood. This means you have a higher risk of developing diabetes and an increased risk of developing heart disease.

Body Mass Index (BMI) Chart Find your height and weight on the chart to determine your body mass index. An ideal range _Â?– ql– ˜n– Â&#x;R}– –  – nÂŁDÂ?– Â&#x;O– xÂĄÂ˜Â?– ÂŚn¥– ˜– Â?_Â?a– MnÂ?– \_T\– (bnn;– xÂ?DÂ?Â?ÂĄÂ?D8– Â?˜Â?naD8– nÂ?˜Dn Â?˜\Â?_˜_Â?8– \D Â?˜–;_Â?D Â?D– k;–2DÂ?˜ _k–2 k2DÂ?Â?}–– –nM–Â&#x;O–˜n–Â&#x;l}l–_Â?–2nkÂ?_;DÂ?D;–nÂŁDÂ?¤D_T\˜8– k;– – – nM–šŠ–nÂ?–\_T\DÂ?–_Â?–2nkÂ?_;DÂ?D;–n(DÂ?D}–nÂ?–xDnxbD–¤\nÂ?D– –f Œ–(D–\_T\DÂ?–;ÂĄD–˜n–b Â?TD–(nkD– structure or greater muscle mass, the waist circumference measurement described above will help determine whether you are truly at higher risk for serious diseases. HT. IN. 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 BMI

BODY WEIGHT (POUNDS) 91 94 97 100 104 107 110 114 118 121 125 128 132 136 140 144 148 152 156 19

96 99 102 106 109 113 116 120 124 127 131 135 139 143 147 151 155 160 164 20

100 104 107 111 115 118 122 126 130 134 138 142 146 150 154 159 163 168 172 21

Desirable Range

105 109 112 116 120 124 128 132 136 140 144 149 153 157 162 166 171 176 180 22

110 114 118 122 126 130 134 138 142 146 151 155 160 165 169 174 179 184 189 23

115 119 123 127 131 135 140 144 148 153 158 162 167 172 177 182 186 192 197 24

119 124 128 132 136 141 145 150 155 159 164 169 174 179 184 189 194 200 205 25

124 128 133 137 142 146 151 156 161 166 171 176 181 186 191 197 202 208 213 26


129 133 138 143 147 152 157 162 167 172 177 182 188 193 199 204 210 216 221 27

134 138 143 148 153 158 163 168 173 178 184 189 195 200 206 212 218 224 230 28

138 143 148 153 158 163 169 174 179 185 190 196 202 208 213 219 225 232 238 29

143 148 153 158 164 169 174 180 186 191 197 203 209 215 221 227 233 240 246 30

148 153 158 164 169 175 180 186 192 198 203 209 216 222 228 235 241 248 254 31

153 158 163 169 175 180 186 192 198 204 210 216 222 229 235 242 249 256 263 32

158 163 168 174 180 186 192 198 204 211 216 223 229 236 242 250 256 264 271 33

162 168 174 180 186 191 197 204 210 217 223 230 236 243 250 257 264 272 279 34

167 173 179 185 191 197 204 210 216 223 230 236 243 250 258 265 272 279 287 35

Obesity/Increased Health Risk

Heart & Vascular Center 7

Lifestyle Changes for a Healthier Heart Exercise A person who does not exercise has an _k2D D;– _a– nM– \D ˜– ;_D D}– ¥D2__kT– `¡˜–š©–f_k¡˜D– –; ¦–¤_bb–\Dbx–¦n¡7 – 1–bn¤D–¦n¡–(bnn;–xD¡D – 1–– _D–˜\D–  ––z‡Tnn;ˆ{–2\nbD˜Dnb8– and lower your total cholesterol and triglyceride levels – 1––bn¤D–(bnn;–¡T –z_M–¦n¡–\ £D– ;_ (D˜D– k;–Tb¡2nD–_k˜nbD k2D{ – 1–bnD–¤D_T\˜ ˜\D– (DkDN˜– nM– D¥D2_D– _k2b¡;D– bn¤DD;– ˜D–bD£Db8–_fxn£D;–DkD–nM–¤Dbb^(D_kT8– _fxn£D;– ‚¡ b_˜¦– nM– bDDx– k;– ;D2D D;– risk of osteoporosis (a disease causing bone ˜n–(D2nfD–¤D aD– k;–fnD–(_˜˜bD{} _fxbD–¤ ¦–˜n–_k2D D– 2˜_£_˜¦–_k–D£D¦; ¦– life include: – 1– aD–˜\D–˜ _–_k˜D ;–nM–˜\D–DbD£ ˜n} – 1–– a–M ˜\D– ¤ ¦–Mnf–˜\D–Dk˜ k2D– to your job or stores. – 1––\Dk–¦n¡–Tn–\nxx_kT– ˜–˜\D– f bb8–¤ ba–Mn–q©–˜n–qO–f_k¡˜D– before you shop. – 1–– k2nxn ˜D–D¥D2_D–_k˜n–¦n¡–\n¡D– work and yard work. – 1––\_bD–¤ ˜2\_kT–˜DbD£__nk8–˜ k;–¡x– and walk around the room during commercials rather than walking to the refrigerator.

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– –

1––˜ ˜– k–D¥D2_D–n¡˜_kD}– n_k– k– exercise group. 1––_k;– k–D¥D2_D–¦n¡–b_aD– k;– gradually increase your activity level.

\D–Tn b–_–˜n–D¥D2_D–Mn–š©–˜ _T\˜–f_k¡˜D– ˜\DD–˜n–N£D–; ¦– –¤DDa8–xDMD (b¦–; _b¦8–˜n– improve your cardiovascular health.

Limit Alcohol Intake _ka_kT–fnD–˜\ k–nkD–˜n–˜¤n–D£_kT–nM– alcohol a day relaxes the heart muscle too much and limits the amount of blood the \D ˜–MDD;–_˜DbM}–\Dk–¦n¡–;_ka–˜nn–f¡2\– alcohol, the heart muscle cannot pump or ‚¡DD¨D– – ˜nkTb¦}– ¥˜ – P¡_;– 2 k– (¡_b;– up inside the heart, causing it to stretch or get bigger. The extra pressure on the heart muscle weakens the heart, eventually 2 ¡_kT–2nkTD˜_£D–\D ˜–M _b¡D–z(¡_b;^¡x–nM– P¡_;–_k–˜\D–\D ˜– k;–b¡kT{} – _ka_kT– b TD– fn¡k˜– nM– b2n\nb– _k^ creases blood pressure, cholesterol and tri^ glyceride levels. This causes atherosclerosis, or hardening of the arteries. kD–D£_kT–nM– b2n\nb–_–D‚¡ b–˜n7 – 1––q}O–n¡k2D–E©^xnnM–;_˜_bbD;– x__˜–zb_‚¡n{ – 1–qŸ–n¡k2D–(DD–n–¤_kD–2nnbD – 1–O–n¡k2D–¤_kD

Lifestyle Changes for a Healthier Heart There is conflicting evidence about the effect nM– b2n\nb– nk– _k2D _kT–  – 2\nbD˜Dnb– bD£Db– z˜\D– xn˜D2˜_£D– 2\nbD˜Dnb{}– nfD– studies have shown that one serving of alcohol per day may increase this level. Other studies have shown that the part of ˜\D–  – ˜\ ˜– _– DbD£ ˜D;– _– kn˜– ˜\D– Tnn;– cholesterol. The action of all heart medicines may be changed with drinking alcohol. If ¦n¡– \ £D– ‚¡D˜_nk– (n¡˜– ¡_kT– b2n\nb8– please discuss this with your doctor.

Stress Many people try to avoid stress as much as possible; others thrive on it. No matter what you do, stress is unavoidable. Any change, even positive or good change, brings some ˜D}– ˜D– _– ˜\D– (n;¦Š– ¤ ¦– nM– ;D b_kT– with change. Once you begin to view stress as a part of normal life, you can begin to recognize and learn to deal with it better.

People who successfully deal with stress in ˜\D_–b_£D–MDDb–fnD–Db ¥D;}–nfD–DMMD2˜_£D– ˜D–f k TDfDk˜–˜D2\k_‚¡D–_k2b¡;D7 – 1–D¥D2_D – 1–fD;_˜ ˜_nk – 1–¡D–nM–T¡_;D;–_f TD¦ – 1––f¡2bD–Db ¥ ˜_nk–b_˜Dk_kT–˜n–f¡_2– ;DDx–(D ˜\_kT–˜D2\k_‚¡D–£__˜_kT– with friends – 1–˜ a_kT–˜_fD–˜n–;n– k– 2˜_£_˜¦–¦n¡–Dk`n¦ – 1–D ;_kT– –(nna – 1–˜D–f k TDfDk˜–2b  The best way to manage stress is to practice healthy habits such as eating a nutritious diet, exercising, avoiding alcohol and drugs and getting six to eight hours of sleep a night.

nkT^˜Df–˜D–˜\ ˜–¦n¡–;n–kn˜–;D b–¤_˜\– properly may become bad for your health and may lead to heart disease by: – 1–_k2D _kT–(bnn;–xD¡D – 1–_k2D _kT–\D ˜– ˜D – 1–_k2D _kT–2\nbD˜Dnb–bD£Db – 1–_k2D _kT–(bnn;–¡T –bD£Db nfD–xn_(bD–¦fx˜nf–nM–˜D– D7 – 1–__˜ (_b_˜¦ – 1–(n¤Db–xn(bDf – 1––˜DkD–f¡2bD–_k–˜\D–` ¤8–kD2a– and shoulders – 1–;DxD_nk – 1–fnn;–¤_kT – 1–bDDx–xn(bDf – 1–˜nf 2\–xn(bDf

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Lifestyle Changes for a Healthier Heart Cardiac Rehabilitation Our Cardiac Rehabilitation program guides you in making lifestyle changes that will help your heart. The purpose of cardiac rehabilitation is to help people return to everyday life. An important goal is to prevent a heart attack and halt or slow disease progression. Cardiac rehab focuses on these main areas: – 1–DÂĽDÂ?2_Â?D–˜n–f aD–Œn¥–Â?˜Â?nkTDÂ? – 1–D;ÂĄ2 ˜_nk– (nÂĄÂ˜Â–ÂŚnÂĄÂ?–\D Â?˜–xÂ?n(bDf – 1– ;ÂŁ_2D–nk–\D b˜\Œ–\ (_˜Â? – 1–– Â?Â?_Â?˜ k2D–¤_˜\–f a_kT–b_MD–2\ kTDÂ?8– Â?ÂĄ2\– Â?–bnÂ?_kT–¤D_T\˜–nÂ?–‚¥_˜˜_kT– smoking – 1––2nÂĄkÂ?Db_kT–˜n–\Dbx–Œn¥–2nxD–¤_˜\– depression and learn how to deal with stress The patients in the program will be a lot like you. Anyone with heart disease, regardless nM– TD8–¤_bb–(DkDN˜–MÂ?nf–2 Â?;_ 2–Â?D\ (} People who go to cardiac rehab include those who have had heart disease such as angina or heart event such as a recent heart attack; recent heart surgery; cardiac intervention such as balloon angioplasty or stent placement; or a heart transplant.

The Three Phases of Cardiac Rehabilitation Phase I - Inpatient \_bD– ÂŚn¥– Â?D– _k– ˜\D– \nÂ?x_˜ b8– ˜\D– \ Â?D– – kÂĄÂ?Â?D–z\D Â?˜–D;ÂĄ2 ˜nÂ?{–f Œ–Â?DD–Œn¥– k;–ŒnÂĄÂ?– family. This education starts after you have been treated for a heart problem. The nurse ¤_bb– ˜D 2\– ÂŚn¥– (nÂĄÂ˜Â– ÂŚnÂĄÂ?– Â?xD2_N2– \D Â?˜– condition and risk factors that caused your heart disease. You will be given written material. You may watch a video or about your heart problems and treatments. The Phase I

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nurse also will explain the outpatient Phase II cardiac rehab program, which is designed to help your heart get healthy again and help you reduce your risk factors. You will receive written information regarding entry into a program.

Phase II - Immediate Outpatient Prior to discharge we will order referral for cardiac rehab. Cardiac rehab is usually scheduled two to six weeks after leaving the hospital, depending on your condition and recovery. The program 2nÂŁDÂ?Â?–š”–nkD^\nÂĄÂ?–Â?DÂ?Â?_nkÂ?–nÂŁDÂ?–qÂ&#x;–¤DDaÂ?– znk; ÂŚ^D;kDÂ?; ÂŚ^Â?_; ÂŚ{}– \D2a– ÂŚnÂĄÂ?– insurance policy for coverage before attending a cardiac rehab program. Most _kÂ?ÂĄÂ? k2DÂ?– ¤_bb– 2nÂŁDÂ?– \nÂ?x_˜ b^ MNb_ ˜D;– outpatient programs. At each session, you will be monitored closely by a cardiac rehab nurse and an exercise physiologist. A personal exercise plan will be developed based on your needs, abilities and goals. These exercise classes are fun, upbeat and slightly challenging. Along with each exercise session, our staff will review health topics.

Lifestyle Changes for a Healthier Heart Topics include: – 1– D ˜–;_D D – 1–bnn;–xD¡D–f k TDfDk˜ – 1– _MD˜¦bD–2\ kTD– k;–Tn b–D˜˜_kT – 1–¡˜_˜_nk b–2n¡kDb_kT – 1–˜D–f k TDfDk˜ – 1–¥D2_D–T¡_;Db_kD – 1–D_T\˜–f k TDfDk˜ Goals for Phase II: – 1–– fxn£D–¦n¡–DkDT¦–bD£Db–(¦– strengthening your heart with exercise – 1––n£_;D–D;¡2 ˜_nk– (n¡˜–b_MD˜¦bD– changes that will keep your heart healthy – 1––D;¡2D–˜\D–MD – k;– k¥_D˜¦– (n¡˜– increasing your activities and exercise – 1––_˜–¦n¡–_k–f a_kT–n2_ b8–Dfn˜_nk b– and psychological adjustments to your heart disease and lifestyle changes The Cardiovascular and Pulmonary Rehabilitation Gym at Penrose-St. Francis (719) 776-2508

Phase III - Maintenance Program Phase III of cardiac rehab is a supervised exercise program that is available to those who complete Phase II. This phase teaches independent exercising without a monitor. It is available to you for as long as you choose to participate. It is not typically covered by insurance. Goals for Phase III: – 1–D ˜D– k–nkTn_kT–D¥D2_D–xnT f – 1––MMD–¡xxn˜–kD2D ¦–Mn–b_MD˜¦bD– changes – 1––_˜–¦n¡–_k–D 2\_kT–Tn b–¡2\– – _k;DxDk;Dk˜–b_£_kT– k;•n–D˜¡k_kT– to work – 1––D£Dk˜–n–bn¤–˜\D–xnTD_nk–nM– heart disease

The Cardiac Rehab Team You are the most important member of the team! Your commitment to take care of yourself is the key to your recovery and ongoing heart health. The cardiac rehab team involves health care providers who are trained to guide your recovery. Your team includes: – 1–¦n¡ – 1–¦n¡–M f_b¦ – 1––;n2˜n–z¦n¡–M f_b¦–;n2˜n8– 2 ;_nbnT_˜– k;•n–\D ˜–¡TDnk{ – 1–2 ;_ 2–k¡D – 1–D¥D2_D–x\¦_nbnT_˜ – 1–;_D˜_˜_ k Coming back after a heart attack, heart surgery or a diagnosis of heart disease can be challenging for many reasons. Take advantage of the program classes and work with your health care team to design your own plan to lead a healthier life.

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Lifestyle Changes for a Healthier Heart NOTES

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Eating with Your Heart’s Consent

Heart & Vascular Center

Eating with Your Heart’s Consent


our doctor wants you to improve your heart health by eating foods low in cholesterol, fat (especially saturated fat) and sodium. Making healthy food choices can be an important way to lower blood pressure, weight and cholesterol levels. The guidelines in this booklet are a first step toward accomplishing these goals.

Make a Change and Take it to Heart Changing your diet and sticking with the changes can be difficult. It is easier if you make changes slowly. It may take several months of diet and lifestyle changes to see a drop in your blood cholesterol levels. You will want to resist going back to your old lifestyle and eating habits so you do not lose the progress you have made. By sticking with new eating habits, you will help your heart - and the rest of your body. The following information will explain why you should eat certain foods and not others. If you follow your diet closely on most days, you usually can eat small amounts of food high in fat or cholesterol for special occasions. The same is true for food high in sodium unless you have congestive heart failure or kidney disease. In those cases, you always should avoid high-sodium foods, since they can cause serious problems. Your dietitian can help you make changes in your diet. If your cholesterol still does not come down after making healthier food choices, or if you already have heart disease, your dietitian may have some special recommendations. If you are taking cholesterol-lowering medication, diet works with the medicine to help bring your cholesterol levels down.

The Diet-Heart Connection Cholesterol is a waxy material that all animals make and store. Your body needs it to make certain hormones. It also is used for building cells. If your blood cholesterol

level is high, you are more likely to develop atherosclerosis, a buildup of fatty substances along your artery walls. You cannot control the amount of cholesterol your body makes, but you can limit the cholesterol you take in from animal products. If you lower the amount of cholesterol in your body, you may be able to slow down or prevent atherosclerosis. There are changes you can make in your diet that might help: – 1– nD–¤D_T\˜–_M–¦n¡– D–n£D¤D_T\˜} – 1– ˜2\–¦n¡–n;_¡f–_k˜ aD} – 1– ˜–bD–M ˜8–DxD2_ bb¦– ˜¡ ˜D;–M ˜} – 1––\Dk–¦n¡–\ £D–˜n–¡D–M ˜–Mn– cooking, use an unsaturated fat (monounsaturated or polyunsaturated). – 1– ˜–MD¤D–\_T\^2\nbD˜Dnb–Mnn;} – 1–– ˜–fnD–¤\nbD–T _k8–£DTD˜ (bD– and fruits.

Lose Weight if You are Overweight If you weigh more than you should, your dietitian can help you find ways to lose weight safely. Fad diets are not the answer. If it sounds too good to be true, it probably is. Fast weight loss is not good for your health. You should not lose more than one to two pounds a week. In most cases, you should not try to lose weight before or right after surgery. You may not need a special weight-loss diet. If you eat less fat and smaller portions of food, you will take in fewer calories and lose some weight.

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Eating with Your Heart’s Consent Watch Your Sodium Intake Sodium is a mineral that helps control the amount of water in your body. Too much sodium can cause your body to hold extra fluid. This may affect your blood pressure. It also makes the heart work harder. This can be a problem if the heart already has been damaged by atherosclerosis. People with heart problems and high blood pressure should eat less sodium. Sodium is found in everything you eat. The amount found naturally in fresh fruits, fresh vegetables and fresh meat usually is not a concern. Most of the sodium in your diet comes from the sodium that is added when food is processed and from salt you add to your food (salt is made of sodium and chloride). You can reduce the amount of sodium in your diet by not adding extra salt to foods at the table. You also can reduce the amount of salt you add when cooking.

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Try to eat fewer processed foods. Salted snack foods, processed meats (such as hot dogs, lunch meats and sausage), canned soups and frozen dinners tend to be high in sodium. Instead, choose low-sodium soups and reduced-sodium frozen dinners. If you have certain health problems such as congestive heart failure, you may need to follow a stricter low-sodium diet. You may find that foods taste bland until you get used to less salt. Try adding herbs and spices to foods. Try mixing different flavors like chicken with orange sauce or meatloaf with pineapple. There are two major types of salt substitutes available. One is a mixture of herbs and spices. Another is made with potassium chloride either by itself or mixed with other ingredients and spices. Check with your doctor before using any salt substitute made with potassium chloride.

Eating with Your Heart’s Consent Salt-Free Seasoning Ideas You can add avor to food without adding salt. Studies have shown that after eight to 12 weeks on a lower-sodium diet, people actually prefer less salty foods. Start with these ideas and create your own combinations to suit your taste. If you use fresh herbs instead of dried herbs, use twice the amount.


bay leaf, dry mustard powder, green pepper, marjoram, fresh mushrooms, nutmeg, onions or onion powder, pepper, sage or thyme

Chicken: green pepper, lemon juice, marjoram, fresh mushrooms, paprika, parsley, poultry seasoning, sage or thyme


bay leaf, curry powder, dill, dry mustard powder, green pepper, lemon juice, marjoram, onions or paprika


curry powder, garlic or garlic powder, mint, mint jelly, pineapple or rosemary


apple, applesauce, garlic or garlic powder, onions or sage


bay leaf, curry powder, ginger, marjoram or oregano


garlic or garlic powder, lemon juice, onions or vinegar


dill, ginger, honey, marjoram, mint or thyme


green or red pepper, nutmeg or fresh tomato


chives, dill, garlic or vinegar

Green beans: lemon juice, marjoram, nutmeg, pimiento or sweet basil Greens:

onion or onion powder, pepper or vinegar


green pepper, mint, fresh mushrooms, onion or parsley


dill, green pepper, mace, onions, paprika or parsley


brown sugar, cinnamon, ginger, mace, nutmeg or onion


basil, marjoram, onions or oregano

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Eating with Your Heart’s Consent Eating from the Major Food Groups On the following pages you will find charts listing many common foods. The foods are listed in three columns, showing how you should use them in your diet. Use these charts to help you make your food choices. If you do, your diet should fall within hearthealthy guidelines: – 1––kn–fnD–˜\ k–š©–xD2Dk˜–nM–2 bn_D– D– from fat – 1––kn–fnD–˜\ k–nkD^˜\_;–nM–˜n˜ b–M ˜–_– saturated – 1––kn–fnD–˜\ k–Ÿ©©–f_bb_T f–nM– cholesterol – 1––f_b;–n;_¡f–D˜_2˜_nk–nM–kn–fnD– ˜\ k–R8©©©–f_bb_T f–xD–; ¦ Foods in the Good Choices column are very low in fat, cholesterol and sodium. Unless you are on other diet restrictions, you can eat these foods every day. Foods in the Use in Moderation column contain some fat and cholesterol. Many of these foods are an important part of a hearthealthy diet. You can use them, but you need to limit the portion or how often you eat them. Foods in the Avoid column should not be a regular part of your diet. They are either very high in fat, cholesterol or sodium. _f_˜– Mnn;– 2\n_2D– from this group to twice a month - less is even better. Foods that are marked with an “*” are high in sodium but are low in fat or cholesterol. In addition to eating good foods, drink

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D_T\˜–˜n–q©–Tb D–nM–¤ ˜D–n–P¡_;–D 2\–; ¦}– Drinking water helps prevent constipation and keeps your body hydrated.

Eat Plenty of Fruits, Vegetables and Grains Fruits, vegetables and whole grains taste good and are good for you. They are full of vitamins and minerals and other natural ingredients that your body needs. They can help fill you up because they are high in fiber. Some kinds of fiber also may help lower your cholesterol level. Gradually increase the fiber in your diet by choosing whole-grain cereals, whole-grain breads, fruits, vegetables and dried beans. Set a goal of gradually increasing your fiber intake to Ÿ©–˜n–šO–T f–nM–N(D–xD–; ¦} There are two types of fiber found in foods: soluble and insoluble. Soluble fiber binds with cholesterol and removes it from the body. Some foods high in soluble fiber include apples, broccoli, dried beans, lentils, oatmeal, pears and raisins. Insoluble fiber (“roughage”) adds bulk to stools and helps prevent constipation and promotes regularity. Foods high in insoluble fiber include bran cereals, cauliflower, fruits and vegetables with edible skins, dried beans and peas, nuts and seeds.

Caution: Be careful when you add fiber to your diet. You may have cramping, gas and diarrhea if you suddenly eat large amounts of fiber. Add high-fiber foods to your diet slowly.

Eating with Your Heart’s Consent Bread, Cereal, Rice and Pasta 6 to 11 servings per day Suggested serving size: 1 slice bread (1-ounce slice) ½ cup rice, pasta (cooked) 4 to 6 soda crackers ½ cup starchy vegetables, cooked Each serving in the ďŹ rst column contains: EŠ–2 bnÂ?_DÂ?8–š–TÂ? fÂ?–xÂ?n˜D_k8– qO–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜D–q–TÂ? f–M ˜













*High in sodium but not high in fat. **Look for good and moderate choices under “Fats� on page 13.

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Eating with Your Heart’s Consent Vegetables 3 to 5 servings per day Suggested serving size: 1 cup raw leafy vegetables ½ cup other vegetables, cooked or raw Each serving in the first two columns contains: ŸO–2 bn_D8–Ÿ–T f–xn˜D_k8 O–T f–2 (n\¦; ˜D8–©–T f–M ˜

GOOD CHOICES Fresh, frozen (plain) or canned (unsalted, “no salt added” or rinsed): s!RTICHOKEs!SPARAGUS s"AMBOOSHOOTS s"EANSGREENORWAX s"EETS s"ROCCOLI s"RUSSELSSPROUTS s#ABBAGE s#ARROTS s#AULImOWER s#ELERY s#ORN













*High in sodium but not high in fat. **Starchy vegetables are higher in calories and carbohydrates.

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Eating with Your Heart’s Consent Fruit 2 to 4 servings per day Suggested serving size: ½ cup unsweetened juice or canned fruit 1 medium piece of fresh fruit 1 cup diced melon 2 pieces dried fruit Each serving in the ďŹ rst two columns contains: ”Š–2 bnÂ?_DÂ?8–Š–TÂ? fÂ?–xÂ?n˜D_k qO–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜D,–Š–TÂ? fÂ?–M ˜

GOOD CHOICES Fresh, frozen, canned




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Eating with Your Heart’s Consent Why You Should Limit Foods With Fat The amount and kind of fat in your diet affects how your body makes and uses cholesterol. TD– fn¡k˜– nM– k¦– M ˜8– DxD2_ bb¦– saturated fat, tend to raise your cholesterol. Unsaturated fats (monounsaturated and polyunsaturated) may help control it. Try to limit the total amount of fat in ¦n¡–;_D˜–˜n–ŸO–˜n–šO–xD2Dk˜–nM–¦n¡–2 bn_D– by using the guidelines in this section. Use monounsaturated and polyunsaturated fat when you need to use fat, but use as little as possible. No more than one-third of ¦n¡–M ˜–\n¡b;–(D– ˜¡ ˜D;}– ˜2\–n¡˜–Mn– hidden fat. Fried foods, mayonnaise, dessert toppings, sauces, gravies and fat in baked goods all can add too much fat to your diet. Unsaturated Fat Monounsaturated and polyunsaturated fats may help control your cholesterol level. These fats are liquid at room temperature. Most vegetable oils are unsaturated. Olive oil, peanut oil and canola oil are good sources of monounsaturated fat. Safflower, sunflower, corn, soybean and flaxseed oils are good sources of polyunsaturated fat. Saturated Fat Saturated fats can raise cholesterol levels in the blood. They are solid at room temperature. Animal fats tend to be high in saturated fat. Trim fat from your meat. Remove skin from chicken and ˜¡aD¦}–  ˜– f bbD– xn˜_nk– nM– fD ˜}– ¦– to avoid high-fat animal products such as butter, lard, gravies, sauces and whole milk dairy products. A few vegetable oils have a high natural saturated fat content. Coconut oil, palm and palm kernel oil and cocoa butter (found in chocolate) are saturated. Saturated fat \n¡b;–(D–b_f_˜D;–˜n–q©–T f–xD–; ¦}

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Transunsaturated fats (or “trans fats”) form when vegetable oils are processed into stick margarine or shortening. This type of fat should be limited in the diet. Snack foods and baked goods made with “partially hydrogenated vegetable oil” or “vegetable shortening” are sources of trans fats. Other sources of trans fats include crackers, cookies, French fries, fast foods and fried foods served at restaurants. Read and compare labels to find margarines that have the least amount of saturated fat and trans fats. Choose tub or liquid margarine, or trans fat-free spreads. Use olive oil or canola oil when cooking.

Eat Fewer Foods Containing Cholesterol Cholesterol is found only in foods made with meat, poultry, fish, eggs, dairy or other animal products. You still can enjoy many of them if you watch your serving sizes and select animal products that are lowest in cholesterol and fat. Often, animal products that are high in fat also are high in cholesterol (like butter, cheese, gravy and fatty meats, such as steak). There also are some high-cholesterol foods that are not \_T\–_k–M ˜}–¥ fxbD– D–DTT–¦nba8–\_fx– and organ meats (liver, brain and kidneys). _f_˜–fD ˜–˜n–”–n¡k2D–xD–; ¦} There is no danger of getting too little cholesterol in your diet. Your liver makes as much cholesterol as your body needs and sometimes more.

Eating with Your Heart’s Consent Milk, Yogurt & Cheese 2 to 3 servings per day Suggested serving size: 1 cup skim or fat-free milk Each serving in the first column contains: l©–2 bn_D 8 grams protein 12 grams carbohydrate 1 gram fat








(no more than 4 ounces per day selected from the following) sMILK s"UTTERMILKMADEFROMLOW FATOR SKIMMILK


Milk Drinks



Milk Drinks


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Eating with Your Heart’s Consent Meat, Poultry, Fish, Dried Beans, Eggs and Nuts No more than 5-6 ounces per day. Trim off fat before cooking. Bake, broil, microwave, roast or grill meat without adding extra fat. _f_˜–(DDM– k;–xna–˜n–Ÿ–D£_kT–xD–¤DDa} Each ounce in the second column contains: OO–2 bn_D8–“–T f–xn˜D_k ©–T f–2 (n\¦; ˜D8–š–T f–M ˜

GOOD CHOICES These have 1 gram of fat or less per serving and less than 1 gram of saturated fat. They also are low in sodium.

USE IN MODERATION Even though these are good choices, portions must still be limited. They have between 2 and 5 grams of fat per ounce and up to 2 grams of saturated fat.






AVOID These have more than 5 grams of fat per ounce (with more than 2 grams saturated fat) or are high in cholesterol or sodium.





Eating with Your Heart’s Consent Meat, Poultry, Fish, Dried Beans, Eggs and Nuts (Continued)



You do not have to give up meat entirely, Pork but watch the portions you eat. Aim for s(AMLEANCENTERSLICES

3-ounce servings. s,OINCHOPS ROAST s4ENDERLOIN It is OK to eat red meat occasionally. Aim for two servings per week, 3 ounces Beef each serving. Choose lean meats. s'ROUNDBEEF LEANFROMROUND ORSIRLOIN Eat heart-healthy ďŹ sh such as salmon, s2OASTSSIRLOINTIP ROUND RUMP tuna, mackerel and lake trout two ARM to three times a week, in 3-ounce to s3TEAKSmANK SHOULDER ROUND 4-ounce servings. TENDERLOIN s#HIPPEDBEEF










Organ Meats s,IVER s+IDNEY s"RAIN s(EART s4ONGUE


*High in sodium but not high in fat

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Eating with Your Heart’s Consent Fats No more than 6 to 8 teaspoons per day (This includes any fat used in processing or preparing food.)

Suggested serving size: 1 tablespoon regular salad dressing 1 teaspoon margarine, oil, mayonnaise 1 tablespoon nuts and seeds Each serving in the second and third columns contains: RO–2 bnÂ?_DÂ?8–Š–TÂ? fÂ?–xÂ?n˜D_k8 Š–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜D8–O–TÂ? fÂ?–M ˜




These items have less than 2 grams of fat per serving and less than 1 gram of saturated fat.

These items have up to 5 grams of fat per serving but less than 1 gram of saturated fat.

These items have the same amount of fat as items in the second column, but they are higher in saturated fat.


Oils (Monounsaturated)






*High in sodium but not high in fat

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Eating with Your Heart’s Consent Fats (Continued)



Use unsaturated oil or monounsaturated Nuts & Seeds fats when baking. s.UTS UNSALTED ALMONDS WALNUTS PEANUTS PECANSLIMITTOONE When baking a cake, substitute TABLESPOON applesauce, baby food prunes s3EEDS UNSALTEDnSESAME SUNmOWER or pureed prunes for cooking oil. LIMITTOTABLESPOONDAILY



*High in sodium but not high in fat

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Eating with Your Heart’s Consent Miscellaneous











& Condiments







Seasonings & Sauces




High in sodium but not high in fat. ** See guidelines under “Milk,” page 10. *** Look for good and moderate choices under “Fats,” page 13.

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Seasonings & Sauces s3EASONINGSALT




Eating with Your Heart’s Consent The Mediterranean Diet For an even stricter heart-healthy diet, many heart specialists and dietitians recommend a Mediterranean-style diet emphasizing more vegetables and olive oil and less meat. Research has shown that people who live in countries that border the Mediterranean Sea tend to have lower rates of heart disease. This may be due, at least in part, to foods traditionally eaten in this part of the world, though other lifestyle differences exist as well. – \_bD– D 2\– 2n¡k˜¦– \ – _˜– n¤k– culture, ethnic background, traditions and agricultural production, there are similar patterns to their traditional diets:

– –

–1––_D˜–_–\_T\–_k–M¡_˜8–£DTD˜ (bD8–k¡˜8– seeds, beans, whole-grain breads and whole-grain cereals 1––b_£D–n_b–_–¡D;– –˜\D–f `n–M ˜– source in the diet (olive oil is high in monounsaturated fat) 1–– _¦–xn;¡2˜8–N\– k;–xn¡b˜¦– D– eaten in small amounts and only a few times per week

– – –

1––D;–fD ˜–_–D ˜Dk–£D¦–_kMD‚¡Dk˜b¦– (a few times per month) and in very small amounts 1––TT– D–D ˜Dk–_kMD‚¡Dk˜b¦–z¨Dn–˜n– four times per week) 1––D;–¤_kD–_–2nk¡fD;–_k–bn¤–˜n– moderate amounts (check with your doctor before drinking any alcoholic beverages, even in moderation). Purple grape juice offers the same health benefits of red wine but with out the alcohol.

You may wish to include some of these guidelines in your heart-healthy diet. Choose plenty of fruits and vegetables five to eight servings per day. Consider including vegetarian meals in your diet. Choose brown rice, whole-wheat pasta and whole-grain breads. Make a stir fry using a variety of vegetables and a small amount of meat. Drink six glasses of water per day unless your doctor recommends otherwise. For more information on the Mediterranean diet, go to medi terraneandiet or

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Eating with Your Heartโ€™s Consent Seven Ways to Size Up Your Servings D ยยกยDย–Mnn;ย–xnยย˜_nkยย–ยnย–ยฆnยกย–aknยคย–Dยฅ 2ย˜bยฆย–\nยคย–fยก2\ย–Mnn;ย–ยฆnยกย– ยDย–D ย˜_kT}ย–\Dkย– ย–Mnn;ย–ย2 bDย– or measuring cups are not handy, you can still estimate your portion. Remember:















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= = = = = = =

1 oz.

Eating with Your Heart’s Consent Eating Out Choose foods with care when eating out. Often you can ask for foods that are not on the menu (such as skim milk, or margarine instead of butter). You also can ask for food to be made with no extra fat or salt. Remember, just because a portion is large or an item comes with the food ordered (such as gravy, sauces and whipped toppings) does not mean you have to eat it. Ask for the chef to leave off the sauces and gravies. Order the smaller-sized portion if available. –  ˜_kT–\D b˜\M¡bb¦– ˜–M ˜–Mnn;–D˜ ¡ k˜– can be a challenge. Choose a small hamburger or grilled chicken sandwich instead of a double or triple cheeseburger. Some fast food restaurants offer side salads and low-fat or fat-free salad dressings. Avoid fatty sandwich toppings, such as bacon, mayonnaise and cheese - choose lettuce, tomato, onion, ketchup and mustard instead. Avoid “supersizing,” which can add significant amounts of fat and calories to your meal. For example, an extra large soft ;_ka– zRE– n¡k2D{– ;;– (n¡˜– RO©– 2 bn_D8– k;– k– D¥˜ – b TD– n;D– nM– Dk2\– M_D– z“– n¡k2D{– ;;– (n¡˜– ”©©– 2 bn_D– ˜n– ¦n¡– meal. Many fast food restaurants have k¡˜_˜_nk–_kMnf ˜_nk–nk–˜\D_–D(–_˜D–zDD– page 18), or information may be available at the restaurant. Frequently eating at fast food restaurants is not recommended, but when you do, use the available nutrition information to help you make better food choices.

Appetizers Choose fruit, fruit juice, fresh vegetables with low-fat dip or salad with low-fat or fatfree dressing. Avoid cheeses, fried foods or high-fat dips and spreads.

Soups and Salads Choose plain fruit salads, gelatin salads or vegetable salads. Use fat-free dressing or a small amount of regular oil-based dressing (such as Italian, French or vinaigrette) served on the side (dip your fork into the dressing and then spear the salad). Avoid salads made with cream cheese, mayonnaise, sour cream, bacon, high-fat meats or eggs. Most restaurant soups are salty. Avoid cream soups and chowders, as these soups are high in fat and salt. Some vegetable and chickenbased soups can be low in fat.

Entrees Choose baked or broiled fish (without fat added), grilled or roasted chicken or turkey (do not eat the skin), lean veal, pork or beef zb_f_˜–˜\D– fn¡k˜–˜n–š–n¡k2D{}– M–˜\D–xn˜_nk– served is large, you can share it with someone or take some home for another meal.

Starches Select a baked potato (avoid sour cream and butter), unbuttered rice, noodles or other pasta, plain rolls or bread. Avoid buttered noodles and rice, rice pilafs or wild rice dishes, au gratin, scalloped, fried, buttered or mashed potatoes.

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Eating with Your Heart’s Consent Shopping and Cooking Tips Read Food Labels Make a habit of reading labels before buying food. Use them to compare different foods and different brands. Try to find the foods with the lowest amount of fat, cholesterol and sodium. Ingredient Listings Food labels tell you what ingredients are in the product. They are listed in decreasing order of how much is in the food. Avoid foods made with ingredients high in cholesterol, saturated fat or sodium. In general, look for Mnn;–¤_˜\–kn–fnD–˜\ k–š–T f–nM–M ˜–xD– q©©–2 bn_D–n–kn–fnD–˜\ k–š©–xD2Dk˜–nM– the total calories coming from fat.

Vegetables Ask for vegetables made without fat. Avoid vegetables that are buttered, creamed or made with fat or cheese.

Desserts Choose fruit ice, low-fat ice cream and frozen yogurt, sherbet and angel food cake. Avoid pies, cakes, cookies, ice cream, puddings and custard.

Beverages Select skim or 1% milk if available (or the lowest fat milk available), coffee, ¡k¤DD˜DkD;– ˜D 8– `¡_2D– zf ;D– ¤_˜\– q©©|– juice) or diet soft drinks. Alcoholic beverages and drinks made with caffeine are allowed if approved by your doctor. Avoid whole milk and drinks made with ice cream.

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Nutrition Facts The Nutrition Facts section of the label will help you decide which foods are good choices. Start by reading the serving size. Serving Size - Is it a normal serving for you? If you normally eat half or twice that serving size, then you will get half or twice the amount of nutrients per serving. Total Fat - The number next to Total Fat is the number of grams of fat in a serving size. If you normally eat twice the serving size listed, you will eat double the grams of fat listed. Saturated Fat - Next look at the numbers for saturated fat. The lower the number, the better.

Eating with Your Heart’s Consent Trans Fat - The lower the number, the better. If this number is not listed separately on the label, add up the grams of saturated fat, monounsaturated fat and polyunsaturated fat. The difference between this number and the Total Fat listed can tell you how much trans fat is in one portion of that food. nn;–¤_˜\–š–T f–nM–M ˜–n–bD–xD–D£_kT– and 1 gram or less of saturated fat usually can be worked into your diet. Foods with more total fat or saturated fat also can be part of your diet, but you need to be careful about how much and how often you eat these foods. Remember that you do not want more than one-third of your total fat intake for the day to come from saturated fat.

others may not. Be sure to read the nutrition information on the label. “Fat-Free” Foods – 1––\D2a–D£_kT–_¨D}–nfD–nM–˜\DD– foods are made with fat. The amount of fat in the serving size listed may be so small that the product can be labeled fat free. You may be getting some fat if you eat larger portions of these foods. – 1––\D2a–˜\D–2 bn_D– k;–n;_¡f–_k– – serving. Many of these foods are high in sugar, calories or sodium. You may need to limit your servings or limit the sugar and sodium in your diet if you are trying to lose weight.

Cholesterol -– nna– ˜– ˜\D– k¡f(D– Mn– cholesterol. You should eat no more than Ÿ©©–f_bb_T f–xD–; ¦}–DfDf(D–˜\ ˜–nkb¦– animal products contain cholesterol. Meats, fish, some dairy products and cheese will have high numbers. Fruits, vegetables and grain products will not have any unless animal products are added. Sodium -– nna– ˜– \n¤– f¡2\– n;_¡f– _– _k– a serving. Your goal is to eat no more than R8©©©–f_bb_T f–xD–; ¦} % Daily Value - This column is just a general T¡_;D}– ˜–_–( D;–nk– –xDnk–¤\n–D ˜–Ÿ8©©©– calories per day. It shows what percentage of the daily recommended amount of nutrients you would get in one serving of the food. _k2D– ¦n¡– f ¦– D ˜– fnD– n– bD– ˜\ k– Ÿ8©©©– calories per day, these numbers may not be correct for you. Many foods are labeled as “low-fat,” “lean,” “low saturated fat,” “light” and so on. Some of these foods may be good choices, while

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Eating with Your Heart’s Consent Manufacturers’ Terms Here are definitions of terms commonly used by manufacturers: Sodium Free -– bD– ˜\ k– O– fT– nM– n;_¡f– xD–

serving Salt Free - meets the requirements for “Sodium

Free” (see above) Very Low Sodium - šO– fT– n– bD– n;_¡f– xD–

serving Low Sodium -– qR©– fT– n– bD– n;_¡f– xD–

product. If the food gets one-half or more of its calories from fat, there must be a reduction nM–O©–xD2Dk˜–nM–˜n˜ b–M ˜–n–2 bn_D–z˜\D–˜Df– “light” also can mean color or texture). Lean -–bD–˜\ k–q©–T f–nM–M ˜8–¤_˜\–bD–˜\ k–

R–T f–nM– ˜¡ ˜D;–M ˜8– k;–bD–˜\ k–lO–fT– nM–2\nbD˜Dnb–xD–šr–n¡k2D–D£_kT–zn–q©©– gram serving) Extra Lean - bD–˜\ k–O–T f–nM–M ˜8–¤_˜\–bD– ˜\ k–Ÿ–T f– ˜¡ ˜D;–M ˜8– k;–bD–˜\ k–lO– fT– 2\nbD˜Dnb– xD– šr– n¡k2D– D£_kT– zn– q©©–T f–D£_kT{

serving Reduced Sodium -– ˜– bD ˜– ŸO– xD2Dk˜– bD– sodium when compared with the “regular” product

Follow these guidelines when selecting convenience foods:

when compared with the “regular” product

Frozen Meals - meals should contain less than ”©©–fT–nM–n;_¡f– k;–bD–˜\ k–q©–T f–nM– M ˜8–n– –_kTbD–Dk˜DD–¤_˜\–bD–˜\ k–ŸO©–fT– nM–n;_¡f– k;–bD–˜\ k–š–T f–nM–M ˜

Light in Sodium - O©– xD2Dk˜– bD– n;_¡f– xD–

Sweets - one serving should contain less than

Less Sodium - ˜–bD ˜–ŸO–xD2Dk˜–bD–n;_¡f–

serving when compared with the “regular” product

qR©–fT–nM–n;_¡f– k;–š–T f–nM–M ˜–n–bD Snack Foods - one serving should contain less

salt is added during processing

˜\ k–qR©–fT–nM–n;_¡f– k;–š–T f–nM–M ˜–n– less

Fat Free - contains a trivial amount of fat,

Cheese - one serving should contain less than

Unsalted, Without Added Salt, No Salt Added - no

saturated fat or cholesterol Low Fat - š–T f–nM–M ˜–n–bD–xD–D£_kT Low Saturated Fat - 1 gram of saturated fat or

less per serving Low Cholesterol -–Ÿ©–fT–nM–2\nbD˜Dnb–n–bD–

per serving Light - the product contains one-third fewer

calories or half the fat of the “regular”


ŸO©–fT–nM–n;_¡f– k;–O–T f–nM–M ˜–n–bD– per ounce

Eating with Your Heart’s Consent Buying Meat, Fish, Poultry –

– –

– –

1––\nnÂ?D–nkbŒ–£DÂ?Œ–bD k–2ÂĄÂ˜Â?–nM–fD ˜}– There are different grades of meat, partly based on the amount of fat. “Primeâ€? meat has the most fat. “Choiceâ€? meat has less fat. “Selectâ€? meat is even lower in fat. 1––Â?_f– bb–£_Â?_(bD–M ˜–MÂ?nf–fD ˜}–n–kn˜– eat poultry skin. 1––b k–2nÂ?Â?D2˜–xnÂ?˜_nk–Â?_¨DÂ?}–D ˜–¤_bb– shrink a little during cooking. A piece of cooked meat the size of a deck of 2 Â?;Â?–_Â?– (nÂĄÂ˜Â–ÂšÂ–nÂĄk2DÂ?} 1––Â? _Â?D8–(Â?n_b8–Â?n Â?˜8–TÂ?_bb–nÂ?–xn 2\–ŒnÂĄÂ?– meat, ďŹ sh and poultry. 1––n–kn˜–MÂ?ÂŚ}– kÂ?˜D ;8–;_x–fD ˜–_k–Â?a_f– milk, plain yogurt, egg substitute or egg white, then dip into bread crumbs and bake.

Using Butter, Margarine and Oils –

– –

1–– Â?–f Â?T Â?_kD–nÂ?–(ÂĄÂ˜Â˜DÂ?–(D˜˜DÂ?ƒ–ÂĄÂ˜Â˜DÂ?– contains cholesterol, and some margarines contain trans fats. Select a soft tub margarine free of cholesterol and trans fats with no more than 2 grams of saturated fat per serving. 1––Â?D–nkbŒ–Â?D2nffDk;D;–n_bÂ?– k;– margarines when cooking. Use the smallest amount you can. 1––nMÂ˜Â–Â˜ÂĄ(–f Â?T Â?_kDÂ?–¤nÂ?a–¤Dbb– Â?– bread spreads and on vegetables and potatoes, but may not work well in baked goods. Use stick margarine or recommended oils instead when baking, but use the smallest amount you can.

Substitute Monounsaturated and Polyunsaturated Fats for Saturated Fats: If a recipe calls for 1 cup margarine or butter, substitute ž cup unsaturated oil. If a recipe calls for 1 cup solid shortening, substitute ž cup unsaturated oil. If a recipe calls for 1 tablespoon margarine, substitute 2Ÿ teaspoons unsaturated oil.

Fat-Free Broth or Juice –

– – – –

1––Â?D–M ˜^MÂ?DD–`ÂĄ_2D–MÂ?nf–fD ˜–MnÂ?– ¥–`ÂĄÂ?}– It also can be used as a soup base or thickened for gravy. Use one of these methods to make fatfree meat broth: 1––;;–_2D–2ÂĄ(DÂ?–˜n–2nnb–‚¥_2abÂŚ}–DfnÂŁD– fat as it becomes solid. 1––DMÂ?_TDÂ? ˜D–MnÂ?– –kÂĄf(DÂ?–nM–\nÂĄÂ?Â?}– Remove solid fat. 1––a_f–M ˜–nMM–˜\D–˜nx–¤_˜\– –x xDÂ?–˜n¤Db– or sponge. 1––Â?D– –Â?xD2_ b–fD Â?ÂĄÂ?_kT–2ÂĄx–¤_˜\– – bottom spout. The fat-free broth will pour out ďŹ rst.

Chocolate –

1––DTÂĄb Â?–2\n2nb ˜D–2nk˜ _kÂ?–Â? Â˜ÂĄÂ? ˜D;– fat. Cocoa powder can be used instead, since most of the fat has been removed.

If a recipe calls for 1 ounce unsweetened ( a_kT– 2\n2nb ˜D8– Â?ÂĄ(Â?˜_Â˜ÂĄÂ˜D– š– ˜ (bDÂ?xnnkÂ?– cocoa powder plus 1 tablespoon of allowed oil.

Heart & Vascular Center 21

Eating with Your Heart’s Consent Cream Cheese

Sour Cream




1––Â?D–M ˜^MÂ?DD–2Â?D f–2\DDÂ?D–_k–xb 2D–nM– regular cream cheese. 1–––bn¤^M ˜8–bn¤^2\nbDÂ?˜DÂ?nb–Â?ÂĄ(Â?˜_Â˜ÂĄÂ˜D– can be made with plain yogurt: Pour low-fat or non-fat plain yogurt into a colander or strainer lined with a coffee ďŹ lter or cheesecloth. Place a container underneath strainer, and cover with a clean dish towel. Allow to drain in refrigerator for 24 hours.

Tomato Sauce – –

Cream Soup Base –

1––Â?D–M ˜^MÂ?DD–nÂ?–bn¤^M ˜–Â?nÂĄÂ?–2Â?D f}–b _k8– unavored, fat-free or low-fat yogurt also can be used.

1––_¼–2\ÂĄkaÂ?–nM–2nnaD;–xn˜ ˜n8–Â?a_f–f_ba– and onion in a blender.

1––¥Œ–bn¤^M ˜8–bn¤^Â?n;_ÂĄf–˜nf ˜n–Â? ÂĄ2DÂ?} 1–– aD–ŒnÂĄÂ?–n¤k–Â? ÂĄ2D}–˜ Â?˜–¤_˜\–‡kn– salt addedâ€? canned tomatoes, tomato paste or tomato juice. Add lots of onions, herbs and spices. “No salt addedâ€? canned crushed tomatoes only need to be heated with some basil, garlic and oregano for a quick, tasty sauce.

White Sauce Base Eggs –

1––ÂĄ(Â?˜_Â˜ÂĄÂ˜D–DTT–¤\_˜DÂ?–nÂ?–DTT–Â?ÂĄ(Â?˜_Â˜ÂĄÂ˜DÂ?– for whole eggs:

If a recipe calls for 1 whole egg, substitute with 2 egg whites or Ÿ cup egg substitute, or 1 egg white plus 1 teaspoon oil If a recipe calls for: 1 egg yolk, substitute with 1 tablespoon cornstarch, our or arrowroot per ½ cup of liquid.

Seasoning –



1––£n_;–¥Â?_kT– ;;D;–M ˜–nÂ?–Â? b˜–MnÂ?–nk_nkÂ?8– garlic (or onion and garlic powders), black or cayenne pepper, basil, sage, thyme, rosemary, cinnamon, nutmeg, oregano or tarragon. 1––Â?Œ–MÂ?ÂĄ_˜Â?– k;–MÂ?ÂĄ_˜–`ÂĄ_2DÂ?–˜n–P ÂŁnÂ?–fD ˜Â?– and vegetables. Pineapple, apple, apricot, lemon and orange work well with many foods. 1–– n¤^M ˜–Â? ÂĄ2DÂ?–b_aD–Â? bÂ? Â?– bÂ?n–2 k–f aD– foods more tasty.

22 Heart & Vascular Center


1––Db˜–q–˜n–Â&#x;–˜ (bDÂ?xnnkÂ?–nM– bbn¤D;–n_b– or margarine. Add 1 to 2 tablespoons of our. Cook for a few minutes over low heat, stirring often. Slowly add 1 cup skim milk. Continue to stir over low heat until sauce thickens.

Eating with Your Heart’s Consent Heart-Healthy Recipes

Here are some low-fat, low-salt recipes to get you started.

MEAT DISHES Oven-Fried Parmesan Chicken

Chicken Cacciatore

1–4 boneless, skinless chicken breast halves 1–q–2ÂĄx–knkM ˜–xb _k–ŒnTÂĄÂ?˜ 1–›–2ÂĄx–xb _k–(Â?D ;–2Â?ÂĄf(Â? 1–R–˜ (bDÂ?xnnkÂ?– Â?fDÂ? k–2\DDÂ?D 1–Â&#x;–˜ (bDÂ?xnnkÂ?–PnÂĄÂ? 1–q–˜ (bDÂ?xnnk–x xÂ?_a 1–x_k2\–2 ÂŚDkkD–xDxxDÂ? 1–q–˜D Â?xnnk–nk_nk–xn¤;DÂ? 1–r–˜D Â?xnnk–T Â?b_2–xn¤;DÂ? 1–nk^Â?˜_2a–2nna_kT–Â?xÂ? ÂŚ

1–R–(nkDbDÂ?Â?8–Â?a_kbDÂ?Â?–2\_2aDk–(Â?D Â?˜Â? 1–q–2 k–zq”–n¨}{–Â?˜D¤D;–˜nf ˜nDÂ? 1––q–nk_nk8–Â?b_2D;8–nÂ?–q–2ÂĄx–MÂ?n¨Dk– chopped onion 1–½ tablespoon each dried oregano & basil 1–q–2 k–zE–n¨}{–˜nf ˜n–Â? ÂĄ2D 1–Â&#x;–2ÂĄxÂ?–MÂ?n¨Dk–xD Â? 1–r–2ÂĄx–2\nxxD;–TÂ?DDk–xDxxDÂ?Â? 1–R–2ÂĄxÂ?–2nnaD;–2nÂĄÂ?2nÂĄÂ?–nÂ? 1–š–2ÂĄxÂ?–2nnaD;–x Â?˜ Note to people with sodium restrictions: Use tomatoes with no salt added.

Place the chicken in yogurt and refrigerate. Â?D\D ˜–nÂŁDk–˜n–ROŠ> Mix the remaining ingredients (except cooking spray) in a Ziploc bag. Place the chicken in the bag and shake one piece at a time. Place chicken on prepared baking sheet and lightly spray the top with non-stick Â?xÂ? ÂŚ}– aD–Â&#x;Š–f_kÂĄÂ˜DÂ?–nÂ?–¥k˜_b–2\_2aDk–_Â?– fork-tender and juices run clear. Makes 4 servings. Nutrition facts per serving: Â&#x;EŠ–2 bnÂ?_DÂ? šR–TÂ? fÂ?–xÂ?n˜D_k 16 grams carbohydrates 4 grams fat 1 gram ďŹ ber “R–fT–2\nbDÂ?˜DÂ?nb EŠ–fT–2 b2_ÂĄf 2 grams iron šq”–fT–Â?n;_ÂĄf 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

1. Spray large saucepan with non-stick spray. Add chicken, onions and green xDxxDÂ?Â?– k;–Â? ÂĄÂ˜D–MnÂ?–O–f_kÂĄÂ˜DÂ?}–;;– remaining ingredients, except peas. Cover and simmer, stirring occasionbbÂŚ8–MnÂ?–Â&#x;O–˜n–šO–f_kÂĄÂ˜DÂ?}–;;–xD Â?– k;– 2nna–MnÂ?–O–˜n–“–f_kÂĄÂ˜DÂ?} Â&#x;}––\_bD– 2\_2aDk– _Â?– 2nna_kT8– xÂ?Dx Â?D– couscous or pasta according to package directions. š}––DÂ?ÂŁD– 2\_2aDk– (Â?D Â?˜Â?– nÂŁDÂ?– 2nnaD;– couscous or pasta. Makes 4 servings. Nutrition facts per serving: RÂ&#x;“–2 bnÂ?_DÂ? šO–TÂ? fÂ?–xÂ?n˜D_k ”š–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 9 grams ďŹ ber š–TÂ? fÂ?–M ˜ ”š–fT–2\nbDÂ?˜DÂ?nb lš–fT–2 b2_ÂĄf 4 mg iron “ŠE–fT–Â?n;_ÂĄf 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

Heart & Vascular Center 23

Eating with Your Heart’s Consent Chicken Fajitas

Pasta, Chicken and Vegetables

1–R–(nkDbDÂ?Â?8–Â?a_kbDÂ?Â?–2\_2aDk–(Â?D Â?˜Â? 1–q–˜D Â?xnnk–2\_b_–xn¤;DÂ? 1–q–˜D Â?xnnk–nk_nk–xn¤;DÂ? 1–s–˜D Â?xnnk–T Â?b_2–xn¤;DÂ? 1–Â&#x;–˜ (bDÂ?xnnkÂ?–b_fD–`ÂĄ_2D 1–E–PnÂĄÂ?–˜nÂ?˜_bb Â?

1––q–( T–zq”–n¨}{–MÂ?n¨Dk– ˜ b_ k^Â?Â˜ÂŚbD– mixed vegetables 1–q–2 k–zqO–n¨}{–2\nxxD;–˜nf ˜nDÂ? 1––Â&#x;–(nkDbDÂ?Â?8–Â?a_kbDÂ?Â?–2\_2aDk–(Â?D Â?˜Â?– (about 8 oz.) 1–q–˜D Â?xnnk–f_k2D;–T Â?b_2 1–q–˜D Â?xnnk–( Â?_b 1–q–˜D Â?xnnk–nÂ?DT kn 1– Â?fDÂ? k–2\DDÂ?D 1–E–n¨}–;Â?Œ–x Â?˜

Toppings as desired: salsa, non-fat or lowfat sour cream, chopped tomatoes, chopped lettuce, shredded low-fat Cheddar cheese. 1. Cut chicken in ½â€? strips. Put in bowl, sprinkle with spices and lime juice. Set Â?_;D–MnÂ?–qO–f_kÂĄÂ˜DÂ?} 2. Prepare other fajita toppings. Heat nonstick skillet until hot. Spray with nonstick spray, add chicken, stir-frying until chicken is brown on all sides and cooked throughout. š}–– Â?f– ˜nÂ?˜_bb Â?– _k– nÂŁDk– nÂ?– f_2Â?n¤ ÂŁD– briey. Put chicken in tortillas, add ˜nxx_kTÂ?– Â?– ;DÂ?_Â?D;}– Â? x– k;– Â?DÂ?ÂŁD– immediately. Makes 8 tortillas. Nutrition facts per serving: 214 calories 16 grams protein 28 mg carbohydrates Š–TÂ? fÂ?–N(DÂ? 4 grams fat šq–fT–2\nbDÂ?˜DÂ?nb 8 mg calcium 1.9 mg iron š“Š–fT–Â?n;_ÂĄf Serve with: seasoned rice and cooked carrots 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

1. Cut chicken in ½â€? strips and cook in a skillet sprayed with non-stick spray for O–f_kÂĄÂ˜DÂ?}–;;–˜nf ˜nDÂ?– k;–Â?x_2DÂ?– k;– Â?_ffDÂ?– MnÂ?– O– f_kÂĄÂ˜DÂ?}– ;;– ÂŁDTD˜ (bDÂ?– and continue to simmer until vegetables Â?D–˜Dk;DÂ?8– (nÂĄÂ˜Â–Â&#x;Š–f_kÂĄÂ˜DÂ?} Â&#x;}––\_bD– ÂŁDTD˜ (bDÂ?– Â?D– Â?_ffDÂ?_kT8– 2nna– pasta according to package directions, nf_˜˜_kT– Â? b˜8– _M– ;DÂ?_Â?D;}–\Dk– ˜Dk;DÂ?8– drain pasta. š}––b 2D– x Â?˜ – nk– – xb ˜D– k;– ˜nx– ¤_˜\– vegetable mixture. Sprinkle with Parmesan cheese. Makes 4 servings. Nutrition facts per serving: RŠO–2 bnÂ?_DÂ? 26 grams protein ”O–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 9 grams ďŹ ber O–TÂ? fÂ?–M ˜ šl–fT–2\nbDÂ?˜DÂ?nb 181 mg calcium R}O–fT–_Â?nk šOR–fT–Â?n;_ÂĄf Serve with: whole grain dinner roll and canned pineapple 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

24 Heart & Vascular Center

Eating with Your Heart’s Consent 15 Minute Chili

Chicken and Bulgur

1–q–b(}–TÂ?nÂĄk;Â–Â˜ÂĄÂ?aDÂŚ 1–q–2ÂĄx–MÂ?DÂ?\–nÂ?–MÂ?n¨Dk–2\nxxD;–nk_nkÂ? 1––q–2 k–zq”–n¨}{–x_k˜n–(D kÂ?8– drained & rinsed 1––q–2 k–zq”–n¨}{–a_;kDŒ–(D kÂ?8– drained & rinsed 1–q–2 k–zÂ&#x;E–n¨}{–Â?˜D¤D;–˜nf ˜nDÂ? 1–q–˜ (bDÂ?xnnk–2\_b_–xn¤;DÂ? 1–q–˜ (bDÂ?xnnk–2ÂĄf_k–xn¤;DÂ? 1–r–2ÂĄx–Â? bÂ?

1––š–b(Â?}–2\_2aDk–x_D2DÂ?–z(Â?D Â?˜8–˜\_T\8– drumstick), skinned 1–qr–2ÂĄx–2\_2aDk–(Â?n˜\8–2 kkD; 1–q–2ÂĄx–2nb;–¤ ˜DÂ? 1–q–2ÂĄx–(ÂĄbTÂĄÂ?–¤\D ˜ 1–r–2ÂĄx–MÂ?DÂ?\–nÂ?–MÂ?n¨Dk–2\nxxD;–nk_nkÂ? 1–r–˜D Â?xnnk–2ÂĄÂ?Â?ÂŚ 1–r–˜D Â?xnnk–f_k2D;–T Â?b_2 1–– teaspoon salt 1–Â&#x;–2ÂĄxÂ?–Â?b_2D;–2 Â?Â?n˜Â? 1–q–2ÂĄx–Â?b_2D;–¨¥22\_k_ 1–r–2ÂĄx–MÂ?n¨Dk–2\nxxD;–TÂ?DDk–xDxxDÂ?

1. In a large pot, brown turkey with chopped onions. Add tomatoes and chop tomatoes with spoon, breaking into small pieces. 2. Add seasonings and salsa to turkey mixture. Stir in drained, rinsed beans. š}–nna–¥k˜_b–\n˜}  aDÂ?–qŠ–2ÂĄxÂ?} Nutrition facts per cup: 186 calories 14 grams protein 22 grams carbohydrates “–TÂ? fÂ?–N(DÂ? O–TÂ? fÂ?–M ˜ š”–fT–2\nbDÂ?˜DÂ?nb “O–TÂ? fÂ?–2 b2_ÂĄf š}š–fT–_Â?nk RO”–fT–Â?n;_ÂĄf Serve with: pasta, rice or a baked potato, and a green salad 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

1. In a Dutch oven (large pan with lid), combine the ďŹ rst 8 ingredients. Bring the mixture to a boil. Reduce heat, cover k;–Â?_ffDÂ?–MnÂ?–qŠ–f_kÂĄÂ˜DÂ?} 2. Turn the chicken over and add the 2 Â?Â?n˜Â?}– nÂŁDÂ?– k;– Â?_ffDÂ?– qŠ– ˜n– qO– minutes. š}––;;– ˜\D– ¨¥22\_k_– k;– TÂ?DDk– xDxxDÂ?}– nÂŁDÂ?– k;– Â?_ffDÂ?– kn˜\DÂ?– qŠ– f_kÂĄÂ˜DÂ?– or until the chicken is cooked through. Makes 6 servings. Nutrition facts per serving: Â&#x;lš–2 bnÂ?_DÂ? šE–TÂ? fÂ?–xÂ?n˜D_k Â&#x;O–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 6 grams ďŹ ber O–TÂ? fÂ?–M ˜ 91 mg cholesterol 48 mg calcium 2 mg iron q“R–fT–Â?n;_ÂĄf Serve with: hard roll and canned fruit 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

Heart & Vascular Center 25

Eating with Your Heart’s Consent Lemon-Herb Roast Chicken 1–DTD˜ (bD–n_b–Â?xÂ? ÂŚ 1–r–˜ (bDÂ?xnnk–;Â?_D;–˜\ÂŚfD8–2Â?ÂĄf(bD; 1–r–˜D Â?xnnk–;Â?_D;–( Â?_b8–2Â?ÂĄf(bD; 1–r–˜D Â?xnnk–xDxxDÂ? 1–s–˜D Â?xnnk–Â? b˜ 1–R^xnÂĄk;–Â?n Â?˜_kT–2\_2aDk 1–Â&#x;–fD;_ÂĄf–T Â?b_2–2bnÂŁDÂ?8–f_k2D; 1–q–bDfnk8–2ÂĄÂ˜Â–_k˜n–¤D;TDÂ? 1–q–( Œ–bD M 1–r–fD;_ÂĄf–nk_nk 1–r–2ÂĄx–;Â?Œ–¤\_˜D–¤_kD–zÂ?DTÂĄb Â?–nÂ?–knk b2n\nb_2{ Â?D\D ˜– ˜\D– nÂŁDk– ˜n– šOŠ>}– _T\˜bŒ– Â?xÂ? Œ– – Â?n Â?˜_kT– x k– k;– Â? 2a– ¤_˜\– ÂŁDTD˜ (bD– n_b– spray. In a small bowl, stir together the thyme, basil, pepper and salt. Discard the giblets and all the visible fat from the chicken. Rub the outside of the chicken with the herb mixture. Put the chicken with the breast side up on the rack in the roasting pan. Put the garlic, lemon, bay leaf and onion in the chicken. Pour the wine into the pan. – _T\˜bŒ–Â?xÂ? ÂŚÂ–Â˜\D–nÂĄÂ˜Â?_;D–nM–˜\D–2\_2aDk–¤_˜\–£DTD˜ (bD–n_b–Â?xÂ? ÂŚ} –  aD–MnÂ?–Â&#x;Š–f_kÂĄÂ˜DÂ?–xDÂ?–xnÂĄk;8–nÂ?–¥k˜_b–˜\D–_k˜DÂ?k b–˜DfxDÂ? Â˜ÂĄÂ?D–Â?D 2\DÂ?–qEŠ>–nÂ?– the juices run clear when a thigh is pierced with a sharp knife. – D˜–Â?DÂ?˜–MnÂ?–qO–f_kÂĄÂ˜DÂ?–(DMnÂ?D–2 Â?ÂŁ_kT}–_Â?2 Â?;–˜\D–Â?a_k–(DMnÂ?D–Â?DÂ?ÂŁ_kT–˜\D–2\_2aDk} Makes 6 servings. Nutrition facts per serving: 188 calories šq–TÂ? fÂ?–xÂ?n˜D_k 1 gram carbohydrates Š–TÂ? fÂ?–N(DÂ? qŠÂ&#x;–fT–2\nbDÂ?˜DÂ?nb R}O–TÂ? fÂ?–˜n˜ b–M ˜ 1 gram saturated fat 1 gram polyunsaturated fat q}O–TÂ? fÂ?–fnknÂĄkÂ? Â˜ÂĄÂ? ˜D;–M ˜ Â&#x;qŠ–fT–Â?n;_ÂĄf 4HISRECIPEISREPRINTEDWITHPERMISSIONFROMh4HE.EW !MERICAN(EART!SSOCIATION#OOKBOOK v3EVENTH%DITION #OPYRIGHTŠBYTHE!MERICAN(EART!SSOCIATION 0UBLISHEDBY#LARKSON0OTTER0UBLISHERS ADIVISIONOF2ANDOM (OUSE )NC!VAILABLEFROMBOOKSELLERSEVERYWHERE

26 Heart & Vascular Center

Eating with Your Heart’s Consent Chicken and Vegetable Soup 1–q–xnÂĄk;–(nkDbDÂ?Â?8–Â?a_kbDÂ?Â?–2\_2aDk–(Â?D Â?˜Â?8– bb–£_Â?_(bD–M ˜–;_Â?2 Â?;D; 1–q–fD;_ÂĄf–¨¥22\_k_8–˜\_kbŒ–Â?b_2D; 1–q–fD;_ÂĄf–Â?D;–(Dbb–xDxxDÂ?8–2\nxxD; 1–q›–2ÂĄxÂ?–M ˜^MÂ?DD8–bn¤^Â?n;_ÂĄf–2\_2aDk–(Â?n˜\ 1–Â&#x;–nÂĄk2DÂ?–;Â?_D;–kn^ÂŚnba–DTT–knn;bDÂ? 1–r–2ÂĄx–MÂ?n¨Dk–¤\nbD^aDÂ?kDb–2nÂ?k 1–r–2ÂĄx–¤ ˜DÂ? 1–r–˜D Â?xnnk–;Â?_D;–˜\ÂŚfD8–2Â?ÂĄf(bD; 1–R–nÂ?–O–fD;_ÂĄf–TÂ?DDk–nk_nkÂ?–zTÂ?DDk– k;–¤\_˜D–x Â?˜Â?{8–NkDbŒ–2\nxxD;–z (nÂĄÂ˜Â–r–2ÂĄx{ 1–s–2ÂĄx–NkDbŒ–Â?k_xxD;–MÂ?DÂ?\–x Â?Â?bDÂŚ 1–q–˜ (bDÂ?xnnk–nb_ÂŁD–n_b 1–r–˜D Â?xnnk–Â? b˜ 1–s–˜D Â?xnnk–xDxxDÂ? 1–Â&#x;–˜ (bDÂ?xnnkÂ?–Â?\Â?D;;D;–nÂ?–TÂ? ˜D;– Â?fDÂ? k–2\DDÂ?D Cut the chicken into bite-size pieces. Heat a Dutch oven over medium-high heat. Remove from the heat and lightly spray with ÂŁDTD˜ (bD–n_b–Â?xÂ? Œ–z(D_kT–2 Â?DMÂĄb–kn˜–˜n–Â?xÂ? Œ–kD Â?– –T Â?–P fD{}–nna–˜\D–2\_2aDk–MnÂ?–Â&#x;–˜n–š–f_kÂĄÂ˜DÂ?8– or until no longer pink on the outside, stirring constantly. Transfer the chicken to a plate. – _T\˜bŒ–Â?xÂ? ÂŚÂ–Â˜\D–ÂĄÂ˜2\–nÂŁDk–¤_˜\–£DTD˜ (bD–n_b–Â?xÂ? Œ–zkn–kDD;–˜n–¤_xD–2bD k–NÂ?Â?˜{}–nna– the zucchini and bell pepper for 2 minutes, or until just beginning to brown lightly on the edges, stirring constantly. Stir in the broth, noodles, corn, water, and thyme. Increase the heat to high and bring to a (n_b}–D;ÂĄ2D–˜\D–\D ˜– k;–Â?_ffDÂ?8–2nÂŁDÂ?D;8–MnÂ?–qŠ–f_kÂĄÂ˜DÂ?} – ˜_Â?–_k–˜\D–2\_2aDk– k;– kŒ– 22ÂĄfÂĄb ˜D;–`ÂĄ_2DÂ?}–nna–MnÂ?–š–f_kÂĄÂ˜DÂ?8–nÂ?–¥k˜_b–˜\D–2\_2aDk–_Â?– no longer pink in the center. Remove from the heat. Stir in the remaining ingredients except the Parmesan. To serve, ladle into bowls. Sprinkle with the Parmesan. Makes 4 servings. Nutrition facts per serving: 268 calories šq–TÂ? fÂ?–xÂ?n˜D_k 21 grams carbohydrates 4 grams ďŹ ber 68 mg cholesterol 6 grams total fat q}O–TÂ? fÂ?–Â? Â˜ÂĄÂ? ˜D;–M ˜ 1 gram polyunsaturated fat š–TÂ? fÂ?–fnknÂĄkÂ? Â˜ÂĄÂ? ˜D;–M ˜ Rš”–fT–Â?n;_ÂĄf 4HISRECIPEISREPRINTEDWITHPERMISSIONFROMh4HE.EW!MERICAN(EART!SSOCIATION#OOKBOOK v3EVENTH%DITION #OPYRIGHTŠBYTHE !MERICAN(EART!SSOCIATION0UBLISHEDBY#LARKSON0OTTER0UBLISHERS ADIVISIONOF2ANDOM(OUSE )NC!VAILABLEFROMBOOKSELLERSEVERYWHERE

Heart & Vascular Center 27

Eating with Your Heart’s Consent Rosemary-Sage Steak 1––q–xnÂĄk;–(nkDbDÂ?Â?–˜nx–Â?_Â?bn_k–Â?˜D a8– bb– visible fat discarded Marinade 1––s–2ÂĄx–2\nxxD;–nk_nk 1––Â&#x;–˜ (bDÂ?xnnkÂ?–MÂ?DÂ?\–bDfnk–`ÂĄ_2D 1–––br–˜ (bDÂ?xnnkÂ?–;Â?Œ–¤\_˜D–¤_kD–zÂ?DTÂĄb Â?– or nonalcoholic) 1–––q–˜ (bDÂ?xnnk–NkDbŒ–2\nxxD;–MÂ?DÂ?\– rosemary or 2 teaspoons dried, crushed 1––q–˜ (bDÂ?xnnk–NkDbŒ–2\nxxD;–MÂ?DÂ?\–Â? TD– or 2 teaspoons dried 1––r–˜ (bDÂ?xnnk–_`nk–fÂĄÂ?˜ Â?; 1––Â&#x;–fD;_ÂĄf–T Â?b_2–2bnÂŁDÂ?8–f_k2D; 1––q–˜D Â?xnnk–nb_ÂŁD–n_b 1––s–˜D Â?xnnk–xDxxDÂ? 1––s–˜D Â?xnnk–Â? b˜ Put the steak in a resealable plastic bag. In a small bowl, stir together the marinade ingredients. Pour over the steak. Seal the bag and turn to coat. Refrigerate for 1 to 24 hours, turning occasionally. Preheat the grill on medium-high. Drain the steak, discarding the marinade. Grill for 8 to 12 minutes on each side, or until desired doneness. Makes 4 servings. Nutrition facts per serving: qOq–2 bnÂ?_DÂ? 24 grams protein Š–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? Š–TÂ? fÂ?–N(DÂ? “q–fT–2\nbDÂ?˜DÂ?nb O}O–TÂ? fÂ?–˜n˜ b–M ˜ 2 grams saturated fat Š–TÂ? fÂ?–xnbÂŚÂĄkÂ? Â˜ÂĄÂ? ˜D;–M ˜ Â&#x;}O–TÂ? fÂ?–fnknÂĄkÂ? Â˜ÂĄÂ? ˜D;–M ˜ Â&#x;šR–fT–Â?n;_ÂĄf 4HISRECIPEISREPRINTEDWITHPERMISSIONFROMh4HE.EW!MERICAN(EART !SSOCIATION#OOKBOOK v3EVENTH%DITION #OPYRIGHTŠBYTHE!MERICAN (EART!SSOCIATION0UBLISHEDBY#LARKSON0OTTER0UBLISHERS ADIVISIONOF 2ANDOM(OUSE )NC!VAILABLEFROMBOOKSELLERSEVERYWHERE

28 Heart & Vascular Center

FISH DISHES Poached Fish with Vegetables 1––qÂ&#x;–n¨}–nÂ? kTD–Â?nÂĄT\Œ–nÂ?–n˜\DÂ?–f_b;– white ďŹ sh 1–Â&#x;–˜nf ˜nDÂ?8–;_2D; 1–Â&#x;–Â?f bb–¨¥22\_k_8–Â?b_2D; 1–s–2ÂĄx–MÂ?DÂ?\–nÂ?–MÂ?n¨Dk–2\nxxD;–nk_nkÂ? 1–›–2ÂĄx–Â?b_2D;–fÂĄÂ?\Â?nnfÂ? 1–q–2 k–£DTD˜ (bD–(Â?n˜\ 1–q–˜n–qr–˜D Â?xnnkÂ?–;Â?_D;–f Â?`nÂ? f 1–r–˜D Â?xnnk–T Â?b_2–xn¤;DÂ? 1. Place broth in large skillet and bring to simmer. Add half the garlic powder then the ďŹ sh. Top with vegetables, add the rest of the garlic powder and the marjoram. 2. Cover and cook over medium heat for (nÂĄÂ˜Â–qŠ–˜n–qO–f_kÂĄÂ˜DÂ?}–\D2a–˜\D–NÂ?\– to make sure it is aky before serving. Makes 4 servings. Nutrition facts per serving: (includes 1 cup steamed rice): 114 calories 18 grams protein 8 grams carbohydrates Â&#x;š–TÂ? fÂ?–M ˜ 22 mg cholesterol 44 mg calcium 98 mg iron RŠq–fT–Â?n;_ÂĄf 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

Eating with Your Heart’s Consent Baked Herbed Fish with Rice

Sauteed Cod with Black Beans

1–”–2ÂĄxÂ?–2nnaD;–Â?_2D 1––qr–b(Â?}–2 ˜NÂ?\8–2n;8–nÂ? kTD–Â?nÂĄT\ÂŚ8– haddock or other ďŹ lleted ďŹ sh 1–q–˜D Â?xnnk–n_b 1–x_k2\–nM–Â? b˜ 1–q–˜D Â?xnnk–˜\ÂŚfD–nÂ?–˜ Â?Â? Tnk 1–q–˜D Â?xnnk–f_k2D;–T Â?b_2 1–›–2ÂĄx–MÂ?DÂ?\–nÂ?–MÂ?n¨Dk–2\nxxD;–nk_nk 1––q–2ÂĄx–¤\_˜D–¤_kD–nÂ?–Â?a_f–f_ba– (not both) 1–Â?xÂ?_kabD–nM–x xÂ?_a

1––qr–b(Â?}–2n;8–˜\ ¤D;–z2 k– bÂ?n–¥Â?D–¤\_˜D– ďŹ sh or sole) 1––R–˜D Â?xnnkÂ?–nb_ÂŁD–n_b8–;_ÂŁ_;D; 1––q–nk_nk8–2\nxxD; 1––š–2bnÂŁDÂ?–T Â?b_28–f_k2D; 1––q–˜D Â?xnnk–TÂ?nÂĄk;–2ÂĄf_k 1––q–2 k–(b 2a–(D kÂ?8–Â?_kÂ?D;– k;–;Â? _kD; 1––q–2 k–zqR–n¨}{–;_2D;–˜nf ˜nDÂ? 1––q–2 k–zR–n¨}{–f_b;–;_2D;–TÂ?DDk–2\_b_Â? 1––Â&#x;–˜ (bDÂ?xnnkÂ?–MÂ?DÂ?\–b_fD–`ÂĄ_2D 1––Â? b˜– k;–xDxxDÂ?–˜n–˜ Â?˜D

1. ˜ Â?˜–2nna_kT–Â?_2D}–Â?D\D ˜–nÂŁDk–˜n–RŠŠ>} 2. Place ďŹ sh ďŹ llets in baking dish. Combine oil with thyme, salt and garlic. Spread over ďŹ sh. Top with onions. Pour wine or milk over the ďŹ sh. š}–– aD–MnÂ?–qŠ–˜n–qO–f_kÂĄÂ˜DÂ?–nÂ?–¥k˜_b–NÂ?\– akes with a fork.

Note to patients with sodium restrictions: Use no-salt-added tomato sauce and omit added salt.

Makes 4 servings. Nutrition facts per serving: (includes 1½ cups rice per serving): OÂ&#x;E–2 bnÂ?_DÂ? R“–TÂ? fÂ?–xÂ?n˜D_k “š–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 2 grams ďŹ ber 2 grams fat lš–fT–2\nbDÂ?˜DÂ?nb qR“–fT–2 b2_ÂĄf Ršš–fT–_Â?nk 211 mg sodium 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

Season cod with salt and pepper. In a large Â?a_bbD˜8– \D ˜– š– ˜D Â?xnnkÂ?– nM– nb_ÂŁD– n_b– nÂŁDÂ?– medium-high heat. Cook ďŹ llets in the oil for about two minutes per side or until ďŹ sh akes easily when tested with a fork. Remove from skillet and keep warm. In the same skillet, cook onion and garlic in remaining olive oil over medium heat until soft, about ďŹ ve minutes. Stir in cumin and cook one minute. Add beans and tomatoes; gradually add chilis to taste. Cover and cook over low \D ˜–MnÂ?–qŠ–f_kÂĄÂ˜DÂ?}–˜_Â?–_k–b_fD–`ÂĄ_2D– k;– season to taste. Serve cod over the black bean mixture. Makes 6 servings. Nutrition facts per serving: Â&#x;Šš–2 bnÂ?_DÂ? 4 grams fat (.6 grams saturated fat) 42 mg cholesterol ”šO–fT–Â?n;_ÂĄf 16 grams carbohydrates Â&#x;O–TÂ? fÂ?–xÂ?n˜D_k O–TÂ? fÂ?–N(DÂ? 2ECIPE3OURCE*UNGLE*IMS)NTERNATIONAL-ARKET

Heart & Vascular Center 29

Eating with Your Heart’s Consent Tasty Tuna Pattie

Poached Fish

1–Â&#x;–2ÂĄxÂ?–Â?nM˜–(Â?D ;–2Â?ÂĄf(Â? 1– cup fresh or frozen chopped onions 1–Â&#x;–2ÂĄxÂ?–P aD;Â–Â˜ÂĄk 1–q–˜ (bDÂ?xnnk–bDfnk–`ÂĄ_2D 1––q–˜D Â?xnnk–nk_nk–xn¤;DÂ? 1–; Â?\–xDxxDÂ? 1–q–˜ (bDÂ?xnnk–;Â?_D;–x Â?Â?bDŒ–P aDÂ? 1–q–¤\nbD–DTT–xbÂĄÂ?–q–DTT–¤\_˜D 1–r–˜D Â?xnnk–;_bb 1–q–˜ (bDÂ?xnnk–£DTD˜ (bD–n_b

The best ďŹ sh to use for poaching are salmon and mahi mahi.

1. Drain tuna, ake. Combine all ingredients except oil. Shape into 6 patties. 2. Spray non-stick skillet with non-stick spray. Add oil. Heat on medium and cook patties until golden brown. Turn patties at least once. Makes 6 servings. Nutrition facts per serving: qRO–2 bnÂ?_DÂ? 16 grams protein 9 grams carbohydrates 1 gram ďŹ ber 4 grams fat O“–fT–2\nbDÂ?˜DÂ?nb Â&#x;“–fT–2 b2_ÂĄf 1 mg iron Â&#x;EŠ–fT–Â?n;_ÂĄf Serve with: cucumber dill sauce (below) on a multi-grain bun, cooked spinach and fruit cup.

Cucumber Dill Sauce Mix together: 1–q–2ÂĄx–xb _k–knk^M Â˜Â–ÂŚnTÂĄÂ?˜ 1–q–˜ (bDÂ?xnnk–bDfnk–`ÂĄ_2D8–q–˜D Â?xnnk–;_bb 1–q–˜D Â?xnnk–_`nk–fÂĄÂ?˜ Â?; 1–s–2ÂĄx–NkDbŒ–2\nxxD;–2ÂĄ2ÂĄf(DÂ? 1–s–2ÂĄx–NkDbŒ–2\nxxD;–TÂ?DDk–nk_nk 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG


1–Â&#x;–2ÂĄxÂ?–¤ ˜DÂ? 1–r–2ÂĄx–bn¤^M ˜8–bn¤^Â? b˜–2\_2aDk–(Â?n˜\ 1–qŠ–xDxxDÂ?2nÂ?kÂ? 1–q–( Œ–bD M 1–q–2DbDÂ?Œ–Â?_(8–2\nxxD; nf(_kD– bb– _kTÂ?D;_Dk˜Â?– _k– – qŠˆ– nÂ?– qÂ&#x;ˆ– skillet or in a large sauce pan. Bring to a boil, reduce heat and add the ďŹ sh to the x k}–_ffDÂ?–MnÂ?–qŠ–˜n–qÂ&#x;–f_kÂĄÂ˜DÂ?–nÂ?–¥k˜_b– ďŹ sh akes easily when tested with a fork at the thickest part. Fish may be served with sliced lemon or strained poaching liquid (boil to reduce by half). Add chopped parsley (optional) and serve over ďŹ sh. Sprinkle ďŹ sh with garlic. Sautee for two to three minutes per side. 3OURCE*UNGLE*IMS)NTERNATIONAL-ARKET

Eating with Your Heart’s Consent Tip on Preparing Fish

Sweet & Saucy Sole

\Dk–2nna_kT–N\8–;n–kn˜–2nna–_˜–˜nn–bnkT8– or it will dry out.

1–q–2 k–˜nf ˜n– ¡2D8–E–n¨} 1–s–2¡x–x 2aD;–(n¤k–¡T  1–s–2¡x–fnb D 1–š–˜ (bDxnnk–fnb D 1–š–˜ (bDxnnk–aD˜2\¡x 1–Ÿ–˜ (bDxnnk– xxbD–2_;D–£_kDT  1–Ÿ–˜ (bDxnnk–;_D;–f_k2D;–nk_nk 1–q–˜ (bDxnnk–n2D˜D\_D– ¡2D 1–q–˜ (bDxnnk–f¡˜ ; 1–r–2¡x–;_2D;–(Dbb–xDxxD 1–s–˜D xnnk–D 2\8–T b_2–xn¤;D8 1– b˜– k;–xDxxD 1– teaspoon each, cinnamon and nutmeg 1–š–\DD˜– b¡f_k¡f–Mn_b 1–R^”–nbD–NbbD˜8–R–˜n–”–n¨}–D 2\

Grilled Fish Spray grill with non-stick cooking spray (use outside grill or George Foreman Grill®) Sprinkle fish with salt-free seasoning, such as Mrs. Dash®}–_bb–Mn– (n¡˜–R–˜n–O–f_k¡˜D– (no need to turn). Fish is done when it flakes easily when tested with a fork at the thickest part.

Sauteed Fish Spray skillet with non-stick cooking spray and turn heat to medium. Sprinkle fish with garlic. Sautee for two to three minutes per side. 3OURCE*UNGLE*IMS)NTERNATIONAL-ARKET

Note to people with sodium restrictions: Use no-salt-added tomato sauce and omit ¼ teaspoon added salt. Blend all ingredients, except seafood, in (n¤b– k;–bD˜–D˜–q©–˜n–qO–f_k¡˜D}–D\D ˜– broiler or grill to medium high. Make a foil pan out of the aluminum Mn_b}–D– –lˆ–¥–qšˆ–( a_kT–x k– – –( D}– Remove foil from pan and form a tight rim with 1” sides. Spray foil with non-stick cooking spray. Dip sole into sauce and place in foil pan. Cover and vent. – n_b–n–T_bb–n£D–_k;_D2˜–\D ˜8– (n¡˜–O– minutes, and check to see if it is done. Brush with extra sauce. Makes 4 to 6 servings. Nutrition facts per serving: 288 calories Ÿ–T f–˜n˜ b–M ˜–z}š–T f– ˜¡ ˜D;–M ˜{ ”š–fT–2\nbD˜Dnb EOq–fT–n;_¡f š“–T f–2 (n\¦; ˜D šŸ–T f–xn˜D_k 1 gram fiber 3OURCE*UNGLE*IMS)NTERNATIONAL-ARKET Heart & Vascular Center 31

Eating with Your Heart’s Consent VEGETARIAN DISHES Glazed Sweet Potatoes

Mashed Sweet Potatoes for One

1–Â&#x;–fD;_ÂĄf–Â?¤DD˜–xn˜ ˜nDÂ? 1–r–2ÂĄx–¥kÂ?¤DD˜DkD;– xxbD–`ÂĄ_2D–nÂ?–2_;DÂ?

1––q–˜n–Â&#x;–˜ (bDÂ?xnnkÂ?–nÂ? kTD–nÂ?– pineapple juice 1–– to Âź teaspoon cinnamon, nutmeg or ginger

q}– Â?\– k;–2ÂĄÂ˜Â–xn˜ ˜nDÂ?–_k˜n–2\ÂĄkaÂ?} 2. Place in small saucepan, cover with water and bring to a boil. š}––n_b–MnÂ?–qŠ–˜n–qO–f_kÂĄÂ˜DÂ?–nÂ?–¥k˜_b–˜Dk;DÂ?}– Drain and let cool slightly. R}––\Dk– 2nnb– DknÂĄT\– ˜n– ˜nÂĄ2\8– Â?b_x– nMM– skin. Add apple juice and cook over low heat until the liquid forms a shiny glaze.  aDÂ?–š–Â?DÂ?ÂŁ_kTÂ?} Nutrition facts per serving: 188 calories 2 grams protein 44 grams carbohydrates Â&#x;}“–TÂ? fÂ?–N(DÂ? Š–TÂ? fÂ?–M ˜ Š–fT–2\nbDÂ?˜DÂ?nb Â&#x;O8ŠŠŠ– –£_˜ f_k––zRlE|–{ Â&#x;O–fT–£_˜ f_k––zRÂ&#x;|–{ š”–fT–2 b2_ÂĄf 1.6 mg iron 22 mg sodium 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

q}–– Â?\– – Â?¤DD˜– xn˜ ˜n– k;– x_DÂ?2D– _˜– several times with a fork, then place on a paper towel. 2. Microwave for approximately 6 minutes nÂ?–¥k˜_b–2nnaD;–˜\Â?nÂĄT\}– D˜–Â?_˜–MnÂ?–q–˜n– 2 minutes. š}––ÂĄÂ˜Â– nxDk– k;– f Â?\– ¤_˜\– `ÂĄ_2D– k;– seasonings to taste. Makes one serving. Nutrition facts per serving: qÂ&#x;Š–2 bnÂ?_DÂ? 2 grams protein 29 grams carbohydrates Â&#x;}“–TÂ? fÂ?–N(DÂ? Š–TÂ? fÂ?–M ˜ Š–TÂ? fÂ?–2\nbDÂ?˜DÂ?nb Â&#x;O8ŠŠŠ– –£_˜ f_k––zRlE|–{ Â&#x;O–fT–£_˜ f_k––zRÂ&#x;|–{ 29 mg calcium 1.6 mg iron 21 mg sodium 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

32 Heart & Vascular Center

Eating with Your Heart’s Consent Roasted Seasoned Potatoes


1––š–fD;_ÂĄf–Â?¤DD˜–xn˜ ˜nDÂ?8– peeled and diced 1––š–fD;_ÂĄf–Â?ÂĄÂ?Â?D˜–xn˜ ˜nDÂ?8– unpeeled and diced 1–q–˜D Â?xnnk–T Â?b_2–xn¤;DÂ? 1–q–˜ (bDÂ?xnnk–2\_b_–xn¤;DÂ? 1–q–˜ (bDÂ?xnnk–Â?ÂĄT Â? 1–s–˜D Â?xnnk–Â?D Â?nk_kT–Â? b˜

1–Rˆ–˜n–Eˆ–PnÂĄÂ?–˜nÂ?˜_bb Â? 1–r–2ÂĄx–M ˜^MÂ?DD–Â?DMÂ?_D;–(D kÂ? 1–r–2ÂĄx–Â?\Â?D;;D;–bn¤^M ˜–\D;; Â?–2\DDÂ?D 1–q–2ÂĄx–;_2D;–MÂ?DÂ?\–˜nf ˜nDÂ?

q}––Â?D\D ˜– nÂŁDk– ˜n– š“O>}– _T\˜bŒ– n_b– – roasting pan. 2. Mix together the seasonings and toss with the potatoes, making sure they are thoroughly coated. š}–n Â?˜–MnÂ?–RO–f_kÂĄÂ˜DÂ?}

1. Spread 2 tablespoons refried beans on each tortilla. Put Âź cup chopped tomatoes on top of the refried beans.Sprinkle 2 tablespoons of cheese evenly over tortilla and fold in half. 2. Place in skillet and cook on one side 1 ˜n–š–f_kÂĄÂ˜DÂ?}–ÂĄÂ?k–nÂŁDÂ?– k;–2nna–¥k˜_b– cheese is melted. Serve with salsa and/or low-fat sour cream or yogurt. Makes 4 servings.

Makes 6 servings. Nutrition facts per serving: q”Š–2 bnÂ?_DÂ? š–TÂ? fÂ?–xÂ?n˜D_k š“–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? š}š–TÂ? fÂ?–N(DÂ? }O–TÂ? fÂ?–M ˜ Š–fT–2\nbDÂ?˜DÂ?nb 26 mg calcium 1.4 mg iron ”O–fT–Â?n;_ÂĄf

Nutrition facts per serving: Â&#x;šR–2 bnÂ?_DÂ? 11 grams protein RŠ–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? š–TÂ? fÂ?–N(DÂ? 6 grams fat qŠ–fT–2\nbDÂ?˜DÂ?nb qO“–fT–2 b2_ÂĄf 2.2 mg iron ROl–fT–Â?n;_ÂĄf Serve with: Spanish rice and corn



Heart & Vascular Center 33

Eating with Your Heart’s Consent Fast Lane Chow Mein

Tasty Cucumber Salad

1–qr–2ÂĄxÂ?–¤ ˜DÂ? 1–– cup fresh or frozen chopped onion 1–s–˜n–r–˜D Â?xnnk–T Â?b_2–xn¤;DÂ? 1–q–Â?˜ ba–2DbDÂ?ÂŚ8–˜\_kbŒ–Â?b_2D; 1–Â&#x;r–2ÂĄxÂ?–fÂĄÂ?\Â?nnfÂ?8–Â?b_2D; 1–q–2ÂĄx–TÂ?DDk–2 (( TD8–Â?b_2D; 1–Â&#x;–2ÂĄxÂ?–MÂ?n¨Dk–a bD–nÂ?–(Â?n22nb_8–2\nxxD; 1––q–2 k–zqO–n¨}{–2 kkDbbnk_–nÂ?–¤\_˜D–(D kÂ?8– drained and rinsed 1–Â&#x;–x 2a TDÂ?–( aD;–Â? fDk–knn;bDÂ?

1–Â&#x;–b Â?TD–2ÂĄ2ÂĄf(DÂ?Â?8–xDDbD;– k;–Â?b_2D; 1–R–TÂ?DDk–nk_nkÂ?8–f_k2D; 1–r–Â?f bb–TÂ?DDk–(Dbb–xDxxDÂ?8–2\nxxD; 1–s–2ÂĄx–Â?D;ÂĄ2D;^M ˜–Â?nÂĄÂ?–2Â?D f 1–q–˜ (bDÂ?xnnk–€–q–˜D Â?xnnk–¤\_˜D–£_kDT Â? 1–q–˜D Â?xnnk–Â?ÂĄT Â? 1––q–˜ (bDÂ?xnnk–MÂ?DÂ?\–;_bb–nÂ?–q–˜D Â?xnnk– dried dill 1–– teaspoon pepper 1–Â? b˜–˜n–˜ Â?˜D (omit salt if you have a sodium restriction)

1. Heat ½ cup water in a large pot. Add the onions and garlic. Cook until onion is soft, (nÂĄÂ˜Â–O–f_kÂĄÂ˜DÂ?}–;;–2DbDÂ?ÂŚ8–fÂĄÂ?\Â?nnfÂ?8– cabbage and kale or broccoli. 2. Place ramen noodles into a plastic bag, and using a large spoon, break them into pieces. Add to vegetable mixture, along with 1 ramen seasoning packet, beans and 1 cup water. š}––˜_Â?–˜n–f_ÂĽ}–nÂŁDÂ?– k;–2nna–nÂŁDÂ?–fD;_ÂĄf^ \_T\– \D ˜– MnÂ?– (nÂĄÂ˜Â– O– ˜n– “– f_kÂĄÂ˜DÂ?}– ;;– more water if needed. Makes 6 servings. Nutrition facts per serving: q“Â&#x;–2 bnÂ?_DÂ? 8 grams protein šš–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 6 grams ďŹ ber 1 gram fat Š–fT–2\nbDÂ?˜DÂ?nb “”–fT–2 b2_ÂĄf 2.4 mg iron ORl–fT–Â?n;_ÂĄf Serve with: fresh kiwi and strawberries or mixed canned fruits. !DAPTEDFROMh&OODFOR(EALTH v.OVEMBER BY.UTRITION#OUNCILOF'REATER #INCINNATIWWWNUTRITIONCOUNCILORG

34 Heart & Vascular Center

In a large bowl, combine all ingredients except the cucumbers. Mix until well combined. Add cucumbers and mix. Cover and chill at least two hours before serving. Makes 8 servings. Nutrition facts per serving: šŠ–2 bnÂ?_DÂ? q–TÂ? f–M ˜–zŠ–TÂ? fÂ?–Â? Â˜ÂĄÂ? ˜D;–M ˜{ 2 grams cholesterol qŠR–fT–Â?n;_ÂĄf O–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 1 gram ďŹ ber 1 gram protein 4 grams sugar 2ECIPE3OURCE*UNGLE*IMS)NTERNATIONAL-ARKET

Eating with Your Heart’s Consent Baked Fries with Creole Seasoning

Pasta Fagioli with Vegetables

1––R–fD;_ÂĄf–¥kxDDbD;–Â?ÂĄÂ?Â?D˜–xn˜ ˜nDÂ?–zbs–˜n– l½ pounds)

1–›–2ÂĄx–MÂ?DÂ?\–nÂ?–MÂ?n¨Dk–2\nxxD;–nk_nkÂ?–nÂ?– 1–Â&#x;–˜D Â?xnnkÂ?–nk_nk–xn¤;DÂ? 1–Â&#x;–2ÂĄxÂ?–Â?b_2D;–2 Â?Â?n˜Â? 1––q–2 k–zq”–n¨}{–TÂ?D ˜–knÂ?˜\DÂ?k–(D kÂ?8– drained & rinsed 1––q–2 k–zÂ&#x;E–n¨}{–Â?˜D¤D;–˜nf ˜nDÂ?8– Italian-style 1–q–˜ (bDÂ?xnnk–nb_ÂŁD–n_b 1–q–˜D Â?xnnk–;Â?_D;–( Â?_b–nÂ?–Â?nÂ?Df Â?ÂŚ 1–›–˜D Â?xnnk–f_k2D;–T Â?b_2 1–Â&#x;–2ÂĄxÂ?–x Â?˜ 8–¥k2nnaD; 1–Â&#x;–2ÂĄxÂ?–¤ ˜DÂ?

Creole or Cajun Seasoning 1–r–˜D Â?xnnk–2\_b_–xn¤;DÂ? 1–r–˜D Â?xnnk–TÂ?nÂĄk;–2ÂĄf_k 1–r–˜D Â?xnnk–nk_nk–xn¤;DÂ? 1–r–˜D Â?xnnk–T Â?b_2–xn¤;DÂ? 1–r–˜D Â?xnnk–x xÂ?_a 1–r–˜D Â?xnnk–(b 2a–xDxxDÂ? 1–s–˜D Â?xnnk–Â? b˜ 1–– teaspoon cayenne (optional) DTD˜ (bD–n_b–Â?xÂ? ÂŚ Cut the potatoes into long strips about ½â€? ¤_;D}– k– –b Â?TD–(n¤b8–bD˜–˜\Df–Â?n a–MnÂ?–qO– minutes in enough cold water to cover by 1â€?. Meanwhile, in a small bowl, stir together the seasoning ingredients. Set aside. – Â?D\D ˜–˜\D–nÂŁDk–˜n–ROŠ>}– _T\˜bŒ–Â?xÂ? Œ– a large baking sheet with vegetable oil spray. Drain the potatoes and pat dry with paper towels. Spread the potatoes in a single layer nk–˜\D–( a_kT–Â?\DD˜}– _T\˜bŒ–Â?xÂ? ÂŚÂ–Â˜\D–˜nxÂ?– with vegetable oil spray. Sprinkle with the seasoning mixture. –  aD–MnÂ?–šŠ–˜n–šO–f_kÂĄÂ˜DÂ?8–nÂ?–¥k˜_b–2Â?_Â?x} Makes 4 servings. Nutrition facts per serving: qŠ”–2 bnÂ?_DÂ? 4 grams protein Â&#x;“–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? š–TÂ? fÂ?–N(DÂ? Š–fT–2\nbDÂ?˜DÂ?nb Š–TÂ? fÂ?–˜n˜ b–M ˜ qOŠ–fT–Â?n;_ÂĄf 4HISRECIPEISREPRINTEDWITHPERMISSIONFROMh4HE.EW!MERICAN(EART!SSOCIATION #OOKBOOK v3EVENTH%DITION #OPYRIGHTŠBYTHE!MERICAN(EART!SSOCIATION 0UBLISHEDBY#LARKSON0OTTER0UBLISHERS ADIVISIONOF2ANDOM(OUSE )NC

1. Spray Dutch oven (large pan with lid) with non-stick spray. Add olive oil and \D ˜}–;;–nk_nkÂ?– k;–T Â?b_2}–nna–Â&#x;–˜n–š– minutes. 2. Add tomatoes with juice, water and basil. _ffDÂ?– O– f_kÂĄÂ˜DÂ?8– 2\nxx_kT– ˜nf ˜nDÂ?– with a spoon to break into small pieces. š}––;;– (D kÂ?8– 2 Â?Â?n˜Â?– k;– ÂĄk2nnaD;– x Â?˜ }–nna–¥k˜_b–x Â?˜ –_Â?–˜Dk;DÂ?8–“–˜n–qŠ– minutes. Season with salt and pepper, if desired. Serve with Parmesan cheese. Makes 4 servings. Nutrition facts per serving: RRš–2 bnÂ?_DÂ? q“–TÂ? fÂ?–xÂ?n˜D_k 82 grams carbohydrates 11 grams ďŹ ber O–TÂ? fÂ?–M ˜ Š–fT–2\nbDÂ?˜DÂ?nb 168 mg calcium 6 mg iron ROš–fT–Â?n;_ÂĄf Serve with: green salad and Italian bread !DAPTEDFROMh-ONDAYTO&RIDAY#OOKBOOKvBY-ICHELE5RVATER  BY.UTRITION #OUNCILOF'REATER#INCINNATI WWWNUTRITIONCOUNCILORG

Heart & Vascular Center 35

Eating with Your Heart’s Consent Broccoli Cheddar Soup

Shells with Black Bean and Vegetable Sauce

1–q–2ÂĄx–MÂ?DÂ?\–nÂ?–MÂ?n¨Dk–2\nxxD;–nk_nkÂ? 1–q–x 2a TD–zq”–n¨}{–MÂ?n¨Dk–(Â?n22nb_–x_D2DÂ? 1––Â&#x;–2ÂĄxÂ?–xDDbD;8–;_2D;–Â?D;–xn˜ ˜nDÂ?–z (nÂĄÂ˜Â–Â›Â– lb.) 1––q–2 k–zqR–n¨}{–Â?D;ÂĄ2D;^Â?n;_ÂĄf–2\_2aDk– broth 1–q–( Œ–bD M 1––›–2ÂĄxÂ?–Â?\Â?D;;D;8–Â?D;ÂĄ2D;^M ˜–Â?\ Â?x– Cheddar cheese 1½ cups 1% milk 1––; Â?\–xDxxDÂ?

1–q–˜D Â?xnnk–T Â?b_28–f_k2D; 1–q–2ÂĄx–2\nxxD;–nk_nk 1–r–b Â?TD–Â?D;–xDxxDÂ?8–2\nxxD; 1–q–2ÂĄx–Â?b_2D;–MÂ?DÂ?\–nÂ?–MÂ?n¨Dk–2 Â?Â?n˜Â? 1–q–(n¼–MÂ?n¨Dk8–2\nxxD;–(Â?n22nb_ 1––q– qOs– n¨}– 2 k– (b 2a– (D kÂ?8– Â?_kÂ?D;– k;– drained 1–q–bRr–n¨}–2 k–Â?˜D¤D;–˜nf ˜nDÂ? 1–Â&#x;–˜D Â?xnnkÂ?–nb_ÂŁD–n_b 1–Â&#x;–2ÂĄxÂ?–;Â?Œ–Â?f bb–Â?\Dbb–x Â?˜ 1–q–2ÂĄx–¤ ˜DÂ? 1–r–˜D Â?xnnk–2\_b_–xn¤;DÂ? 1–q–˜D Â?xnnk–2ÂĄf_k 1–q–˜D Â?xnnk–T Â?b_2–xn¤;DÂ? 1–q–˜D Â?xnnk–nk_nk–xn¤;DÂ?

1. Coat a large Dutch oven with non stick spray, place over medium heat until hot. Add nk_nkÂ?’–Â? ÂĄÂ˜D–O–f_kÂĄÂ˜DÂ?} Â&#x;}–;;–r–x 2a TD–(Â?n22nb_– k;–kDÂĽÂ˜Â–ÂšÂ– ingredients. Bring to a boil. Cover, reduce \D ˜– k;–Â?_ffDÂ?–Â&#x;Š–f_kÂĄÂ˜DÂ?–nÂ?–¥k˜_b– vegetables are tender. š}–_Â?2 Â?;–( Œ–bD M}–ÂĄÂ?DD–\n˜–(Â?n22nb_– mixture using hand-held blender. Return to pan and add cheese, milk, pepper and remaining broccoli. 4. Cook over medium heat until chopped broccoli is just tender, stirring until cheese melts.  aDÂ?–“–Â?DÂ?ÂŁ_kTÂ?} Nutrition facts per serving: 111 calories .9 grams protein 12 grams carbohydrates 1 gram ďŹ ber š–TÂ? fÂ?–M ˜ 12 mg cholesterol 188 mg calcium }O–fT–_Â?nk qŠ“–fT–Â?n;_ÂĄf

_T\˜bŒ–Â?xÂ? Œ– –b Â?TD–knk^Â?˜_2a–Â?a_bbD˜–¤_˜\– cooking oil spray, add olive oil and heat over medium high. Saute garlic, onion and red pepper until lightly brown. Add all remaining ingredients and bring to a boil, stirring constantly. Reduce heat to a simmer, cover and cook until pasta is ˜Dk;DÂ?– k;– Â? ÂĄ2D– _Â?– ˜\_2a8– (nÂĄÂ˜Â– “– ˜n– qŠ– minutes. – 7– M– ÂŚn¥– xÂ?DMDÂ?– 2Â?_Â?x– ÂŁDTD˜ (bDÂ?8– add carrots and broccoli after mixture boils and heat is reduced to a simmer. Makes 4 servings.

Serve with: ½ sandwich of your choice or hard roll and green salad.

Nutrition facts per serving: 414 calories q“–TÂ? fÂ?–xÂ?n˜D_k ““–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 12 grams ďŹ ber 4 grams fat Š–fT–2\nbDÂ?˜DÂ?nb qšŠ–fT–2 b2_ÂĄf 6.22 mg iron OE“–fT–Â?n;_ÂĄf



36 Heart & Vascular Center

Eating with Your Heart’s Consent Basic Stir-Fried Vegetables

Mediterranean Skillet Dinner

1–q–˜ (bDÂ?xnnk–n_b 1–q–˜D Â?xnnk–TÂ?nÂĄk;–T_kTDÂ? 1–q–˜D Â?xnnk–f_k2D;–T Â?b_2 1––q–b(}–£DTD˜ (bDÂ?–zÂ?DD–Â?ÂĄTTDÂ?˜D;– combinations) 1––q–˜D Â?xnnk–2nÂ?kÂ?˜ Â?2\ 1––Â&#x;–˜ (bDÂ?xnnkÂ?–¤ ˜DÂ? 1––s–2ÂĄx–˜n–r–2ÂĄx–2\_2aDk–nÂ?–£DTD˜ (bD–(Â?n˜\ 1––q–˜ (bDÂ?xnnk–Â?D;ÂĄ2D;^Â?n;_ÂĄf–Â?nŒ–Â? ÂĄ2D 1––r–˜D Â?xnnk–Â?ÂĄT Â?

1––1½ cup wheat bulgur 1––q–2 k–zqO–n¨}{–Â?˜D¤D;–˜nf ˜nDÂ?8– Italian style 1––1 can (14 oz.) reduced-sodium chicken broth 1––1 can (16 oz.) chickpeas, drained & rinsed 1––2 tablespoons Parmesan cheese 1––1 teaspoon basil

1. Clean and chop or slice vegetables for cooking or use pre-cleaned and chopped varieties. 2. Combine broth, soy sauce, ginger and sugar in a small bowl. Combine water and cornstarch in a separate small bowl. š}–– k– – b Â?TD– Â?a_bbD˜– Â?xÂ? ÂŚD;– ¤_˜\– knk^Â?˜_2a– spray, heat oil. Add garlic and stir fry for (nÂĄÂ˜Â–ÂšÂŠÂ–Â?D2nk;Â?}–;;–£DTD˜ (bDÂ?– 22nÂ?;_kT– to their cooking times. Stir fry until crisp tender. 4. Add broth mixture. Simmer, covered, until vegetables are done. Thicken sauce with cornstarch paste. Makes 4 servings. Nutrition facts per serving: (includes 1 cup steamed rice): Â&#x;OŠ–2 bnÂ?_DÂ? 4 grams fat Serve with: steamed rice

1. Heat broth to boiling in a skillet with a lid. Add wheat bulgur and cover. Cook ÂĄk˜_b– ¤\D ˜– (ÂĄbTÂĄÂ?– _Â?– ˜Dk;DÂ?8– (nÂĄÂ˜Â– qŠ– minutes. 2. Add tomatoes, chickpeas and basil. Cook until heated through. Add Parmesan cheese.  aDÂ?–O–Â?DÂ?ÂŁ_kTÂ?} Nutrition facts per serving: šŠq–2 bnÂ?_DÂ? qš–TÂ? fÂ?–xÂ?n˜D_k Ol–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? qš–TÂ? fÂ?–N(DÂ? š–TÂ? fÂ?–M ˜ O–fT–2\nbDÂ?˜DÂ?nb 121 mg calcium š–fT–_Â?nk O”š–fT–Â?n;_ÂĄf Serve with: green salad and Italian bread 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG


Suggested Combinations for basic stir-fried vegetables 1––2 (( TD8–nk_nkÂ?8–TÂ?DDk–xDxxDÂ?8–MÂ?DÂ?\– mushrooms, carrots and snow peas 1–\_kDÂ?D–2 (( TD– k;–;Â?_D;–fÂĄÂ?\Â?nnfÂ? 1–(Â?n22nb_8–MÂ?DÂ?\–fÂĄÂ?\Â?nnfÂ?– k;–2 Â?Â?n˜Â? 1––¨¥22\_k_8–TÂ?DDk–xDxxDÂ?8–fÂĄÂ?\Â?nnfÂ?8– onions and tomatoes 1–2 ÂĄb_Pn¤DÂ?– k;–MÂ?DÂ?\–fÂĄÂ?\Â?nnfÂ? Heart & Vascular Center 37

Eating with Your Heart’s Consent DESSERTS Chocolate Oatmeal Cookies

Simply Superb Banana Cream Pie

1––qr–2ÂĄxÂ?–NÂ?fbŒ–x 2aD;–b_T\˜–(Â?n¤k–Â?ÂĄT Â? 1––r–2ÂĄx–Â?_M˜D;–¥kÂ?¤DD˜DkD;–2n2n –xn¤;DÂ? 1––r–2ÂĄx–M ˜^MÂ?DD–f_ba 1––s–2ÂĄx– 22Dx˜ (bD–Â?˜_2a–f Â?T Â?_kD8–Â?nM˜DkD; 1––s–2ÂĄx–xÂĄÂ?DD;–;Â?_D;–xbÂĄfÂ?–nÂ?–¥kÂ?¤DD˜DkD;– baby food dried plums 1––Â&#x;–˜D Â?xnnkÂ?–£ k_bb –DÂĽÂ˜Â? 2˜ 1––q›–2ÂĄxÂ?– bb^xÂĄÂ?xnÂ?D–PnÂĄÂ? 1––Â&#x;r–˜D Â?xnnkÂ?–( a_kT–xn¤;DÂ? 1––s–˜D Â?xnnk–Â? b˜ 1––br–2ÂĄxÂ?–¥k2nnaD;–‚¥_2a^2nna_kT–n ˜fD b

1––Â&#x;–2ÂĄxÂ?–Â?b_2D;–( k k –zÂ&#x;–fD;_ÂĄf– bananas) 1––q–2\n2nb ˜D^P ÂŁnÂ?D;–TÂ? \ f–2Â? 2aDÂ?–x_D– crust 1––q–x 2a TD–Â?ÂĄT Â?^MÂ?DD–_kÂ?˜ k˜–( k k – pudding mix 1–– cup non-fat dry milk powder 1––q–– cups water 1––q–2ÂĄx–b_T\˜–¤\_xxD;–2Â?D f 1––q–˜ (bDÂ?xnnk–2\n2nb ˜D–Â?ÂŚÂ?ÂĄx

Â?D\D ˜–˜\D–nÂŁDk–˜n–šOŠ> In a large mixing bowl, cream the brown sugar, cocoa powder, milk, margarine, dried plums and vanilla. In a small bowl, sift together the our, baking powder and salt. Beat into the brown sugar mixture. Stir in the oatmeal. Drop by teaspoonfuls onto ungreased ( a_kT– Â?\DD˜Â?}– zn¥– Â?\nÂĄb;– \ ÂŁD– (nÂĄÂ˜Â– ”Š– cookies.)  aD– MnÂ?– “– ˜n– l– f_kÂĄÂ˜DÂ?8– nÂ?– ÂĄk˜_b– Â?D˜– _k– ˜\D– center (the cookies don’t jiggle when gently shaken).  aDÂ?–šŠ–Â?DÂ?ÂŁ_kTÂ?}–¤n–2nna_DÂ?–xDÂ?–Â?DÂ?ÂŁ_kT} Nutrition facts per serving: qŠŠ–2 bnÂ?_DÂ? 2 grams protein 21 grams carbohydrates 1 gram ďŹ ber Š–fT–2\nbDÂ?˜DÂ?nb 1 gram total fat ““–fT–Â?n;_ÂĄf 4HISRECIPEISREPRINTEDWITHPERMISSIONFROMh4HE.EW!MERICAN(EART!SSOCIATION #OOKBOOK v3EVENTH%DITION #OPYRIGHTŠBYTHE!MERICAN(EART!SSOCIATION 0UBLISHEDBY#LARKSON0OTTER0UBLISHERS ADIVISIONOF2ANDOM(OUSE )NC!VAILABLEFROM BOOKSELLERSEVERYWHERE

38 Heart & Vascular Center

ÂŚDÂ?–( k k Â?–nk–(n˜˜nf–nM–x_D–2Â?ÂĄÂ?˜}– k– – medium bowl, combine dry pudding mix and dry milk powder. Add water. Mix well using a wire whisk. Blend in Âź cup light whipped cream. Pour mixture over ( k k Â?}–DMÂ?_TDÂ? ˜D–MnÂ?– (nÂĄÂ˜Â–qO–f_kÂĄÂ˜DÂ?}– Spread remaining ž cup whipped cream evenly over ďŹ lling. Drizzle chocolate syrup over top. Refrigerate until ready to serve. Makes 8 servings. Nutrition facts per serving: 214 calories 6 grams fat šE–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? š–TÂ? fÂ?–xÂ?n˜D_k 1 mg cholesterol }“–TÂ? fÂ?–N(DÂ? “E–fT–2 b2_ÂĄf }“–fT–_Â?nk 298 mg sodium 2ECIPE3OURCE!DAPTEDBYTHE.UTRITION#OUNCILOF'REATER#INCINNATIFROM h(EALTHY%XCHANGES#OOKBOOKvBY*O!NNA-,UND WWWNUTRITIONCOUNCILORG

Eating with Your Heart’s Consent Strawberry-Peach Dream Cake

Apple Raisin Crunch

1––q–x 2aD˜–zÂ&#x;–˜D Â?xnnkÂ?{–¥kP ÂŁnÂ?D;–TDb ˜_k 1––Â&#x;–˜ (bDÂ?xnnkÂ?–Â?ÂĄT Â? 1––s–2ÂĄx–2nb;–Â?a_f–f_ba 1––q”–n¨}–;_2D;–xD 2\DÂ?–_k–`ÂĄ_2D8–;Â? _kD; 1––›–2ÂĄx–Â?a_f–f_ba8–\D ˜D;–˜n–(n_b_kT 1––q– kTDb–Mnn;–2 aD8–2ÂĄÂ˜Â–_k˜n–x_D2DÂ? 1––qŠ–n¨}–MÂ?n¨Dk–Â?˜Â? ¤(DÂ?Â?_DÂ?8–˜\ ¤D; 1––E–n¨}–b_T\˜–¤\_xxD;–˜nxx_kT8–˜\ ¤D;

1–DTD˜ (bD–n_b–Â?xÂ? ÂŚ

In a blender, sprinkle unavored gelatin over cold milk; let stand 2 minutes. Add hot milk and process at low speed until gelatin is completely dissolved, about 2 minutes. Add strawberries and sugar; process at a high speed until blended. Pour into a large glass bowl. Chill, stirring occasionally, until mixture mounds slightly when dropped from – Â?xnnk8– (nÂĄÂ˜Â– Â&#x;Š– f_kÂĄÂ˜DÂ?}– nb;– _k– ¤\_xxD;– topping, then peaches and cake. Chill for 2 hours until set. Makes 4 servings. Nutrition facts per serving: Â&#x;ŠO–2 bnÂ?_DÂ? O–TÂ? fÂ?–xÂ?n˜D_k less than 1 gram fat Rš–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 1 gram dietary ďŹ ber less than 1 mg cholesterol .41 mg iron “š–fT–2 b2_ÂĄf Â&#x;“E–fT–Â?n;_ÂĄf 2ECIPE3OURCE.UTRITION#OUNCILOF'REATER#INCINNATIWWWNUTRITIONCOUNCILORG

Filling 1––Â&#x;–xnÂĄk;Â?–Â? kkŒ–f_˜\– xxbDÂ?8–xDDbD;8– 2nÂ?D;8– k;–Â?b_2D;–z (nÂĄÂ˜Â–Or–2ÂĄxÂ?{8–nÂ?–Â&#x;– Â&#x;Š^nÂĄk2D–2 kÂ?–¥kÂ?¤DD˜DkD;–Â?b_2D;– xxbDÂ? 1––r–2ÂĄx–Â? _Â?_kÂ? 1––r–2ÂĄx–MÂ?DÂ?\–nÂ? kTD–`ÂĄ_2D 1––– cup sugar 1––s–˜D Â?xnnk–TÂ?nÂĄk;–kÂĄÂ˜fDT Topping 1––s–2ÂĄx–NÂ?fbŒ–x 2aD;–; Â?a–(Â?n¤k–Â?ÂĄT Â? 1––›–2ÂĄx–¥k2nnaD;–‚¥_2a^2nna_kT–n ˜fD b 1––r–˜D Â?xnnk–TÂ?nÂĄk;–2_kk fnk 1––Â&#x;–˜ (bDÂ?xnnkÂ?–b_T\˜–Â?˜_2a–f Â?T Â?_kD8–fDb˜D; Â?D\D ˜–˜\D–nÂŁDk–˜n–šOŠ> – _T\˜bŒ– Â?xÂ? Œ– k– Eˆ– Â?‚¥ Â?D– ( a_kT– x k– with vegetable oil spray. Put all the ďŹ lling ingredients except the nutmeg in the baking pan. Stir together. Sprinkle the nutmeg over the apple mixture. In a small bowl, stir together the topping ingredients. Sprinkle over the apple mixture.  aD–MnÂ?–RŠ–f_kÂĄÂ˜DÂ?}– D˜–2nnb–Â?b_T\˜bŒ–(DMnÂ?D– serving. Makes 6 servings. Nutrition facts per serving: Â&#x;OE–2 bnÂ?_DÂ? 2 grams protein Ol–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 4 grams ďŹ ber Š–fT–2\nbDÂ?˜DÂ?nb š–TÂ? fÂ?–˜n˜ b–M ˜ šq–fT–Â?n;_ÂĄf 4HISRECIPEISREPRINTEDWITHPERMISSIONFROMh4HE.EW!MERICAN(EART!SSOCIATION #OOKBOOK 3EVENTH%DITION v#OPYRIGHTŠBYTHE!MERICAN(EART!SSOCIATION 0UBLISHEDBY#LARKSON0OTTER0UBLISHERS ADIVISIONOF2ANDOM(OUSE )NC!VAILABLE FROMBOOKSELLERSEVERYWHERE

Heart & Vascular Center 39

Eating with Your Heart’s Consent 1-2-3 Peach Cobbler 1––r–˜D Â?xnnk–TÂ?nÂĄk;–2_kk fnk 1––q–˜ (bDÂ?xnnkÂ–Â˜ÂĄ(–f Â?T Â?_kD 1––q–˜ (bDÂ?xnnk–£ k_bb –DÂĽÂ˜Â? 2˜ 1––q–2ÂĄx–;Â?Œ–x k2 aD–f_ÂĽ 1––Â&#x;–˜ (bDÂ?xnnkÂ?–2nÂ?kÂ?˜ Â?2\ 1–– cup all-purpose our 1–q–2ÂĄx–xD 2\–kD2˜ Â? 1–s–2ÂĄx–Â?ÂĄT Â? 1–– cup pineapple juice or peach juice 1–Â&#x;–2 kÂ?–zq”–n¨}–D 2\{–xD 2\DÂ?8–x 2aD;–_k–`ÂĄ_2D8–;Â? _kD;’–nÂ?–q›–b(}–MÂ?DÂ?\8–Â?b_2D;–xD 2\DÂ? 1–– cup evaporated skim milk 1–s–˜D Â?xnnk–kÂĄÂ˜fDT 1–q–˜ (bDÂ?xnnk–(Â?n¤k–Â?ÂĄT Â? Combine cinnamon, vanilla, cornstarch, peach nectar and pineapple or peach juice in sauce pan over medium heat. Stir constantly until mixture thickens and bubbles. Add sliced peaches to f_ÂĽÂ˜ÂĄÂ?D}–D;ÂĄ2D–\D ˜– k;–Â?_ffDÂ?–MnÂ?–NÂŁD–˜n–qŠ–f_kÂĄÂ˜DÂ?}– k– kn˜\DÂ?–Â? ÂĄ2D–x k8–fDb˜–f Â?T Â?_kD– k;–Â?D˜– Â?_;D}– _T\˜bŒ–Â?xÂ? Œ–Eˆ–Â?‚¥ Â?D–Tb Â?Â?–;_Â?\–¤_˜\–2nna_kT–Â?xÂ? ÂŚ}–nÂĄÂ?–\n˜–xD 2\–f_ÂĽÂ˜ÂĄÂ?D– into dish. In another bowl, combine pancake mix, our, sugar and melted margarine. Stir in milk. Quickly spoon this over peach mixture. Combine nutmeg and brown sugar. Sprinkle on ˜nx–nM–( ˜˜DÂ?}– aD– ˜–RŠŠ>–MnÂ?–qO–˜n–Â&#x;Š–f_kÂĄÂ˜DÂ?–nÂ?–¥k˜_b–Tnb;Dk–(Â?n¤k}– Cool and cut into 8 pieces. Makes 8 servings. Nutrition facts per serving: Â&#x;“q–2 bnÂ?_DÂ? 4 grams total fat less than 1 mg cholesterol Â&#x;”š–fT–Â?n;_ÂĄf 2 grams total ďŹ ber 4 grams protein OR–TÂ? fÂ?–2 Â?(n\ÂŚ;Â? ˜DÂ? 2ECIPESOURCE.UTRITION#OUNCILOF'REATER#INCINNATI WWWNUTRITIONCOUNCILORG


Exercising for a Healthier Heart

Heart & Vascular Center

Exercising for a Healthier Heart


xercising frequently is one of the best things you can do for your heart. Cardiovascular ďŹ tness allows the heart and blood vessels to supply the body with the oxygen it needs during rest and exercise. A ďŹ t person will be able to carry out daily activities with little or no fatigue. You also will be able to respond to physical and emotional stress without an excessive increase in heart rate and blood pressure. Check with your doctor before beginning any exercise program to see if you have any exercise restrictions.

Make Exercise a Permanent Part of Your Life


1––˜Â?nkTDÂ?–\D Â?˜–fÂĄÂ?2bD}–\D–fnÂ?D–Œn¥– use your heart muscle, the stronger it becomes

It is important to design a life-long home exercise routine. Walking is one of the easiest and most convenient options, but there may be others you enjoy. Cardiovascular exercise should be continuous and rhythmical. It should be done at a comfortable pace. The “no pain, no gain� principle does not apply. If you stick with a regular, consistent program, you can expect these rewards:


1–– fxÂ?nÂŁD;–¥Â?D–nM–nÂĽÂŚTDk–_k–˜\D–(n;ÂŚ} The ability of the body to use oxygen effectively is considered by many to (D–˜\D–(DÂ?˜–fD Â?ÂĄÂ?D–nM–nÂŁDÂ? bb–N˜kDÂ?Â?


1–D˜˜D�–�bDDx– ˜–k_T\˜


1––˜�nkTD�–(nkD�– k;– –bn¤D�–�_�a–nM– osteoporosis



1–D˜˜D�–�D�_�˜ k2D–˜n–;_�D �D


1–D2�D �D–_k–  – k;–_k2�D �D–_k– 


1–– n¤DÂ?–Â?˜Â?DÂ?Â?8– kÂĽ_DÂ˜ÂŚ8–(nÂ?D;nf8– frustration and simple depression


1––nÂ?D–DkDÂ?TŒ– k;–Dk;ÂĄÂ? k2D–zÂ?˜ f_k {– throughout the day 1–– fxÂ?nÂŁD;– xxD Â? k2D — a slimmer, trimmer body — better blood ow throughout your body — better posture


1––D2�D �D;–¤D_T\˜ — less body fat — increased muscle tone


1–D2Â?D Â?D;– xxD˜_˜D–Mnbbn¤_kT–DÂĽDÂ?2_Â?D


1–– k2Â?D Â?D;–DMN2_Dk2Œ–nM–˜\D–\D Â?˜ — lower heart rate and blood pressure — more blood pumped out of the heart with each beat

Heart & Vascular Center 1

Exercising for a Healthier Heart How to Design an Exercise Program Your exercise plan should be based on the FITT principle: Frequency of training Intensity of training Time of training Type of training

Frequency n–_fxn£D– k;–f _k˜ _k–¦n¡–N˜kD–bD£Db8– ¦n¡– \n¡b;– D¥D2_D– ˜\DD– ˜n– N£D– ; ¦– – ¤DDa}–_ (D˜_2–kDD;–˜n–D¥D2_D–D£Dk–; ¦– a week to help control blood sugar levels. People who only exercise “every once in a while” have a greater risk of exercise-related heart attack compared to those who work out more regularly, according to a report Mnf–˜\D–fD_2 k– D ˜–n2_ ˜_nk}

n¡– ;n2˜n– f ¦– D2nffDk;– – xD2_N2– k¡f(D–zx¡bD– ˜D{–Mn–\n¤–M ˜–¦n¡–\D ˜– should beat for safe exercise. This is called ¦n¡–˜ TD˜–\D ˜– ˜D}–bn¤–;n¤k–_M–¦n¡–TD˜– above this heart rate. If you are not in cardiac rehab, ask you doctor about your target heart rate. Exercising above your target heart rate increases the risk of problems and is not advised for people with heart disease. There are two ways to tell if you are working out safely: Talk Test: You should be able to talk normally while exercising. If you are too short of breath to carry on a conversation, ¦n¡– D–¤na_kT–˜nn–\ ;}–bn¤–;n¤k} Target Heart Rate: You should keep your target heart rate within the range given to you by your doctor or cardiac rehab staff.

Intensity n¡–¤_bb–TD˜–˜\D–fn˜–(DkDN˜–Mn–¦n¡–\D ˜– when you exercise hard enough to get your \D ˜– ˜D–zx¡bD{–Ÿ©–xn_k˜– (n£D–D˜_kT}

HOW TO TAKE YOUR PULSE Your pulse or heart rate is the number of times your heart beats in one minute. Checking your pulse will help you and your doctor know how your heart is handling the exercise. Your nurse can help you find your pulse. It is found at the wrist below the base of the thumb. You also can take your pulse on your neck between your voice box and the big muscle on the side of your neck. Use the pads of your first two to three fingers, not your thumb. Press gently until you can count the beats and feel the rhythm of the pulse. Using a watch or clock with a second hand, count how many beats you feel in 10 seconds. Multiply the number you get by six to get the number of beats in one minute, which is your pulse rate. If your pulse feels slow, fast or jumps around, count the beats for one full minute (60 seconds). Practice counting your pulse. Practice is necessary to assure accuracy, especially with exercise.

2 Heart & Vascular Center

Number of beats per 10 seconds (x 6) = Pulse Rate 8 = 48 9 = 54 1O = 6O 11 = 66 12 = 72 13 = 78 14 = 84 15 = 90 16 = 96 17 = 102

18 = 108 19 = 114 20 = 120 21 = 126 22 = 132 23 = 138 24 = 144 25 = 150 26 = 156 27 = 162

Exercising for a Healthier Heart Time

How to Exercise

If you are just starting an exercise program, (DT_k–¤_˜\–O–˜n–q©–f_k¡˜D–nM–D¥D2_D8–Mn¡– times a day. Add 5 minutes more each week ¡k˜_b– ¦n¡– D– (bD– ˜n– ;n– š©– ˜n– ”©– f_k¡˜D– nk2D– –; ¦8–˜\DD–˜n–N£D–˜_fD– –¤DDa}

Each exercise session should start with a warm-up and stretching, and end with a cool-down and stretching. Wear comfortably N˜˜_kT– \nD– ¤_˜\– nM˜– nbD}– \D– \nD– should not rub or chafe against your feet.


Warm-up: A warm-up helps the body prepare for aerobic exercise by slowly raising the body’s temperature and pulse. This is best done by walking or bicycling slowly for 5 minutes.

The best kind of exercise is aerobic. This exercise is done by using your arms and/or legs in a continuous, rhythmic movement _k–n;D–˜n–_k2D D–¦n¡–\D ˜– ˜D–zx¡bD{}– Aerobic activities include: 1–Dn(_2– 1– k2_kT 1–_2¦2b_kT– 1– _a_kT 1– nTT_kT– 1–n¤_kT 1–¡kk_kT– 1–a ˜_kT–z_2D–n–nbbD{ 1–¤_ff_kT– 1–˜ ˜_nk ¦–(_aD 1– ba_kT Pick an aerobic exercise that you enjoy, and you will most likely keep doing it on – DT¡b – ( _}– ˜\D– 2˜_£_˜_D– zxn˜8– T ;Dk_kT8–\nxx_kT8–\n¡D¤na8–D˜2}{–\Dbx– _fxn£D– ¦n¡– n£D bb– N˜kD8– (¡˜– ¤_bb– kn˜– improve your heart health for long-term (DkDN˜}

Tracking Your Progress One of the easiest ways to monitor your progress is to write down what you do. Keep track of: – {–¤D_T\˜–zD2n;–nk2D– –¤DDa{ – ({––(bnn;–xD¡D–z_M–¦n¡–\ £D– –\nfD– fnk_˜n_kT–a_˜{ – 2{–f_k¡˜D–nM–D¥D2_D–D 2\–; ¦ – ;{––¦fx˜nf}–D–¦n¡–\ £_kT– k¦– symptoms that would be of concern? If so, be sure to contact your doctor – D{––Tb¡2nD–£ b¡D–zMn–xDnxbD–¤_˜\– ;_ (D˜D{

Stretching: After doing 5 minutes of warmup, you should stretch to prevent injury. To stretch properly, stretch the muscle and \nb;– ˜\ ˜– xn_˜_nk– Mn– q©– ˜n– š©– D2nk;– z;nkŠ˜–(n¡k2D{}–D ˜\D–knf bb¦–;¡_kT–˜\D– stretch - do not hold your breath. Aerobic Exercise: Aerobic exercise can make all the muscles in your body stronger, _k2b¡;_kT– ¦n¡– \D ˜}– DD– ˜¦xD– nM– Dn(_2– exercise in the previous column. Cool-Down: The reason for a cool-down is to help the body return to a resting state. End your exercise session by slowing down your exercise for 5 minutes. Then repeat the stretching exercises that you did during your warm-up. This takes away the waste products that build up during exercise and helps reduce muscle soreness. The cooldown time slowly lowers you heart rate and blood pressure, helps prevent injuries and reduces the pooling of blood in your bDT}– nfD– D¥xD˜– (Db_D£D– ˜\_– _– ˜\D– fn˜– important part of your workout. Stop exercising and tell your doctor if you have any of these symptoms during, or even several hours after, exercise:

Heart & Vascular Center 3

Exercising for a Healthier Heart – – – – – – – – – – – –

1–b_T\˜\D ;D;kDÂ?Â? 1–2\DÂ?˜–;_Â?2nfMnÂ?˜ 1–Â? x_;–\D Â?˜–(D ˜ 1–` ¤–;_Â?2nfMnÂ?˜ 1– Â?f–;_Â?2nfMnÂ?˜ 1–¥xxDÂ?–( 2a–;_Â?2nfMnÂ?˜ 1–;_¨¨_kDÂ?Â? 1–k ÂĄÂ?D 1–¥kÂĄÂ?ÂĄ b–Â?\nÂ?˜kDÂ?Â?–nM–(Â?D ˜\ 1–Â?ÂĄ;;Dk–¤D akDÂ?Â? 1–Â?DÂŁDÂ?D–nÂ?–¥kÂĄÂ?ÂĄ b–M ˜_TÂĄD 1–Â?DÂŁDÂ?D–;_Â?2nfMnÂ?˜–nM– kŒ–a_k;}

Hints for a Successful Exercise Program – –

– –

q}––D˜–Â?\nÂ?˜^– k;–bnkT^˜DÂ?f–Tn bÂ?–MnÂ?– ÂŚnÂĄÂ?Â?DbM}–D¤ Â?;–ŒnÂĄÂ?Â?DbM–¤\Dk–Œn¥– meet them. Â&#x;}––Â?D‚¥Dk˜bŒ–Â?DÂŁ_D¤–˜\D–(DkDN˜Â?–nM– exercise for you. 3. Exercise with music or in front of the television. 4. Wait one hour after eating before exercising. O}––_2a– k–DÂĽDÂ?2_Â?D–Œn¥–b_aD–˜\ ˜–N˜Â?–_k˜n– your lifestyle. ”}––ÂĽDÂ?2_Â?D–¤_˜\– –MÂ?_Dk;–MnÂ?–(n˜\–Â? MDÂ˜ÂŚÂ– and motivation. 7. Follow the walking guidelines to the right.

WALKING When you ďŹ rst come home from the hospital, you should begin to walk daily. If you are feeling extremely tired and ill on a given day, you can skip that day. Walk at a comfortable, easy pace. Follow these guidelines: s$ONOTWALKWITHINONEHOURAFTERMEALS s7ALKONLEVELGROUND AVOIDINGHILLSANDGRADES s7ALKINSIDEIFTHETEMPERATUREISABOVE degrees or below 32 degrees (with wind chill), humidity is greater than 70 percent or there is a pollution alert. s)NSUMMER WALKINTHECOOLERPARTOFTHEDAYAND wear light, loose-ďŹ tting clothes. s)NWINTER PUTONHATANDGLOVESANDWEARASCARF to cover your nose and mouth. s!LWAYSCARRYAN)$WITHYOUANDDONTWALKIN secluded places. Listen to your body. If you develop any form of chest discomfort, extreme shortness of breath, dizziness, sudden weakness or excessive sweating, stop and rest ďŹ ve minutes or until the symptoms go away. Call your doctor if the symptoms do not go away completely, or if you have these symptoms again. !S YOUR BODY GROWS STRONGER AFTER YOU LEAVE THE hospital, you should increase to a moderate, steady WALKING PACE &OLLOW YOUR DOCTORS ORDERS OR THE instructions given to you.

4 Heart & Vascular Center

Your Heart Medications

Heart & Vascular Center

Your Heart Medications Taking Your Medications Taking your medications as prescribed is an important part of keeping your heart healthy. It is important for you and your family to understand the reasons for each medicine and be aware of possible side effects or drug and food interactions that can occur. Many types of medicines are prescribed for heart patients. It is important for you and your family to understand the reasons for each medicine and be aware of possible side effects or drug and food interactions that can occur. After you leave the hospital, your medicines may change. Always make sure you fully understand the changes. It is important to know which medicines to continue and which medicines to stop. You will be given general information about your medicines. Please consult your pharmacist or physician for more detailed information if you have any questions or concerns about your medicines.









Heart & Vascular Center 1

Your Heart Medications Listed below are common types of heart medications. Before discharge, your nurse will review your medications with you. For more information, go to the page number listed after each medicine. HEART MEDICINES






































2 Heart & Vascular Center

Your Heart Medications ACE-Inhibitors Ramipril (Altace®) Lisinopril (Prinivil®, Zestril®) Enalapril (Vasotec®) Captopril (Capoten®) Benazapril (Lotensin®) Moexipril (Univasc®) Quinipril (Accupril®) Trandolapril (Mavik®)

Angiotensin II Receptor Blockers (ARBs) Losartan (Cozaar®) Valsartan (Diovan®) Candesartan (Atacand®) Irbesartan (Avapro®) Olmesartan (Benicar®)

Side Effects: Dizziness, drowsiness, dry cough,

sensitivity to the sun. Call your doctor if:

1––n¡–\ £D–¤Dbb_kT–nM–˜\D–M 2D8–b_x8–˜nkT¡D–n– throat. Call 911 if you are having difficulty breathing. 1–n¡–;D£Dbnx–2\D˜–x _k} 1–n¡–;D£Dbnx–D¥˜DfD–¤D akD} 1–n¡–;D£Dbnx– k–_DT¡b –\D ˜(D ˜} 1–n¡–;D£Dbnx–¦Dbbn¤_kT–nM–a_k–n–D¦D} 1––n¡– ;D£Dbnx– – ;¦– 2n¡T\– ˜\ ˜– 2nk˜_k¡D– beyond a few days. Other changes may occur when using these medications. If you have questions about these changes, call your doctor or pharmacist.


Food and Drug Interactions: Check with your

Lotrel® (Benazapril and Amlodipine)

pharmacist or doctor before taking any over-the-counter cough, cold, allergy or diet drugs. Check with your pharmacist or doctor before taking any over-the-counter pain/fever relievers that contain ibuprofen or naproxen (NSAIDs). Tell them about any other drugs you are taking. Ask them to check for any drug interactions. This medication should be taken with plain water. Your doctor may want you to maintain a reduced sodium and/or calorie diet. Your dietitian can advise you on foods that meet this need. Check with your doctor if you are using a salt substitute.

Uses: These drugs are used to reduce blood

pressure (hypertension), and for congestive heart failure and kidney disease. Instructions: Take

this drug exactly as prescribed. Take it at the same time(s) each day. Do not suddenly stop taking this drug without talking to your doctor. If you miss a dose, take it as soon as you remember but not if it is within eight hours of the next dose. If it is, skip the missed dose and resume your usual dosing schedule. Do not take two doses at one time to catch up. Females: Do not take this medicine if you are pregnant or breast feeding. Notify any physician or dentist that you are on this medication before you have surgery.


Your Heart Medications Antiarrhythmics Amiodarone (Cordarone®, Pacerone®) Propafenone (Rythmol®) Procainamide (Procanbid®) Sotalol (Betapace®) Uses: These drugs are used to slow the heart rate or to treat ventrical or atrial arrhythmias. Instructions: Take

this drug exactly as prescribed. Take it at the same time(s) each day. Sustained action or long-acting tablets or capsules must be swallowed whole and must not be crushed. Do not suddenly stop taking this type of drug without talking to your doctor. If you miss a dose, take it as soon as you remember but not if it is within eight hours of the next dose. If it is, skip the missed dose and resume your usual dosing schedule. Do not take two doses at one time to catch up. Count your number of heartbeats per one minute each morning. If your number of heartbeats in one minute is less than 60, call your doctor to check if you should take your medicine. Side Effects: This medicine may make you

feel dizzy or faint, especially if you get up quickly after sitting or lying down. Swelling of hands and feet may occur. You may experience fatigue, constipation or dry mouth. Amiodarone (Cordarone®, Pacerone®) also may cause increased sensitivity to the sun.


Call your doctor if:

1–n¡–;D£Dbnx–\_£D8–_˜2\_kT8– \} 1–n¡–;D£Dbnx–D£DD–;_¨¨_kD} 1–n¡–;D£Dbnx–D£DD–k ¡D } 1–n¡–;D£Dbnx–˜n¡(bD–(D ˜\_kT} 1––n¡–;D£Dbnx–_DT¡b –\D ˜(D ˜8–bn¤– heartbeat, palpitations. 1––n¡–;D£Dbnx–bn¤D–bDT–¤Dbb_kT–n– unexplained weight gain. 1–n¡–;D£Dbnx–2\D˜–x _k} 1–n¡–;D£Dbnx–;_MN2¡b˜¦–¤ ba_kT} 1–n¡–;D£Dbnx–(b¡D;–£__nk} 1–n¡–;D£Dbnx–¡k¡¡ b–(¡__kT–n–(bDD;_kT} Other changes may occur when using these medications. If you have questions about these changes, call your doctor or pharmacist. Food and Drug Interactions: Check with your

pharmacist or doctor before taking any overthe-counter cough, cold, allergy, or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions.

Your Heart Medications Beta Blockers Atenolol (Tenormin®, Tenoretic®) Acebutolol (Sectral®) Timolol (Blocadren®, Timolide®) Carvedilol (Coreg®) Metoprolol (Lopressor®, Toprol XL®) Sotalol (Betapace®) Bisoprolol (Zebeta®, Ziac®) Uses: These drugs are used to slow the

heart rate (pulse) and lower blood pressure (hypertension). They can also be used for the treatment of angina (chest pain), tremors or migraine headaches. These drugs protect your heart by decreasing the amount of work your heart has to do. Instructions: Take

this drug exactly as prescribed. Take it at the same time(s) each day. Sustained action or long-acting capsules must be swallowed whole and must not be crushed. Do not suddenly stop taking this drug without talking to your doctor. If you miss a dose, take it as soon as you remember but not if it is within eight hours of the next dose. In this case, skip the missed dose and then follow your usual dosing schedule. Do not take two doses at one time to catch up. Count your number of heartbeats for one minute before each dose. If your number of heartbeats in one minute is less than 60, call your doctor to check if you should take your medicine. If it is bedtime and you feel well, you may miss that dose and call the doctor in the morning.

Call your doctor if:

1––n¡– D–;_ (D˜_2– k;–\ £D–_k2D D;– episodes of low blood sugar. 1–n¡–\ £D–;_¨¨_kD–¤\Dk–˜ k;_kT–¡x} 1–n¡–;D£Dbnx– –\ \–2n¡T\} 1–n¡–;D£Dbnx–˜n¡(bD–(D ˜\_kT} 1–n¡–;D£Dbnx–k ¡D –n–£nf_˜_kT} 1––n¡–;D£Dbnx–¤Dbb_kT–nM–MDD˜–n–bn¤D–bDT8– or unexplained weight gain. 1–n¡–;D£Dbnx–2\D˜–x _k} Other changes may occur when using these medications. If you have questions about these changes, call your doctor or pharmacist. Food and Drug Interactions: Check with your

pharmacist or doctor before taking any over-the-counter cough, cold, allergy or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions. This drug can be taken with or without food. Your doctor may want you to maintain a reduced sodium and/or calorie diet. Your dietitian can advise you on foods that meet this need.

Side Effects: These drugs may make your feet

and hands more sensitive to cold weather. Talk to your doctor if you have a decrease in sex drive, because the doctor may be able to change your medicine. Since beta blockers slow your heart rate, they may make you feel tired.


Your Heart Medications Blood-Thinning Agents Aspirin Clopidrogel (Plavix®) Enoxaparin (Lovenox®) Warfarin (Coumadin®) Effient Uses: These medications are used to prevent

and treat heart attacks by preventing blood clots. Instructions: Take aspirin with food to decrease stomach irritation. Take Plavix® with a full glass of water. It can be taken with or without food. Lovenox® is an injection. Follow the instructions provided.

Take at the same time every day. If you miss a dose one day, do not double your dose the next day. Alert any physician or dentist taking care of you that you are on this medication. Aspirin can cause stomach bleeding, and alcohol can make this worse. A special note about Plavix®: If you are taking Plavix® because you have a drugcoated stent, missing a dose for even a few days can cause the stent to become blocked. Research shows you need to take Plavix® for one year before you can safely stop it. If you cannot afford it, discuss this with your doctor before you stop taking it. Side Effects: Easy bruising, prolonged bleeding.


Call your doctor if:

1––n¡–;D£Dbnx– k– bbDT_2–D 2˜_nk–z \8– itching, hives). 1––n¡–;D£Dbnx–(bnn;¦–;_ \D 8–˜ ¦–˜nnb8– blood in vomit or urine. 1–n¡–;D£Dbnx–¤Dbb_kT–nM–˜\D–b_x} 1–n¡–;D£Dbnx–˜n¡(bD–(D ˜\_kT} 1–n¡–;D£Dbnx–¡;;Dk–D£DD–\D ; 2\D} 1––n¡–;D£Dbnx–2nkM¡_nk–n–k¡f(kD–nk– the face, arm or leg. 1–n¡–;D£Dbnx–2\D˜–x _k} Other changes may occur when using these medications. If you have questions about these changes, call your doctor or pharmacist. Food and Drug Interactions: Check with your

physician or pharmacist before taking any over-the-counter medications that contain ibuprofen, naproxen, or any other NSAID. Also check with your physician or pharmacist before taking any over-thecounter herbal products. Warfarin: Do not change brands of warfarin

without consulting your physician. Do not start or stop medications, including vitamins and herbs, without double checking with your physician. Vitamin K-rich vegetables may decrease the effects of warfarin (e.g. spinach, broccoli). Avoid drastic changes in diet. Blood tests will be done regularly to adjust your dose.

Your Heart Medications Calcium Channel Blockers Diltiazem (Cartia XL®, Cardizem®, Tiazac®) Verapamil (Calan®, Isoptin®) Amlodipine (Norvasc®) Nifedipine (Procardia®, Adalat CC®) Felodipine (Plendil®) Isradapine (Dynacirc®) Uses: These drugs are used to slow the heart rate (irregular heartbeat) and reduce blood pressure (hypertension). They also can be used for the treatment of angina (chest pain). Instructions: Take

this drug exactly as prescribed. Take it at the same time(s) each day. Sustained action or long-acting tablets or capsules must be swallowed whole and must not be crushed. Do not suddenly stop taking this drug without talking to your doctor. If you miss a dose, take it as soon as you remember but not if it is within eight hours of the next dose. If it is, skip the missed dose and resume your usual dosing schedule. Do not take two doses at one time to catch up.

Call your doctor if:

1–n¡–;D£Dbnx–\_£D8–_˜2\_kT8– \} 1–n¡–;D£Dbnx–D£DD–;_¨¨_kD} 1–n¡–;D£Dbnx–D£DD–k ¡D } 1–n¡–;D£Dbnx–_DT¡b –\D ˜(D ˜} 1––n¡–;D£Dbnx–¤Dbb_kT–nM–MDD˜–n–bn¤D–bDT8– or unexplained weight gain. 1–n¡–;D£Dbnx–2\D˜–x _k} Other changes may occur when using these medications. If you have questions about these changes, call your doctor or pharmacist. Food and Drug Interactions: Check with your

pharmacist or doctor before taking any over-the-counter cough, cold, allergy or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions. Avoid grapefruit juice if you are taking felodipine, nifedipine, verapamil, amlodipine.

Count your number of heartbeats per one minute each morning. If your number of heartbeats in one minute is less than 60, call your doctor to check if you should take your medicine. Side Effects: This medicine may make you

feel dizzy or faint, especially if you get up quickly after sitting or lying down. Swelling of hands and feet may occur. You may experience fatigue, constipation or dry mouth.


Your Heart Medications Digitalis Digoxin (Lanoxin®, Lanoxicap®, Digitek®) Uses: This medication strengthens your heartbeat, controls your heart rate and improves blood circulation. Instructions: Take

this drug exactly as prescribed. Take it at the same time each day. Do not suddenly stop taking this drug or switch brands without talking to your doctor. If you miss a dose, take it as soon as you remember but not if it is within 12 hours of the next dose. If it is, skip the missed dose and resume your usual dosing schedule. Do not take double doses. Count your number of heartbeats per one minute each morning. If your number of heartbeats in one minute is less than 60, do not take your medicine. Call your doctor to see if you should take it. If it is a weekend or holiday, hold your medicine until the next business day and then call your doctor. Side Effects: This drug may cause nausea,

vomiting, diarrhea, loss of appetite, drowsiness, headache, muscle weakness or fatigue as your body adjusts to the medication. Confusion, dizziness, vision problems or changes in heart rate also may occur.


Call your doctor if:

1–n¡–;D£Dbnx–2nkM¡_nk} 1––n¡–\ £D–(b¡D;–£__nk–n–DD–¦Dbbn¤^ green halos around objects. 1––n¡–;D£Dbnx– x_;–\D ˜(D ˜–TD ˜D–˜\ k– 100 beats per minute. 1––n¡–\ £D– –bn¤–\D ˜(D ˜–bD–˜\ k–”©– beats per minute. Other changes may occur when using this medication. If you have questions about these changes, call your doctor or pharmacist. Food and Drug Interactions: Many drugs interact

with this medicine and can possibly cause side effects. Check with your pharmacist or doctor before taking any over-the-counter cough, cold, allergy or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions. This drug can be taken with food or milk to avoid stomach upset. Your physician may periodically check a blood level to measure the amount of drug in your blood, monitor for effectiveness and adjust your dose if needed.

Your Heart Medications Diuretics Loop Diuretics Furosemide (Lasix®) Torsemide (Demadex®) Bumetanide (Bumex®) Thiazide Diuretics Hydrochlorothizide(Hydrodiuril®) Chlorothiazide (Diuril®) Metolazone (Zaroxolyn®) Uses: Diuretics are “water pills” that remove

excess water from the body by increasing urination. Diuretics are used to treat fluid retention and swelling (edema), high blood pressure, congestive heart failure or other conditions as determined by your physician. Instructions: Take

this drug exactly as prescribed. This medication increases the frequency of urination. Take the last dose of the day before 6 p.m. If you miss a dose, take it as soon as you remember unless it is almost time for the next dose. In that case, skip the missed dose and take the next one as directed. Do not double doses.

Call your doctor if:

1––n¡–;D£Dbnx– k– bbDT_2–D 2˜_nk8–¡2\– – hives, rash, itching or trouble breathing. 1––n¡–;D£Dbnx–D£DD–k ¡D 8–£nf_˜_kT–n– diarrhea (decreases potassium). 1––n¡–;D£Dbnx–f¡2bD–2 fx–z_˜–f ¦–(D– – sign of low potassium). 1–n¡–;D£Dbnx–D£DD–˜\_˜–z;D\¦; ˜_nk{} 1––n¡–\ £D–_kT_kT–_k–¦n¡–D –n–\D _kT– loss (loop diuretics). 1–n¡–;D£Dbnx–¤D akD–n–;_¨_kD} Food and Drug Interactions: Many drugs interact

with these medicines and can possibly cause side effects. Check with your pharmacist or doctor before taking any over-the-counter cough, cold, allergy or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions.

Side Effects: You may experience dizziness and

lightheadedness. Rise slowly from a sitting or lying position. These drugs may increase sun sensitivity. Other effects include nausea, vomiting, diarrhea, rash, muscle cramps, dry mouth, thirst and weakness. Thiazide diuretics can affect blood sugar and diabetics may need to adjust medications. Thiazide diuretics can worsen gout. These medicines may drive potassium from your body. Your physician may prescribe a potassium-rich diet (bananas) or potassium supplement. You may need blood tests to monitor your potassium level.


Your Heart Medications Lipid-Lowering Agents Statins Simvastatin (Zocor®) Pravastatin (Pravachol®) Atorvastatin (Lipitor®) Lovastatin (Mevacor®) Fluvastatin (Lescol®) Rosuvastatin (Crestor®) Vytorin (Zocor® and Zetia®) Nicotinic Acid Niacin (Niaspan®, Niacor®) Cholesterol Absorption Inhibitor Ezetimibe (Zetia®) Fibrates Gemfibrozil (Lopid®) Fenofibrate (Tricor®) Bile-Acid Binding Resins Colestipol (Colestid®) Colesevelam (Welchol®) This is general information about lipidlowering agents with a focus on the statins. Please consult your pharmacist or physician for detailed information on a specific product. Uses: These medications are used to lower cholesterol and triglyceride levels when diet and exercise alone have not lowered them enough. Reducing cholesterol and triglycerides helps prevent strokes and heart attacks. Each class of lipid-lowering agent can be used alone or in combination with another agent. Instructions: Take these drugs exactly as

prescribed. Extended release products must not be crushed. If you miss a dose, take it as soon as you remember unless it is almost time for the next dose. In that case, skip the missed dose and take the next one as directed. Do not double doses.


Side Effects: Gastrointestinal side effects are

common. These drugs can affect the liver, so periodic blood tests are required. Combinations of statins plus either fibrates, nicotinic acid or ezetimibe may be beneficial but can increase the risk of serious muscle pain, and can sometimes lead to kidney failure. Niacin can cause flushing, tingling or a sensation of warmth when you first start taking it. These effects usually stop with continued use. Call your doctor if:

1––n¡–;D£Dbnx–f¡2bD–x _k–n–˜Dk;DkD– especially if you have a fever or feel fatigued. 1––n¡–\ £D– bbDT_2–D 2˜_nk8–¡2\– –\_£D8– rash or trouble breathing. 1––n¡–;D£Dbnx–D¥˜DfD–¤D akD–_k–¦n¡– arms or legs. Food and Drug Interactions: Many drugs interact

with these medicines and can possibly cause side effects. Check with your pharmacist or doctor before taking any over-the-counter cough, cold, allergy or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions.

Your Heart Medications Nitrates Isosorbide Mononitrate (Imdur®, Ismo®, Monoket®) Isosorbide Dinitrate (Isordil®) Nitroglycerin Patch (Nitrodur®, Nitroderm®) Nitroglycerin SL Tab (Nitrostat®) Nitroglycerin SL Spray (Nitrolingual®) Uses: This medication helps relax the

blood vessels and improves blood flow. Nitroglycerin is used to treat chest pain. Instructions: Take these drugs exactly as prescribed. Extended-release products must not be crushed. If you miss a dose, take it as soon as you remember unless it is almost time for the next dose. In that case, skip the missed dose and take the next one as directed. Do not double doses. For sublingual tablets, at the first sign of chest pain, sit or lie down and place one tablet under your tongue and allow it to dissolve. If there is no relief after five minutes, take another tablet. If there is no relief after three tablets, call 911 or have someone drive you to a hospital emergency room.

Call your doctor if:

1–n¡–;D£Dbnx– –D£DD–\D ; 2\D} 1–n¡–\ £D–;¦–fn¡˜\} 1–n¡–;D£Dbnx– – \} 1–n¡–\ £D–(b¡D;–£__nk} 1––n¡–\ £D–kD¤–2\D˜–x _k–Db_D£D;–(¦– nitroglycerine tablets or spray. 1––n¡–\ £D–2\D˜–x _k–kn˜–2nk˜nbbD;–¤_˜\– your medication. Call 911 if you have chest pain unrelieved by three doses (tablet or spray) of nitroglycerin. Food and Drug Interactions: Do not take Viagra® with nitroglycerin. Certain drugs for migraines and high blood pressure may interact with nitroglycerin. Do not drink alcohol with this medication. Check with your pharmacist or doctor before taking any over-the-counter cough, cold, allergy or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions.

Topical patches are often removed at bedtime to allow a drug-free time period. This helps prevent building a tolerance to the drug. Side Effects: Nitroglycerin can cause head-

aches, dizziness, flushing, rapid heartbeat, nausea or vomiting. Headaches often are a sign that the medication is working. Treat headaches with Tylenol® (acetaminophen). Rise slowly from a sitting or lying position to prevent dizziness and lightheadedness.

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Your Heart Medications Pain Medications Hydrocodone/Acetaminophen (Vicodin®) Oxycodone/Acetaminophen (Percocet®) Propoxyphene Napyslate/Acetaminophen (Darvocet-N 100®) Tramadol/Acetaminophen(Ultracet®) Uses: These medications are painkillers

(analgesics). They contain a combination of a narcotic analgesic and acetaminophen (Tylenol®) to treat moderate to severe pain. Instructions: Take

this drug exactly as prescribed. Take it only for the condition for which it was prescribed. Do not take more or take it for a longer time than prescribed. Do not take more than 4,000 mg of acetaminophen (Tylenol®) per day. Make sure you understand how much Tylenol® each pain tablet contains and how many tablets you can take per day. If one tablet has 500 mg of acetaminophen, you can take up to eight tablets per day. If one tablet has 325 mg of acetaminophen, you can take up to 12 tablets per day. Side Effects: This medication may make you dizzy or drowsy. Do not drive or operate machinery unless you are fully alert. It also may cause nausea, vomiting or constipation. Take with food to minimize stomach upset. A stool softener may help relieve constipation.

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Call your doctor if:

1–n¡–;D£Dbnx– – \} 1–n¡–D¥xD_Dk2D–˜n¡(bD–(D ˜\_kT} 1–n¡–\ £D–˜n¡(bD–¡_k ˜_kT} 1–n¡–\ £D–_kT_kT–_k–¦n¡–D } 1–n¡–;D£Dbnx–;DxD_nk–n–\ bb¡2_k ˜_nk} 1–n¡–\ £D– – x_;–\D ˜(D ˜} 1–n¡–;D£Dbnx–(bnn;¦–n–; a–¡_kD} 1–n¡–;D£Dbnx–¦Dbbn¤_\–a_k–n–D¦D} Food and Drug Interactions: Check with your

pharmacist or doctor before taking any over-the-counter cough, cold, allergy or diet drugs. Tell them about any other drugs you are taking. Ask them to check for any drug interactions. Talk to your health care provider if you are taking sedatives, antihistamines, antidepressants or nerve medicines. Do not drink alcohol while taking this medication, as the combination may cause liver damage. With the exception of Tylenol®, these medications are controlled substances. It is illegal to give them to anyone else.

Your Heart Medications Proton Pump Inhibitors Omeprazole (Prilosec®) Rabeprazole (Aciphex®) Lansoprazole (Prevacid®) Esomeprazole (Nexium®) Pantoprazole (Protonix®) Histamine H2 Blockers Famotidine (Pepcid®) Ranitidine (Zantac®) Nizatidine (Axid®) Uses: These drugs are used to treat conditions in which there is too much acid in the stomach. They also are used to treat duodenal and gastric ulcers and gastroesophageal reflux disease (GERD). Instructions: Take

Call your doctor if:

1–n¡–;D£Dbnx– – \} 1––n¡–;D£Dbnx– –¤nDk_kT–nM–¦n¡–˜nf 2\– condition. These medicines may interact with other medications and can possibly cause side effects. Check with your pharmacist or doctor before taking any medication. Tell them about any other drugs you are taking. Ask them to check for any drug interactions.



this drug exactly as

prescribed. Proton Pump Inhibitors: Best if taken before breakfast (Nexium® should be taken one hour before breakfast). Swallow the tablet or capsule whole. Do not crush, break, chew or split the tablet or capsule. If needed, capsule may be opened and the granules in the capsule may be sprinkled on a spoonful of cold applesauce or yogurt for immediate use; or you may mix the granules in tap water, apple or orange juice and drink immediately. Histamine H2 Blockers: Take 30 minutes before a meal and/or at bedtime for best results. Side Effects: These drugs may cause dizziness

or headache. Other rare side effects include rash. Notify your physician if this should occur.


Your Heart Medications NOTES


Heart Surgery

Heart & Vascular Center

Heart Surgery


our doctor has recommended heart surgery as the best treatment option for your heart condition. In most cases, the surgery will be an open-heart procedure in which the breastbone is cut open so the surgeon can work on the heart. Minimally invasive surgery eliminates the need to open the breastbone and can be used in select cases. A member of your health care team and the surgeon will discuss with you the type of surgery recommended for you.

Coronary Artery Bypass Your doctor may recommend coronary artery bypass as a treatment for blockages in the coronary arteries. The coronary arteries supply blood to the heart muscle. Blockages in these arteries can cause chest pain, shortness of breath, and heart attacks. Blockages can be treated with medicine, catheter based procedures, or bypass surgery. Bypass surgery reroutes blood around the blockages so that the heart has new blood supply. Bypass surgery relieves the symptoms caused by the blockages and prevents heart attacks from occurring. While more invasive than catheter procedures, bypass surgery is the most durable treatment for coronary artery disease and provides the greatest survival advantage of any treatment option. Bypass surgery is traditionally done through an “open heart” approach. This technique divides the breastbone to access the heart. This approach is usually required in order to bypass arteries on different areas of the heart. Bypass grafts are constructed using arteries from under the breastbone and veins from the leg. The left internal mammary artery is harvested from under the breastbone and used to bypass blood around a blockage on the heart. Sometimes, both the left and right mammary arteries are utilized. The mammary artery graft usually stays open for the rest of the patient’s life. Additional bypasses are created using a vein harvested from the leg or arteries from the forearm. The leg has several vein

Heart Attack


Lack of Blood Flow

Coronary Bypass Surgery



Bypass using an artery


Bypass using a vein

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Heart Surgery systems and is not permanently affected by removing the vein for bypass. The leg vein or arm artery is connected to the aorta just above the heart, then to the coronary artery beyond the blockage. Vein grafts are less durable than arteries, however, two out of three vein grafts are still working well after ten years. The blockages are left in the coronary arteries and blood flow bypasses the blockage by going through the new grafts. The blockages are not removed from the coronary arteries as this would damage the coronary artery and is less durable than bypassing around the blockage. Risks of coronary bypass surgery include heart attack, stroke, kidney or respiratory failure, and death. In mostcases these risks are all less than 2-4%. You doctor will go over your specific risks and recommended procedures.

Aortic Valve Surgery The aortic valve is the most commonly operated on valve in the heart. The aortic valve allows flow out of the heart, and prevents blood from coming back into the heart. The valve can either leak, called aortic insufficiency that allows blood back into the heart, or not open well – a condition call stenosis. Most aortic valve operations are done for aortic stenosis associated with aging. Aortic stenosis prevents blood from flowing easily from the heart out to the body and puts and added workload on the heart leading to thickening of the heart muscle. Often even severe aortic stenosis can have no symptoms. When present, symptoms can include shortness of breath, fatigue, and passing out. Once symptoms are present, over half of patients will die within two years without treatment. Treatment of aortic valve disease, whether stenosis or insufficiency, involves the removal

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of the native aortic valve and placement of a prosthetic valve. This can be done using a minimally invasive approach if aortic valve replacement is the only procedure required. Minimally invasive approaches can include a partial division of the breastbone, or an approach between the ribs. If coronary bypass or other procedures are required at the time of surgery, then a standard incision through the breastbone is required.

Mitral Valve Surgery The mitral valve is between the lungs and the main pumping chamber of the heart, the left ventricle. In rheumatic heart disease the valve typically closes slowly over time resulting in restriction of flow into the heart. This is also often associated with leakage from the valve. Mitral valve disease leads to shortness of breath, fatigue, irregular heart rhythms, and high blood pressure in the lungs. In rheumatic mitral valve disease, the valve usually cannot be repaired and requires removal and replacement with a prosthetic valve. Mitral valve prolapse and degenerative mitral valve disease leads to leakage of the mitral valve. When the mitral valve leaks, blood is pushed backwards into the lungs with each heartbeat resulting in shortness of breath, fatigue, and eventually irregular heart rhythms and high blood pressure in the lungs. Over time, congestive heart failure develops. Fortunately, the mitral valve can typically be repaired in degenerative mitral valve disorders. Mitral valve repair restores the function of the mitral valve and preserves the function of the heart. Mitral valve surgery can be accomplished without dividing the breastbone by working through the ribs on the right side of the chest. Both valve repair and, if necessary, valve replacement can be done using this approach.

Heart Surgery If coronary bypass or other procedures are required, however, a minimally invasive approach cannot be utilized.

Aortic Aneurysm Repair The aorta is the main blood vessel that carries blood from the heart to the body. The aortic root attaches the aorta to the heart and includes the aortic valve and the origins of the coronary arteries. The ascending aorta then goes up towards the neck, turns in the aortic arch, then heads down the body as the descending thoracic aorta. Below the diaphragm it becomes the abdominal aorta. Aneurysms of the aorta are areas of enlargement greater than 50% larger than the normal aorta. Once enlarged, the aorta will never get smaller and typically continues to grow. Causes of aneurysms include smoking, high blood pressure, high cholesterol, family history, and some connective tissue disorders such as Marfan’s Syndrome. Once diagnosed, the entire aorta will require lifelong surveillance – even after repair of the aneurysm.

As aneurysms enlarge, there is an increased risk of the aneurysm rupturing or the inner layer of the aneurysm tearing, called aortic dissection. Both of these conditions can be fatal and will leave the aorta permanently damaged. Aneurysm repair is designed to prevent these complications. Elective aneurysm repair is typically done when the risk of surgery is lower than the risk of an aneurysm related complication. For most aneurysms, a discussion about repair should begin when the aneurysm reaches 4cm in diameter. Elective aneurysm repair is generally low risk, while the complications of rupture and dissection typically carry a high risk of death and permanent complications. The goal of aneurysm surgery is to remove the diseased aorta before complications occur. At the time of surgery, the aneurysmal aorta is completely removed and replaced with a graft made of synthetic material. After repair, the remaining aorta will require periodic follow-up with CT scans to be sure no additional aneurysms develop.

Endovascular Aneurysm Repair

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Heart Surgery

Thoracic Endoluminal Repair of Chronic Type B Dissection

For some aneurysms an endovascular approach may be possible. The technique involves placing a prosthetic graft into the aneurysm, rather than removing the aneurysm. By placing the endovascular graft inside the aneurysm, the blood is channeled through the graft, preventing pressure on the walls of the aneurysm and eliminating the risk of aneurysm rupture. Endovascular grafts are placed into the arteries in the groin through a small incision. Once inside the artery, the endovascular graft is advanced through the arterial system and positioned using X-rays for guidance. Typically, there are no chest incisions with endovascular aneurysm repair. Endovascular repair is usually done for aneurysms of the descending thoracic aorta and abdominal aorta. Aneurysms of the ascending aorta and aortic arch require an open surgical approach due to the branches present in these areas.

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Surgery for Atrial Fibrillation Atrial fibrillation is an irregular heart rhythm that leads to a nine times increase risk of stroke and double risk of death. Often, atrial fibrillation can be managed by medications or catheter based procedures. However, sometimes these treatments are ineffective, or a patient with atrial fibrillation is undergoing heart surgery for a different reason. Surgical treatment for atrial fibrillation is called a MAZE procedure. This is because the procedure involves making scars that block abnormal electrical conduction within the heart and form a “MAZE” which channels the electrical signals in the correct direction. The MAZE procedure can be done at the time of other heart surgery or can be done as a minimally invasive stand-alone procedure. Either heat energy or cold energy is used to create the scars that channel the electrical

Heart Surgery signals of the heart. In addition to channeling the electrical signals, the left atial appendage is removed. The left atrial appendage is the source of most strokes from atrial fibrillation. By removing the left atrial appendage, the risk of stroke is significantly decreased. When done minimally invasively, a video camera is used to work between the ribs and it is not necessary to divide the breastbone. Patients are typically in the hospital for one to three days after the procedure and are discharged without any restrictions. Atrial fibrillation surgery done at the time of other open-heart surgery does not extend the length of the procedure significantly. Patients are typically maintained on anti-arrhythmic medications and anticoagulation for three to six months before an assessment is made about the efficacy of the MAZE procedure. There is often atrial fibrillation that occurs in the first several months following the MAZE procedure. The occurrence of atrial fibrillation in the post-operative period is not concerning and does not mean that the MAZE procedure did not work. Atrial fibrillation following any surgery in the chest is very common due to the inflammation, irritation, and scarring that occur on and around the heart following surgery. Patients are given a three to six month period following surgery to allow for healing and resolution of inflammation before the efficacy of the MAZE procedure can be assessed. Once an assessment of the success of the MAZE procedure has been made, consideration can be give to stopping anti-arrhythmic medications and anticoagulation.

Prosthetic Heart Valve Choices There are two basic types of heart valves that can be implanted – mechanical valves and tissue valves. There is not one option that

Valve Replacement Options is right for all patients. You should have an open discussion with your surgeon about the advantages and disadvantages of each option for your particular situation. Mechanical heart valves are made from carbon and have the advantage of being very durable and not wearing out over time. However, they have the disadvantage of requiring blood thinner medication for life to prevent the formation of blood clots on the valve. Tissue valves are made from the tissue from the sac around the heart from a cow (bovine pericardium), or the actual heart valve from a pig (porcine valve). The living cells are removed during

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Heart Surgery processing so there is no rejection of tissue valves. Since they are made from natural tissue, tissue valves have the advantage of not requiring blood thinners, except aspirin. Unfortunately, tissue valves have a limited lifespan, lasting approximately 1525 years depending on a variety of factors, including the age of the patient at the time of implantation. In general, mechanical heart valves are favored for younger patients while older patients choose tissue valves. Patients receiving mechanical heart valves require life-long blood thinners (anticoagulation). Blood tests are required one to two times a week to check anticoagulation levels initially, and approximately two to three times a month once a regimen as been established. Anticoagulation can be managed quite well by most patients and has a low annual risk of significant bleeding. For patients choosing tissue valves, aspirin is recommended but no further anticoagulation is necessary. Since tissue valves can wear out over time, your cardiologist will monitor the function of your valve with echocardiograms. If a tissue valve does wear out and need to be replaced, this can be done with another operation, or can be done with a catheter delivered valve in some cases.

Robotic and Minimally Invasive Surgery Many procedures can now be done without the traditional incision associated with “open heart” surgery. With traditional open-heart surgery, the entire breastbone is divided and opened to allow the surgeon access to the heart and great vessels. Minimally invasive and robotic approaches do not open the entire breastbone, but rather are approached through a partial opening of the breastbone or by working between the ribs. Some of

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the these procedures are done with the assistance of tele-manipulated instruments – often referred to as “robotic” surgery – while others are done using long thin instruments held by the surgeon. Both approaches are similar in that the operation is done without opening the entire breastbone. In most cases, a separate incision in the groin is necessary to allow connection of the heart lung machine. A limited incision, whether on a portion of the breastbone or between the ribs, speeds the recovery following surgery. In addition, less invasive approaches are associated with lower need for blood transfusion, lower rates of infection, shorter lengths of stay, and for some patients lower mortality. Your surgeon will discuss with you if your condition could potentially be treated with a minimally invasive approach. Even if a minimally invasive procedure is planned, in rare cases, the procedure may need to be converted to a standard procedure for your safety.

Diagram of minimally invasive mitral valve surgery

Heart Surgery The Journey of Hearth Surgery Heart Surgery – Preparation You will meet with your surgeon and other members of the surgical team either in the office or the hospital about your condition and why surgery is being considered as a treatment option. You should understand the nature of your problem and why surgery is felt to be a good treatment for you. You should also understand the basic nature of the procedure recommended and the risks involved with the operation. If having valve surgery, you should discuss the different types of prosthetic heart valves available and selected which type you would prefer. For outpatients, a pre-operative appointment will be made where you will receive pre-operative teaching about what to expect with surgery and the recovery process. This will be done by the nursing staff and by our nurse practitioner if you are admitted to the hospital. You will have standard blood work, a chest x-ray, and other tests done before surgery. For almost all patients, a coronary angiogram (“heart cath”) will be done prior to surgery. The coronary angiogram is performed in the hospital by your cardiologist. This typically takes half of a day at the hospital and is scheduled by your cardiologist two or more days before your surgery. You may also need some additional test for your particular condition. We encourage you to ask questions throughout the process. It is best to have a family member/friend accompany you to take notes and write down questions. Your surgeon or a surgical team member will go over your medications and discuss with you any medications that may need to be stopped or changed prior to surgery. The

day before surgery, you should take your medications as directed unless instructed otherwise by your surgeon. Medications that typically need to be stopped prior to surgery include Warfarin/Coumadin, Plavix, Predaxa, Effient, and other blood thinners, diabetic medications such as Metformin, and blood pressure medications of the class call ACE inhibitors (lisinopril, Zestril, and others). Aspirin should not be stopped prior to surgery unless specifically directed to do so. You should not take any medications on the morning of surgery unless specifically told to do so. You will be given special soap to shower with the night before surgery, you will also be given antibiotic ointment to place in your nostrils the night before surgery. You should not eat or drink after midnight the night before surgery. It is okay to brush your teeth with a small sip of water the morning of surgery. You should avoid people who are ill prior to surgery. Avoidance of large crowds and air travel during the week prior to surgery is also recommended. Vaccines such and flu and pneumonia are not recommended less than two weeks before surgery. You should continue to be as active as your condition allows unless directed otherwise. Regular walking is good preparation for your surgical recovery. If you would like to tour the Intensive Care Unit or the Cardiovascular Unit where your post-operative recovery will occur this can be arranged through our office. If you smoke, it is recommended that you stop smoking for at least a week prior to surgery. Stopping smoking causes your body to produce a great deal of mucus in the lungs several days after stopping smoking. If you wait until the day before surgery to stop smoking, you will experience heavy phlegm

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Heart Surgery in the first several days after the operation. Coughing during this time is already difficult due to pain from the incision. Excessive phlegm plus poor coughing after surgery can rapidly lead to pneumonia, a potentially fatal complication.

Heart Surgery – Day of Surgery You will arrive in the pre-operative (pre-op) preparation area approximately two hours before the scheduled time of your operation. For patients coming from home, you will be given an arrival time when your surgery is scheduled in the office. For patients already in the hospital, you will be taken to the preop area by the hospital staff. Two family members can accompany you in the pre-op area. The pre-op area has limited space and cannot accommodate larger groups. In the pre-op area, a nurse will review with you the operation planned, your medications, and when you last ate or drank. An IV will be started in a vein in your arm and your chest, abdomen, groins, and legs will be shaved. You will have the opportunity to meet with the anesthiologist and ask any questions you may have about the anesthetic plan. Almost always, the anesthesia will be general anesthesia that involves going to sleep completely with a breathing tube placed into the windpipe for control of the airway during the operation. If you or family members have had previous problems with anesthesia be sure to tell the anethesiologist about these issues. Please be patient while waiting in the pre-op area. We realize that this is a time of great anxiety for you and your family. Please also recognize that only the first operation of the day starts exactly on time; all other “scheduled” times are estimates of when the next operation will begin. Scheduled surgery times are affected

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by many things such as the emergency operations, unexpected difficulties during surgery, and surgical, anesthesia, and patient delays. Any of these factors can cause your “scheduled” time to be moved up sooner, delayed, or cancelled completely. If this happens, we apologize for the stress caused to you and your family. If changes occur to the scheduled time please understand that the change is necessary because we believe that it is in your best interest, or for another patient with an urgent need for surgery.

Heart Surgery – In Hospital Recovery Following heart surgery, you are taken directly to the Critical Care Unit (ICU) on the second floor, you will not go to the “Recovery Room”. Various monitoring lines will be attached to you after you go to sleep with the anesthesia. When you first awake from anesthesia, there is usually a breathing tube in your throat. This will be removed as soon as you are awake from anesthesia and strong enough to breath on your own. While the breathing tube is in place, you will not be able to talk. Your nurse will give you sedation and pain medication to keep you comfortable until the tube can be safely removed. There will also be monitoring lines attached to your wrist and through a big IV line in your neck or upper chest. There will also be tubes coming from the bottom of your chest to drain fluid. You will also have a tube in your bladder to drain urine. Typically the monitoring lines, urine catheter, and drainage tubes are removed in the first few days after surgery. Patients usually spend one to three days in intensive care before moving to the Cardiovascular Unit (CVU). After leaving intensive care, you

Heart Surgery will spend three to five days on CVU progressing on a standard pathway. During this time, any remaining drainage tubes or monitoring lines will be removed. You will usually also have temporary pacing wires placed during surgery in case a pacemaker is needed after surgery. If a pacemaker is not necessary, these wires will also be removed on CVU. Removal of the drainage tubes is associated with brief pain, while removal of pacing wires and monitoring lines is generally not painful. On the first full day on CVU you will take a shower and begin to walk in the hall. You will eat all of your meals sitting in the chair. Walking will be initially done with a specialized walker to aid you in your balance. You should not try to walk alone at first but allow the nurses to assist you. Patients who have traditional open-heart surgery through the breastbone have lifting restrictions for six weeks following surgery. These restrictions are in place to allow the breastbone to heal properly. To facilitate healing, we ask that you not lift anything greater than five to eight pounds during this time. It is also important not to push yourself up from a chair or do other movements that place stress on the breastbone. The nurses and therapists will teach you about these precautions and restrictions while you are in the hospital. Your medications will be different following surgery than they were before surgery. Prior to discharge, a team member will go over all of the medications that your surgeon wants you to be on at home. At discharge, you will be given a written list of these medications, dosages, when to take the medicine, and how long you are expected to be on each medicine. You will receive a prescription for any new medications. You should follow the written discharge

medication instructions even if they are different from what you were taking before. You should not resume any of the medications that you were on previously unless you are told to do so. Each patient’s home situation is unique. Our team will work with you, case management, and social work to assess your unique situation and what needs you may have when you get home. Everyone will require some assistance following heart surgery and there are numerous resources available to tailor a plan that meets your needs. Almost all patients will also go home on oxygen for several weeks. This is normal given that we are one of the highest altitude heart surgery programs in the world. At your post-operative appointment your oxygen level will be re-assessed and many patients are taken off oxygen at that time. Prior to going home, you will have a home care plan put together which will include medication instructions, home health care, home oxygen, and outpatient cardiac rehab. We will discuss this plan with you and your family to be sure there are no questions and that you understand the plan and your responsibilities.

Heart Surgery – Recovery at Home Once at home, your recovery will continue. We will provide you will an activity log to chart your progress. We expect that you will continue to work just as hard at home as you did in the hospital. Regular walking and graduated activity are essential to your recovery and the discharge plan should be followed and your progress charted in your log. It is also important to follow your weight, blood pressure, pulse, and temperature at home daily and track these

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Heart Surgery in your patient log. Patients with diabetes should also chart their blood sugar levels. Your patient log will be reviewed at your post-operative visit. We recommend that you begin taking short outings after the first week at home. Make trips away from home short and to places you enjoy – go sightsee or get a treat. Gradually make longer trips and errands. If you have a traditional open-heart operation through the breastbone you may drive three weeks after surgery if you are not taking prescription pain medication. You should keep driving trips short at first and slowly work up to longer outings. Air travel is safe approximately three weeks after surgery but should be discussed with your surgeon. Outpatient cardiac rehab is typically begun two weeks after leaving the hospital. Cardiac rehab is an outpatient program that you attend three times a weeks for approximately one hour. The program can continue up to 12 weeks depending on your needs. We highly recommend cardiac rehab for patients who had heart attacks, who had heart failure, or are over age 60. Cardiac Rehab is available at Penrose Hospital and St. Francis Medical Center in Colorado Springs, St. Mary Corwin Hospital in Pueblo, and St. Thomas Moore Hospital on Canon City. For patients who live too far to come to the hospital for rehab we will craft a home exercise program for you at the time of discharge. Following surgery you may have a poor appetite and not enjoy foods that were once favorites. It is important that you continue to drink fluids and eat what you can. While you do need enough calories to heal and recover, you do not have to clean your plate when you get home. If you have a poor appetite, try favorite foods or whatever sounds good – even if they are not “healthy” choices. While proper diet is very important, you

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are already under a great deal of stress and you cannot make too many changes at once. Trying a radically different diet when you first come home from surgery is not likely to succeed. Instead, we recommend that you get through the first several weeks after surgery before making dramatic lifestyle changes. Once things have settled down, then make small changes in an incremental fashion. This will increase the odds that the changes will become a permanent lifestyle change for you. Healthy diet and lifestyle are important to you over the long term, not in the days and weeks immediately after surgery. Returning to work after heart surgery is stressful. You will need to be honest about your progress and readiness to begin working again. Some people are ready to return to work sooner than others, and some jobs are easier to return to than others. If your work involves physical labor then you will need to be six weeks out from surgery in order for your lifting restrictions to be lifted before considering returning to work. If you can do some work by email or phone, you may begin to start doing these things sooner on a limited basis. When you are ready, we recommend that you return to work on a part time basis at first. Ideally, this would be half days, three days a week initially. From this you can slowly increase the number of days and then the length of your days. It is important to recognize stressors that may cause you to want to return to work sooner such as financial pressure, supervisor pressure, or guilt over the burden placed on co-workers by your absence. It is important to identify these factors and consider how they may be affecting your decision to return to work. If you have paperwork necessary to be absent from work, or to return to work, please bring that paperwork to our office to be completed.

Heart Surgery Many patients experience varying degrees of depression following heart surgery. This is especially true for patients who had heart attacks and/or needed urgent surgery. These feelings are common and should be discussed with your family and doctors. The stress of major surgery, the long recovery, and the shock of a new diagnosis of heart disease all play a role in feeling depressed. These feelings are often the strongest approximately two weeks after going home from the hospital. After being home for a week or more, progress is not as fast as the ďŹ rst week in the hospital and this frustrates many patients. One month after surgery, most patients are still experiencing some fatigue and have less endurance. These feelings should be discussed with your family, your doctors, and with the cardiac rehab staff. Other patients at cardiac rehab are also a good resource to

help you realize that you are not alone in your feelings. The combination of time and open discussion is usually sufďŹ cient to work through the depression and frustration. Many patients have questions about resuming intimacy and sexual activities. While it is important to emotionally reconnect with loved ones after a signiďŹ cant life event such as heart surgery, it is also important to remember that sexual activity is exercise. When you are walking regularly for more than 10 minutes without stopping you can consider resuming sex. It is also important to remember that lifting restrictions on your healing breastbone may preclude some positions. Avoid positions in which you have to hold yourself up with your arms as this places excessive stress on the healing breastbone until your lifting restrictions are over.

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Heart Surgery The following charts will give you a quick reference on what to expect before surgery, on the day of surgery and during your hospital stay.

Cardiac Surgery Patient Pathway Before Your Surgery General Information 1–n¡–¤_bb–kDD;–˜n–\ £D–D^;f__nk–D˜_kT–z{–Mn–b (–˜D˜8– – k;–2\D˜–^ ¦} 1–n¡–¤_bb–D2D_£D–_kMnf ˜_nk– (n¡˜–¦n¡–¡TD¦– k;–\nx_˜ b–˜ ¦} 1–k– kD˜\D_nbnT_˜–¤_bb–˜ ba–¤_˜\–¦n¡8–˜\D–fnk_kT–nM–¡TD¦} 1–n¡–¤_bb–(D–T_£Dk– –b¡kT–D¥D2_D–z_k2Dk˜_£D–x_nfD˜D{} 1– 2˜_2D–˜ a_kT–bn¤8–;DDx–(D ˜\–D£D b–˜_fD– –; ¦8–¡_kT–¦n¡–b¡kT–D¥D2_D} 1–_kT–¦n¡–b¡kT–D¥D2_D–¤_˜\–¦n¡–˜n–˜\D–\nx_˜ b–nk–¦n¡–; ¦–nM–¡TD¦} 1–Dxn˜–˜n– fD– ¦–¡TD¦–˜¤n–\n¡–(DMnD–¦n¡–2\D;¡bD;–¡TD¦} Diet 1–\D–k_T\˜–(DMnD–¡TD¦8–;n–kn˜–D ˜–n–;_ka– M˜D–f_;k_T\˜} 1– ˜– –b_T\˜–;_kkD–˜\D–k_T\˜–(DMnD–¦n¡–¡TD¦} 1–n–kn˜–˜ aD– k¦–fD;_2_kD–˜\D–fnk_kT–nM–¡TD¦–¡kbD–_k˜¡2˜D;–˜n–;n–n} Activities at Home 1– aD– –\n¤D–˜\D–k_T\˜–(DMnD–¡TD¦–¡_kT–˜\D–xD2_ b–n x–˜\ ˜–¤ –T_£Dk–˜n–¦n¡} 1–M˜D–¦n¡–\n¤D8–xb 2D–˜\D–knD– k˜_(_n˜_2–_k–D 2\–kn˜_b– –;_D2˜D;} 1–¡˜–nk–2bD k–x ` f – M˜D–¦n¡–\n¤D} 1–D˜– –Tnn;–k_T\˜Š–bDDx8– a–Mn– –bDDx_kT–x_bb– \D ;–nM–˜_fD–_M–¦n¡–˜\_ka–¦n¡–¤_bb–kDD;–_˜} Discharge Planning 1––n¡–¤_bb–kDD;–˜n–\ £D– k– ;¡b˜–zM f_b¦–fDf(D–n–M_Dk;{–¤_˜\–¦n¡–Mn–ŸR–\n¡– –; ¦–Mn– the first week (seven days) after you go home. You need a bathroom scale, thermometer, blood pressure cuff, and antibacterial soap when you go home.

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Heart Surgery Cardiac Surgery Patient Pathway Day of Surgery General Information 1ย–ย˜ MMย–ยค_bbย–ย\nยคย–ยฆnยกยย–M f_bยฆย–ย˜\Dย–bn2 ย˜_nkย–nMย–ย˜\Dย–ยค _ย˜_kTย–ยnnf} 1ย– f_bยฆย–fDf(Dยยย–ย\nยกb;ย–bDย˜ย–ย˜\Dย–ยฃnbยกkย˜DDยย–aknยคย–_Mย–ย˜\Dยฆย–bD ยฃD} 1ย–ยกยTDยยฆย–b ยย˜ยย–Mnยกยย–ย˜nย–ย_ยฅย–\nยกยย} 1ย–nยกยย–ยยกยTDnkย–ยค_bbย–ย˜ baย–ย˜nย–ยฆnยกยย–M f_bยฆย– Mย˜Dยย–ยยกยTDยยฆ} 1ย–nยกยย–M f_bยฆย–ยค_bbย–(Dย– (bDย–ย˜nย–ยDDย–ยฆnยกย– (nยกย˜ย–nkDย–\nยกยย– Mย˜Dยย–ยฆnยกย– ยDย–nยกย˜ย–nMย–ยยกยTDยยฆ} 1ย–ย–nยกย–ยค_bbย–\ ยฃDย– kย–ย–ย˜ยก(Dย–zDk;nย˜ย 2\D bย–ย˜ยก(D{ย–^ย– ย–ย˜ยก(Dย–ย˜\ ย˜ย–TnDยย–;nยคkย–ยฆnยกยย–ย˜\ยn ย˜ย– k;ย–_kย˜nย– your lungs to give you oxygen during surgery. 1ย–nยกย–2 kknย˜ย–ย˜ baย–ยค\_bDย–ย˜\Dย–ย–ย˜ยก(Dย–_ยย–_kย–xb 2D} 1ย–ย–\Dย–ย–ย˜ยก(Dย–ยค_bbย–(Dย–ย˜ aDkย–nยกย˜ย–ยค\Dkย–ยฆnยกย– ยDย– (bDย–ย˜nย–(ยD ย˜\Dย–2nfxbDย˜Dbยฆย–nkย–ยฆnยกยย–nยคkย–zย˜ยคnย– to 12 hours after surgery). 1ย–nยกย–ยค_bbย–(Dย–ยกย_kTย–ยฆnยกยย–bยกkTย–DยฅDย2_ยDยย–DยฃDยยฆย–\nยกยย– Mย˜Dยย–ย˜\Dย–ย–ย˜ยก(Dย–_ยย–nยกย˜} 1ย–nยกย–ยค_bbย–(Dย–T_ยฃDkย– ย–\D ยย˜ย–x_bbnยคย–ย˜nย–\nb;ย–ย˜nย–ยฆnยกยย–2\Dยย˜ย–ยค\Dkย–ยฆnยกย–2nยกT\} Diet 1ย–ย–nยกย–ยค_bbย–(Dย–T_ยฃDkย–_2Dย–2\_xยย– Mย˜Dยย–ย˜\Dย–ย–ย˜ยก(Dย–_ยย–ยDfnยฃD;}ย–\Dkย–ย_xยย–nMย–b_ย‚ยก_;ย– until your appetite returns. Activity 1ย–nยกย–ยค_bbย–(Dย–ยbDDxยฆย–Mnยย–ย˜\Dย–Nยยย˜ย–qยŸย–\nยกยยย– Mย˜Dยย–ยยกยTDยยฆ} 1ย–nยกยย–kยกยยDย–f ยฆย–ย_ย˜ย–ยฆnยกย–ยกxย–_kย–(D;} Comfort 1ย–nยกย–ยค_bbย–(Dย–T_ยฃDkย–x _kย–fD;_2 ย˜_nkย–ย˜\ยnยกT\ย–ยฆnยกยย– ย–ย˜nย–aDDxย–ยฆnยกย–2nfMnยย˜ (bD} 1ย–ย–Dย–ยค_bbย– ยaย–ยฆnยกย–ย˜nย–ย ย˜Dย–ยฆnยกยย–x _kย–Mยnfย–ยฉย–ย˜nย–qยฉ7ย–ย‡ยฉยˆย–fD kยย–knย–x _kย– k;ย–ย‡qยฉยˆย–_ยย–ย˜\Dย–ยคnยยย˜ย– pain you can imagine. After Surgery 1ย–nยกย–ยค_bbย–\ ยฃDย–ย˜Dfxnย ยยฆย–x 2_kTย–ยค_ยDยย–_kย–ยฆnยกยย–2\Dยย˜ย–Mnยย–ย˜\ยDDย–ย˜nย–Mnยกยย–; ยฆย} 1ย–nยกย–ยค_bbย–\ ยฃDย–ย˜ยก(Dยย–_kย–ยฆnยกยย–2\Dยย˜ย–ย˜nย–;ย _kย– kยฆย–Dยฅ2Dยยย–(bnn;ย–Mnยย–nkDย–ย˜nย–ย˜ยคnย–; ยฆย} 1ย–ย–nยกย–ยค_bbย–\ ยฃDย– ย–ย˜ยก(Dย–_kย–ยฆnยกยย–(b ;;Dยย–znbDยฆย–2 ย˜\Dย˜Dย{ย–ย˜nย–;ย _kย–ยฆnยกยย–ยกย_kDย–Mnยย–nkDย– to two days.

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Heart Surgery Cardiac Surgery Patient Pathway Days 1-5 After Surgery General Information 1––n¡–M f_b¦– k;–M_Dk;–f ¦–£__˜–_k– –Mnf–q© f–^–”xf8–Exf–^–” f– k;–ŸR•; ¦–n¡˜_;D– ICU. Your rest is very important; therefore, we suggest short visits. 1–¤n–£__˜n– ˜– –˜_fD–_k–˜\D– } 1–D£D b–˜¡(D– k;–2 ˜\D˜D–¤_bb–(D–Dfn£D;8–¡¡ bb¦–nk–; ¦–nkD–n–˜¤n} 1––fDf(D–nM–˜\D–¡T_2 b–˜D f–¤_bb–£__˜–¦n¡–; _b¦} Breathing 1––n¡–¤_bb–(D–¡_kT–¦n¡–b¡kT–D¥D2_D–nk–¦n¡–n¤k}– aD–q©–;DDx–(D ˜\–D£D¦– hour during the day. 1– nb;–¦n¡–x_bbn¤–˜n–¦n¡–2\D˜–¤\Dk–¦n¡–2n¡T\} 1–n¡–¤_bb–˜_bb–kDD;–n¥¦TDk}–M˜Dk–¡TD¦– k;– ˜–\nfD–Mn–˜¤n^–Mn¡–¤DDa} Diet 1–n¡–;_D˜–¤_bb–2\ kTD–‚¡_2ab¦–Mnf–b_‚¡_;–˜n– –DT¡b –;_D˜} 1–\D–˜ MM–¤_bb–fD ¡D–¤\ ˜–¦n¡–D ˜–n–;_ka– k;–¦n¡–¡_kD–n¡˜x¡˜} 1– ˜–_–knf b–˜n–\ £D– –xnn– xxD˜_˜D8–(¡˜–¤D–¤ k˜–¦n¡–˜n–D ˜} 1– D˜–¦n¡–k¡D–akn¤–_M–¦n¡–\ £D–k ¡D } Activities 1– ˜\D–¤_˜\–\Dbx} 1– D k–\n¤–˜n–2 D–Mn–¦n¡–_k2__nk} 1–_˜–_k– –2\ _–¤_˜\–\Dbx–Mn–D£D¦–fD b} 1– ba–¤_˜\–\Dbx–˜\DD–˜_fD–D 2\–; ¦} 1– _f_˜–b_M˜_kT–˜n–kn–fnD–˜\ k–O–xn¡k;} 1–bbn¤–Mn–D˜–(D˜¤DDk– 2˜_£_˜_D} Comfort 1– aD–x _k–fD;_2 ˜_nk– –kDD;D;} 1––Dbb–¦n¡–k¡D–¤\Dk–¦n¡–kDD;–x _k–fD;_2 ˜_nk–^–x _k– ˜D;–TD ˜D–˜\ k–R– (on a scale of 1 to 10). Discharge Planning  D–f k TD–2 k–\Dbx7 1–  kTD–Mn–D£_2D– M˜D–;_2\ TD} 1– k¤D–_k¡ k2D–‚¡D˜_nk– k;–xn£_;D–¡xxn˜}

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Heart Surgery Managing Your Care at Home Walking You will continue your walks when you get home, increasing a little bit every day. (See section on “Exercising for a Healthier Heart.â€?) Walking is important as you build your strength. It should become a habit that will protect your heart’s health for the future. Energy conservation – 1––n¥– ¤_bb– Â?˜_bb– (D– ˜_Â?D;– ¤\Dk– ÂŚn¥– Tn– home. You will need to rest between activities. Plan your day to allow rest breaks, for example, after your shower, before and after your walks, etc. – 1––\ Â?D–ŒnÂĄÂ?–¤nÂ?a–¤_˜\–n˜\DÂ?Â?–_M–_˜–_Â?–˜nn– hard, if it makes you tired or if you get short of breath. – 1––_˜– ¤\DkDÂŁDÂ?– xnÂ?Â?_(bD7– ¤\Dk– ÂŚn¥– Â?D– getting dressed, preparing food in the kitchen, etc. – 1–– _Â?˜Dk–˜n–ŒnÂĄÂ?–(n;Œ– k;–Â?DÂ?˜–¤\Dk–Œn¥– are tired. Diabetes management If you have diabetes, continue to check your blood sugar at home. Call your primary care doctor if your medicines are not controlling your blood sugar. Activities of daily living – 1––ÂĄÂ?k– ;n¤k– ˜\D– ¤ ˜DÂ?– ˜DfxDÂ? Â˜ÂĄÂ?D– _k– the shower and limit your shower to ďŹ ve to seven minutes to avoid fatigue. – 1–– aD–Â?ÂĄÂ?D– bb–ŒnÂĄÂ?–Â?ÂĄxxb_DÂ?– Â?D–¤_˜\_k– reach and not above your head. – 1–– _f_˜– Â?D 2\_kT– nÂŁDÂ?– ÂŚnÂĄÂ?– \D ;– MnÂ?– objects —it makes your heart work harder. – 1––_˜– ;n¤k– ˜n– xÂĄÂ˜Â– nk– Â?n2aÂ?– k;– x k˜Â?}– Bending over and reaching down can place too much strain on your chest.

Lifting For six weeks, do not lift, push or pull objects ˜\ ˜–¤D_T\–fnÂ?D–˜\ k–O–xnÂĄk;Â?}–ÂĽ fxbDÂ?7– 2 Â?–;nnÂ?Â?8–xÂĄÂ?Â?DÂ?–zE–˜n–qÂ&#x;–xnÂĄk;Â?{8–T bbnk–nM– f_ba–zE–xnÂĄk;Â?{8–2\_b;Â?Dk8–xD˜Â?}–b_;D–n(`D2˜Â?– or use a rolling cart if needed. Getting out of bed First roll to your side, slide your feet off the bed and then use your forearm/elbow to gently push yourself up to a sitting position. Do not pull on someone’s arm to get up. Sleeping with your chest up on several pillows may be more comfortable at ďŹ rst and makes it easier to get up. When getting up from a seated position, follow these guidelines: – 1–£n_;–bn¤–nÂ?–Â?nM˜–2\ _Â?Â?} – 1–Â?D– –x_bbn¤} – 1–nkÂ?_;DÂ?– –Â? _Â?D;–˜n_bD˜–Â?D ˜} – 1–2nn˜–˜n–˜\D–D;TD–nM–˜\D–Â?D ˜} Hold your pillow or put your hands between your knees or across your chest; do not push up from arm rests or pull on something to get up (lifting restriction). Use your legs to push up; use a rocking motion if that helps give you momentum to get up. If someone helps you get up, have the person hold onto the waist of your pants. Do not let the person pull using your arms. When getting into a car, sit down ďŹ rst. Then swing your legs in. When getting out, swing your legs out ďŹ rst. Then stand up. You may need a pillow to sit on.

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Heart Surgery Managing Your Care at Home


Walking You will continue your walks when you get home, increasing a little bit every day. (See section on “Exercising for a Healthier Heart.�) Walking is important as you build your strength. It should become a habit that will protect your heart’s health for the future.

Lifting For six weeks, do not lift, push or pull objects ˜\ ˜–¤D_T\–fnÂ?D–˜\ k–O–xnÂĄk;Â?}–ÂĽ fxbDÂ?7– 2 Â?–;nnÂ?Â?8–xÂĄÂ?Â?DÂ?–zE–˜n–qÂ&#x;–xnÂĄk;Â?{8–T bbnk–nM– f_ba–zE–xnÂĄk;Â?{8–2\_b;Â?Dk8–xD˜Â?}–b_;D–n(`D2˜Â?– or use a rolling cart if needed.

Energy conservation – 1––n¥– ¤_bb– Â?˜_bb– (D– ˜_Â?D;– ¤\Dk– ÂŚn¥– Tn– home. You will need to rest between activities. Plan your day to allow rest breaks, for example, after your shower, before and after your walks, etc. – 1––\ Â?D–ŒnÂĄÂ?–¤nÂ?a–¤_˜\–n˜\DÂ?Â?–_M–_˜–_Â?–˜nn– hard, if it makes you tired or if you get short of breath. – 1––_˜– ¤\DkDÂŁDÂ?– xnÂ?Â?_(bD7– ¤\Dk– ÂŚn¥– Â?D– getting dressed, preparing food in the kitchen, etc. – 1–– _Â?˜Dk–˜n–ŒnÂĄÂ?–(n;Œ– k;–Â?DÂ?˜–¤\Dk–Œn¥– are tired. Diabetes management If you have diabetes, continue to check your blood sugar at home. Call your primary care doctor if your medicines are not controlling your blood sugar. Activities of daily living – 1––ÂĄÂ?k– ;n¤k– ˜\D– ¤ ˜DÂ?– ˜DfxDÂ? Â˜ÂĄÂ?D– _k– the shower and limit your shower to ďŹ ve to seven minutes to avoid fatigue. – 1–– aD–Â?ÂĄÂ?D– bb–ŒnÂĄÂ?–Â?ÂĄxxb_DÂ?– Â?D–¤_˜\_k– reach and not above your head. – 1–– _f_˜– Â?D 2\_kT– nÂŁDÂ?– ÂŚnÂĄÂ?– \D ;– MnÂ?– objects —it makes your heart work harder.

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1––_˜– ;n¤k– ˜n– xÂĄÂ˜Â– nk– Â?n2aÂ?– k;– x k˜Â?}– Bending over and reaching down can place too much strain on your chest.

Getting out of bed First roll to your side, slide your feet off the bed and then use your forearm/elbow to gently push yourself up to a sitting position. Do not pull on someone’s arm to get up. Sleeping with your chest up on several pillows may be more comfortable at ďŹ rst and makes it easier to get up. When getting up from a seated position, follow these guidelines: – 1–£n_;–bn¤–nÂ?–Â?nM˜–2\ _Â?Â?} – 1–Â?D– –x_bbn¤} – 1–nkÂ?_;DÂ?– –Â? _Â?D;–˜n_bD˜–Â?D ˜} – 1–2nn˜–˜n–˜\D–D;TD–nM–˜\D–Â?D ˜} Hold your pillow or put your hands between your knees or across your chest; do not push up from arm rests or pull on something to get up (lifting restriction). Use your legs to push up; use a rocking motion if that helps give you momentum to get up. If someone helps you get up, have the person hold onto the waist of your pants. Do not let the person pull using your arms. When getting into a car, sit down ďŹ rst. Then swing your legs in. When getting out, swing your legs out ďŹ rst. Then stand up. You may need a pillow to sit on.

Heart Surgery Climbing stairs – 1–– _f_˜–˜ _–˜n–nkD–n–˜¤n–˜_x– –; ¦– ˜– first; increase as your body allows. – 1–– M– ¦n¡– \ £D– – bDT– _k2__nk8– Tn– ¡x– ¤_˜\– your “good leg” first and go down stairs using the leg with the incision first. – 1––Dk˜b¦– \nb;– nk– ˜n– – \ k; _b}– n– kn˜– pull yourself up with it. – 1––¡˜– – ( aD˜– kD – ˜\D– ˜Dx– ˜n– 2nbbD2˜– things that need to go with you; have someone else carry it for you (lifting restriction). Checking your heart rate (pulse) Check your pulse every day; write it on your activity diary. Use your finger tips to press gently at your wrist below your thumb or on your neck between your voice box and the big muscle on the side of your neck. Use a watch or clock with a second hand and count the number of beats you feel in 10 seconds. Multiply this number by six to figure the number of beats in one minute. For more detailed instructions on taking your pulse, see the last section of this book on “Exercising for a Healthier Heart,” page 2.

Driving – 1––n– ;_£_kT– Mn– ˜\DD– ¤DDa– M˜D– ¦n¡– leave the hospital. – 1––¡˜– ¦n¡– x_bbn¤– ¡k;D– ¦n¡– D ˜– (Db˜– for comfort. When not driving. – 1–– _f_˜–bn2 b–_;D•;_£D–˜n–RO–f_k¡˜D}– Stop to stretch when you are tired. – 1––\Dk–(DT_kk_kT–˜n–;_£D– T _k8– £n_;– long periods of driving, rush hour traffic and bad weather. Visitors – 1–– _f_˜– ˜\D– k¡f(D– nM– £__˜n– k;– \n¤– long they stay. You will be tired. – 1––n– kn˜– bbn¤– k¦nkD– ˜n– £__˜– _M– ˜\D¦– are sick (cough, fever, sore throat, a cold). You are more likely to pick up an infection.

Common Concerns After Going Home Constipation and poor appetite Being less active and taking pain medication can make you constipated after surgery. Eat plenty of high-fiber foods like fruits and vegetables (see green section on “Eating with Your Heart’s Consent”) and drink liquids. An over-the-counter stool softener, laxative or enema may be used. A lack of activity also can affect your appetite. Try eating five to six small meals each day instead of three larger meals. See the green nutrition section for ideas to make foods taste better.

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Heart Surgery It takes extra calories and protein to heal wounds. Try to eat a high-protein food with D 2\–fD b}–nn;–xÂ?n˜D_k–Â?nÂĄÂ?2DÂ?–_k2bÂĄ;D7 1––nÂĄb˜Â?ÂŚ8–NÂ?\–nÂ?–bD k–fD ˜–^–˜Â?ÂŚÂ–Â˜n–D ˜– – total of 6 ounces daily 1––_ba–zÂ?a_f–nÂ?–q|{–^–˜Â?ÂŚÂ–Â˜n–\ ÂŁD–Â&#x;–2ÂĄxÂ?– daily 1–D;ÂĄ2D;^M ˜–2\DDÂ?DÂ? 1–TT–Â?ÂĄ(Â?˜_Â˜ÂĄÂ˜DÂ?– k;–DTTÂ? 1–nTÂĄÂ?˜ Iron can help rebuild your blood. Vitamin C helps you absorb iron and also is good to help wounds heal and ďŹ ght infection. Foods \_T\–_k–_Â?nk–_k2bÂĄ;D7 1–nÂ?˜_ND;–2DÂ?D bÂ? 1– D k–(DDM8–xnÂ?a8–£D b8–b f( 1–x_k 2\8–2\ Â?; 1– Dk˜_bÂ?8–;Â?_D;–(D kÂ?– k;–xD Â? 1– _f –(D kÂ?8–Â?nÂŚ(D kÂ?– k;–˜nMÂĄ nn;–Â?nÂĄÂ?2DÂ?–nM–_˜ f_k–7 1–_˜Â?ÂĄÂ?–MÂ?ÂĄ_˜Â?– k;–`ÂĄ_2DÂ?–znÂ? kTDÂ?{ 1–  Â?a– TÂ?DDk– ÂŁDTD˜ (bDÂ?– z(Â?n22nb_8– TÂ?DDk– peppers, leafy greens) 1–nf ˜nDÂ? 1– _¤_ 1–˜Â? ¤(DÂ?Â?_DÂ?

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Heart rhythm — skipped beats, irregular rhythm You may notice an occasional skipped beat or you may be more aware of your heartbeat after surgery. This is normal. If you feel more than ďŹ ve skipped beats each minute, call your doctor. If you notice a fast, irregular heartbeat that does not go away or causes you to feel dizzy or short of breath, call your surgeon. Atrial ďŹ brillation, a rapid, irregular rhythm, is sometimes caused by irritation and swelling in the heart after surgery. It usually lasts for a few weeks, and often needs to be controlled with medicine during that time. Depression and forgetfulness It is normal to feel a wide range of emotions after surgery. Pain, boredom, limits on your activities and being out of your normal routine can affect the way you feel. It is common to feel “downâ€? or discouraged after surgery, when you don’t think you are improving as fast as you should. Talk about what is bothering you. Find some activities that you enjoy and are able to do. If the “downâ€? feeling lasts too long, tell your doctor. It also is common to be forgetful for a while after surgery. A lack of normal sleep and the use of pain medicines can add to your forgetfulness. This should get better in the weeks after surgery.

Heart Surgery Sleep problems 1–– ˜Š– 2nffnk– ˜n– \ £D– bDDx– xn(bDf– in the weeks after heart surgery. You may be more comfortable sleeping in a recliner chair at first. 1–– ˜–\Dbx–˜n–D˜– –(D;˜_fD–n¡˜_kD}–n–˜n– bed at a regular time and get up at the same time each day. Rest during the day, but limit naps to one-half hour. 1––£n_;–Mnn;–\_T\–_k–¡T – ˜–(D;˜_fD}– Do not eat late, heavy meals. Try herbal tea at bedtime. Chamomile is a good choice. Avoid caffeine (coffee, tea, cola) in the evening. 1–– aD– ¦n¡– x _k– fD;_2_kD– nkD^\ bM– hour before bedtime to make you more comfortable. 1––¦– – qO^f_k¡˜D– \n˜– Mnn˜– ( ˜\– n– – warm shower an hour before bed time. Ask your loved ones for a 10-minute backrub. 1––D–D xb¡T}– aDk–˜\D–nnf– –f¡2\– as possible. Turn the alarm clock away so you can’t see the numbers glaring during the night. 1–– M–¦n¡– D– ¤ aD– k;–2 kŠ˜–TD˜–( 2a–˜n– sleep, get out of bed and do a task to make your eyes tired (read a dull book, play solitaire, pick up your knitting or needlework). Don’t turn on the television (it is too stimulating). Sexual activity Ask your surgeon at your first follow-up visit about resuming sex. Sexual activity is considered a moderate exercise. When you can climb two flights of stairs without problems, it is usually okay to have sex. Wait one to three hours after a full meal before sexual activity. Don’t drink alcohol for three hours before sex. Make sure you are rested.

Don’t use positions that cause you to support your weight with your arms funtil six weeks after surgery. If you have chest pain, shortness of breath or skipped heart beats, stop and rest. Some medicines can affect sexual activity. If you think this is causing a problem for you, talk to your doctor. Do not stop taking a medicine without talking to your doctor first. Returning to work It will be weeks before you are ready to return to work. It will depend on the type of work you do, your physical condition before the surgery, the type of surgery that you had and how well you are healing. Cardiac rehab can help provide you with the stamina and endurance you need for your work day. Your surgeon will tell you when you can go back to work. Ask your doctor if you have any work restrictions (e.g., lifting or driving). You may need to provide documentation to your supervisor indicating any work restrictions. \Dk–¦n¡– D–( 2a– ˜–¤na8–DfDf(D7 1. Start slowly. Pace yourself. Returning to work after a major cardiac event is usually very tiring. Try to start back gradually -talk to your manager about working half days for the first week.

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Heart Surgery 2. Make exercise part of your daily routine. Talk to your doctor about cardiac rehab. n– fnD– _kMnf ˜_nk8– DD– ‡ _MD˜¦bD– Changes for a Healthier Heart.” š}––DfDf(D– k¡˜_˜_nk}– nna– Mn– \D ˜^– healthy eating options at work. If your company has a cafeteria, ask the staff what healthy nutrition choices they offer. If you eat out for lunch, ask die restaurants for a breakdown of the nutrition content of their menu items. Packing your own lunch is the easiest way to ensure you get the nutrients you need without the fat and sodium you want to avoid. 4. Combine diet and exercise by walking past the vending machines. Bring an extra piece of fruit from home instead of purchasing a less-healthy snack from the vending machine at work.

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Impact of heart surgery on Your Family Having a heart or lung operation is definitely a family event. The reality is that major surgery is a big deal—not just for the patient, but for a lot of other people, too. Ordinary life goes on hold as families adjust schedules, change plans, talk, wait, and worry. Each of us has a family, even if our family is a friend, a neighbor or even a special pet. Experience and research shows that when patients and families have access to the people and information they need, and are invited to actively participate in care and decision making, every kind of outcome improves. Patients recover better and faster, ¤_˜\–bD–˜D– bb– n¡k;}– _MD–˜ ¦–2bnD– to normal for everyone. Certainly hospitals are fast-paced, intimidating places. But ethically and legally, the patient and only the patient is the person truly in charge. If a patient is competent to make decisions, nothing will happen unless he or she agrees that it should. Remember this, and use it. With this perspective as a starting point— that control ultimately rests with the patient and family and not the healthcare team— then mutually respectful relationships of trust and shared accountability can be reached. Honesty, openness, trust, and mutual respect are the building blocks. When these are achieved, anxiety and fear are greatly reduced. Good care and rewarding friendships usually follow. If you are interested in learning more about how patients and family can participate in care and decision making, helpful information is available from the Institute for Family Centered Care. One more thought, based on watching many patients and families go through

Heart Surgery serious illness and recovery. Surprisingly, at the far end of the difficult experience of being ill and having surgery, patients and their families often find an unexpected new wholeness and happiness in their lives. What may seem at first to be the worst thing that could ever happen turns out to be, in a surprising and unexpected way, a time of deep personal and family healing and learning that reorients every priority and makes life truly worth living. Major life events like heart surgery or lung surgery help us see and appreciate the things that really matter. ˜˜_(¡˜D;–˜n–}– ¡b–}–\b_kT}

Guidelines for family members Heart disease and heart surgery affect the whole family. Things may change at home. Chores may have to be done by someone who usually does not do them and roles may be switched.

It is normal to be tired, anxious, scared, confused, angry, sad, helpless or even depressed after having a family member go through heart surgery and then dealing with changes at home. These feelings are not “bad” or “wrong.” Talk about how you MDDb}–  f_kT– ¦n¡– MDDb_kT– T_£D– ¦n¡– nfD– control over them. It is important to take care of yourself ¤\_bD–¦n¡– D–\Dbx_kT– –bn£D;–nkD–\D b7 – 1– ˜– –\D b˜\¦8–( b k2D;–;_D˜} – 1––D˜–nfD–D˜’–k x–¤\Dk–¦n¡– “patient” naps. – 1– aD– –¤ ba} – 1–– 2˜_2D–;DDx–(D ˜\_kT–n–n˜\D– relaxing exercises. – 1––22Dx˜–\Dbx–Mnf–M f_b¦– k;–M_Dk;}– Don’t be afraid to ask for help. – 1–– ba–¤_˜\– –˜¡˜D;–M_Dk;–n–nfDnkD– who also has been through this. – 1–– aD–˜\D–x\nkD–nMM–˜\D–\nna–n–bD˜–˜\D– answering machine take over for a while.

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Heart Surgery Daily Activity Log for Open-Heart Surgery Patients Week 1

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Dates: Walk 1 Walk 2 Walk 3 Walk 4

3 min. 3 min. 3 min. 3 min.

Breathing Exercises: 10x each hour Weight: Call doctor if youâ&#x20AC;&#x2122;ve gained 2 lbs/day or 5 lbs/week Heart Rate at rest: Call doctor if <50 or >110 beats per minute Check temperature in morning. Call doctor if above 100.6 F Finger stick blood sugars

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4 min. 4 min. 4 min. 4 min.

5 min. 5 min. 5 min. 5 min.

6 min. 6 min. 6 min. 6 min.

7 min. 7 min. 7 min. 7 min.

8 min. 8 min. 8 min. 8 min.

9 min. 9 min. 9 min. 9 min.

Heart Surgery Daily Activity Log for Open-Heart Surgery Patients Week 2

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Dates: Walk 1 Walk 2 Walk 3

10 min. 10 min. 10 min.

11 min. 11 min.

12 min. 12 min.

13 min. 13 min.

14 min. 14 min.

15 min. 15 min.

16 min. 16 min.

Breathing Exercises: 10x each hour Weight: Call doctor if youâ&#x20AC;&#x2122;ve gained 2 lbs/day or 5 lbs/week Heart Rate at rest: Call doctor if <50 or >110 beats per minute Check temperature in morning. Call doctor if above 100.6 F Finger stick blood sugars

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Heart Surgery Daily Activity Log for Open-Heart Surgery Patients Week 3

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Dates: Walk 1

17 min.

Breathing Exercises: 10x each hour Weight: Call doctor if youâ&#x20AC;&#x2122;ve gained 2 lbs/day or 5 lbs/week Heart Rate at rest: Call doctor if <50 or >110 beats per minute Check temperature in morning. Call doctor if above 100.6 F Finger stick blood sugars

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18 min.

19 min.

20 min.

21 min.

22 min.

23 min.

Heart Surgery Daily Activity Log for Open-Heart Surgery Patients Week 4

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Dates: Walk 1

24 min.

25 min.

26 min.

27 min.

28 min.

29 min.

30 min.

Breathing Exercises: 10x each hour Weight: Call doctor if youâ&#x20AC;&#x2122;ve gained 2 lbs/day or 5 lbs/week Heart Rate at rest: Call doctor if <50 or >110 beats per minute Check temperature in morning. Call doctor if above 100.6 F Finger stick blood sugars

Heart & Vascular Center 25

Heart Surgery NOTES

26 Heart & Vascular Center

Your Diagnosis and Treatment: Electrical Problems of the Heart Heart & Vascular Center

Your Diagnosis and Treatment: Electrical Problems of the Heart


our heart’s pumping action is regulated by electrical impulses, telling the heart chambers when to contract. When the heart pumps too quickly or too slowly, or without a steady rhythm, the body may not receive the blood it needs to function. Abnormal heart rates may cause symptoms such as faintness, dizziness, lightheadedness, nausea, fatigue, shortness of breath and anxiety. Devices such as pacemakers and implantable cardiac defibrillators are able to identify abnormal rhythms and correct them so the rhythm returns to normal. The heart’s pumping action is controlled by an electrical system that sends out impulses, or signals. An electrical signal starts in the right atrium in the sinus node (also called the sino-atrial node). The sinus node tells the top of the heart (atria) when and how fast to pump. It is the “pacemaker” of the heart. The signal is then sent to the atrioventricular node (AV node) in the middle of the heart. The AV node holds the signal until the bottom chambers of the heart (ventricles) are filled with blood. It then sends the signal to the ventricles through a conduction pathway of specialized fibers


that tell the ventricles when to pump the blood out to the body. If the heart’s chambers are contracting too quickly or too slowly, the heart cannot pump blood efficiently.

Diagnosis of Your Heart Problem Electrophysiology is a branch of cardiology that focuses on electrical problems of the heart that cause abnormal rhythms. One of the most common diagnostic tests for testing heart rhythms is the electrocardiogram, more commonly called an ECG. The ECG creates a picture of the electrical activity of your heart, as sensed from the surface of your skin. An electrophysiology study (EPS) provides a more in-depth examination of your heart’s electrical system. The study measures exactly how the electrical impulses flow through your heart during a heartbeat.


1 2

5 7 6

The Heart’s Electrical Pathway 1. sinus node 2. right atrium 3. left atrium 4. AV node 5. impulses spread through ventricles 6. right ventricle 7. left ventricle

Heart & Vascular Center 1

Your Diagnosis and Treatment: Electrical Problems of the Heart The physician, an electrophysiologist, will place two or more temporary pacemaker catheters into the different chambers of your heart. A pacemaker catheter is a thin, insulated tube with tiny wires inside. These catheters are usually inserted through the veins in your upper leg, neck or arm areas. They allow the physician to record the electrical impulses in your heart and to pace your heart at a faster rate to reproduce the abnormal rhythm or symptoms that you have experienced. The physician will be able to see the actual recording of your heart’s electrical activity and be able to determine where the abnormal activity is occurring. With this information, your physician will be able to identify an appropriate treatment for your specific arrhythmia. The pacing catheters are removed at the end of the procedure. Some of the most common conditions identified by an EPS include: Arrhythmia, a heart rate that is faster or slower than the average heart rate. Bradycardia, a slow heartbeat, less than 60 beats per minute. This can be caused by the sino-atrial node not working properly or by a blockage of the electrical pathways of the heart. By identifying problem areas, your doctor can recommend therapies to help prevent life-threatening conditions such as cardiac arrest, in which the heart beats very fast or stops completely. Timely treatment also may prevent sudden cardiac death, which usually is caused by ventricular tachycardia or ventricular fibrillation. Ventricular tachycardia (V-Tach or VT) is a fast heartbeat caused by an abnormal

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impulse coming from a single area of the ventricle. The rapid rate of 120 to 250 beats per minute may produce dizziness, weakness and unconsciousness. Ventricular fibrillation (V-Fib) is a very fast, irregular heart rate caused by electrical short-circuiting in the ventricle. The heart beats so fast that it is not able to pump any blood to the body. A heart in fibrillation may beat more than 300 times a minute. The person will pass out and need immediate attention.

Your Diagnosis and Treatment: Electrical Problems of the Heart Before Your Electrophysiology Procedure You will: Â&#x2013; Â&#x2013; Â&#x2013; Â&#x2013;

Â&#x2013; Â&#x2013;

Â&#x2013; Â&#x2013;

Â&#x2013; Â&#x2013;

1Â&#x2013;Â&#x2013;have been told not to eat or drink anything after midnight, except for your medications with a small sip of water. 1Â&#x2013;Â&#x2013;(DÂ&#x2013; Â?aD;Â&#x2013;Â&#x2DC;nÂ&#x2013;Â?_TkÂ&#x2013; Â&#x2013;2nkÂ?DkÂ&#x2DC;Â&#x2013;MnÂ?fÂ&#x2013;MnÂ?Â&#x2013;Â&#x2DC;\DÂ&#x2013; procedure and for sedation. 1Â&#x2013;Â&#x2013;have blood work and your medical history checked by the staff admitting you. 1Â&#x2013;Â&#x2013;\ ÂŁDÂ&#x2013;Â&#x2DC;\DÂ&#x2013;\ _Â?Â&#x2013;2b_xxD;Â&#x2013; Â&#x2DC;Â&#x2013;Â&#x2DC;\DÂ&#x2013; Â?D Â&#x2013;¤\DÂ?DÂ&#x2013; the doctor will be working. This area could be the groin, neck or upper chest. The most common site is the groin. 1Â&#x2013;Â&#x2013;(DÂ&#x2013;Â&#x2DC; aDkÂ&#x2013;Â&#x2DC;nÂ&#x2013;Â&#x2DC;\DÂ&#x2013;xÂ?n2D;ÂĄÂ?DÂ&#x2013;Â?nnf8Â&#x2013;¤\DÂ?DÂ&#x2013; two to three staff members will be preparing for your procedure. 1Â&#x2013;Â&#x2013;(DÂ&#x2013; xb 2D;Â&#x2013; nkÂ&#x2013; Â&#x2013; \D Â?Â&#x2DC;Â&#x2013; fnk_Â&#x2DC;nÂ?8Â&#x2013; \ ÂŁDÂ&#x2013; Â&#x2013; clip placed on your ďŹ nger or toe to read your bloodâ&#x20AC;&#x2122;s oxygen level, and have a blood pressure cuff placed on your arm that inďŹ&#x201A;ates automatically. 1Â&#x2013;Â&#x2013;\ ÂŁDÂ&#x2013;Â&#x2DC;\DÂ&#x2013; Â?D Â&#x2013;¤\DÂ?DÂ&#x2013;Â&#x2DC;\DÂ&#x2013;;n2Â&#x2DC;nÂ?Â&#x2013;¤_bbÂ&#x2013;(DÂ&#x2013; working cleaned with a special soap and covered with a sterile sheet. 1Â&#x2013;Â&#x2013;be asked to keep your arms under the sterile sheet and to not bend or move your legs. Your hands maybe restrained as a reminder to keep them under the drapes. 1Â&#x2013;Â&#x2013;(DÂ&#x2013;T_ÂŁDkÂ&#x2013;fD;_2_kDÂ&#x2013;Â&#x2DC;\Â?nÂĄT\Â&#x2013;ÂŚnÂĄÂ?Â&#x2013; Â&#x2013;Â&#x2DC;nÂ&#x2013; help you relax. You may become very sleepy. 1Â&#x2013;Â&#x2013;(DÂ&#x2013; T_ÂŁDkÂ&#x2013; fD;_2_kDÂ&#x2013; (ÂŚÂ&#x2013; Â&#x2DC;\DÂ&#x2013; ;n2Â&#x2DC;nÂ?Â&#x2013; Â&#x2DC;nÂ&#x2013; numb die area where he or she will be putting the catheters into the vein or artery. The doctor will position the catheters in your heart to record your internal EKG.

If you have a normal electrophysiology study, no further treatment will be recommended. If the EPS reveals a problem, your doctor may recommend an ablation or implant procedure to correct any irregular heartbeats. Your doctor also may prescribe medical treatment.

After Your Electrophysiology Procedure You may have a closure device at the site where the doctor inserted the catheters, if the artery was used and if the incision is large enough for a device. You will be given written information on this. You will: Â&#x2013; 1Â&#x2013;Â&#x2013;(DÂ&#x2013;fnÂŁD;Â&#x2013;nMMÂ&#x2013;nMÂ&#x2013;Â&#x2DC;\DÂ&#x2013;xÂ?n2D;ÂĄÂ?DÂ&#x2013;Â&#x2DC; (bDÂ&#x2013;Â&#x2DC;nÂ&#x2013; Â&#x2013; recovery area. Â&#x2013; 1Â&#x2013;Â&#x2013;(DÂ&#x2013;xb 2D;Â&#x2013;nkÂ&#x2013; Â&#x2013;\D Â?Â&#x2DC;Â&#x2013;fnk_Â&#x2DC;nÂ?8Â&#x2013;\ ÂŁDÂ&#x2013; kÂ&#x2013; automatic blood pressure cuff placed on your arm and an oxygen monitor (a ďŹ nger clip) placed on a ďŹ nger. Â&#x2013; 1Â&#x2013;Â&#x2013;(DÂ&#x2013; Â?aD;Â&#x2013;Â&#x2DC;nÂ&#x2013;DfxÂ&#x2DC;ÂŚÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;(b ;;DÂ?Â&#x2013; Â&#x2DC;Â&#x2013;Â&#x2DC;\_Â?Â&#x2013; time. Â&#x2013; 1Â&#x2013;Â&#x2013;\ ÂŁDÂ&#x2013;Â&#x2DC;\DÂ&#x2013;2 Â&#x2DC;\DÂ&#x2DC;DÂ?Â&#x2013;Â?DfnÂŁD;Â&#x2013;MÂ?nfÂ&#x2013;Â&#x2DC;\DÂ&#x2013;Â?_Â&#x2DC;DÂ&#x2013; and have ďŹ rm pressure applied for 10 to 20 minutes. This is to prevent bleeding. Â&#x2013; 1Â&#x2013;Â&#x2013;\ ÂŁDÂ&#x2013; ÂŚnÂĄÂ?Â&#x2013; (bnn;Â&#x2013; xÂ?DÂ?Â?ÂĄÂ?DÂ&#x2013; 2\D2aD;Â&#x2013; (ÂŚÂ&#x2013; a nurse every 15 minutes for the ďŹ rst hour. Â&#x2013; 1Â&#x2013;\ ÂŁDÂ&#x2013; Â&#x2013;( k; TDÂ&#x2013; xxb_D;Â&#x2013;Â&#x2DC;nÂ&#x2013;Â&#x2DC;\DÂ&#x2013;Â?_Â&#x2DC;D} Â&#x2013; 1Â&#x2013;Â&#x2013;kDD;Â&#x2013;Â&#x2DC;nÂ&#x2013;Â&#x2DC;DbbÂ&#x2013;Â&#x2DC;\DÂ&#x2013;Â?Â&#x2DC; MMÂ&#x2013;Â?_T\Â&#x2DC;Â&#x2013; ¤ ÂŚÂ&#x2013;_MÂ&#x2013;ÂŚnÂĄÂ&#x2013; feel a warm, wet feeling at the catheter site; you could be bleeding. Â&#x2013; 1Â&#x2013;(DÂ&#x2013;nkÂ&#x2013;(D;Â&#x2013;Â?DÂ?Â&#x2DC;Â&#x2013;MnÂ?Â&#x2013;nkDÂ&#x2013;Â&#x2DC;nÂ&#x2013;Â&#x2DC;¤nÂ&#x2013;\nÂĄÂ?Â?} Â&#x2013; 1Â&#x2013;Â&#x2013;xÂĄÂ&#x2DC;Â&#x2013; ÂŚnÂĄÂ?Â&#x2013; \ k;Â&#x2013; nÂŁDÂ?Â&#x2013; Â&#x2DC;\DÂ&#x2013; ( k; TDÂ&#x2013; k;Â&#x2013; press ďŹ rmly if you have to cough or sneeze. Â&#x2013; 1Â&#x2013;Â&#x2013;xnÂ?Â?_(bÂŚÂ&#x2013;\ ÂŁDÂ&#x2013; Â&#x2013;(Â?ÂĄ_Â?DÂ&#x2013; Â&#x2DC;Â&#x2013;Â&#x2DC;\DÂ&#x2013;Â?_Â&#x2DC;D}Â&#x2013;\_Â?Â&#x2013; is normal. Â&#x2013; 1Â&#x2013;Â&#x2013;xnÂ?Â?_(bÂŚÂ&#x2013; MDDbÂ&#x2013; Â&#x2013; bÂĄfxÂ&#x2013; Â&#x2DC;Â&#x2013; Â&#x2DC;\DÂ&#x2013; Â?_Â&#x2DC;D}Â&#x2013; MÂ&#x2013; _Â&#x2DC;Â&#x2013; is walnut size or bigger, let the nurse know. Â&#x2013; 1Â&#x2013;\ ÂŁDÂ&#x2013;x _kÂ&#x2013;fD;_2_kDÂ&#x2013; ÂŁ _b (bD} Â&#x2013; 1Â&#x2013;Â&#x2013;TnÂ&#x2013;( 2aÂ&#x2013;Â&#x2DC;nÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;Â?nnfÂ&#x2013; k;8Â&#x2013; Â&#x2DC;Â&#x2013;Â&#x2DC;\DÂ&#x2013;Â&#x2DC;_fDÂ&#x2013; of discharge, be given instructions for what to do when you go home, including eating, activities, medications, etc.

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Your Diagnosis and Treatment: Electrical Problems of the Heart Treatment for Irregular Heart Rhythms Treatment options for irregular heartbeats include implanting devices to regulate the heart and performing interventional procedures on the heart to alter abnormal function. For life-threatening heart rhythms, a deďŹ brillator may be used to stop extremely rapid and irregular heartbeats and return the heartbeat to normal. A deďŹ brillator is an external or internal device that can deliver an electric shock, to re-set the heart rhythm. Permanent Pacemaker A permanent pacemaker is a small, lightweight electronic device that is placed in your upper chest through a small incision. The pacemaker consists of a generator and leads. The leads allow the generator to monitor your heart rhythm and to send out electrical impulses to make your heart beat when needed. Some problems that may require a pacemaker include: Â&#x2013; 1Â&#x2013;Â&#x2013; _bÂĄÂ?DÂ&#x2013; nMÂ&#x2013; Â&#x2DC;\DÂ&#x2013; Â?_kn^ Â&#x2DC;Â?_ bÂ&#x2013; kn;DÂ&#x2013; Â&#x2DC;nÂ&#x2013; Â?Dk;Â&#x2013; out an impulse, resulting in a slow heart rate. Â&#x2013; 1Â&#x2013;Â&#x2013;Â&#x2013;(bn2aÂ&#x2013;_kÂ&#x2013;nÂ?Â&#x2013;(Dbn¤Â&#x2013;Â&#x2DC;\DÂ&#x2013;Â&#x2013;kn;DÂ&#x2013;¤\_2\Â&#x2013; prevents the impulse from the sinoatrial node from reaching the lower chambers (ventricles) of the heart. Â&#x2013; 1Â&#x2013;Â&#x2013;(knÂ?f bÂ&#x2013; \D Â?Â&#x2DC;Â&#x2013; Â?\ÂŚÂ&#x2DC;\fÂ?Â&#x2013; Â&#x2DC;\ Â&#x2DC;Â&#x2013; Â?DÂ&#x2013; knÂ&#x2DC;Â&#x2013; controlled by medications. Your pacemaker implant will take place in the electrophysiology lab. You will have a team of people assisting with this procedure. The team includes a doctor, nurses and technicians. They will all have hats and masks on once you are in the procedure room.

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Internal Cardioverter DeďŹ brillator (ICD) An internal cardioverter deďŹ brillator (ICD) is a small, lightweight electronic device that is placed in your upper chest through a small incision. It keeps track of your rhythm. When you have an arrhythmia, the ICD helps your rhythm return to normal by either pacing or delivering a small shock to your heart. Your doctor will program the deďŹ brillator to automatically treat your arrhythmia. ICDs are recommended if you have had a cardiac arrest or if you have a fast heart rhythm problem that could lead to cardiac arrest. The ICD is not a cure but it can save your life by quickly stopping a dangerous rhythm. The deďŹ brillator system has two parts: a generator and leads.

Your Diagnosis and Treatment: Electrical Problems of the Heart The generator (deďŹ brillator) is a smooth, lightweight metal case containing a tiny microchip and a battery. It is the size of a pager. The generator does the following: Â&#x2013; 1Â&#x2013;aDDxÂ?Â&#x2013;Â&#x2DC;Â? 2aÂ&#x2013;nMÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;\D Â?Â&#x2DC;Â&#x2013;Â?\ÂŚÂ&#x2DC;\f Â&#x2013; 1Â&#x2013;Â&#x2013;Â?Dk;Â?Â&#x2013;nÂĄÂ&#x2DC;Â&#x2013;DbD2Â&#x2DC;Â?_2 bÂ&#x2013;xÂĄbÂ?DÂ?Â&#x2013; k;Â&#x2013;Â?\n2aÂ?Â&#x2013; when needed Â&#x2013; 1Â&#x2013;Â?D2nÂ?;Â?Â&#x2013;ÂŚnÂĄÂ?Â&#x2013;\D Â?Â&#x2DC;Â&#x2013;Â?\ÂŚÂ&#x2DC;\f Â&#x2013; 1Â&#x2013;Â&#x2013;Â?D2nÂ?;Â?Â&#x2013;Â&#x2DC;\DÂ&#x2013;xÂĄbÂ?DÂ?Â&#x2013; k;Â&#x2013;Â?\n2aÂ?Â&#x2013;Â&#x2DC;\DÂ&#x2013; Â&#x2013; sends out The leads are small wires covered with a soft ďŹ&#x201A;exible plastic that are connected to the generator. The leads are inserted through a vein and placed inside your heart. Leads do the following: Â&#x2013; 1Â&#x2013;Â&#x2013;\DbxÂ&#x2013; Â&#x2DC;\DÂ&#x2013; TDkDÂ? Â&#x2DC;nÂ?Â&#x2013; aDDxÂ&#x2013; Â&#x2DC;Â? 2aÂ&#x2013; nMÂ&#x2013; k;Â&#x2013; record your heart rhythm Â&#x2013; 1Â&#x2013;Â&#x2013;2 Â?Â?ÂŚÂ&#x2013; xÂĄbÂ?DÂ?Â&#x2013; k;Â&#x2013; Â?\n2aÂ?Â&#x2013; MÂ?nfÂ&#x2013; Â&#x2DC;\DÂ&#x2013; generator to the heart The shocks that are sent by the ICD can be mild or strong and may feel brieďŹ&#x201A;y uncomfortable. They will not harm your body and they wonâ&#x20AC;&#x2122;t shock anyone near you.

Heart Failure Therapy A special pacemaker or ICD can be implanted to help the heart pump more efďŹ ciently by coordinating the left and right ventricular contractions. The ICD and pacemaker are referred to as a biventricular ICD or biventricular pacemaker. These devices also will treat abnormal heart rhythms by either pacing or delivering a small shock to stop rapid and irregular heartbeats. These devices are used in patients with heart failure. These newer devices are referred to as cardiac resynchronization therapy (CRT). CRT resynchronizes the contractions of the heartâ&#x20AC;&#x2122;s left ventricle by sending tiny electrical impulses to the heart muscle, which

can help the heart pump blood throughout the body more efďŹ ciently and reduce heart failure symptoms. In 2005, a new CRT device became available to patients with heart failure. It has the ability to monitor thoracic ďŹ&#x201A;uid accumulation. This device will allow physicians to monitor a patientâ&#x20AC;&#x2122;s status and adjust medications. The goal is to prevent patients from being readmitted to the hospital.

Before Your Pacemaker/ICD Implant You will: Â&#x2013; 1Â&#x2013;Â&#x2013;\ ÂŁDÂ&#x2013; (DDkÂ&#x2013; Â&#x2DC;nb;Â&#x2013; knÂ&#x2DC;Â&#x2013; Â&#x2DC;nÂ&#x2013; D Â&#x2DC;Â&#x2013; nÂ?Â&#x2013; ;Â?_kaÂ&#x2013; anything after midnight, except for your medications with a small sip of water (one fourth of a cup). Â&#x2013; 1Â&#x2013;Â&#x2013;(DÂ&#x2013; Â?aD;Â&#x2013;Â&#x2DC;nÂ&#x2013;Â?_TkÂ&#x2013; Â&#x2013;2nkÂ?DkÂ&#x2DC;Â&#x2013;MnÂ?fÂ&#x2013;MnÂ?Â&#x2013;Â&#x2DC;\DÂ&#x2013; procedure and for sedation. Â&#x2013; 1Â&#x2013;Â&#x2013;\ ÂŁDÂ&#x2013; (bnn;Â&#x2013; ¤nÂ?aÂ&#x2013; k;Â&#x2013; ÂŚnÂĄÂ?Â&#x2013; fD;_2 bÂ&#x2013; history checked by the staff admitting you. Â&#x2013; 1Â&#x2013;Â&#x2013;\ ÂŁDÂ&#x2013;Â&#x2DC;\DÂ&#x2013;\ _Â?Â&#x2013;nkÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;2\DÂ?Â&#x2DC;Â&#x2013;2b_xxD;Â&#x2013; k;Â&#x2013; cleaned with a solution. Â&#x2013; 1Â&#x2013;Â&#x2013;(DÂ&#x2013;Â&#x2DC; aDkÂ&#x2013;Â&#x2DC;nÂ&#x2013;Â&#x2DC;\DÂ&#x2013;xÂ?n2D;ÂĄÂ?DÂ&#x2013;Â?nnf8Â&#x2013;¤\DÂ?DÂ&#x2013; you will have two to three staff members preparing for your procedure. Â&#x2013; 1Â&#x2013;Â&#x2013;(DÂ&#x2013; xb 2D;Â&#x2013; nkÂ&#x2013; Â&#x2013; \D Â?Â&#x2DC;Â&#x2013; fnk_Â&#x2DC;nÂ?8Â&#x2013; \ ÂŁDÂ&#x2013; Â&#x2013; clip placed on your ďŹ nger or toe to read your bloodâ&#x20AC;&#x2122;s oxygen level, and have a blood pressure cuff placed on your arm that inďŹ&#x201A;ates automatically. Â&#x2013; 1Â&#x2013;Â&#x2013;\ ÂŁDÂ&#x2013;Â&#x2DC;\DÂ&#x2013; Â?D Â&#x2013;¤\DÂ?DÂ&#x2013;Â&#x2DC;\DÂ&#x2013;;n2Â&#x2DC;nÂ?Â&#x2013;¤_bbÂ&#x2013;(DÂ&#x2013; working cleaned with a special soap and covered with a sterile sheet. Â&#x2013; 1Â&#x2013;Â&#x2013;(DÂ&#x2013; Â?aD;Â&#x2013;Â&#x2DC;nÂ&#x2013;aDDxÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013; Â?fÂ?Â&#x2013;ÂĄk;DÂ?Â&#x2013;Â&#x2DC;\DÂ&#x2013; sterile sheet and to not bend or move your legs. Â&#x2013; 1Â&#x2013;Â&#x2013;(DÂ&#x2013;T_ÂŁDkÂ&#x2013;fD;_2_kDÂ&#x2013;Â&#x2DC;\Â?nÂĄT\Â&#x2013;ÂŚnÂĄÂ?Â&#x2013; Â&#x2013;Â&#x2DC;nÂ&#x2013; help you relax. You may become very sleepy.

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Your Diagnosis and Treatment: Electrical Problems of the Heart – – – – – –

1––(D– T_£Dk– fD;_2_kD– (¦– ˜\D– ;n2˜n– to numb the area where he will be inserting the pacemaker/ICD. 1––\ £D– k– _k2__nk– (n¡˜– nkD– ˜n– ˜\DD– inches long for the insertion of the generator. 1––\ £D– bD ;– ˜\D ;D;– ˜\n¡T\– – £D_k– to your heart and connected to the generator. 1––\ £D– ˜\D– TDkD ˜n– xb 2D;– `¡˜– ¡k;D– the skin. This is called a “pocket.” 1––\ £D–˜\D–TDkD ˜n– k;–bD ;–˜D˜D;–(¦– the physician and programmed at that time for your specific need. 1––\ £D– ˜\D– _k2__nk– 2bnD;– ¤_˜\– ˜_˜2\D– and covered with steri-strips and a bandage.

The procedure will take one to two hours, and the doctor will talk with your family when the procedure is finished.

After Your Pacemaker/ICD Implant You will: – 1––(D–fn£D;–nMM–nM–˜\D–xn2D;¡D–˜ (bD–˜n– – recovery area or back to your room. – 1––(D–xb 2D;–nk– –\D ˜–fnk_˜n8–\ £D– k– automatic blood pressure cuff placed on your arm and an oxygen monitor (a finger clip) placed on a finger. – 1––kDD;–˜n–b_f_˜–˜\D–fn£DfDk˜–nM–¦n¡– f– on the side of the implant for the first 24 to 72 hours. – 1–\ £D–x _k–fD;_2_kD– £ _b (bD} – 1––(D–T_£Dk–¤_˜˜Dk–_k˜¡2˜_nk– ˜–˜\D–˜_fD– of discharge for what to do when you go home, including eating, activities, medications, driving, etc.

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Electrophysiology Interventional Procedures Ablation Ablation is a procedure to fix an abnormal heart rhythm. Catheters are inserted in the femoral vein or subclavian vein and threaded to the heart to locate where the abnormal heart rate is starting. The doctor will pinpoint the location and insert a special catheter so the tip of the catheter touches the area. Energy waves will be sent through the catheter to destroy (ablate) the tissue at the problem area. The goal is to restore your rhythm to normal. This procedure may last two to four hours. Common arrhythmias that may be treated with an ablation procedure include: –


1––AV nodal re-entrant tachycardia (also called supraventricular tachycardia), in which impulses traveling through the AV node may get trapped in an extra pathway that lies in or near the AV node. The trapped impulses make the atria beat faster. 1––Tachycardia caused by an accessory (extra) pathway

Your Diagnosis and Treatment: Electrical Problems of the Heart Â&#x2013;


Â&#x2013; Â&#x2013;

1Â&#x2013;Â&#x2013;Â&#x2DC;Â?_ bÂ&#x2013; N(Â?_bb Â&#x2DC;_nk8Â&#x2013; _kÂ&#x2013; ¤\_2\Â&#x2013; Â&#x2DC;\DÂ&#x2013; Â&#x2DC;Â?_ Â&#x2013; receive extra impulses from multiple short circuits, causing them to contract more quickly and unevenly. Sometimes they beat so fast and unevenly that they stop contracting and begin to quiver. 1Â&#x2013;Â&#x2013;Â&#x2DC;Â?_ bÂ&#x2013;PÂĄÂ&#x2DC;Â&#x2DC;DÂ?8Â&#x2013; Â&#x2013;2nk;_Â&#x2DC;_nkÂ&#x2013;_kÂ&#x2013;¤\_2\Â&#x2013;Â&#x2DC;\DÂ&#x2013; atria have a large short circuit. Impulses loop around and around inside this circuit. These impulses tell the atria to beat very fast. 1Â&#x2013;Â&#x2013;DkÂ&#x2DC;Â?_2ÂĄb Â?Â&#x2013;Â&#x2DC; 2\ÂŚ2 Â?;_ 8Â&#x2013; Â&#x2013;M Â?Â&#x2DC;Â&#x2013;\D Â?Â&#x2DC;Â&#x2013;(D Â&#x2DC;Â&#x2013; caused by short circuits in the ventricle resulting from previous scarring. 1Â&#x2013;Â&#x2013;nbMM^ Â?a_kÂ?nk^\_Â&#x2DC;DÂ&#x2013; z{Â&#x2013; ÂŚkdrome, in which an extra pathway connects the atria and ventricles. Impulses passing through the ventricles may travel along this extra pathway

back to the atria. The impulses from the extra pathway can make the atria beat faster or allow impulses to move into the ventricles too quickly, possibly causing a dangerous arrhythmia.

Cardioversion Cardioversion is a procedure to make an abnormal heartbeat return to normal. An electric current is sent through pads placed on your skin to your heart. Before the procedure starts, you will be given medicine through your IV to put you to sleep. After the procedure, you may notice that the skin is red and sore (like a sunburn) where the pads were. Your doctor may order an ointment for you to put on this slight burn from the electrical current.

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Your Diagnosis and Treatment: Electrical Problems of the Heart NOTES

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Living with Heart Failure

Heart & Vascular Center

Living with Heart Failure What is Heart Failure? Heart failure is not a disease, but a condition that occurs when your heart does not pump as well as it should. This does not mean that your heart has stopped working. Chronic heart failure, a type of heart failure that cannot be fixed, is a problem that you will have for the rest of your life. Although there is no cure for chronic heart failure, it can be managed successfully.

Causes of Heart Failure All of us lose some blood-pumping ability in our hearts as we get older. If you have heart failure, however, other health problems have either damaged the heart or made it work too hard. If you have heart failure, chances are you have (or had) one or more of the following: Coronary artery disease - Less blood reaches the heart muscle. The area of muscle with decreased blood doesn’t pump as well. The healthy heart muscle that remains has to work harder.

Past heart attack (myocardial infarction) - A part

of the heart muscle dies and the remaining healthy muscle has to pump even harder to keep up. High blood pressure (hypertension) - When

pressure in the blood vessels is too high, the heart has to pump harder than normal. Over time, the heart chambers get larger and weaker. Abnormal heart valves - When valves don’t open

or close completely during each heartbeat, the heart muscle has to work harder to keep the blood moving in the proper direction. Heart muscle disease (cardiomyopathy) or inflammation (myocarditis) - Heart muscle can

be damaged by drug or alcohol abuse, viral infections or unknown reasons. With any heart muscle damage, the rest of the heart has to work harder. Heart defects present at birth - If the heart

doesn’t form correctly, the healthy parts have to work harder to make up for it. Severe lung disease - When the lungs don’t

work properly, the heart has to work harder to get oxygen-rich blood to the rest of the body. Diabetes - If you have diabetes, you have up

to eight times greater risk of having heart failure. The disease process in diabetes can damage the heart muscle. Good control of your glucose (sugar) level can decrease this risk. Abnormal heart rhythms, too slow or too fast, can make heart failure worse.

Coronary artery disease

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Living with Heart Failure Signs and Symptoms

Types of Heart Failure

Your heart pumps blood to all parts of your body—your feet, legs, hands, brain and muscles. Heart failure occurs when the heart cannot pump enough blood to keep up with the body’s needs. Congestion (buildup of fluid) can occur. Because of this, you may notice any of the following signs or symptoms: – 1–¤Dbb_kT–_k–˜\D–MDD˜8– kabD– k;•n–bDT – 1–bn ˜_kT–zP¡_;–_k– (;nfDk{ – 1–b¡_;–_k–¦n¡–b¡kT – 1–n¡T\ – 1––\n˜kD–nM–(D ˜\–¤_˜\– 2˜_£_˜¦8–n– even at rest – 1–_MN2¡b˜¦–(D ˜\_kT–¤\_bD–b¦_kT–P ˜ – 1– a_kT–¡x–¤_˜\–\n˜kD–nM–(D ˜\ – 1––_D;kD– k;–M ˜_T¡D–¤_˜\–˜\D– simplest activities – 1– n–nM– xxD˜_˜D – 1– ¡D – 1––D_T\˜–T _k–n£D– –\n˜–xD_n;–nM– time – 1– k (_b_˜¦–˜n–2nk2Dk˜ ˜D – 1– x_;–\D ˜– ˜D8–nM˜Dk–_DT¡b  – 1–_¨¨_kD–n–b_T\˜\D ;D;kD – 1–D2D D;–¡_k ˜_nk – 1––\D–kDD;–˜n–¡_k ˜D–fnD–nM˜Dk–;¡_kT– the night

Heart failure can involve the heart’s left side, right side or both. It usually affects the left side first, causing shortness of breath. The term congestive heart failure often is used to describe everyone with heart failure. However, congestion (the buildup of fluid) is just one feature of the condition and does not apply to everyone. Systolic heart failure occurs if the left side of the heart loses its ability to pump blood throughout the body. The normal heart pumps more than half of its blood out of the left side with each beat. The amount of blood that is pumped out is called the ejection fraction. A normal ejection fraction is greater than 50 percent. With systolic heart failure, the ejection fraction falls below 40 percent. The heart begins to receive more blood than it can pump out to the body. Over time, the heart gets bigger and stretches as it works harder to pump more blood. Diastolic heart failure occurs when the heart wall becomes thick and stiff over time, and the heart has a problem relaxing. Because the muscle has become stiff, the heart cannot properly fill with blood. The ejection fraction is normal. However, the volume of blood received and pumped by the heart is less than normal. People with this type of heart failure also may have shortness of breath, swelling of the feet and other heart failure symptoms. \D– D¤– na– D ˜– n2_ ˜_nk– z {– defines classes of heart failure, according to how it affects a person’s life. With medication and lifestyle changes, you may be able to improve your class level and your quality of life.

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Living with Heart Failure Class

How You Feel


No symptoms and no limitation in ordinary physical activity.


Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.


Marked limitation of activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.


Severe limitations. Symptoms present even at rest.

Frequent Diagnostic Tests for Heart Failure

may show changes in your heartâ&#x20AC;&#x2122;s electrical pattern when you are doing aerobic activity.

Your doctor makes the diagnosis of heart failure by evaluating your symptoms and doing a physical examination. Tests that may be performed include: electrocardiogram (ECG), chest x-ray, echocardiogram (echo), exercise stress test, multi-gated ventriculoTÂ? fÂ&#x2013; zÂ&#x2013; Â?2 k{Â&#x2013; nÂ?Â&#x2013; 2 Â?;_ 2Â&#x2013; 2 Â&#x2DC;\DÂ&#x2DC;DÂ?_¨ tion (angiogram).

The MUGA scan will tell how much blood your heart pumps with each beat. This will let your doctor know the strength of your heart muscle.

An ECG may show if you had a heart attack in the past or if the left ventricle is thick. It also shows any abnormal heartbeats. A chest x-rayÂ&#x2013;Â?\n¤Â?Â&#x2013;Â&#x2DC;\DÂ&#x2013;nÂĄÂ&#x2DC;b_kDÂ&#x2013; k;Â&#x2013;Â?_¨DÂ&#x2013;nMÂ&#x2013; the heart. It also shows any congestion in your lungs. An echocardiogram (echo) uses sound waves from outside the body to examine Â&#x2DC;\DÂ&#x2013; \D Â?Â&#x2DC;Â&#x160;Â?Â&#x2013; Â?_¨D8Â&#x2013; Â?\ xD8Â&#x2013; fnÂŁDfDkÂ&#x2DC;8Â&#x2013; ÂŁ bÂŁDÂ?8Â&#x2013; muscle and pumping ability. The echo will tell the doctor your ejection fraction.

A cardiac catheterization will allow your doctor to check for blockages in the arteries that supply blood to your heart muscle and check your heartâ&#x20AC;&#x2122;s pumping ability.

Treating Heart Failure Heart failure caused by structural problems, such as a heart valve problem, may be cured. These defects can be ďŹ xed with surgery. There is no cure for heart failure caused by damaged heart muscle. However, treatment can improve your quality of life and length of survival. This is accomplished through lifestyle changes (how you live and eat every day) and medication.

An exercise stress test will look at your heart rhythm while you are exercising. This test

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Living with Heart Failure You can lessen the effects of heart failure by controlling your risk factors for heart disease: – 1––˜nx–fna_kT–n–¡D–nM–n˜\D–˜n( 22n– products – 1–bnD–¤D_T\˜–_M–kDD;D; – 1– £n_;– b2n\nb – 1––f aD–;_D˜ ¦–2\ kTD–˜n–D;¡2D–˜\D– amount of salt and fat you eat – 1––TD˜–DT¡b –D¥D2_D8–(¡˜–\ £D– –;n2˜n– monitor the amount and intensity of activity. D£D b–˜¦xD–nM–;¡T–\ £D–xn£Dk–¡DM¡b–_k– the treatment of heart failure: – 1––_¡D˜_2– z¤ ˜D– x_bb{– \Dbx– D;¡2D– ˜\D– amount of fluid in the body and are useful for persons with fluid retention and high blood pressure. – 1––_T_˜ b_– _k2D D– ˜\D– Mn2D– nM– ˜\D– heart’s contractions (pumping action), helping to improve circulation. – 1––kT_n˜Dk_k– 2nk£D˜_kT– Dk¨¦fD– z{– inhibitors or angiotensin receptor (bn2aD– z{– _fxn£D– ¡£_£ b– k;– may slow, or perhaps even prevent, the loss of heart pumping action. ACE_k\_(_˜n– k;––bn¤D–˜\D–xD¡D– inside the arteries and veins. As a result, the heart does not have to work as hard to pump the blood through the vessels. – 1––D˜ – (bn2aD– (bn2a– ˜\D– DMMD2˜– nM– harmful stress hormones (substances produced by your body that make heart failure worse and contribute to your symptoms). – 1––b;n˜DnkD– _k\_(_˜n– xD£Dk˜– ˜\D– retention of salt and fluid in the body. This may prevent your heart failurefrom getting worse.

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Pacemakers and Defibrillators Pacemakers and defibrillators are devices that are placed by the doctor to help your heart failure. The doctor puts the device just under your skin, near the collarbone. Insulated wires are threaded through blood vessels and connected to the device. The wires may be placed in one or both sides of the heart. Internal cardioverter defibrillator (ICD) is a device used to reset the heart if it goes into an erratic or very fast rhythm. This is used to prevent sudden death. A jolt is felt ¤\Dk–˜\D– –ND}– M–˜\_–\ xxDk8–Tn–˜n–˜\D– emergency room. Cardiac resynchronization (CRT)/biventricular pacemaker (BiV) may be used to treat certain types of heart failure. The doctor puts a special pacemaker just under your skin near the collarbone. The purpose of – _– ˜n– bD˜– (n˜\– _;D– nM– ¦n¡– \D ˜– (D ˜– ˜nTD˜\D}– n¡– ¡¡ bb¦– 2 kkn˜– MDDb– ˜\D– – electrical impulses.

Living with Heart Failure Living with Heart Failure Weigh Yourself Daily Please do the following: – 1––D_T\–¦n¡DbM–N˜–˜\_kT–_k–˜\D– morning after you urinate and before eating. – 1–D_T\–¦n¡DbM–¤_˜\n¡˜–2bn˜\D–nk} – 1––D–˜\D– fD–2 bD– k;–xb 2D–_˜–nk– – hard surface. – 1––_˜D–;n¤k–¦n¡–¤D_T\˜–D£D¦–; ¦–nk– a weight record. – 1–– bb–¦n¡–;n2˜n–_M–¦n¡–¤D_T\˜–TnD– up by 2 to 3 pounds overnight, or if it goes up 5 pounds over a week. – 1––_kT–¦n¡–¤D_T\˜–D2n;–¤_˜\–¦n¡–˜n– every doctor’s appointment. – 1– aD–¦n¡–fD;_2 ˜_nk– –xD2_(D;}

Maintain Daily Activities and Exercise DxDk;_kT– nk– \n¤– ( ;– ¦n¡– \D ˜– M _b¡D– is, you may have difficulty with your daily activities. Always consult your doctor for suggestions on daily activity and exercise. The benefits of regular exercise include: – 1–˜DkT˜\Dk–f¡2bD – 1– Dbx–¦n¡–MDDb–(D˜˜D–Dfn˜_nk bb¦ – 1– Dbx–¦n¡–bDDx–(D˜˜D – 1–D;¡2D–˜D– k;–˜Dk_nk – 1–– Dbx–¦n¡–2nk˜nb–\¦xD˜Dk_nk–z\_T\– blood pressure) – 1–– Dbx–¦n¡–2nk˜nb–2\nbD˜Dnb ¡TTD˜_nk–Mn–f k T_kT–¦n¡–; _b¦– activities: – 1–– 2D–¦n¡DbM–˜\n¡T\n¡˜– 2˜_£_˜_D–^– don’t rush. – 1––x 2D– 2˜_£_˜_D–˜\n¡T\n¡˜–˜\D–; ¦8– allowing for lots of rest periods.

¡TTD˜_nk–Mn–D¥D2_D7 – 1––nfMn˜ (bD8–D ¦–D¥D2_D–_– recommended for most people who \ £D–\D ˜–M _b¡D}–˜¡;_D–\n¤– exercise may slow the progression of heart failure and decrease your symptoms. – 1––DT¡b – D¥D2_D– f ¦– \Dbx– ¦n¡– MDDb– better and become stronger so that you can enjoy your regular activities. It can give you a more positive out look on life. – 1––£n_;– n¡˜;nn– D¥D2_D– ¤\Dk– _˜– _– ˜nn– hot, too humid or too cold. – 1––˜nx– ¤\ ˜– ¦n¡– D– ;n_kT– _M– ¦n¡– \ £D– any of the following: - Increased or unusual fatigue - Increased shortness of breath - Coughing after exertion – ^– _T\˜\D ;D;kD–n–;_¨¨_kD - Chest pain

Eat Healthy You will need to make changes in the food you eat and limit the amount of sodium that you eat. The most common source of sodium is table salt. Too much sodium in your diet can cause your body to hold more fluid. This extra fluid makes it harder for your heart to pump. Your doctor will tell you how much sodium you are allowed. Usually the amount is 2,000 mg (2 grams) per day. 1 level teaspoon of salt = 2,400 mg of sodium.

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Living with Heart Failure Here are some ways to limit the amount of sodium in your diet. Â&#x2013;

q}Â&#x2013;Â&#x2013;D ;Â&#x2013; b (DbÂ?Â&#x2013; nkÂ&#x2013; Â&#x2DC;\DÂ&#x2013; Mnn;Â&#x2013; ÂŚnÂĄÂ&#x2013; (ÂĄÂŚ}Â&#x2013; Choose reduced-sodium foods. 2. Limit the use of canned, ready-to-use and processed foods that are high in sodium such as bacon, sausage, cold 2ÂĄÂ&#x2DC;Â?8Â&#x2013; MÂ?n¨DkÂ&#x2013; ;_kkDÂ?Â?8Â&#x2013; 2 kkD;Â&#x2013; Â?nÂĄxÂ?8Â&#x2013; chips and other salted snacks. 3. Limit or avoid high-sodium condiments such as soy sauce, pickles, olives, BBQ sauce, mustard and ketchup. 4. Use other seasoning such as pepper, garlic, onions, salt-free herb blends or \DÂ?( bÂ&#x2013; ÂŁ_kDT Â?}Â&#x2013; nÂ&#x2013; knÂ&#x2013; ;;Â&#x2013; Â? bÂ&#x2DC;Â&#x2013; Â&#x2DC;Â&#x2013; Â&#x2DC;\DÂ&#x2013; table. This includes anything that says â&#x20AC;&#x153;saltâ&#x20AC;? on the label such as garlic Â? bÂ&#x2DC;8Â&#x2013; Â?D Â?nkD;Â&#x2013; Â? bÂ&#x2DC;Â&#x2013; nÂ?Â&#x2013; nk_nkÂ&#x2013; Â? bÂ&#x2DC;}Â&#x2013; DDÂ&#x2013; the diet section in your book for lowsodium seasoning ideas.

You may be asked to limit the amount of ďŹ&#x201A;uids you drink. The heartâ&#x20AC;&#x2122;s work is easier if _Â&#x2DC;Â&#x2013;\ Â?Â&#x2013;bDÂ?Â?Â&#x2013;PÂĄ_;Â&#x2013;Â&#x2DC;nÂ&#x2013;xÂĄfx}Â&#x2013;_Â?2ÂĄÂ?Â?Â&#x2013;¤_Â&#x2DC;\Â&#x2013;ÂŚnÂĄÂ?Â&#x2013; doctor the amount of ďŹ&#x201A;uids that you should drink.

So...What Can You Eat? A 2-gram sodium diet can include a wide ÂŁ Â?_DÂ&#x2DC;ÂŚÂ&#x2013; nMÂ&#x2013; Mnn;Â?}Â&#x2013; Â?DÂ?\Â&#x2013; fD Â&#x2DC;Â?8Â&#x2013; Â?ÂĄ2\Â&#x2013; Â?Â&#x2013; chicken, ďŹ sh, lean beef, and fresh pork (such as pork chops or pork roast), should be limited to 6 ounces per day. Choose yogurt, graham crackers, fresh fruit and ÂŁDTDÂ&#x2DC; (bDÂ?8Â&#x2013; ÂĄkÂ? bÂ&#x2DC;D;Â&#x2013; xÂ?DÂ&#x2DC;¨DbÂ?Â&#x2013; nÂ?Â&#x2013; ;Â?ÂŚÂ&#x2013; 2DÂ?D bÂ&#x2013; Â?ÂĄ2\Â&#x2013; Â?Â&#x2013;Â?nÂ?Â&#x2DC;D;Â&#x2013;_k_^\D Â&#x2DC;Â?} Â?DÂ?\8Â&#x2013; MÂ?n¨DkÂ&#x2013; k;Â&#x2013; 2 kkD;Â&#x2013; MÂ?ÂĄ_Â&#x2DC;Â?Â&#x2013; Â?DÂ&#x2013; ÂŁDÂ?ÂŚÂ&#x2013; bn¤Â&#x2013; _kÂ&#x2013; Â?n;_ÂĄf8Â&#x2013; Â?Â&#x2013; Â?DÂ&#x2013; MÂ?DÂ?\Â&#x2013; k;Â&#x2013; MÂ?n¨DkÂ&#x2013; xb _kÂ&#x2013;ÂŁDTDÂ&#x2DC; (bDÂ?Â&#x2013;z ÂŁn_;Â&#x2013;MÂ?n¨DkÂ&#x2013;ÂŁDTDÂ&#x2DC; (bDÂ?Â&#x2013;_kÂ&#x2013; sauces or butter). Choose fresh potatoes or noodles cooked without added salt, instead

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of convenience mixes. Breads, cereals and baked goods can be included in the diet in fn;DÂ? Â&#x2DC;DÂ&#x2013; fnÂĄkÂ&#x2DC;Â?}Â&#x2013; DDÂ&#x2013; Â&#x2DC;\DÂ&#x2013; Â&#x;^TÂ? fÂ&#x2013; Â?n;_ÂĄfÂ&#x2013; food list on the next pages for more details. Choose carefully when eating out, as restaurant meals can be high in sodium. Avoid foods that contain salty ingredients, such as sandwiches with bacon or ham, or entrees that contain cheese or cheese sauce. Avoid soups in restaurants. Ask for salad dressing on the side, so you can control how much you use, or ask for oil and vinegar for your salad. If youâ&#x20AC;&#x2122;re not sure how a menu item is prepared, ask your server. DfDf(DÂ?8Â&#x2013; _MÂ&#x2013; ÂŚnÂĄÂ&#x2013; \ ÂŁDÂ&#x2013; ;_ (DÂ&#x2DC;DÂ?Â&#x2013; k;Â&#x2022;nÂ?Â&#x2013; high cholesterol or coronary artery disease, ÂŚnÂĄÂ&#x2013;¤_bbÂ&#x2013;kDD;Â&#x2013;Â&#x2DC;nÂ&#x2013;b_f_Â&#x2DC;Â&#x2013;M Â&#x2DC;8Â&#x2013;2\nbDÂ?Â&#x2DC;DÂ?nb8Â&#x2013; k;Â&#x2022; or carbohydrates in your diet, in addition Â&#x2DC;nÂ&#x2013;b_f_Â&#x2DC;_kTÂ&#x2013;Â? bÂ&#x2DC;}Â&#x2013;DMDÂ?Â&#x2013;Â&#x2DC;nÂ&#x2013;Â&#x2DC;\DÂ&#x2013;;_DÂ&#x2DC;Â&#x2013;Â?D2Â&#x2DC;_nkÂ&#x2013;nMÂ&#x2013; your book for help making low-fat, lowcholesterol food choices. Your dietitian also can help you make the right food choices. Taking the time to plan meals can take the guesswork out of eating a diet that has multiple restrictions.

Living with Heart Failure Two-Gram Sodium Food List FOOD GROUP Soup

ALLOW Homemade soups made without added salt and with allowed ingredients. Unsalted broth or bouillon. Low-sodium canned soups. Low-sodium cream soups made with allowed amount of milk.

AVOID Regular broth or bouillon. Regular canned or frozen soups or dry soup mixes. Any soup made with added salt or salty ingredients.

Meats and Meat Substitutes 1 oz. contains approximately 22 mg sodium. Limit meat and other substitutes to 6 ounces per day.

Fresh beef, veal, pork, lamb, poultry, game, fresh or frozen unsalted plain fish (no breading or batter), unsalted canned salmon or canned tuna. Regular peanut butter limited to 1 tablespoon per day.

Canned, dried, salted or smoked meats, such as bacon, ham, salt pork, sausage, hot dogs, metts, brats, chipped beef, corned beef, luncheon meats or Kosher meat. Regular canned salmon, tuna or sardines. Canned, dried, smoked or salted fish. Regular cottage cheese. Regular cheeses.

As desired: low-sodium cheese, dried beans and dried peas (prepared without salty ingredients - see “Avoid” Low-fat or fat-free cheese (unless list). Low-sodium peanut butter. also low in sodium). Regular frozen dinners. Eggs 1 egg contains about 65 mg sodium.

Limit eggs to 3 per week. Occasionally Eggs prepared with salt, salted meat an additional egg may be substituted or bacon fat. for 2 ounces of meat.

Potatoes and Starches ½ cup provides about 5 mg sodium.

Fresh white and sweet potatoes. Brown or white rice, macaroni, noodles, pasta prepared without added salt or high-sodium seasonings. Unsalted potato chips.

Frozen, instant, powdered or regular canned potatoes. Seasoned rice, pasta and potato side dishes (such as convenience macaroni and cheese mixes, etc.)

Vegetables ½ cup serving of most fresh or frozen vegetables contains about 10 mg sodium. Vegetables naturally higher in sodium contain about 40 mg sodium per ½ cup serving.

All fresh or frozen vegetables except those listed under “Avoid.” Lowsodium tomato juice. Low-sodium vegetable juices. Low-sodium or “no-salt-added” canned vegetables. “No-salt-added” tomato sauce, paste or puree.

Vegetables and vegetable juices canned with salt. Any vegetable prepared in brine, such as sauerkraut, pickles or hominy. Frozen succotash, lima beans and peas. Vegetables cooked with salty meat or salted fat. Regular canned tomato sauce, paste or puree.

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Living with Heart Failure Two-Gram Sodium Food List (cont’d) FOOD GROUP Breads and Cereals 1 serving of regular bread contains about 150 mg sodium.

ALLOW White, whole wheat, whole grain, Italian, sourdough, French breads. Yeast rolls. Pita bread. Hamburger or sandwich buns. Crackers with “unsalted tops” or low-sodium crackers. Unsalted matzo. Unsalted or low-sodium pretzels.

AVOID Breads, crackers or rolls with salted tops. Quick breads made with regular baking powder, baking soda, salt or self-rising flour. Prepared baking mixes. Salted snack foods. Quick-cooking or instant hot cereals.

All cereal except those listed under “Avoid.” Fats 1 tsp. of salted butter or margarine contains about 45 mg sodium. 1 tbsp. regular salad dressing provides between 100-200mg sodium.

Limit: -regular butter or margarine to no more than 5 tsp. per day. -regular salad dressing to no more than 1 tbsp. per day.

Salted butter, margarine or regular salad dressings in excess of daily allowance. Bacon, salt pork, fat-free salad dressings (unless also low in sodium).

One tbsp. of cream cheese can be substituted for 1 tsp. regular butter or margarine. As desired: Unsalted margarine, butter, oil, vegetable shortening, low-sodium mayonnaise, unsalted salad dressings made with allowed ingredients, unsalted gravy.

Fruits One serving of fruit contains about 2 mg sodium.

All fresh, frozen or canned.

Milk 1 cup provides about 120 mg sodium.

Limit to 2 cups per day: Whole, 2%, Buttermilk. Malted milk. Milk mixes. 1%, skim milk. Reconstituted non-fat Dutch processed chocolate. Regular dry milk. Chocolate milk. Evaporated cheeses. Cottage cheese. or condensed milk. Cocoa made with milk allowance. Yogurt. Soy milk.

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Living with Heart Failure Two-Gram Sodium Food List (cont’d) FOOD GROUP Beverages

ALLOW Coffee, tea (decaffeinated or regular). Regular non-carbonated beverages. Regular soft drinks. Sugar-free (diet) soft drinks sweetened with NutraSweet® or Splenda®. Salt-free club soda.

AVOID Commercially softened water (purified water is OK). Artificially sweetened beverages containing sodium. Club soda. Sports or “energy” drinks.


Limit to one serving a day from the following list: regular cakes, cookies, gelatin, pie. As desired:

Any regular dessert in excess of daily allowance.

Fruit ice; sherbet; baked dessert prepared without added salt, baking powder or baking soda. Ice cream, pudding, custard should be used as part of milk allowance. Seasonings

Herbs, spices, pepper, sodium-free seasoning mixes such as Mrs. Dash. Fresh garlic and onion. Garlic and onion powders. Butter substitutes, such as Molly McButter.

Salt, “lite” salt, “Salt Sense,” seasoning salts such as celery salt, garlic salt and onion salt. Lemon pepper (unless sodium-free). Monosodium glutamate (MSG). Meat tenderizers. Cooking wines. Some flavored vinegars (check label).

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Living with Heart Failure Your Heart Failure Management ... It Takes Teamwork

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The daily management of your heart failure is b_aDÂ&#x2013; Â&#x2013;Â&#x2DC;D fÂ&#x2013;¤nÂ?a_kTÂ&#x2013;Â&#x2DC;nÂ&#x2013;xÂĄÂ&#x2DC;Â&#x2013; Â&#x2013;x¥¨¨bDÂ&#x2013;Â&#x2DC;nTDÂ&#x2DC;\DÂ?}Â&#x2013; \DÂ&#x2013;x_D2DÂ?Â&#x2013;nMÂ&#x2013;Â&#x2DC;\DÂ&#x2013;x¥¨¨bDÂ&#x2013; Â?D7Â&#x2013;PÂĄ_;Â&#x2013;( b k2D8Â&#x2013; diet, activity and medications. Each player on the team has certain responsibilities to 2nfxbDÂ&#x2DC;DÂ&#x2013;Â&#x2DC;\DÂ&#x2013;x¥¨¨bD8Â&#x2013; k;Â&#x2013;ÂŚnÂĄÂ&#x2013; Â?DÂ&#x2013;Â&#x2DC;\DÂ&#x2013;fnÂ?Â&#x2DC;Â&#x2013; important part of the team.


You have certain responsibilities: Â&#x2013; 1Â&#x2013;D_T\Â&#x2013;ÂŚnÂĄÂ?Â?DbMÂ&#x2013;; _bÂŚ} Â&#x2013; 1Â&#x2013; Â&#x2DC;Â&#x2013;\D bÂ&#x2DC;\ÂŚ} Â&#x2013; 1Â&#x2013; _kÂ&#x2DC; _kÂ&#x2013;; _bÂŚÂ&#x2013; 2Â&#x2DC;_ÂŁ_Â&#x2DC;ÂŚÂ&#x2013; k;Â&#x2013;DÂĽDÂ?2_Â?D} Â&#x2013; 1Â&#x2013;Â&#x2013; aDÂ&#x2013; bbÂ&#x2013;fD;_2 Â&#x2DC;_nkÂ?Â&#x2013; Â?Â&#x2013;xÂ?DÂ?2Â?_(D;Â&#x2013; k;Â&#x2013; report any side effects. Your family can help by: Â&#x2013; 1Â&#x2013;Â&#x2013; Â&#x2DC;2\_kTÂ&#x2013;MnÂ?Â&#x2013;Â?¤Dbb_kT8Â&#x2013;Â?\nÂ?Â&#x2DC;kDÂ?Â?Â&#x2013; of breath, or changes in how you are feeling. They may be able to see changes before you do. Â&#x2013; 1Â&#x2013;Â&#x2013;ÂĄxxnÂ?Â&#x2DC;_kTÂ&#x2013;ÂŚnÂĄÂ&#x2013;_kÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;DMMnÂ?Â&#x2DC;Â?Â&#x2013;Â&#x2DC;nÂ&#x2013;D Â&#x2DC;Â&#x2013; the right foods. Â&#x2013; 1Â&#x2013;k2nÂĄÂ? T_kTÂ&#x2013;ÂŚnÂĄÂ&#x2013;Â&#x2DC;nÂ&#x2013;Â?Â&#x2DC; ÂŚÂ&#x2013; 2Â&#x2DC;_ÂŁD} Â&#x2013; 1Â&#x2013;Â&#x2013; kn¤_kTÂ&#x2013;Â&#x2DC;\DÂ&#x2013;fD;_2 Â&#x2DC;_nkÂ?Â&#x2013;ÂŚnÂĄÂ&#x2013; Â?DÂ&#x2013; taking, and reminding you to take them. Your health care providers also are part of the team. As part of giving you the best possible care, they will give you the information you need to know.

When to Call Your Doctor Please call your doctor if you have any of these symptoms commonly associated with heart failure. By treating these symptoms early, you can prevent or decrease your time in the hospital. Â&#x2013; 1Â&#x2013;Â&#x2013; ÂŁDÂ&#x2013;fnÂ?DÂ&#x2013;Â&#x2DC;Â?nÂĄ(bDÂ&#x2013;(Â?D Â&#x2DC;\_kT8Â&#x2013;DÂ?xD2_ bbÂŚÂ&#x2013; if youâ&#x20AC;&#x2122;re lying down.

10 Heart & Vascular Center

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1Â&#x2013;DÂ&#x2DC;Â&#x2013;fnÂ?DÂ&#x2013;Â&#x2DC;_Â?D;Â&#x2013;¤_Â&#x2DC;\Â&#x2013;Â?_fxbDÂ&#x2013; 2Â&#x2DC;_ÂŁ_Â&#x2DC;_DÂ?} 1Â&#x2013;Â&#x2013; _kÂ&#x2013;fnÂ?DÂ&#x2013;Â&#x2DC;\ kÂ&#x2013;Â&#x;Â&#x2013;xnÂĄk;Â?Â&#x2013;_kÂ&#x2013; Â&#x2013;; ÂŚÂ&#x2013;nÂ?Â&#x2013;OÂ&#x2013; pounds in a week. 1Â&#x2013;Â&#x2013; ÂŁDÂ&#x2013;fnÂ?DÂ&#x2013;Â?¤Dbb_kTÂ&#x2013;Â&#x2DC;\ kÂ&#x2013;ÂĄÂ?ÂĄ bÂ&#x2013;_kÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013; feet and ankles. 1Â&#x2013;Â&#x2013; ÂŁDÂ&#x2013;;D2Â?D Â?D;Â&#x2013; xxDÂ&#x2DC;_Â&#x2DC;DÂ&#x2013;nÂ?Â&#x2013;(bn Â&#x2DC;_kTÂ&#x2013;_kÂ&#x2013; the abdomen. 1Â&#x2013;Â&#x2013;nÂĄT\Â&#x2013; Â&#x2DC;Â&#x2013;k_T\Â&#x2DC;Â&#x2013;nÂ?Â&#x2013;\ ÂŁDÂ&#x2013; Â&#x2013;2nÂĄT\Â&#x2013;Â&#x2DC;\ Â&#x2DC;Â&#x2013; wonâ&#x20AC;&#x2122;t go away. 1Â&#x2013; _kÂ&#x2DC;Â&#x2013;nÂ?Â&#x2013;\ ÂŁDÂ&#x2013;;_¨¨ŒÂ&#x2013;Â?xDbbÂ?} 1Â&#x2013;Â&#x2013; ÂŁDÂ&#x2013;Â&#x2DC;_T\Â&#x2DC;kDÂ?Â?8Â&#x2013;xÂ?DÂ?Â?ÂĄÂ?DÂ&#x2013;nÂ?Â&#x2013;x _kÂ&#x2013;_kÂ&#x2013; your chest. 1Â&#x2013;Â&#x2013; ÂŁDÂ&#x2013;x bx_Â&#x2DC; Â&#x2DC;_nkÂ?^ (knÂ?f bÂ&#x2013;\D Â?Â&#x2DC;(D Â&#x2DC;Â?Â&#x2013; that are forceful, rapid, slow or irregular. 1Â&#x2013; ÂŁDÂ&#x2013;Â&#x2DC;Â?nÂĄ(bDÂ&#x2013;¤_Â&#x2DC;\Â&#x2013;ÂŚnÂĄÂ?Â&#x2013;x_bbÂ?} 1Â&#x2013;Â?_k Â&#x2DC;DÂ&#x2013;bDÂ?Â?Â&#x2013;nMÂ&#x2DC;Dk}

Resources The following Internet sources have good information about heart failure. American Heart Association Heart Failure Society of America National Heart, Lung, and Blood Institute Cardiology Channel ¤¤¤}2 Â?;_nbnTÂŚ2\ kkDb}2nfÂ&#x2022;2\MÂ&#x2022;Â&#x2013; This interactive Web site lets you put in your risk factors and treatment, then guides ÂŚnÂĄÂ&#x2013; _kÂ&#x2013; ¤\ Â&#x2DC;Â&#x2013; Â&#x2DC;nÂ&#x2013; Â?aÂ&#x2013; ÂŚnÂĄÂ?Â&#x2013; ;n2Â&#x2DC;nÂ?}Â&#x2013; DbD2Â&#x2DC;Â&#x2013; â&#x20AC;&#x153;Treatment ProďŹ lerâ&#x20AC;? on the left-hand side of the page, and follow the directions after that.

Living with Heart Failure Weight Log: D_T\–¦n¡DbM–; _b¦– ˜–˜\D– fD–˜_fD}–D2n;–¦n¡–¤D_T\˜–\DD} Sunday







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Heart & Vascular Center 11

Living with Heart Failure NOTES

12 Heart & Vascular Center

Diabetes Management

Heart & Vascular Center

Diabetes Management


iabetes is a lifelong disease that can have serious consequences for the heart and blood vessels. Complications from diabetes include coronary artery disease, high blood pressure, high cholesterol and blockages in the blood vessels that may lead to amputation. With proper management of your disease, however, you can greatly reduce the risk of further damage to your heart and blood vessels. The following guidelines will help you in your journey to recovery and wellness. Diabetes is a disease in which you have too much sugar in your blood. When you have Type 1 diabetes, your body can no longer make insulin, a chemical that lets the sugar get into your cells to give you energy. Type 2 diabetes often is linked to being overweight and inactive. Your body still makes some insulin. Either your cells resist the insulin, or you may not make enough insulin. You may be able to control your blood sugar with diet and exercise. Some people may need to take pills to control their sugar, and some people may need to use insulin shots. There is a link between diabetes and heart disease. High blood sugar acts like sandpaper and causes the walls of the arteries to become rough. This allows “bad” cholesterol to build up in the walls of an artery, causing more plaque. Controlling your blood sugar can help slow or prevent this damage.

Exercise regularly. Exercise helps you lose weight and keep your blood sugar wellcontrolled. It also helps your cardiovascular system. For the person with diabetes, exercise is as important as diet and medication. Test your blood sugar regularly. Monitoring your sugar every day is the only way that you know how well you are taking care of your diabetes. You can no longer depend on the way you feel to tell you whether your blood sugar is well-controlled. Take your medication as prescribed. Talk with your health care provider or pharmacist to learn the best time of day to take your medicine so that you get the greatest benefit from your pills or insulin.

Self Care Diabetes is a chronic disease and currently cannot be cured. However, when it is managed properly, you can prevent damage to the tissues in your body. Eat Smart. Certain foods will help to keep your blood sugar under control. A visit with a dietitian is very important. A dietitian will teach you how to eat well-balanced meals and snacks. Smart eating is a good way to lose extra weight. This will help your body use insulin better.

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Diabetes Management Eat Smart Smart eating is the first step in taking care of your diabetes. You do not need special or diet foods. Food that is good for you also is good for the whole family. The types and amounts of foods you eat every day will make a big difference in your blood sugar. Your body makes sugar from the carbohydrates you eat. Carbohydrates are starches and complex sugars. They include food made with flour or sugar, rice, and certain vegetables, such as corn, peas and potatoes.

Basic Guidelines to a Healthy Diabetic Diet 1. Eat 3 balanced meals each day. Meals should include protein (meat, cheese, fish, poultry, eggs, peanut butter or tofu), and high-fiber foods such as fresh fruit, vegetables, whole grains and beans. 2. Have a small evening snack before bedtime. It should contain protein, such as low-fat cheese and crackers, or half a sandwich. 3. Eat about the same amount of food each day. Watch your portion sizes. Do not take second helpings. 4. Meals should be four to five hours apart. Do not skip meals. If meals are delayed, eat a small snack. 5. Eat less fat. Use low-fat cooking methods like baking, roasting, broiling, grilling, poaching, steaming or boiling, instead of frying. 6. Sweets such as cake, ice cream or cookies should be eaten less often. When eaten, they should be part of the meal, and not an extra snack. 7. Limit alcohol (beer, wine and liquor) to one to two servings per day.

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8. Try to lose weight if you are overweight. Even small amounts of weight loss can make a big difference in your blood sugar control. 9. Use the Nutrition Facts panel on food labels to help you make healthier food choices. Select foods that are low in fat and high in fiber. Examples of non-nutritive sweeteners that are approved for use by the Food and Drug Administration (FDA) are: Saccharine (Sweet & Low®) Aspartame (Equal®, Nutrasweet®) Acesulfame (Sweet One®) Sucralose (Splenda®) Sugar alcohols (sorbitol, mannitol, xylitol) occasionally can be used in small amounts. They have about the same amount of calories as table sugar. When used in large amounts, they can cause diarrhea and cramps.

Sugar Free and Diet Foods If a food is advertised as “sugar free” it has very little or no sugar, but it may still be high in fat and calories, and may still contain carbohydrates - be cautious and read the label. Also be careful with foods labeled “reduced” or “less.” They may have less sugar or calories than the regular products, but may still raise blood sugar levels.

Diabetes Management Testing Your Blood Sugar To keep your blood sugar as close to normal as possible, you must test your blood sugar frequently. Other terms for this are monitoring your blood sugar or blood glucose. Obtain a blood glucose monitor that you can use yourself at home after you are discharged. The nurse will show you and/or your family how to use the monitor so that you can regularly test your blood sugar. We recommend that you test four times a day your first week home from the hospital. Generally, you should test right before each meal and before you go to bed. Your doctor or nurse will tell you what schedule you should use. Be certain you haven’t had anything to eat for two hours before you test so that your results are accurate. If you have eaten within two hours, your blood sugar may be high.

Heart disease strikes people with diabetes twice as often as those who don’t have diabetes. Lower your risk of heart disease and stroke by following the ABCs of diabetes management: A: A1c test. Have this blood test every three to six months. B: Blood Pressure. Check at every doctor’s visit. C: Cholesterol level. Check at least once a year. You can reduce your risk for complications if you are educated about your disease, learn and practice the skills necessary to better control your blood glucose, blood pressure and cholesterol levels and receive regular checkups.

Your blood glucose goals are: 1–DMnD–(D aM ˜–zM ˜_kT{7––“©–˜n–qq© 1–DMnD–fD b7––bD–˜\ k–qŸ© 1–¤n–\n¡– M˜D–fD b7––“©–˜n–qR© 1–D;˜_fD7––q©©–˜n–qR© Call your primary care doctor (family doctor) _M–¦n¡–¡T –˜ ¦– (n£D–q”©–D 2\–˜_fD–¦n¡– test it for a 24-hour period. When your sugar stays above these goals, your healing is much slower. If you have surgery, you are at greater risk of getting an infection in one of your incisions. It is very important that your blood sugar remains within these ranges.

A1c There is a second blood test that shows how well your diabetes is controlled. An A1c blood test measures your average blood sugar levels over a two- to three-month period to tell you if your current treatment plan is working as it should. Based on the results of this test, your doctor may make changes in your medication. This test gives results over a longer time than daily blood sugar readings. It also helps predict risk for heart disease and other problems. The level for people with diabetes should be less than 6.5 percent. Your treatment may be changed if the level is higher. You should have this test done every three to six months.

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Diabetes Management Helpful Hints for Blood Sugar Testing Be sure you know how to use your meter and that the batteries in your meter are good. Most meters will give you a picture of a battery on the display screen when the batteries are getting weak. Check your strips to be sure that they haven’t expired. Strips are sensitive to light, heat and moisture. Keep them in their original container until you are ready to use them. If your meter requires calibration, make certain that the number in the meter matches the number on your strip container. Refer to your meter instruction manual for changing this number. Wash your hands in warm soapy water before your test. Clean, warm hands will make it easier to get a good drop of blood. Be sure you follow the directions for your meter when you test your sugar. It is important that you do the test exactly the way the maker of your meter tells you to do it. Write your blood sugar results in your diary. Take the diary with you to your regular doctor appointments so that the doctor or the diabetes educator can review and discuss your results with you. This will help you see how your meals, activity and medicines work together to control your sugar. Any time your treatment changes, you should test more often. When you take pills to control your blood sugar, you should test two hours after you eat. This will tell you if your sugar is going too high when you eat. Your doctor wants to know this so that he or she can adjust your medicine if your sugar is too high after meals.

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When you’re going to be away from home at the time when you are supposed to test, take your meter with you. Don’t leave your meter in your hot car during the summer months or out in the cold during the winter. Remember, regular blood glucose testing helps you make decisions about your meals and exercise. It is your key to better control.

Diabetes Medications Type 1 Diabetes People with Type 1 diabetes must take insulin. You must test your blood sugar regularly so you can make decisions about your insulin dose. Talk this over with your doctor or diabetes educator so that you learn how to adjust your insulin dose depending on your blood sugar results, planned activities or meals. There are various types of insulin. Your doctor will help you decide which type of insulin will be best for you and your lifestyle. Remember to be flexible, because your insulin type and dose may need to be changed at times. Take your insulin at the same time every day. Try not to change the time you take it by more than one hour. Some insulins are taken before meals. Be sure you know how soon you should eat after taking your insulin. Your doctor may tell you to take your insulin at bedtime. It is especially important that you take this insulin at the same time each night, because it is designed to last 24 hours.

Diabetes Management Type 2 Diabetes When you have Type 2 diabetes, you may be able to control your blood sugar by your diet alone. Many people with Type 2 diabetes, however, need to take medication. Pills for diabetes are not insulin. They are simply pills that work to make your body produce more insulin, or help your cells use insulin. Take the medicine exactly as it is prescribed. Some pills work best if they are taken before meals, and some should be taken with food. Other medicines for diabetes are taken only if you are going to have a meal. You have to know when to take your pills, how many to take and how often you are supposed to take them. Side effects may occur when you start taking your diabetes pills but will usually go away within a few weeks. Nausea or increased “gas” are common side effects that should last only a short time. Call your doctor if you have vomiting, skin rash, acne, hives or dizziness.

Oral Medications for Diabetes Type 2 Sulfonylureas

Glipizide (Glucotrol, Glucotrol XL) Glyburide (Diabeta, Micronase) Glyburide micronized (Glynase) Glimepiride (Amaryl) These medicines help your body make _k¡b_k}–  aD– ¦n¡– fD;_2_kD– š©– f_k¡˜D– before meals. If you are allergic to sulfa, you usually cannot take a sulfonylurea. Biguanides

Metformin (Glucophage, Glucophage XR, Glumetza) Metformin may help with weight problems because it helps the body use insulin better. It can cause nausea or diarrhea in some people. Take metformin with meals. Thiazolinediones (Glitazones)

Rosglitazone (Avandia) Pioglitazone (Actos) These medicines help your body respond better to insulin. Periodic liver blood tests are needed. Notify your doctor if you develop weight gain or swelling. Take with or without food. Alpha-Glucosidase Inhibitors

Acarbose (Precose) Miglitol (Glyset) These medicines work in your stomach and bowels to slow down the absorption of sugars and carbohydrates. They can cause abdominal pain, gas and diarrhea. Take with the first bite of food at each meal.

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Diabetes Management Insulin Secretagogues (Meglitinides)

Repaglinide (Prandin) Nateglinide (Starlix) These medications increase insulin secretion.  aD–¦n¡–fD;_2_kD–q–˜n–š©–f_k¡˜D–(DMnD– meals to control your blood sugar. Combinations

Glucovance (Glyburide/Metformin) Metaglip (Gilpizide/Metformin) Avandamet (Rosglitazone/Metformin, ACTOplus met (Pioglitazone/Metformin) Duetact (Pioglitazone/Glimeprimide) DPP-4 Inhibitors

Sitagliptin Phosphate (Januvia) Vildagliptin (Galvus) These medications increase the release of insulin and decrease the release of glucose from the liver.

High Blood Sugar — Hyperglycemia High blood sugar may occur within hours or may develop over several days. You may have one or all of the following symptoms: – 1– _T\–(bnn;–¡T –bD£Db–zn£D–Ÿ©©{ – 1–¥˜DfD–˜\_˜ – 1– ˜_T¡D•bDDx_kD – 1–_kT–˜\D–( ˜\nnf– –bn˜ – 1–n¡2\_kD – 1–– _k–_k–˜nf 2\–¤_˜\–n–¤_˜\n¡˜– nausea and vomiting Causes of high blood sugar include: – 1––nn–f¡2\–Mnn;–n–D ˜_kT–˜\D–¤nkT– foods – 1–n˜–Dkn¡T\–;_ (D˜D–x_bb–n–_k¡b_k – 1– bbkD–n–_kMD2˜_nk – 1––n˜–Dkn¡T\–D¥D2_D–zn–kn˜–D¥D2_D–_M– ¦n¡–¡T –_– (n£D–ŸR©{ – 1–˜D

Synthetic Amylin

Pramlintide (Symlin) This medication slows the rate of movement of food from stomach to intestine and signals the liver to decrease glucose output. Incretin Mimetic

What to do to Prevent Hyperglycemia – – –

Exenatide (Byetta) This medication signals the pancreas to make insulin and signals the liver to stop producing glucose. It also slows the rate of movement of food from stomach to intestine.

– –

1––b¤ ¦–˜ aD–¦n¡–;_ (D˜D–fD;_2_kD– unless your doctor tells you not to. 1––D˜–¦n¡–(bnn;–¡T –D£D¦–Mn¡–˜n–_¥– hours. 1–– M–¦n¡–¡¡ bb¦–˜ aD–_k¡b_k8–˜D˜–¦n¡– urine for ketones. Call your doctor if moderate to large ketones are present. 1–– M–¦n¡–(bnn;–¡T –_–n£D–qO©8–;_ka– 8 ounces of sugar-free liquid every one to two hours. 1–– bb–¦n¡–;n2˜n–_M–¦n¡– D–£nf_˜_kT– and unable to eat or drink liquids.

Remember to call your doctor if your blood sugar stays above the goals you’ve been given for 24 hours.

6 Heart & Vascular Center

Diabetes Management Low Blood Sugar — Hypoglycemia Low blood sugar usually occurs quickly and may require that someone help you get treatment. Symptoms include: 1–¤D ˜_kT 1–\ a_kT 1– ˜– k;•n–xn¡k;_kT–\D ˜(D ˜ 1– ¡kTD 1– _˜ (_b_˜¦•nkM¡_nk 1– _k˜_kT Causes of low blood sugar include: 1––nn–f¡2\–_k¡b_k–n–˜nn–f k¦–;_ (D˜D– pills 1–n˜–Dkn¡T\–Mnn;–n–f__kT– –fD b 1––nn–f¡2\–D¥D2_D–n–D¥˜ –x\¦_2 b– activity

What to do to Prevent Hypoglycemia

shaky, eat or drink a fast-acting carbohydrate such as: 1––R–n¡k2D–`¡_2D–zn kTD8– xxbD8–2 k(D¦– or grape) 1–”–n¡k2D–zr–2 k{–nM– –DT¡b –nM˜–;_ka 1–E–n¡k2D–a_f–f_ba 1–š–Tb¡2nD–˜ (bD˜ 1–E–¤DD˜ ˜–2 k;_D 1–Ÿ–˜ (bDxnnk– __k D˜– (bnn;– ¡T – D£D¦– qO– ˜n– š©– f_k¡˜D– ¡k˜_b– _˜– _– (n£D– q©©}–  ˜– – D2nk;– M ˜^ acting carbohydrate if needed. If your next regular meal is more than two hours away, eat a snack such as half a sandwich or three peanut butter or cheese crackers. If you are unconscious, someone should call 911 immediately. You should not be given anything by mouth if you are unconscious. Be sure to tell your doctor about this episode in case your medication needs to be adjusted.

Try to test your blood sugar. If you are too

Heart & Vascular Center 7

Diabetes Management Avoiding Complications of Diabetes

Taking Good Care of Your Feet and Skin

Diabetes can affect every organ of your body, especially your eyes, your heart, your kidneys, your nerves and your feet. You may be able to avoid these problems by controlling your blood sugar.

When you have diabetes, you are more likely to have foot or skin infections. These can be very serious. Therefore, you need to take extra care to protect your feet and skin.

Skin Care For well-controlled blood sugar, you should: Â&#x2013; 1Â&#x2013;Â&#x2013;DÂ?Â&#x2DC;Â&#x2013;ÂŚnÂĄÂ?Â&#x2013;(bnn;Â&#x2013;Â?ÂĄT Â?}Â&#x2013; DDxÂ&#x2013;_Â&#x2DC;Â&#x2013;_kÂ&#x2013;Â&#x2DC;\DÂ&#x2013; ranges suggested by your health care professional. Â&#x2013; 1Â&#x2013;Â&#x2013; ÂŁDÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;q2Â&#x2013;Â&#x2DC;DÂ?Â&#x2DC;D;Â&#x2013;DÂŁDÂ?ÂŚÂ&#x2013;Â&#x2DC;\Â?DDÂ&#x2013;Â&#x2DC;nÂ&#x2013; six months to be sure your sugar is in control even when you are not testing (like when you are sleeping). Â&#x2013; 1Â&#x2013;Â&#x2013;_Â&#x2DC;Â&#x2013;;n¤kÂ&#x2013;¤_Â&#x2DC;\Â&#x2013; Â&#x2013;;_DÂ&#x2DC;_Â&#x2DC;_ k8Â&#x2013;¤\nÂ&#x2013;2 kÂ&#x2013; give you a meal plan that you can follow. Â&#x2013; 1Â&#x2013;ÂĽDÂ?2_Â?DÂ&#x2013;Â?DTÂĄb Â?bÂŚ} Â&#x2013; 1Â&#x2013; aDÂ&#x2013; bbÂ&#x2013;nMÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;fD;_2 Â&#x2DC;_nkÂ&#x2013; Â?Â&#x2013;nÂ?;DÂ?D;} Â&#x2013; 1Â&#x2013;Â&#x2013;Â?DÂ&#x2013;knÂ&#x2013;Â&#x2DC;n( 22nÂ&#x2013;xÂ?n;ÂĄ2Â&#x2DC;Â?Â&#x2013;nÂ?Â&#x2013; recreational drugs. Â&#x2013; 1Â&#x2013;Â&#x2013; _f_Â&#x2DC;Â&#x2013; b2n\nb}Â&#x2013;\DÂ&#x2013;;_DÂ&#x2DC;_Â&#x2DC;_ kÂ&#x2013;¤_bbÂ&#x2013;\DbxÂ&#x2013; you with types and amounts. Â&#x2013; 1Â&#x2013;Â&#x2013;\D2aÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;MDDÂ&#x2DC;Â&#x2013;DÂŁDÂ?ÂŚÂ&#x2013;; ÂŚÂ&#x2013;Â&#x2DC;nÂ&#x2013;(DÂ&#x2013; certain there are no new cuts, corns, reddened areas, increased warmth, swelling, etc. Â&#x2013; 1Â&#x2013;DDÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;;n2Â&#x2DC;nÂ?Â&#x2013;Â?DTÂĄb Â?bÂŚ} Â&#x2013; 1Â&#x2013;Â&#x2013; DDxÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;(bnn;Â&#x2013;xÂ?DÂ?Â?ÂĄÂ?DÂ&#x2013;¤DbbÂ&#x2013; 2nkÂ&#x2DC;Â?nbbD;Â&#x2013;zÂĄk;DÂ?Â&#x2013;qÂ&#x;ŠÂ&#x2022;EŠ{} Â&#x2013; 1Â&#x2013; nÂ?DÂ&#x2013;¤D_T\Â&#x2DC;Â&#x2013;_MÂ&#x2013;ÂŚnÂĄÂ&#x2013; Â?DÂ&#x2013;nÂŁDÂ?¤D_T\Â&#x2DC;} Â&#x2013; 1Â&#x2013;Â&#x2013; DDxÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;2\nbDÂ?Â&#x2DC;DÂ?nbÂ&#x2013;bDÂŁDbÂ?Â&#x2013;ÂĄk;DÂ?Â&#x2013; 2nkÂ&#x2DC;Â?nb7Â&#x2013; DDxÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;  Â&#x2013;ÂĄk;DÂ?Â&#x2013;qŠŠ8Â&#x2013; ÂŚnÂĄÂ?Â&#x2013;  Â&#x2013;nÂŁDÂ?Â&#x2013;RŠÂ&#x2013;MnÂ?Â&#x2013;fDkÂ&#x2013; k;Â&#x2013;nÂŁDÂ?Â&#x2013; OŠÂ&#x2013;MnÂ?Â&#x2013;¤nfDk8Â&#x2013; k;Â&#x2013;ÂŚnÂĄÂ?Â&#x2013;Â&#x2DC;Â?_TbÂŚ2DÂ?_;DÂ?Â&#x2013; ÂĄk;DÂ?Â&#x2013;qOŠ} Â&#x2013; 1Â&#x2013;Â&#x2013;Â?DÂŁDkÂ&#x2DC;Â&#x2013;nÂ?Â&#x2013;f k TDÂ&#x2013;Â?ÂŚfxÂ&#x2DC;nfÂ?Â&#x2013;nMÂ&#x2013; metabolic syndrome.

8 Heart & Vascular Center







Â&#x2013; Â&#x2013;

1Â&#x2013;Â&#x2013; kÂ?xD2Â&#x2DC;Â&#x2013;ÂŚnÂĄÂ?Â&#x2013;DkÂ&#x2DC;_Â?DÂ&#x2013;(n;ÂŚÂ&#x2013;DÂŁDÂ?ÂŚÂ&#x2013;; ÂŚÂ&#x2013; for minor cuts or scratches. If you canâ&#x20AC;&#x2122;t see the bottoms of your feet, have someone look for you or use a hand mirror. 1Â&#x2013;Â&#x2013; Â?\Â&#x2013;; _bÂŚÂ&#x2013;¤_Â&#x2DC;\Â&#x2013;Â?n xÂ&#x2013; k;Â&#x2013;bÂĄaD¤ Â?fÂ&#x2013; water. Dry yourself completely. Pay special attention to the areas between your toes. 1Â&#x2013;Â&#x2013;Â?DÂ&#x2013;bnÂ&#x2DC;_nkÂ&#x2013;Â&#x2DC;nÂ&#x2013; ;;Â&#x2013;fn_Â?Â&#x2DC;ÂĄÂ?DÂ&#x2013;Â&#x2DC;nÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;Â?a_kÂ&#x2013; and feet. Avoid leaving lotion between your toes, because the moisture can cause athleteâ&#x20AC;&#x2122;s foot. 1Â&#x2013;Â&#x2013;Â?_fÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;Â&#x2DC;nDk _bÂ?Â&#x2013; MÂ&#x2DC;DÂ?Â&#x2013;( Â&#x2DC;\_kTÂ&#x2013;¤\DkÂ&#x2013; they are softer. Cut them no shorter than the end of your toe. Be careful to trim them straight across. 1Â&#x2013;Â&#x2013; MÂ&#x2013;ÂŚnÂĄÂ&#x2013;\ ÂŁDÂ&#x2013;Â&#x2DC;Â?nÂĄ(bDÂ&#x2013;Â&#x2DC;Â?_ff_kTÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013; toenails or cannot see your toenails clearly, a podiatrist (foot doctor) can trim them for you. 1Â&#x2013;Â&#x2013; aDÂ&#x2013;Â?ÂĄÂ?DÂ&#x2013;ÂŚnÂĄÂ?Â&#x2013;Â?\nDÂ?Â&#x2013;NÂ&#x2DC;Â&#x2013;¤Dbb}Â&#x2013;ÂĄÂ&#x2DC;Â&#x2013; your hand in your shoe to be certain you have no tears or holes in the lining of your shoes. 1Â&#x2013;Â&#x2013;n2aÂ?Â&#x2013;Â?\nÂĄb;Â&#x2013;NÂ&#x2DC;Â&#x2013;¤DbbÂ&#x2013; k;Â&#x2013;\ ÂŁDÂ&#x2013;knÂ&#x2013; holes. 1Â&#x2013;Â&#x2013;bD kÂ&#x2013; kÂŚÂ&#x2013;2ÂĄÂ&#x2DC;Â?Â&#x2022;Â?2Â? Â&#x2DC;2\DÂ?Â&#x2013;¤_Â&#x2DC;\Â&#x2013; warm soapy water. Place a thin coat of antibiotic ointment (such as PolysporinÂŽ or NeosporinÂŽ) on the cut and cover it with a bandage.

Diabetes Management Remember to see your doctor if you notice: – 1––(knf b–2nbn– k¦¤\DD–nk–¦n¡–a_k–n–MDD˜} – 1––_Tk–nM–_kMD2˜_nk–¡2\– –D;kD8–¤Dbb_kT–n–_k2D D;–¤ f˜\} – 1–– ˜2\¦8–2 2aD;– D –(D˜¤DDk–¦n¡–˜nD–n–nk–¦n¡–\DDb} – 1–– kTn¤k–˜nDk _b8–2nk8–2 bb¡D–n–x _kM¡b– D –nk–¦n¡–MDD˜} – 1––k¦–2¡˜•2 ˜2\D–n–nD–˜\ ˜–;n–kn˜–\D b–2nfxbD˜Db¦–¤_˜\_k–˜¤n–¤DDa}

Standards of Care Special tests and exams need to be part of your diabetes care. Below are guidelines from the American Diabetes Association.



Routine physical exam

Once a year

Blood pressure

At every routine exam

Lipid (cholesterol) test

Yearly; if low risk, every two years

Complete foot exam Eye exam

Yearly, including sensory (nerve) test Yearly, or as recommended by your eye doctor

Microalbumin (protein) urine test Yearly Hemoglobin A1c(HbA1c)

Every three months

Heart & Vascular Center 9

Diabetes Management Resources Our hospitals have a tremendous education program for people with diabetes. For information, call Diabetes Outpatient Education: PenroseHealth Learning Center 3207 N. Academy Blvd., Suite 100 Colorado Spring, CO 80917

Other Resources Diabetes Forecast, a monthly magazine

published by the American Diabetes Association. To subscribe, call q^E©©^ } Diabetes Interview, a monthly magazine. To

¡(2_(D8–2 bb–q^E©©^REE^ER”E}

phone 719-779-3600 American Association of Diabetes Educators (to

Insurance coverage of your diabetes education should be verified before your first scheduled appointment. Otherwise, you will be responsible for payment when you receive the bill. Based on your insurance coverage or by personal self-pay arrangement, you will be scheduled to see the diabetes nurse educator k;– DT_˜DD;– ;_D˜_˜_ k– Mn– š©– f_k¡˜D– ˜n– one hour each on three separate visits. You also will be encouraged to schedule a visit with an exercise specialist of your choice, or as recommended by your doctor. All appointments will be made at approximately one-month intervals. The number of appointments will be modified according to individual needs. It is preferred that the first two visits be scheduled during your first phone call. Learning to manage diabetes is the best way to minimize the potential complications of this disease. We want you to take an active part as an informed member of your diabetes team, along with your physicians, nurse educator, dietitian and exercise specialist.

10 Heart & Vascular Center

find a diabetes educator near you): American Diabetes Association: Children with Diabetes: Juvenile Diabetes Research Foundation

International: National Diabetes Education Program:

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