Heart Matters

速

stages of

heart disease pg. 9

eat your way to

better heart SAHealth210 SAHealth210 Rev. 01/2014

MethodistHealthcareSanAntonio SAHealth210

health pg. 19

Do You Have the Heart

to Pass this Test?

Answer the following questions by checking the appropriate box: “Yes” or “No.”

Your Diet

Your Family History

Do you often eat low-fat, high-fiber foods such as fruits, vegetables, grains and polyunsaturated oils?

Have your family members been free of coronary artery disease before age 40?

Yes

No

Yes No Do you seldom eat high-fat, high-cholesterol foods such as fried foods, gravies and fast foods?

Has your blood cholesterol level been tested?

Yes

No

Yes No Is your total blood cholesterol level under 200?

Do you maintain your weight within 10 percent of your desirable weight?

Yes

Have you never smoked cigarettes, pipes or cigars?

No

Yes No Did you in the past, but quit at least one year ago?

Your Blood Pressure Do you have your blood pressure monitored regularly by your physician?

Yes

No

Is your blood pressure 140/90 or less?

Yes

No

Yes

No

of salty foods?

Do you avoid lots

No

Have your family members been free of diabetes?

Yes

No

Physical Activity Do you exercise for 30 minutes at least 5 times a week?

Yes

No

Yes No Does your exercise program include aerobic workouts such as walking, jogging, swimming, cycling, rowing, or vigorous dance?

No

Smoking Habits Yes

Yes

Your Stress Level Are you relatively free of stress at work or in your personal life?

Yes

No

Are you easygoing, not prone to hostility, yet still able to express your anger in a constructive way?

Yes

No

Do you practice relaxation techniques, such as visualization and deep breathing exercises?

Yes

No

Do you have a regular exercise program that you enjoy?

Yes

No

Assessing Your Risks Your heart works for you 24 hours a day, every day of your life. Only when something goes wrong do we take the time to consider our risk of coronary artery disease. The best time to think about your heart is right now. You can do something about your risk of coronary heart disease.

Start by assessing your risks.

How Did You Score?

The more times you answered “yes,” the lower your risk of coronary artery disease. The more times you answered “no,” the higher your risk of developing coronary heart disease.

You answered “yes”

your risk is

15-18 times

low/below average

10-14 times

moderate/average

5-9 times

high/above average

0-4 times

very high

Now that you have a pretty good idea of where you stand, there’s much you can do to improve your chances of avoiding coronary artery disease. By learning more about your heart and how it works, you can make changes in your lifestyle that will help to lower your risk factors. The decisions you make every day can help to reduce your risk of coronary heart disease by as much as 50 percent!

We’re devoted to Matters of the

Heart.

The miracle that keeps us all going is a steadily beating pump — a hollow muscle that forces life-giving fluid through our bodies. But every minute of the day, someone’s heart fails. In fact, more Americans die from heart disease than from any other. Yet in many cases, it’s a disease that can be prevented.

HeartMatters

represents Methodist Healthcare’s commitment to your heart health, offering you education, resources and tips for improving your heart health. Methodist Healthcare brings patients advanced technology and a staff dedicated to providing outstanding emergency treatment, heart procedures, heart surgery and cardiopulmonary rehabilitation. For more than 50 years, we have strived to bring innovative heart services to men, women and children. Here are just a few examples of the many firsts we initiated in San Antonio: ®

n Methodist Heart Hospital and Methodist Stone

Oak Hospital are the only private hospitals in San Antonio with Hybrid Operating Rooms (Hybrid ORs) which can be used by surgeons to perform complex heart procedures. n Methodist Heart Hospital was the first private

hospital to introduce the Transcatheter Aortic Valve Replacement (TAVR) procedure in 2012 as a therapeutic, less invasive, treatment option for patients in their 70s, 80s and 90s who are not

HeartSick . . . . . . . . . 9-10

24/7 in-house cardiologists. Patients entering

open a blocked coronary artery.

the emergency room with chest pain are sometimes treated with a balloon angioplasty

n In 1986, San Antonio’s first transplant of a human

within 30 minutes of arrival. The national

heart valve was performed by physicians at Methodist

average is 90 minutes. The faster we treat

Hospital.

patients, the better their chances of survival and less damage to the heart.

n Methodist Heart Hospital, a campus of Methodist

n In 2013, Methodist Stone Oak Hospital received

performed nearly 400 heart transplants and implanting more than 160 cardiac assist devices. ®

HeartWorks . . . . . . . . . 2-3

n Methodist Heart Hospital now offers an award-

first in San Antonio to use balloon angioplasty to

HeartMatters

Introduction . . . . . . . . . . 1

HeartBroken. . . . . . . . . 4-8

winning program that features round-the-clock

program in Central and South Texas, having

Contents

candidates for more invasive open heart surgery.

n In 1981, physicians at Methodist Hospital were the

Hospital, today has the largest heart transplant

Table of

the Women’s Choice award for ‘Best Hospitals for Patient Experience for Heart Care.’

HeartAche . . . . . . . . 11-12 HeartCare . . . . . . . . 13-15 HeartMend. . . . . . . . 16-17 Heart’sDesire. . . . . . 18-21 HeavyHeart . . . . . . . 22-25 HeartHelp . . . . . . . . 26-27

is your guide to maintaining a healthy heart and lowering your risk of heart disease.

Methodist Stone Oak Hospital and Methodist Hospital, along with its campuses at Metropolitan Methodist Hospital and Northeast Methodist Hospital, are certified as Chest Pain Centers with specially trained staff ready to diagnose and treat you or your loved ones experiencing any heart-related medical emergency. With all that we have to offer, it’s no wonder Methodist Healthcare is the most preferred provider of heart services

Copyright © 2014 by Methodist Healthcare System

in South Texas.

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

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Information included in HeartMatters® was obtained from the American Heart Association.

1

HeartWorks Understanding Your Heart

Your heart is the strongest muscle you possess. This hollow muscle pump beats an average of 100,000 times a day.

To get a good idea of how hard your heart works, think about how many times you could open and close your fist without stopping. Now think about your heart expanding and contracting 60 to 80 times a minute, tirelessly pumping an average of 2,100 gallons of blood throughout your body every day.

2

Your heart is a dual pump providing two very important functions: supplying oxygen-rich blood and supplying nutrients to your body and to itself.

lungs and lung capillaries. There the blood

The heart has four sections, or chambers. There are two upper chambers, each called an atrium.

The two lower chambers are called ventricles.

The right atrium and ventricle are on the right side of your heart, the left atrium and ventricle on the left side.

of oxygen (when you breath in). The blood

Your heart pushes blood through your body via the arteries. Blood flows through your arteries to smaller arteries (or arterioles), then to microscopic vessels called capillaries. It’s through these tiny vessels that your blood supplies oxygen and nutrients and picks up waste products and carbon dioxide. The blood returns to your heart through your veins, and the whole process begins again.

The aorta branches into smaller and smaller

As blood makes its journey through your body, it first enters your heart into the right atrium and then into the right ventricle. Every time your heart beats, the right ventricle contracts; this forces blood through the arteries and into your

out over your heart from two large branches:

is cleansed of the carbon dioxide (when you breathe out), and takes on fresh supplies then returns to your heart into the other two chambers – first the left atrium and then the left ventricle.

The now oxygen-rich blood finally leaves your heart through a large artery called the aorta. arteries throughout your body. Think of the branches of a tree, and you will get the idea.

The first arterial branches from the aorta are the coronary arteries. These coronary arteries supply your heart with oxygen-rich blood, the life-sustaining fluid for all muscles of your body. All of your coronary arteries spread the right coronary artery sends blood to the right and bottom areas, and the left coronary artery sends blood to the left and front areas of your heart.

Why Are Coronary Arteries So Important?

Healthy coronary arteries are very flexible, with no obstructions that can block the free flow of blood from your heart. The lining of your coronary arteries is made up of a single layer of very smooth cells called the endothelium. Just outside the endothelium lies the intima. These two inside layers of your coronary arteries are delicate and easily damaged. Each plays an important role in the progression of atherosclerosis, or “coronary artery disease.”

Clogged Arteries:

The Beginning of Coronary Heart Disease The first sign of damage to your coronary arteries usually appears in the lining. Risk factors, such as smoking, high cholesterol and high blood pressure injure the endothelium, or surface lining. The endothelium then becomes rough and coarse in places, no longer a continuous smooth surface. These bumpy areas allow cells carrying cholesterol and other fatty substances to collect on the next layer, or the intima.

Over time, these cells collect and stick together, forming a knot of fatty deposit called plaque. As plaque builds up throughout your arteries, it reduces the flow of blood to your heart. Your heart becomes choked, starved for the oxygen it needs to keep pumping.

How Your

Heart Works.

Like all the other muscles of your body, your heart needs oxygen to function properly. In fact, your heart needs a very large supply of oxygen to continuously pump thousands Superior vena cava (from upper body) of gallons of blood through your body every day. Because pulmonary artery your heart receives oxygen only Right (to right lung) through the coronary arteries, it’s important to keep these arteries healthy and free of plaque.

Right pulmonary

needs. When you exert yourself, your heart demands more oxygen.

If you’re exercising really hard, your heart can almost double the number of times it normally beats per minute while you’re at rest. pushes around your body can

Left pulmonary artery (to left lung)

increase by four times as much as when you’re not exercising. When your heart works harder and

Left pulmonary veins (from left lung)

veins (from right lung)

When you’re still and resting, your Right atrium heart beats a steady 50-80 times a minute, pumping about five quarts of blood per minute throughout Right AV valve your body. Your heart requires a certain amount of oxygen just to continue at this level of work, Pulmonary valve whether you’re sleeping, reading Inferior vena cava (from lower body) or watching TV. With healthy coronary arteries, the blood flows freely through the arteries and back again to your heart. Your heart receives the oxygen that it

The amount of blood your heart

Aorta (to body)

faster, it demands more oxygen, more fuel to keep it going. Your

Left atrium

coronary arteries actually widen,

Left AV valve

allowing more blood and more oxygen to flow through your

Left ventricle

heart. When plaque narrows the flow of blood through your coronary arteries, your heart no longer gets the blood and

Right ventricle

oxygen it needs. When your heart

requires more oxygen and can’t get it, you could experience chest pains.

3

HeartBroken Risk Factors for Coronary Artery Disease

Several different risk factors contribute to coronary artery disease, by

Cholesterol Levels Risk Factor: Dyslipidemia (abnormal levels of Total Cholesterol – HDL, LDL, and Triglycerides)

far the most common type of heart disease. Fortunately, you can control many of these risk factors. You must first recognize your own trouble spots.

Only then can you begin to make changes to help lower your risk of developing coronary artery disease.

4

Cholesterol is a white, waxy substance found naturally in some of the foods we eat. It’s also produced by your liver and released into your bloodstream. We need a certain amount of cholesterol to keep our bodies healthy. Fat is in your diet for a reason. It’s where we get our essential fatty acids. Also, if you cut fat out of your diet completely, you’ll get hungry faster. Fat keeps you satiated.

But too much cholesterol can be dangerous.

The extra cholesterol not used by your body can stick to your coronary artery wall, resulting in atherosclerosis – and that can lead to a heart attack.

Your liver produces most of the cholesterol in your body. The cholesterol helps to transport fat to the parts of your body that need it for energy or repair.

The cholesterol doesn’t float around your bloodstream in a free form. It hooks onto a protein and becomes a lipoprotein.

There are several kinds of lipoproteins that can be separated into two basic types: Low-density lipoprotein, or LDL, and high-density lipoprotein, or HDL. LDL is “bad” cholesterol. It contributes to coronary artery disease in many ways. As LDL circulates through your body, delivering fat to various areas, tiny pieces of it can get stuck along the walls that are damaged by other risk factors such as smoking and high blood pressure.

accurately measure this risk factor. A blood cholesterol test is a simple blood test. A small amount of blood is taken and the total amount of cholesterol in your bloodstream is measured. Major risk factors that can contribute to coronary heart disease include: n Diet high in saturated and trans fats n Being overweight (refer to page 21 for healthy weight information)

HDL is “good” cholesterol. Its job is to remove the stuck pieces of LDL from your arteries and return them to the liver for recycling or excretion.

n Tobacco use

If you eat too much saturated and trans fat, your liver will produce more and more LDLs causing LDL pieces to get stuck in your arteries. There won’t be enough HDLs to remove them all. As the LDL deposits build up, your coronary arteries narrow, reducing the flow of blood. A heart attack occurs when the coronary arteries become completely blocked.

n Low HDL cholesterol (<40 mg/dL)*

Because you can’t feel the cholesterol as it builds up in your body, it’s best to get a blood cholesterol level test. In fact, a test is the only way you can

n Hypertension (blood pressure ≥ 140/90 or on antihypertensive medication) n Family history of premature cardiovascular heart disease (in a close

male relative under 55 years; in a close female relative under 65 years) n Age (men 45 years and older; women 55 years and older) *HDL cholesterol ≥60 mg/dL counts as a “negative” risk factor; its presence removes one risk factor from the total count.

Cholesterol Results – What Do They Mean?

LDL Cholesterol

Total Cholesterol

HDL Cholesterol

<200

Desirable

100-129 Near/Above Optimal

<40 200-239 Borderline High Risk ≥60

130-159 Borderline High Risk

≥240

High Risk

<100

Optimal*

Low (good) High (bad)

160-189 High Risk >190

Very High Risk

*Some experts recommend <70 if you are very high risk

Source: NCEP 2002 Guidelines

triglyceride Levels Most fat exists in food as well as in the body in the form of triglycerides, which are present in the blood and together with cholesterol form plasma lipids. Calories consumed during a meal and not used immediately by tissues are converted into triglycerides and transported to fat cells for storage. Hormones regulate the release of triglycerides from fat tissue so they meet the body’s need for energy between meals. Excess triglycerides in the blood can be linked to coronary heart disease in some people. Untreated diabetes can also cause higher than normal triglyceride levels.

You need to know all of your cholesterol levels – LDL, HDL, total cholesterol and triglycerides (also called lipid levels). A low total cholesterol level is one of the first steps to a healthy heart. But don’t be fooled – a low test score doesn’t mean you can eat lots of fattening foods loaded with cholesterol. You may fall into a borderline, or “gray zone.” It’s still a good idea to have a follow-up test to make sure of the results. You may be able to lower your cholesterol with changes in your diet and with exercise.

Though it may take a few months to notice results, the most effective way to lower cholesterol levels is by reducing the amount of saturated and trans fat you eat. Begin to make your food choices based on fat content and the kind of fat you eat.

Though it may take a few months to notice results, the most effective way to lower cholesterol levels is by reducing the amount of saturated and trans fat you eat.

Begin to make your food choices based on fat content and the kind of fat you eat. Check the fat content on labels to make better food choices.

For more information on how to lower your cholesterol, see “A Wise Eater’s Guide to Healthy Living,” page 19.

A regular exercise program can actually help raise the amount of HDL, or “good cholesterol,” in your bloodstream. Raising the amount of HDL will help lower your LDL, or “bad” cholesterol level. A regular exercise program can help you lose weight and strengthen your heart muscles as well. For more information, see “Prescription for an Active Lifestyle,” page 22.

If your cholesterol level doesn’t lower with the combination of changes in your diet and exercise, or you have other risk factors, you will require medication. classification of Accompanying the prescription triglyceride levels for medication, your physician <150 Normal 150-199 Borderline High will recommend a low-choles200-499 High terol, low-fat diet. ≥500 Very High 5

Risk Factor: Smoking If you’re a smoker, you probably know by now that cigarette and cigar smoking increases your risk for heart disease, stroke, cancer and a whole host of unpleasant, even dangerous, conditions.

All Methodist Healthcare facilities and campuses are completely Tobacco-Free. This policy was enacted to safeguard the health of our patients, visitors and staff.

Risk Factor: High Blood Pressure One in four adults in the United States has high blood pressure. Doctors may also refer to high blood pressure as “hypertension.” Hypertension is a symptomless condition that can contribute to very serious health problems, such as heart attack and stroke. Because you can’t feel it happening, hypertension is called the “silent killer.” The only way to know your blood pressure – like cholesterol – is to have it tested.

High blood pressure can increase the rate of atherosclerosis, or “hardening of the arteries.”

The constant hard pressing of blood against your artery walls can injure the inside walls, causing them to erode in places. Cholesterol then hooks onto these places more easily. As you know, too much build up of cholesterol can narrow and ultimately block an artery.

To make matters worse, hardened and narrowed arteries require more pressure to pump the

Smoking injures the lining inside your coronary arteries, resulting in atherosclerosis. Just four cigarettes a day increases your risk of heart attack by 50 percent. More than a pack a day and you climb into the very high-risk group. A smoker’s heart beats an average 10,000 additional times a day, increasing the strain on the heart. In short, the more you smoke, the higher your risk of coronary heart disease.

Without question, eliminating smoking reduces your risk of coronary artery disease. Some studies have found that when you quit, your increased risk of coronary heart disease drops to normal within one year. Other studies have indicated that your risk will drop by half after one year, then approach normal risk after 5-10 years.

Smoking may be an easily identifiable risk factor, but it can also be one of the most difficult to eliminate.

Don’t lose heart. New methods have been introduced to help you quit smoking. Though it’s still not always easy, these techniques can minimize the pain of quitting and end your habit forever.

Talk to your doctor about the best ways to “kick the habit” or call the American Cancer Society at 1-877-YES-QUIT. If you need a referral to a physician who can help you stop smoking, call DoctorSource at 210-575-0355.

normal amount of blood into them. This can lead to a very dangerous cycle resulting in heart attack or stroke.

Your blood pressure is measured in two numbers. The first number indicates the pressure of your heart’s contraction, the amount of pressure it takes to squeeze the blood into your arteries. This is called systolic blood pressure.

The second number is the interval after the contraction, when your heart relaxes and refills with blood. This is called diastolic blood pressure.

If your systolic blood pressure is 140, and your diastolic blood pressure is 90, your blood pressure is “140 over 90,” or 140/90.

Blood pressure levels for adults1 Category

Systolic2

Normal

less than 140

Result

less than 90

Good for you. Your blood pressure is at goal!

H y p e r t e n s i o n

Stage 1

140-159

90-99

You have high blood pressure.

Stage 2

at or greater than 160

at or greater than 100

It is important you visit with your doctor about how to control it.

1 For adults 18 and older who are not on medicine for high blood pressure and do not have a short-term serious illness.

Source: 2014 Evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the Eighth Joint National Committee (JNC8).

2 If systolic and diastolic pressures fall into different categories, overall status is the category with higher results.

What’s My Risk? Generally, the higher your blood pressure, the higher your risk of developing coronary artery disease. Some people are more likely to develop it than others. It is especially common among African Americans, who tend to develop it earlier and more often than Caucasians. Also, many Americans tend to develop high blood pressure as they get older, but hypertension is not a part of healthy aging. Others at high risk of developing hypertension are those who are overweight, those with a family history of high blood pressure and those with a high blood pressure. Sixty million adults (31%) have high blood pressure – that’s 1 in every 3 adults.* *Source: www.CDC.gov

6

Diastolic2

Lowering Your Risk

Risk Factor: sedentary lifestyle

You can lower your risk of high blood pressure by making a few simple changes in your diet and lifestyle. If you are at moderate risk, you can probably lower your blood pressure by exercising, losing weight and reducing your salt intake.

Because of our modern American lifestyle, we require regular doses of exercise. Instead of walking to work or using stairs to reach our offices, most of us ride in cars or buses and use elevators or escalators. Instead of performing physically rigorous chores just to maintain life, most of us sit at home watching television or dine out in restaurants. Some studies suggest that exercise can help to reduce your risk of coronary artery disease. But exercise alone won’t suffice. If you smoke cigarettes, have high blood pressure and eat a high saturated and trans fat diet, no amount of exercise will completely counteract the negative effects of these risk factors. Exercise will contribute greatly to reducing these and other risk factors:

For some people with severe hypertension, a combination of diet, exercise and medication is the only way to reduce their blood pressure.

For an overall eating plan that has been clinically proven to reduce blood pressure, consider the DASH eating plan, outlined on page 19. DASH stands for “Dietary Approaches to Stop Hypertension.”

The DASH eating plan is rich in fruits, vegetables, fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds and nuts. It also contains less salt and sodium; sweets, added sugars, and sugarcontaining beverages; fats; and red meats than the typical American diet. This heart healthy way of eating is also lower in saturated fat, trans fat, and cholesterol and rich in nutrients that are associated with lowering blood pressure – mainly potassium, magnesium, and calcium, protein and fiber. More information on DASH can be found at www.SAHealth.com.

The Mediterranean Diet shown on pages 20-21 is another example of a heart healthy plan.

n C igarette Smoking – If you exercise, you’ll

be more likely to cut down or even quit altogether. n C holesterol – Exercise increases HDL “good

cholesterol.” This can result in a lower total cholesterol level. n High Blood Pressure – Exercise will

strengthen your heart and relax your blood vessels to help lower your blood pressure. n Extra Weight –Exercise is an excellent way to

get rid of extra pounds and stay at your ideal weight. Exercise can actually help control your appetite. n D iabetes – Regular exercise can help keep

blood sugar under control.

For a cardiology physician referral, call DoctorSource at 210-575-0355 or 1-800-333-7333, a free service of Methodist Healthcare.

n S tress – Exercise can help reduce the

worry and anxiety you may experience in your daily life.

There are many ways to exercise. Some offer better conditioning than others. Your exercise program should include aerobic activities on a regular basis. Aerobic exercises are vigorous enough to force your body to use oxygen to produce the energy you need for activity.

Exercises aimed at strengthening your muscles and enhancing flexibility will round out a good exercise regimen.

The American Council on Exercise recommends you should consult your physician before you start an exercise program, especially if you:

n H ave been diagnosed as having a heart

condition and have been told that you should only participate in physical activity recommended by a doctor. n Feel pain (or discomfort) in your chest

when you do physical activity. n E xperience fast, irregular heartbeats or very

slow beats while at rest. n B ecome dizzy and lose your balance, or

lose consciousness. n H ave fallen more than twice in the past year

(no matter what the reason). n Have a bone or joint problem that could

worsen as a result of physical activity. n H ave pain in your legs when you walk. n Take blood pressure or heart medications. n H ave any cuts or wounds on your feet that

don’t seem to heal. n Have experienced unexplained weight loss

in the past six months. n A re a man over 40 or a woman over 50.

Source: www.acefitness.org

If you checked any item on this list, it doesn’t mean that you can’t exercise, only that you should check with your doctor before you start. Your doctor can recommend an appropriate exercise program based upon your present physical condition. Whatever physical activity you choose, it’s important that you enjoy it. Exercise should provide you with pleasure.

You’ll benefit most from exercising if you continue the activity year after year.

7

Risk Factor: Diabetes Classic symptoms of diabetes are: n Increased thirst

n Unexplained weight loss

n Increased urination

n Increased hunger

n Unhealed skin wounds

n Genital infections

Even though different forms of diabetes have different causes, you can identify important risk factors.

Certain risk factors for diabetes overshadow others.

Your family history is your most significant risk factor. Your relatives’ experiences will indicate your comparative risk of diabetes.

The other risk factor involves physical size.

Anyone who is 20 percent overweight is at risk of diabetes and therefore coronary heart disease.

(See “Your Body Mass Index” on page 23 to determine if weight is a factor.)

To determine if you are at risk for diabetes visit www.SAHealth.com to take an online risk test. If you fall into a high-risk group, you should consider having a fasting blood sugar test to find out if you have diabetes. Those who fall into the lower risk group should be tested at their regular medical visits as their age would merit.

If you have diabetes, you can reduce your risk of coronary heart disease by following a few easy

guidelines. Maintain your blood sugar levels as near to normal as possible. Eat regular meals or eat several small meals at regular intervals throughout the day. Reduce the amount of sugar you eat, specifically the refined sugars found in desserts, candy, sodas and many processed foods. Better blood sugar control, along with a high fiber diet (25 grams per day or greater), regular exercise and weight loss result in less severe complications from diabetes, including coronary heart disease.

You may need to take medication to regulate your blood sugar levels. Your doctor may prescribe insulin to help you stabilize your blood sugar levels.

Methodist Healthcare offers diabetes education classes on diet, exercise and lifestyle changes for people who have been diagnosed with the disease. Call the Methodist Healthcare Healthline at 210-575-0355 for information.

Other Risk Factors Obesity If you are overweight by more than 20 percent of your ideal body weight, you run an increased risk of coronary artery disease (see “Your Body Mass Index” page 23). The extra pounds force your heart to work much harder to pump the blood through your body. Losing weight can also help reduce your blood pressure. Just making the effort to adopt a low-fat, low-cholesterol diet can help you lose weight. Shedding those extra pounds will give you more energy for your exercise program.

High C-Reactive Protein A C-Reactive

8

Protein (CRP) test is a blood test conducted to identify the presence of inflammation (swelling) of the arteries. A high or increasing amount of CRP in your blood suggests an increased risk for heart disease, heart attack, stroke and peripheral arterial disease. The American Heart Association (AHA) states CRP may be useful in evaluating patients at moderate risk for heart disease and determining

whether or not intensive treatment is necessary.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done or what the results will indicate.

Uncontrolled Stress and Anger Stress is part of human nature. It’s our way of reacting to fearful or unpleasant situations.

Uncontrolled stress or anger can lead to heart attacks and strokes. Use stress and anger management techniques to lower your risk. Learn to manage stress by practicing relaxation techniques, learning how to manage your time, setting realistic goals and trying some new techniques, such as guided imagery, massage, Tai Chi or yoga. To learn more about stress see “Relaxation Can be Good for Your Health” on page 23. You can also go to Tips for Reducing Stress in Your Life at www.SAHealth.com to explore ways you can reduce stress in your life using various techniques.

Diabetes is a chronic disease that – like high cholesterol and high blood pressure – can remain hidden. It’s estimated about half of those people stricken with diabetes don’t know they have it. To compound the danger, diabetes often presents another set of silent symptoms that may lead to a heart attack. A person who has diabetes and doesn’t know it can have mild heart attack symptoms – mild chest discomfort, nausea, muscle aching – and not suspect a heart attack.

Diabetes hinders your body’s way of using sugars and starches resulting in too much or too little sugar in the bloodstream. It can damage your arteries by allowing the artery cells to split apart more easily. This splitting makes the lining of your arterial walls coarse and bumpy, and that can lead to coronary artery disease.

Age Most people develop some atherosclerosis, or hardening of the arteries, as they grow older. Even if you eliminate all risk factors, you may still develop some form of atherosclerosis as you age. But you can grow older as a vital, energetic and healthy person if you begin to control your risk factors now.

Family History Some experts believe your family’s health history is the most important risk factor to consider. If anyone in your family has had coronary artery disease at an early age (younger than 55 for men, younger than 65 for women), your risk is higher than normal.

Unfortunately, we can’t control our family’s health history. So it’s crucial you begin making changes to reduce the risk factors you can control.

Gender Generally, men have a higher risk of developing coronary heart disease than women. Even after menopause, when women’s death rate from heart attack increases, it’s not as great as men’s.

HeartSick The Stages of Coronary Artery Disease

Understanding the Stages Atherosclerosis

“Hardening of the Arteries” A heart attack strikes most often in a sudden and unexpected surge of pain. But coronary heart disease doesn’t just happen all at once.

It is a very slow, gradual process called atherosclerosis.

Atherosclerosis is the slow buildup of fatty substances inside your artery walls. Just as mineral deposits gradually build up inside water pipes, so too will certain fatty substances build up in your arteries. These fatty blobs, or plaque, lodge inside your arteries, reducing the flow of blood to and from your heart. If atherosclerosis progresses to the point where the arteries become too clogged to allow the blood to flow efficiently, it can cause chest pains called angina pectoris or ultimately, a heart attack.

Angina Pectoris–Acute Blockage

n Exercise stress test

The most common symptom of coronary artery

n Electrocardiogram (ECG)

disease is angina, or “angina pectoris,” usually referred to as “chest pain.” Angina can be described as a discomfort, heaviness, pressure,

n Echocardiogram n Cardiac catheterization For descriptions of these tests, refer to page 12.

aching, burning, squeezing or pain. It can be

Heart Attack–Total Blockage A heart

mistaken for indigestion. Angina can be felt in

attack usually happens when a coronary artery is completely blocked. A blood clot, called an acute coronary thrombosis, usually develops on the injured area of a severely clogged artery. This can occur suddenly with little warning. The blood clot interrupts the flow of blood through the artery to

the chest, abdomen, neck, throat, jaw, arms or back. Angina is caused when blood flow to an area of the heart is decreased. This impairs the delivery of oxygen and vital nutrients to the heart muscle cells. Many times angina is a symptom of coronary artery blockage, but can be a symptom of other heart problems, such as heart valve disease or cardiomyopathy. Occasionally angina can be caused by stress or anxiety. To evaluate your angina, your doctor will first ask you a series of questions to determine what your symptoms are and what brings them on. After examining you, your doctor will order one or more of a series of tests to determine the underlying cause of the angina and the extent of coronary artery disease, if present. These tests may include:

Warning Signs of

Angina Pectoris n Pain occurs during exertion or excitement, then subsides with rest n You feel unusual chest pains that resemble a choking, burning or pressing sensation n Pain may spread to your arms, neck, back or jaw n Pain may be accompanied by sweating, dizziness, nausea or shallow breathing n You experience sudden severe shortness of breath or overwhelming fatigue

Atherosclerosis is a silent culprit. You can’t feel the process – it is just too slow and subtle. Atherosclerosis can begin in childhood and slowly worsen over a period of many years. Risk factors such as tobacco use, high cholesterol, high blood pressure, lack of exercise, diabetes, obesity and uncontrolled stress can significantly increase the rate of progress of atherosclerosis.

the heart. A part of the heart no longer receives any oxygen for an extended period of time. A heart attack, or acute myocardial infarction, causes some portion of the heart muscle tissue to die.

The symptoms that accompany a heart attack are similar to angina pectoris, but differ in several important ways. First, the pain is usually much more severe, lasts much longer and does not go away with rest. Second, a heart attack does not always occur during exertion. Often, a heart attack brings on a sick feeling with weakness, nausea and even fever – more so than angina pectoris.

9

Used with permission from the American Heart Association速

10

HeartAche

Physicians Rely on Special Tests to Diagnose Heart Disease

Noninvasive Tests Noninvasive tests provide information, primarily through electricity, without entering your body. Two common tests are electrocardiogram (EKG) and echocardiography.

Many noninvasive tests provide diagnostic information for your physician without entering your body. Discuss with your doctor which tests are the most appropriate for you.

Electrocardiogram (EKG) measures the electrical activity of the heart through electrodes placed in various positions on your body. The EKG can report abnormalities in the electrical activity of the heart. An EKG can sometimes detect a problem with ischemia (lack of blood flow to the heart muscle) or infarct (heart attack or heart muscle damage). A normal EKG does not mean that everything is normal in your heart.

Holter Monitor is a portable version of an EKG and gives information about the heart rate and rhythm over a continuous period of time, usually 24-48 hours. A patient will keep a diary of activity and any symptoms felt during this time to see if there is a correlation between symptoms and actual EKG changes.

Echocardiogram determines the size of your heart, evaluates how well your heart is pumping and assesses the function of the valves within the heart. A physician reading the test result can view the movement of the heart muscle and whether or not there is “leakage” or backflow through the valves. The echo usually provides an estimation of heart pump function called an “ejection fraction,” which is how much blood is being pumped with each heart beat.

Stress Test helps evaluate how your heart handles activity or work. As the body works harder during the test it requires more oxygen,

After reviewing information from your medical history, physical examination and routine tests, your physician may want to order special tests to provide a so the heart must pump more blood. The test can show areas of the heart that are not getting enough blood and could indicate possible blockage in the coronary arteries. During a routine stress test called an Exercise Tolerance Test (ETT), a person walks on a treadmill or rides a stationary bicycle while the body’s electrical activity, blood pressure and heart rate are continually monitored as activity is gradually increased. This test can give baseline information about cardiac function and a person’s ability to begin an exercise program.

more detailed picture of your heart and circulatory system. The results of these diagnostic tests will help your doctor select the most appropriate treatment option for your heart condition. When your doctor prescribes a certain test, you should understand the goal of each test, what kind of information the test provides, how the test is performed and what the risks are, if any.

11

Noninvasive Tests (cont.)

Thallium Exercise Tolerance Test differs from the routine stress test in only one way. In the final minute of the test, a nuclear medicine isotope, thallium, is injected into the vein in the hand or arm. The thallium goes directly to the heart muscle. The patient is transferred from the treadmill to a camera that follows the thallium. This image can help detect the presence of coronary heart disease or blockage of the coronary arteries. If your physician feels that walking on a treadmill would be too difficult for you, he may recommend a Chemical Stress Test. In this case you are given a medication that increases your heart rate and workload on the heart without actually needing to move around. To allow the physician to take the picture or image of the heart muscle, a medication called a nuclear isotope or â&#x20AC;&#x153;perfusion tracerâ&#x20AC;? is used toward the end of a stress test. The most common nuclear medications used are Thallium or Cardiolite. This nuclear medication reveals areas of the heart muscle that are not getting enough blood.

Coronary Calcium Scan measures the amount of calcium in the walls of your coronary arteries. Plaque consisting of fat, cholesterol and calcium can block coronary arteries. These scans detect the calcium part of a blockage.

Invasive Tests

When combined with other health information, the calcium score can help determine your risk of coronary artery disease or heart attack.

Coronary Computed Tomography Angiography (Cardiac CT Angiogram) helps determine if fatty or calcium deposits have narrowed the coronary arteries. CT imaging combines special radiology equipment with a sophisticated computer program to produce multiple pictures of the coronary blockages, just like a cardiac catheterization. If there are blockages detected, a person will have to go to the cath lab for treatment. CT Angiograms can be used on people with implanted medical devices such as a pacemaker.

Cardiac Magnetic Resonance Imaging (MRI) uses a powerful magnetic field, radio pulses and a computer to produce detailed images of internal body structures. Like CT angiography, the cardiac MRI is a noninvasive test that can detect a variety of heart problems. People who have medical implants (such as a pacemaker) cannot have an MRI. Any other medical implant (such as a stent) must be discussed with the radiologist prior to an MRI.

Invasive testing requires an introduction of medical equipment into your body.

Diagnosing heart disease was revolutionized in the 1950s when small plastic tubes began to be placed directly into the pathways of the circulatory system and even into the heart itself.

Catheterization is still widely used due to its accuracy and can provide very exact information about blood pressure and flow. In addition to the catheters, or tubes themselves, catheterization usually involves injecting dye that will show up on images to clearly show the heart cavity or blood vessel.

Electrophysiology studies may also be performed on patients to pinpoint abnormal heart function.

Using catheterization techniques, wire electrodes are inserted in the heart and can be used to evaluate the effectiveness of medication, the risk of future cardiac events, or the need for a permanent pacemaker or defibrillator. Major advances have been made in catheterization equipment, materials, medicines and processes, making it easier, faster and safer for the patient.

12

HeartCare Treating Coronary Artery Disease

Coronary artery disease is the result of the disparity between the supply of blood to the heart and the demand on the heart. Procedures for treating coronary artery disease are designed to reduce the demand on the heart or increase the supply of blood. These procedures involve the use of medicines (as the primary treatment), various forms of catheterization (non-operative) and surgery (operative).

Medicines

are typically used as a primary treatment to reduce the workload on the heart and/or increase the blood flow. A wide variety of medicines are available to physicians for the treatment of coronary heart disease; research continues to validate the effectiveness of new medicines almost daily.

Treatments for

Peripheral Vascular Disease Percutaneous Transluminal Angioplasty (PTA) A minimally invasive procedure used to enlarge partially blocked blood vessels (typically caused by plaque buildup along the walls). The procedure consists of passing a balloon catheter through the skin and into the vessel to the site of the lesion where the tip of the catheter is inflated to open up the vessel and restore blood flow.

Atherectomy Unlike angioplasty and stents, which push plaque into the vessel wall, atherectomy involves removing the plaque within the artery using a tiny cutting blade or grinding device. These devices remove the obstruction so that blood flow is restored. Most often, this procedure is done when an artery is narrowed by atherosclerosis (and calcium is present or evident).

Peripheral Stents These are used to re-open narrowed arteries which supply blood to the legs. It consists of two components, the stent and the delivery system. The stent is an implant constructed of nickel-titanium alloy tubing, laser-cut into a mesh shape. The stent is mounted within the delivery catheter; a long, thin, tube-like device.

Drug-coated Stents for Lower Extremities These can be used to re-open a particular artery in the thigh* when narrowed or blocked as a result of peripheral artery disease (PAD). The drug-coated stent includes a small metal mesh tube that expands after being inserted into the artery. The stent is coated with a drug that helps prevent recurrent narrowing of arteries. *The FDA indication is Superficial Femoral Artery or SFA

13

Coronary Artery Bypass Surgery Coronary artery bypass surgery (also called CABG or “cabbage”), is an excellent option for those individuals with acute coronary heart disease. Technological advances in procedures and anesthesiology have greatly lowered the risks commonly associated with openheart surgery to a gratifyingly low one to three percent.

During coronary artery bypass surgery, a blood vessel is removed or redirected from one area of the body and placed around the area or areas of narrowing to “bypass” the blockages and restore blood flow to the heart muscle. This vessel is called a graft. These substitute blood vessels can come

from the chest, legs or arms. They are safe to use because there are other pathways that take blood to and from those tissues.

have shorter hospital stays. In addition, studies have shown significantly fewer complications with the beating-heart surgery.

Traditional bypass surgery, where the heart is stopped and the patient is then connected to a heart-lung bypass machine, is performed at Methodist Healthcare hospitals. In addition, specially-trained physicians perform beating heart surgery (off-pump). The beating heart surgery allows the heart and lungs to continue functioning, while surgeons repair the heart. Most patients recover faster after off-pump surgery and

Methodist Healthcare is a leader in providing the latest minimally invasive surgical techniques – also called laparoscopic surgery.

For most patients, this leads to significantly less postoperative pain, a shorter hospital stay, faster recovery and, in some cases, a better overall outcome. Call Methodist HealthLine at 210-575-0355 to find out the locations and services are offered.

When Hearts After years of hard use or disease, it is a fact that some hearts lose function or fail. Even so, you can work with your doctor to improve your quality of life, your chance for survival and your body’s potential to stave off further disease. Dramatic advancements in medical therapy for heart failure, including the development of relatively small, versatile cardiac support devices, have moved transplantation to a “therapy of last resort.” Healthier patients now get better on medical therapy and many of the sicker patients survive with ventricular assist devices. Let’s look at some options.

Pacemakers Conditions in the heart’s own pacing system (often caused by high blood pressure, coronary artery disease or scarring from a heart attack) are corrected with the installation of a pacemaker.

A demand pacemaker is used most commonly. It monitors the heart’s activity and takes control only when the heart rate falls below a programmed minimum — usually 60 beats per minute.

Pacemakers are also used in cases of a heart block, in which the heart stops beating altogether for several seconds, and tachyarrhythmia, an overly rapid heartbeat.

Rate responsive pacemakers can slowly raise or lower the heartbeat to match activity levels.

Bi-ventricular pacemakers (with leads in both ventricles) can make the heart pump stronger and can be helpful to people at risk for heart failure.

14

Fail

Heart Assist Devices

There are three main indications for heart transplant:

More sophisticated implantable assist devices have been designed to take over the pumping function of hearts that are too damaged or diseased to produce adequate blood flow. They enable the natural heart to propel oxygen-rich blood throughout the body until a transplanted donor heart can take over that function, allowing the natural heart to rest and, sometimes, to mend.

n progressive heart failure that’s unresponsive

The lives of people whose hearts are failing are frequently extended successfully with the use of cardiac assist devices. Newer technology is making the devices smaller and easier to implant. Their success requires intensive teaching and strict follow-through by the patients, but the devices allow patients to be completely ambulatory. Heart Transplant Cardiologists at Texas Transplant Institute, located at Methodist Heart Hospital, were among the first in the region to implant these assist devices. To date they have implanted over 160 devices.

Heart Transplant A heart transplant can replace a failing heart that no longer pumps enough to meet the demands of the body. The outlook for heart transplant patients during the first few years after transplant is fairly good — averaging 86 percent one-year survival and 75 percent five-year survival.*

to medical therapy n arrhythmias not responsive to medicine

or therapy n difficult-to-treat angina The Texas Transplant Institute Advanced Heart Failure and Transplant Program at Methodist Heart Hospital is one of the fastest-growing programs in Texas, having transplanted more than 400 hearts since 1985. It was the first Medicareapproved heart transplant program in the region.

The goal of the Heart Transplant Program at Methodist Heart Hospital is to exhaust all medical therapies before resorting to a heart transplant, which is reserved as a final life-saving option.

Transplantation is only considered for patients with severe heart failure who meet transplant criteria and otherwise have healthy organs. Visit www.texastransplant.org for more information.

Whatever your specific condition, taking care of your heart requires that you learn the warning signs of heart failure; notify your doctor immediately if something seems amiss; make every effort to understand what is happening to your body and what your options are; and follow your doctor’s recommendations completely to ensure the best outcome possible. *Source: www.srtr.org

Methodist Healthcare offers a comprehensive advanced congestive heart failure and pulmonary hypertension disease management clinic where medical therapy is optimized prior to determination if cardiac transplantation is indicated. For more information call the clinic at 210-575-8485.

Methodist Healthcare

Offers Innovative Heart Care Cardiovascular Hybrid

not good candidates for the more invasive surgery.

Operating Rooms

Benefits of the TAVR procedure include better

Methodist Heart Hospital, a campus of Methodist

quality of life for patients who previously had no

Hospital, opened the region’s first private hospital-

options when a valve replacement was needed.

based Cardiovascular Hybrid Operating Room (OR) and Methodist Stone Oak Hospital immediately followed. The Hybrid OR offers cardiology specialists and surgeons the opportunity to provide a wider range of services in a single room. From angioplasty and stent placements to coronary bypass, valve replacements and aortic repairs, the Hybrid OR Suites at Methodist Heart Hospital and Methodist Stone Oak Hospital offer the highest level of care from a team of cardiologists, cardiothoracic surgeons and vascular surgeons.

This unique team approach brings together the best of cardiology and cardiovascular surgery by providing a diagnostic and operative environment with advanced technology. Adults and children can be treated in the suite at Methodist Heart Hospital; Methodist Stone Oak’s suites treat adults only.

Transcatheter Aortic Replacement (TAVR) Procedure for Seniors with Heart Valve Conditions

The South Texas Heart Valve Center, a department of Methodist Hospital, is the first and only hospital-based program in South Texas dedicated to heart valve patients. We are constantly looking for new, more effective ways of treating valvular heart disease, and have invested in new equipment and provided training to treat aortic stenosis with a new procedure known as Transcatheter Aortic Valve Replacement, or TAVR. Methodist Heart Hospital is the only private hospital in the area performing the procedure.

This innovative technology is not just a procedure, but a new way of approaching cardiovascular medicine. It means that patients with aortic disease now have a new therapeutic option. It is among the least invasive types of heart valve surgery because the heart valve is replaced without having to open the chest cavity. Since it is much less stressful than open-heart valve replacement, it is an exciting new option for older patients who are

interdisciplinary valve management team led by

Hospital with the 2012 Bill Aston Award for Quality. Established in 2010, the award recognizes the hospital’s measurable success in improving quality and patient outcomes through the sustained implementation of a national and/or state evidence-based patient care initiative.

an outstanding group of highly skilled health

Transitional Heart Failure Clinic

The South Texas Heart Valve Center offers an

care professionals including interventional cardiologists, cardiovascular surgeons, vascular surgeons,

neurologists,

pulmonologists,

radiologists, anesthesiologists and specially trained and experienced cardiac critical care nurses. The team collaborates with referring physicians to provide comprehensive care that includes thorough evaluations, imaging, treatment options and surgical excellence.

To learn more about this procedure, visit the Methodist Healthcare channel at YouTube.com/ SAHealth210.

Cardio-Hospitalists Available Round-the-Clock

Methodist Hospital is the only hospital in the region to offer round-the-clock cardiologists.

When patients arrive at Methodist Hospital and

to Help Patients on the Road to Recovery

The Transitional Heart Failure Clinic, a department of Methodist Hospital, has helped heart failure patients get better and stay better, lowering the incidence of readmission to the hospital.

Most hospitals instruct their patients to see their physician in three weeks after being discharged from the hospital. Clinicians at Methodist Healthcare recognized that three weeks is a long time. With this program, specialized “nurse navigators” identify patients who have experienced heart failure. These patients receive follow-up care at the Transitional Heart Failure Outpatient Clinic within 72 hours of being discharged.

Either a nurse practitioner or a doctor sees them immediately, and then weekly for the first month after their hospital stay.

require cardiac care, they don’t have to wait for a member of the emergency room staff to page an on-call cardiologist. 24 hours a day, seven days a week, Methodist Hospital has two cardiologists in the hospital. In the event of

HeartCheck® healthy heart fairs and seminars

a cardiac emergency, having a cardiologist

are the perfect opportunities to find out about

ready on site can mean the difference between

some of your risk factors. Events are held

life and death. Nationally, the average time it

throughout the year at different locations in

takes between a patient’s arrival at the hospital

San Antonio. During these health fairs, you

to having a heart procedure is 90 minutes. At

can have your blood pressure and cholesterol

Methodist Hospital, the average is well under

checked. You can also discover other helpful

60 minutes, in some cases only 30 minutes.

The cardio-hospitalist program has many advantages including lower costs, shortened length of stay for patients, a lower readmission for patients, and most importantly, in-hospital deaths linked to heart attacks have dropped.

Because of this achievement, the Texas Hospital Association honored Methodist

hints to a healthy heart. To find out more about HeartCheck® please call the

Methodist Healthcare HealthLine

210-575-0355 15

HeartMend Is There Life After Coronary Artery Disease?

Living with coronary artery disease means you need to establish a new and different set of priorities. It’s important to make changes in your daily living such as exercising and adopting better eating habits. It’s important to maintain a positive attitude. While having a heart attack can be frightening, it’s important to realize the worst part is over. You survived and the future can be much better! Here’s what happened to Bill: Bill, 72, never suspected he had a heart problem, until he suffered a heart attack three years ago. While in the emergency room, the retired San Antonio construction inspector’s heart stopped and he had to be jolted back to life. Now he feels great and maintains a positive attitude about his health.

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What was your first sign that something was wrong?

What symptoms did you experience?

I was mowing the backyard when I had my first warning. I felt a tightness in my chest but it went away and I ignored it. A week later, my wife and I traveled out of town to visit our daughter and I took her dog for a walk. I felt the pain again. When I stopped walking, the pain went away. Back home a few days later, I was unloading the car, it happened again. So I called my doctor and she told me to go the hospital emergency room.

What was the diagnosis experience like?

My wife drove me to the emergency room but I wish we had called 9-1-1 because she was so nervous. By the time we got to the emergency room, the pain was severe and constricting. I felt nauseous. A heart catheterization showed blockages, so the doctor did bypass surgery.

What was your initial and then longer-term reaction to the diagnosis?

It didn’t scare me. I know people who had gone through bypass surgery. So I figured I had a good chance of surviving it. I like to believe that I’m a positive thinker. You have to maintain a positive attitude. If you don’t, it’s like a strike – no – make that two strikes against you. I don’t dwell on my heart. I don’t have any complaints and I feel lucky to be alive. God’s letting me stay so I can spoil my five grandchildren.

How is coronary artery disease treated?

After the bypass surgery, I started a cardiac rehabilitation program at the hospital. The rehab staff were amazing. They helped me understand how to change my eating habits, what additional lifestyle changes I needed to make, and got me on a good exercise program that I continue to follow faithfully. I also take a few medications and I visit my doctor routinely.

Did you have to make any lifestyle or dietary changes in response to coronary artery disease?

I used to eat a lot for the taste. I was eating way too much fried food, fast food, and prepackaged food. The dietitian at the rehab program had a one-on-one with me and gave me a great diet plan to follow. My wife decided to follow the diet too. We figured that we’d both eat healthier. We are enjoying cooking together. Three times a week, I do a 50-minute workout at the gym: riding a stationary bike, stepping and rowing on the machines, walking on a treadmill and using weight machines. I play golf one day a week and exercise at home on another day. I have lost weight, and my blood pressure has come down, my blood sugar is under control, and cholesterol levels are looking good! I am also learning to handle the stress in my life.

Does coronary artery disease have any impact on your family?

We eat healthier. We eat a lot more fresh fruit and vegetables than we did before my heart attack. I like staying active and I know it will help me live longer.

What advice would you give to anyone living with coronary artery disease?

It’s all about a healthy eating style and exercise. They are an absolute must if you want to live as long as possible. The dietitian and rehab staff at Methodist Healthcare know what they are doing. If they make suggestions, listen to them.

Heart Failure

Everyday…

• Weigh yourself in the morning before breakfast, write it down and compare to yesterday’s weight

Every Day

*Bill is not a real patient, but rather his story combines many aspects of a person’s experience with heart disease and how Methodist Healthcare staff can help you not only survive but thrive.

The Cardiopulmonary Rehabilitation team at Methodist Healthcare wants to get you back on a path to good health as soon as possible following a heart incident. A multiphase approach begins while you are in the hospital and can continue on an outpatient basis. Studies show those who participate in a cardiac rehab program feel better and live longer, healthier lives. Talk to your doctor about participating in an outpatient rehab program.

Outpatient Cardiopulmonary Rehabilitation at Methodist Healthcare

210-575-8235

• Take your medicine as prescribed • Check for swelling in your feet, ankles, legs and stomach • Eat low salt food • Balance activity and rest periods • Which Heart Failure Zone are you today?

Green, Yellow, or Red?

Methodist Healthcare

Cardiopulmonary Rehabilitation

Zones

Green Zone

ALL CLEAR – This zone is your goal!

• No • No • No • No

shortness of breath weight gain more than 2 pounds swelling of your feet, ankles, legs or stomach chest pain

CAUTION – This zone is a warning!

Yellow Zone

Call your doctor’s office if: • Weight gain of 3 pounds in 1 day or 5 pounds in 1 week • More shortness of breath • More swelling of your feet, ankles, legs or stomach • Feeling more tired, no energy • Dry, hacking cough • Dizziness • Feeling uneasy, you know something is not right • It is harder for you to breathe when lying down, you are needing to sleep sitting up in a chair

EMERGENCY!

Red Zone

• Go to the emergency room or call 911 if you have any of the following: • Struggling to breathe, unrelieved shortness of breath while sitting still • Have chest pain • Have confusion or can’t think clearly

17

Heart’sDesire How to Prevent Health Problems from Attacking You Many people are unaware they have conditions such as high blood pressure or diabetes, especially if they haven’t seen a doctor in a long time. Most people only want to go and see a doctor when they’re sick. By visiting a doctor and getting a physical, you can find out if you have any risk factors and take action to adopt a healthier lifestyle.

Are you like Susan? She hadn’t seen a doctor in years but she had to get a physical before she started a new job.

“The doctor comes in and says, ‘You have high blood pressure.’ He said I needed to lose weight, exercise and quit smoking,” Susan said. “Basically, I needed to change everything about my life! I didn’t like hearing that and that’s probably why I hadn’t seen a doctor in a long time. Now I know if I want to be around to see my children grow up, I have to make some changes. But where do I start?”

If you haven’t seen a doctor in a while, contact DoctorSource, a free physician referral service offered by Methodist Healthcare, by calling 210-575-0355 or online at www.SAHealth.com. We’ll help you find a doctor in an area that’s convenient for you.

nW rite down as much of your own medical

Be prepared for your doctor’s visit. There will likely be paperwork you have to fill out.

history as possible. Your doctor will want to know about childhood diseases, previous surgeries and hospital stays.

Here are some general tips to get you ready:

n Know your family history. Who in your

n Bring a list of all prescription medicines,

family had a heart attack at an early age? Has anyone been diagnosed with high blood pressure, high cholesterol, diabetes or cancer?

vitamins, herbal remedies, dietary supplements, over-the-counter medicines, and any other nonprescription medicines you are taking. Ask the doctor if you’re not sure you are taking everything correctly. Do you know if you’re supposed to take your medicine on an empty stomach or with a meal? How do your prescriptions interact with over-the-counter drugs or herbal remedies you 18

take? What side effects should you watch for?

nM ake a list of concerns and questions

you have. Include any new symptoms you may be having such as pain, a change in appetite, sleep problems, energy level or mood swings. n Consider bringing a friend or relative

with you.

n Be honest. Do not just say what you think the

doctor wants to hear.

Changing the way you eat, cope with stress, and starting an exercise program, are not easy to take on all at once. If you do try to “fix” everything at once, you could be setting yourself up for failure and experience even more stress. Talk to your doctor about adopting a healthier lifestyle in stages. If you can remove just one risk factor, you can reduce your risk of coronary artery disease.

Once you tackle one risk factor, you will feel better and gain confidence in yourself, so you can continue making healthy decisions and better choices. On the following pages, we introduce you to two healthy eating plans: The DASH diet and the Mediterranean diet.

DASH Diet:

re you ready to take A a DASH toward better health?

DASH is not a weight loss diet but an overall approach to improving heart health. Researchers found that the combination of nutrients from this eating pattern help lower blood pressure, manage your weight and possibly reduce your risk of other chronic disease.

DASH stands for Dietary Approaches to Stop Hypertension, which is the name of the research study that looked at the effects of eating patterns on blood pressure. From this study came the DASH diet—a diet rich in fruits, vegetables, and low-fat dairy foods, and low in saturated fat, total fat, and cholesterol. This diet was shown to significantly reduce blood pressure.

The DASH diet combined with low sodium intake can reduce blood pressure even further. Ask your health care provider if the DASH diet is right for you.

TIPS FOR FOLLOWING

Visit the HealthLibrary on SAHealth.com, search “DASH Diet”

THE DASH DIET for more information and suggested meals and recipes.

Food Group

Serving Size

Examples

Significance to the DASH Diet

Grains 7-8 servings per day Check labels for “100% Whole Grain” or “100% Whole Wheat”

1 slice of bread 1 oz. dry cereal ½ cup cooked pasta brown rice or cereal

Whole wheat bread English muffin, pita bread, bagel, cereals, oatmeal

Major sources of energy and fiber

Vegetables 4-5 servings per day

1 cup raw leafy vegetables ½ cup cooked vegetables 6 oz. vegetable juice

Tomatoes, potatoes, carrots, squash, broccoli, turnip greens, spinach, kale, sweet potatoes, beans

Rich sources of potassium, magnesium and fiber

Fruits 4-5 servings per day

½ cup fresh, frozen, canned fruit ¼ cup dried fruit 1 medium fruit 6 oz. juice

Apricots, bananas, dates, oranges, mangoes, peaches, pineapples, raisins, prunes, strawberries

Important sources of potassium, magnesium, and fiber

Low fat or nonfat dairy foods 2-3 servings per day

1 cup yogurt 1.5 oz. cheese 8 oz. milk

Skim or 1% milk, nonfat or low fat yogurt, part skim mozzarella cheese, nonfat cheese

Rich sources of calcium and protein

Meat, poultry and fish No more than 2 servings per day

3 oz. cooked meats, poultry, fish

Select only lean meat, trim away fat, broil roast, boil instead of frying.

Remove skin from poultry

Rich sources of protein and magnesium

Nuts, seeds and legumes 4-5 per week

1.5 oz. or 1/3 cup nuts 1/2 oz. or 2 Tbsp. seeds ½ cup cooked legumes

Almonds, walnuts, sunflower seeds, peas and dry beans (black beans, lentils, kidney beans)

Rich sources of energy, magnesium, potassium, protein and fiber

Fats and Oils 2-3 servings per day

1 tsp. soft margarine 1 Tbsp. low fat mayo 2 Tbsp. light salad dressing 1 tsp. vegetable oil

Soft margarine, low fat mayo, light salad dressing, vegetable oil (such as olive or canola)

DASH allows 27% of calories as fat, including fat in or added to foods

1 Tbsp. sugar 1 Tbsp. jelly/jam ½ oz. jelly beans 8 oz. lemonade

Maple syrup, sugar, jelly/jam, fruit-flavored gelatin, jelly beans, hard candy, fruit punch, sorbet

Sweets should be low in fat and limited by people with diabetes

Sweets

5 servings per week

19

The Mediterranean Diet: A Healthy Option to Reduce Your Risk of Heart Disease In the 1950s, researchers found that the adult life expectancy for people living in the Mediterranean regions (Crete, part of Greece, Southern Italy, and other countries bordering the Mediterranean Sea) were among the highest in the world. They also found that rates of coronary heart disease, certain cancers, and some other diet-related chronic diseases in this region were among the lowest in the world.

Research suggests that the dietary patterns of those living in the region can be a healthful alternative to the traditional American diet. Will the diet alone significantly reduce your risk of heart disease and increase your longevity? Researchers point out that the low incidence of heart disease and low death rate in the Mediterranean countries may be due, in part, to other lifestyle factors, such as more physical activity and extended social support systems.

What Is the Mediterranean Diet?

There is no one typical Mediterranean diet. Many countries border the Mediterranean Sea and variations in the Mediterranean diet exist between these countries. However, according to the American Heart Association, traditional Mediterranean diets have the following characteristics in common: n An abundance of plant foods:

• Fruits • Vegetables • Whole grain breads and cereals • Beans, nuts, and seeds

n Olive oil used as a common

monounsaturated fat source

n Low-to-moderate amounts of fish

n Small amounts of red meat n Low-to-moderate amounts of dairy

products (mostly cheese and yogurt)

n Low-to-moderate amounts of eggs

(zero to four times per week)

n Low-to-moderate amounts of wine

(one glass of red wine per day)

and poultry

Comparison

with the American Diet The American diet is characterized by: • Animal products daily, as main source of protein • White starches, predominantly • Moderate to low in fruits and vegetables • High in saturated and trans fats Unlike the typical American diet, the traditional Mediterranean diet is high in fiber and low in saturated fat. However, the Mediterranean diet is not necessarily low in total fat. But, the types of fats emphasized in the Mediterranean diet are “healthy” monounsaturated fats, like those found in olive oil and canola oil, which do not raise cholesterol levels.

20

Tips for

Mediterranean

Eating

How can you eat more authentically Mediterranean?

• Include an abundance of food from plant sources such as fruits, vegetables, whole grains, seeds and nuts.

• Choose a variety of minimally processed foods, preferably those that are seasonally and locally grown.

• Use olive oil or canola oil as the principal fat in your diet, replacing other fats and oils.

health benefits There has been a lot of research on the potential health benefits of following the Mediterranean diet. According to studies, this diet may offer these benefits: • Reduce the rate of death in people who have had a heart attack • Reduce the rate of heart attack in people who have heart disease • Reduce the rate of stroke • Aid in weight loss • Lower the risk of developing cancer

• Eat low-to-moderate daily amounts of cheese and yogurt (preferably low-fat and non-fat versions).

• Eat fish and poultry at least twice per week.

• Have fresh fruit as your typical daily dessert.

• Eat red meat only a few times per month.

When eating red meat, choose lean cuts and smaller portions. Avoid sausage, bacon, and other meats that are high in fat.

Talk to your doctor about the Mediterranean diet to see if it’s right for you. Find out more by visiting the Health Library on www.SAHealth.com and searching “Mediterranean Diet.”

• Lower HbA1c levels (a measurement of how well the body uses blood sugar) in people with diabetes • Reduce pain in rheumatoid arthritis • Lower the risk of developing type 2 diabetes • Reduce the risk of metabolic syndrome. The term “metabolic syndrome” refers to a group of risk factors for cardiovascular disease. These risk factors include obesity, low amounts of “good” (HDL) cholesterol, high triglycerides, high blood pressure, and pre-diabetes.

It is important to remember, though, that other factors can affect these benefits. For example, people who follow the Mediterranean diet may have a lower risk of cancer because of other lifestyle factors or their environment.

21

HeavyHeart?

Most of us use the bathroom scale to tell us whether we’re at a healthy weight or not. Gaining or losing a pound doesn’t always mean a pound of fat. Small, frequent shifts on the scale usually indicate changes in fluid retention. A combination of two tests you can do at home – Body-Mass Index (BMI) and waist measurement – can give you an idea of what shape you’re in and if you might gain health benefits from losing weight.

Step 1: Measure your Body-Mass Index using the chart on the next page. Look up your height and weight on the chart. Circle the number where they meet. That’s your BMI. Then check “Results” to see if your BMI fits into a healthy range.

Step 2: Measuring your waist. Standing relaxed, measure your waist at the narrowest point (usually at the navel, but this may vary).

For women, a waist measurement of more than 35 inches is associated with higher health risks, for men it is 40 inches.

Using the results chart find your BMI and waist measurement to determine your risk for obesity-related diseases including coronary heart disease and diabetes.

22

Choosing a

Weight Management Program Millions of Americans join some type of structured weight-loss program each year.

Unfortunately, most people in these programs fail to take off weight and keep it off permanently. Before you join any commercial program, make sure it meets these important criteria: 1. Safety Any weight-loss program should ensure you get adequate nutrition. While recommended meal plans may be low in calories, they should still provide all your “Recommended Dietary Allowances.”

2. Reasonable weight-change goals. In general, weight loss should be slow and steady. Rapid weight loss during the first week or two of a diet is mainly loss of fluid not fat. A goal of losing one to two pounds a week is usually reasonable. Some 3people who have certain health conditions may benefit from rapid weight loss.

3. Physician participation Consult your

doctor if you plan to go on a very low-calorie diet or plan to lose more than 15 or 20 pounds.

In addition, you should check with your doctor before going on any weight-loss plan if you have health problems or take medications regularly for a specific health problem.

4. Help in making lifestyle changes Losing weight does little good if you can’t keep it off. Weight-loss programs should help you improve eating and exercise habits so you can maintain a healthy weight.

5. Upfront information on cost Make sure you are aware of all the fees you’ll be expected to pay. You should know exactly what you are paying for and find out whether dietary supplements or food products are included and how much extra they will cost.

6. Frequency The American College of Sports Medicine recommends 60 to 90 minutes of daily physical activity to lose weight or maintain weight loss.

Prescription for an Active Lifestyle:

Move More, Sit Less.

An active lifestyle that includes exercise can help reduce blood pressure and cholesterol levels. The American Heart Association advises adults should engage in 40 minutes of moderate to vigorous physical activity three to four times per week. More specifically, your goal should be to spend two hours and 30 minutes a week engaged in moderate-intensity exercise such as leisurely walking, yard work, golf or bowling.

If you exercise at a vigorous intensity level, consider brisk walking, swimming, tennis or racquetball. An equivalent combination of both moderate and vigorous-intensity exercise is highly recommended. Aerobic activity should be performed in episodes of at least 10 minutes,

preferably spread throughout the week.

Stretching and strengthening activities including curl-ups, push-ups and weight lifting, performed two to three times a week, can also be beneficial.

The key to getting yourself on the track to a more active lifestyle can be as simple as walking the dog, taking the stairs instead of the elevator, parking your car farther away and walking more every day. Once you get moving, consider adopting new activities gradually.

Studies have shown that walking 10,000 steps a day is recommended for health and weight loss.

For most people, 10,000 steps per day is around five miles worth of walking during the day. Unless you have an active job such as a waitress or nurse,

Your Body Mass Index WEIGHT

it would be difficult to log that by just daily activity.

Most people achieve it by one or more sustained walks or runs, equivalent to 30-60 minutes or more of walking per day. Wearing a pedometer to calculate the number of steps you currently average daily and slowly increasing activity will help you achieve this goal.

Always check with your doctor before you start an exercise program.

Relaxation Can Be Good For Your Health

Learning how to relax may seem silly at first.

Relaxation techniques such as biofeedback, meditation and visualization can help you eliminate stress in a reasonable amount of time. Simply engaging in an enjoyable activity can do wonders for relieving your stress. Playing with children, listening to a favorite song or soaking in a warm bath are just a few, simple ways you can escape stressful feelings. You can learn to control stress by recognizing its causes and incorporating practical ways to avoid, reduce or relieve stress. By identifying what causes your stress, you can learn how to prepare yourself and control your reactions to stress.

100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300 21 23 25 27 29 31 33 35 37 39 41 42 44 47 49 51 53 55 57 59 5'0" 19

5'1" 18

20 23 25 26 28 30 32 34 36 38 40 42 43 45 47 49 51 53 55 57

20 22 24 26 27 29 31 33 35 37 38 40 42 44 46 48 49 51 53 55 5'2" 18 19 21 23 25 27 28 30 32 34 35 37 39 41 43 44 46 48 50 51 53 5'3" 17

5'4" 17

18 21 22 24 26 27 29 31 33 34 36 38 39 41 43 45 46 48 50 51 H 5'5" 16 18 20 22 23 25 27 28 30 32 33 35 37 38 40 42 43 45 47 48 50

Check out Self Assessment Tools E 5'6" 16

17 19 21 23 24 26 27 29 31 32 34 36 37 39 40 42 44 45 47 48 on www.SAHealth.com I

17 19 20 22 23 25 27 28 30 31 33 34 36 38 39 40 42 44 45 47 5'7" 15 G This online Health Calculator will automatically: 16 18 20 21 23 24 26 27 29 30 32 33 35 36 38 40 41 43 44 46

H 5'8" 15 n Give you your Body Mass Index 5'9"

14 16 18 19 21 22 24 25 27 28 30 31 32 34 35 37 38 40 41 43 44 T n Determine how many calories you burn per

15 17 19 20 22 23 24 26 27 29 30 32 33 34 36 37 39 40 42 43 5'10" 14 specific type of activity

15 17 18 20 21 22 24 25 26 28 29 31 32 33 35 36 38 39 40 42 5'11" 14 n Give you some ideas of what activities you can participate in to burn a specific amount of calories 6'0" 13

14 16 18 19 20 22 23 24 26 27 28 30 31 33 34 35 37 38 39 41 n Determine how many calories you need 14 16 17 18 20 21 22 24 25 26 28 29 30 32 33 34 36 37 38 40 6'1" 13

to maintain your weight 6'2" 12

14 15 17 18 19 21 22 23 24 26 27 28 30 31 32 33 35 36 37 39 Just log onto www.SAHealth.com and click the 6'3" 12

13 15 16 18 19 20 21 23 24 25 26 28 29 30 31 33 34 35 36 38 HealthSource tab, then click on Self Assessment 13 15 16 17 18 19 21 22 23 24 26 27 28 29 30 32 33 34 35 37 6'4" 12

Tools. It’s an easy way to help you design your

personal weight program.

Example: If you’re 5’10’’ and weigh 200 lbs., your BMI is 29.

If you lose 10 lbs. your BMI goes down to 27.

understanding your results Obesity-related risk of disease

BMI Underweight

below 18.5

Waist measurement 35” or less

Waist measurement more than 35”

Healthy weight

18.5-24.9

Slight Risk

Increased Risk

Moderately Overweight

25-29.9

Increased Risk

High Risk

Severely Overweight

30-34.9

High Risk

Very High Risk

Severely Overweight

35-39.9

Very High Risk

Very High Risk

Extremely Overweight

40 or greater

Extremely High Risk

Extremely High Risk

Methodist Healthcare’s WomanPlus and 55Plus membership programs offer many ways to exercise, including free Line Dancing and a walkers group that meets monthly. Call 210-575-0355 for more information. ®

®

Methodist Healthcare offers regularly scheduled weight-loss seminars conducted by bariatric surgeons. Information is provided on procedures offered such as: Lap Band Surgery, Adjustable Gastric Band Surgery, Gastric Bypass Surgery, or Vertical Sleeve Gastrectomy Surgery.

To learn more, or to sign-up for a seminar, visit www.HealthForLifeCenter.com 23

How Hard Should I For the greatest benefit, your exercising should increase your heart rate (the number of times your heart beats per minute) to between 60 and 75 percent of your maximum heart rate. Any exercise that causes your heart to beat above 75 percent of your maximum heart rate may be too strenuous, unless you’re in excellent physical condition. Exercises that allow your heart to beat below 60 percent do little aerobic conditioning.

exercise?

Your maximum heart rate is usually 220 minus your age. If you’re just beginning, aim for the lower part of your target zone. As you increase your activity level, you can move into the upper part of your target zone. The figures below are averages and should be used as general guidelines.

rating for

perceived exertion 0

Nothing at all

0.5

Very, very slight noticeable)

1

very slight

2

slight

3

moderate

4

SOMEWHAT SEVERE

5

SEVERE (heavy)

(just

6 7

Age

very severe

8 9 10

Very, very severe (maximal)

Rating for Perceived Exertion (RPE) The chart above monitors the intensity of an activity by allowing you to be aware of the “sensation of effort” you are putting forth. You should rate the exertion level you feel during activities from 1 to 10 (1 being the easiest physical work you can do and 10 the most difficult). An RPE of 3-4 corresponds to an approved and safe heart rate for exercise benefit.

24

Heart Rates While Exercising

20 25 30 35 40 45 50 55 60 65 70

Target in beats in beats per minute

60-75% 120-150 117-146 114-142 111-138 108-135 105-131 102-127 99-123 96-120 93-116 90-113

Average maximum heart

100% 200-220 195 190 185 180 175 170 165 160 155 150

*Patients taking beta blockers or other medications for hypertension should check with their doctor regarding appropriate heart rates during exercise or use the RPE Scale.

Used with permission from the American Heart Association速

25

at methodist healthcare when it comes to heart attacks, we don’t skip a beat.

Methodist Healthcare facilities are the most trusted and preferred in the region when it comes to matters of the heart.

If you’re ever experiencing the symptoms of a heart attack, here’s some news you should take to heart.

After evaluation by a review team from the Society of Chest Pain Centers, Methodist Stone Oak Hospital, Methodist Hospital and its campuses at Metropolitan Methodist Hospital and Northeast Methodist Hospital have all been designated as accredited Chest Pain Centers. To achieve this distinction, the hospitals demonstrated their expertise and commitment to high quality patient care and met or exceeded a wide range of standards related to heart care, including:

• Quickly assessing, diagnosing and treating patients with chest pain • Ensuring personnel are trained to the highest standards • Having a functional design that promotes optimal patient care • Continually seeking to improve processes and procedures • Integrating the emergency department with the local EMS

Now your choice for heart care is even easier.

It’s important to know you have a choice where to go for heart care. If you or a loved one is experiencing symptoms of a heart attack, call 911 immediately. You can request to be brought to Methodist Hospital, Northeast Methodist Hospital, Metropolitan Methodist Hospital or Methodist Stone Oak Hospital. Choice does matter. Now more than ever, when you choose Methodist, your heart’s in the right place.

San antonio’s preference for heart care 41.7% methodist

17.4% baptist 8.1% university hospital 8.1% christus

ACT FAST IF YOU THINK YOU’RE HAVING A HEART ATTACK:

STOP WHAT YOU’RE DOING

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26

CALL 911

GO TO A CHEST PAIN CENTER

DON’T PANIC

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Source: National Research Corporation, January-November 2012

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HeartHelp

Your Heart’s in the Right Place with Methodist Healthcare Methodist Heart Hospital

Metropolitan Methodist Hospital

Accredited Chest Pain Center 7700 Floyd Curl Dr. • San Antonio, TX 78229

Accredited Stroke Care and Chest Pain Center 1310 McCullough Ave. • San Antonio, TX 78212

A Campus of Methodist Hospital

210-575-4000 Methodist Heart Hospital located within Methodist Hospital offers the most comprehensive cardiac services in South Texas.

The 120-bed hospital features three cardiac catheterization labs, two electrophysiology labs, four dedicated cardiovascular operating suites, a 12-bed Cardiac Intensive Care Unit, and a 14-bed Cardiac Surgical Intensive Care Unit all equipped with the latest innovative technology. Additionally, a 6-bed Cardiac Observation Unit is offered for those patients experiencing heart-related problems; this unit can accommodate a patient for up to 23 hours while physicians wait for test results to make a diagnosis and develop a treatment plan. In 2012, Methodist Heart Hospital opened the region's first private hospital-based Hybrid Operating Room offering cardiology specialists and surgeons the opportunity to provide a wider range of services in a single room. Additionally, Methodist Heart Hospital is the only hospital in the region that offers a Cardio-Hospitalist program which provides two in-house cardiologists round-theclock, twenty-four hours a day, seven days a week. Methodist Hospital is an accredited Chest Pain Center.

Methodist Heart Hospital is also home to the Texas Transplant Institute Advanced Heart Failure and Transplant Program – the first Medicare-approved heart transplant program in South Texas. The program offers the only comprehensive private hospital based advanced heart failure and pulmonary hypertension clinic in the region. Our heart transplant team is trained to install cardiac assist devices, a bridge to transplantation.

Methodist Hospital

Accredited Stroke Care and Chest Pain Center 7700 Floyd Curl Dr. • San Antonio, TX 78229

210-575-4000 Methodist Hospital was the first hospital built in the South Texas Medical Center and has been providing excellent care for over 50 years. Methodist Hospital created the Heart Center at Methodist Hospital in the 1990s which later evolved into the Methodist Heart Hospital. Methodist Hospital is San Antonio’s most preferred hospital for obstetrics, neurosurgery, cardiac care, and back and neck surgeries. Methodist Hospital offers a broad range of specialties including cardiology, oncology, emergency medicine, neurosciences, maternity care, gynecology and orthopedics. Methodist Hospital is accredited by the Joint Commission in stroke care, is designated as an accredited Chest Pain Center, and is also an accredited Heart Failure Institute.

Methodist Hospital is the first and only hospital in San Antonio to offer an international services program created to ensure a focused and dedicated approach to meeting the unique needs of international patients. Methodist accepts international insurances and is able to provide cost quotes for patients without insurance.

A Campus of Methodist Hospital

210-757-2200 Metropolitan Methodist Hospital serves as San Antonio’s downtown Methodist heart hospital featuring a full range of cardiovascular treatments by a top-notch team of professionals to care for you and your heart from the emergency department, testing and diagnosis, cardiac catheterization, the latest open-heart heart surgery techniques, intensive care and telemetry through rehabilitation. Metropolitan Methodist Hospital is an accredited Chest Pain Center.

Metropolitan Methodist Hospital offers the latest technology in cardiac catheterization procedure. The procedure, Transradial (through-the-wrist) Cardiac Catheterization, allows cardiology experts to access the heart through the patient’s wrist instead of the patient’s groin. For many patients, this procedure offers less discomfort, faster recovery and significant lower risk of complications.

Patients that suffer with low back pain, arthritis, obesity, or peripheral vascular disease will benefit the most from this new technology.

Northeast Methodist Hospital A Campus of Methodist Hospital

Accredited Stroke Care and Chest Pain Center 12412 Judson Rd. • San Antonio, Texas 78233

210-757-7000 Northeast Methodist Hospital has the fastest growing heart program in South Texas, serving northeast San Antonio, Comal and Guadalupe counties. A full range of cardiovascular services including open-heart surgery, cardiac catheterization and cutting-edge interventions for the treatment of coronary artery disease are available.

Northeast Methodist Hospital is also unique in providing individualized education and guidance by a dedicated cardiac liaison nurse.

Methodist Children’s Hospital A Campus of Methodist Hospital

7700 Floyd Curl Dr.

•

San Antonio, TX 78229

210-575-7000 Methodist Children’s Hospital is one of a very few in the United States with a high degree of specialization in pediatric cardiac care. The Methodist Children’s Heart Institute features a multidisciplinary team of experienced board-certified pediatric cardiologists dedicated to complex congenital cardiac and thoracic diseases, from prenatal diagnosis through adulthood. With six cardiac catheterization suites, Methodist Children’s Heart Institute is the only hospital in South Texas providing cardiac interventional and diagnostic procedures, as well as cardiothoracic specialty surgeries, along with a Hybrid Operating Room.

Methodist Specialty and Transplant Hospital A Campus of Methodist Hospital

8026 Floyd Curl Dr.

•

San Antonio, TX 78229

210-575-8110 Methodist Specialty and Transplant Hospital non-invasive cardiology services provide stress testing, echocardiogram, transesophogeal echocardiogram and tilt table studies.

Additionally, Pacemakers and Implantable Cardioverter Difibrillators (ICD) placements are routinely performed for patients that suffer from severe left ventricular heart failure to allow patients a more balanced method of controlling rapid heartbeat (arrhythmia). Two cardiac catheterization labs are fully functional for diagnostic angiography as well as coronary intervention.

Methodist Stone Hospital

Accredited Stroke Care and Chest Pain Center 1139 E. Sonterra Blvd. • San Antonio, TX 78258

210-638-2000 For decades, Methodist Healthcare has been a leader in heart services. At Methodist Stone Oak Hospital, we’re taking that legacy to an even higher level. Cardiac catheterization labs have the most technologically advanced equipment available including a Hybrid Operating Room. In emergency situations, our track record for speed from time of arrival to a completed angioplasty procedure far exceeds the national standards. Patients that experience a major cardiac event can benefit from the use of a therapeutic hypothermia devise designed to cool the body and reduce the chances of brain damage. Methodist Stone Oak Hospital is a leader in providing the latest minimally invasive cardiac surgical techniques. For most patients, this leads to significantly less postoperative pain, a shorter hospital stay, faster recovery and, in some cases, a better overall outcome. Methodist Stone Oak Hospital is an accredited Chest Pain Center and was recently awarded the Women’s Choice Award for Best Hospitals for Patient Experience for Heart Care.

Methodist Texsan Hospital A Campus of Methodist Hospital

6700 IH-10 West

•

San Antonio, TX 78201

210-736-6700 Methodist Texsan Hospital services include excellent cardiac care, inpatient rehabilitation, weight loss surgery, sleep evaluation lab, full service emergency department and orthopedics. Patients in need of cardiovascular services have access to technology and surgical techniques in a hospital specially designed for their treatment and recovery. Methodist Texsan Hospital is equipped with dedicated operating room suites and four heart catheterization labs featuring advanced digital radiological equipment, providing outstanding digital image quality. The operating room suites offer specialized equipment for cardiac, thoracic, and peripheral vascular surgical procedures.

27

Different Strokes pg. 4

The Testing and Treatment of Stroke pg. 6

Life

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MethodistHealthcareSanAntonio

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After a Stroke pg. 8

Do You Know Your

Stroke Risk?

Each box that applies to you equals one point.

Total your score at the bottom of each column and compare to the stroke risk levels.

RISK FACTOR

HIGH RISK

CAUTION

LOW RISK

Blood Pressure

>140/90 or I don’t know

120-139/80-89

< 120/80

Cholesterol

> 240 or I don’t know

200-239

< 200

Diabetes

Yes

Borderline

No

Smoking

I still smoke

I’m trying to quit

I am a non-smoker

Atrial Fibrillation

I have an irregular heartbeat

I don’t know

My heartbeat is not irregular

Diet

I am overweight

I am slightly overweight

My weight is healthy

Exercise

I am a couch potato

I exercise sometimes

I exercise regularly

Family History

Yes

Not sure

No

SCORE

(each box = 1)

If your RED score is 3 or more, please ask your doctor about stroke prevention right away.

Follow us on:

SAHealth210

If your YELLOW score is 4-6, you’re off to a good start.

Keep working on it!

MethodistHealthcareSanAntonio

If your GREEN score is 6-8, congratulations!

You’re doing very well at controlling your risk for stroke!

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SAHealth210

Table of

Contents Introduction . . . . . . . . . . 1 StrokeWorks. . . . . . . . . . 2 StrokeCheck. . . . . . . . . . 3 StrokeTypes . . . . . . . . . 4 StrokeAttack. . . . . . . . . . 5 StrokeCare. . . . . . . . . . 6-7 StrokeMend . . . . . . . . . 8-9 StrokeDefense . . . . . . . . 10 StrokeHelp. . . . . . . . . . . 11 Copyright © 2014 by Methodist Healthcare System All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the Publisher.

Introduction

StrokeMatters is your guide to stroke prevention. In it, you will find easy-to-follow steps to help you lower your risk for stroke.

Your brain is the boss of your body. It runs the show and controls just about everything you do, even when you’re asleep. This includes how your body moves and feels. When a stroke damages a certain part of the brain, your body may no longer work as well as it did before the stroke.

Strokes or Brain Attacks can cause problems with walking, speaking, seeing or feeling. A stroke occurs when a blood vessel is either blocked by a clot or bursts – preventing oxygen and nutrients from reaching part of the brain. Each year, about 795,000 people in the United States suffer a new or recurrent stroke. That means, on average, a stroke occurs every 40 seconds. Someone dies of a stroke every four minutes, and for every five people that die from stroke, about two are men

and three are women.* StrokeMatters is all about preventing the occurrence of stroke. It represents the commitment of Methodist Healthcare to serve you by combating stroke. It is another example of our continued efforts to lead the way in health care in San Antonio, South Texas and beyond.

For more than 15 years, Methodist Healthcare has brought patients the best technology in the diagnosis and treatment of stroke.

It is at the bedside of each patient that Methodist Healthcare earns its reputation as the most trusted provider in South Texas.** *Source: www.strokeassociation.org ** Source: National Research Corporation, January-November 2012

The Texas Neurosciences Institute at Methodist Hospital specializes in stroke prevention and treatment.

Our experienced and innovative medical team of emergency physicians, neurosurgeons, neurologists, neuro-interventional radiologists and vascular surgeons are available 24/7/365 to provide you with expert stroke care.

Methodist Hospital was the first hospital in San Antonio to receive an award from the American Heart/American Stroke Association for excellence in stroke care. At Methodist Healthcare we use evidence-based care as the foundation for the treatment of stroke patients.

Four of our hospitals, Methodist Hospital and its campuses Metropolitan Methodist Hospital, Northeast Methodist Hospital as well as Methodist Stone Oak Hospital, have been designated Primary Stroke Centers by the Joint Commission.

1

strokeWorks Understanding Your Brain

The brain is a complex organ that allows us to think, move, feel, see, hear, taste, and smell. It controls our body, receives information, analyzes information, and stores information â&#x20AC;&#x201C; our memories. The brain produces electrical signals, which, together with chemical reactions, let the parts of the body communicate.

The left side, or hemisphere, of the brain controls how the opposite side (right side) of the body moves and feels, and is responsible for how well we can figure out problems with science, understanding what we read and what we hear people say, number skills such as adding and subtracting, and reasoning. The right side of the brain controls the movements and feelings of the left side of the body and is in charge of how artistic we are, including musical and creative talents.

2

Blood supply to the brain Blood vessels that carry blood to the brain from the heart are called arteries. The brain needs a constant supply of blood, which carries the oxygen and nutrients it needs to function. Each artery supplies blood to specific areas of the brain. A stroke occurs when one of these arteries is blocked or bursts. As a result, part of the brain does not get the blood it needs, so it starts to die.

Causes of Stroke Several different risk factors contribute to the occurrence of stroke or brain attack. Fortunately, you can control many of these risk factors. You must first recognize your own trouble spots. Only then can you begin to make changes to help lower your risk for stroke. Controlling risk factors for heart disease will also help in the prevention of stroke (see HeartMatters pages 4-8 for a review of risk factors).

There are also additional ways in which one can reduce the risk of having a stroke.

s strokeCheck Know Your Stroke Risk

5

Know your re.

Blood Pressu

1

er it. th you doctor to low If it is high, work wi

) is one sure (hypertension e. igh blood pres nH strok of es us ca on of the most comm

ve Find out if you ha tion. a ill r b Fi l Atria

2

ge it. your doctor to mana If you do, work with irregular heart(AF) is an trial fibrillation nA art works ges how your he

rts of beat that chan od to pool in pa and can cause blo od can form clots and blo your heart. This cause a stroke. y choose , your doctor ma ving ha n If you have AF by e ok str r fo k to lower your ris s. ion you take medicat

op.

If you SMOKE, st

3

oke. les the risk for str n Smoking doub

for

risk oking today, your n I f you stop sm to drop. gin be ly te dia imme stroke will

ntrol it. th you doctor to co If it is high, work wi tance l (a fat-like subs

cholestero r stroke. owering your nL duce your risk fo eater ur blood) may re gr

at a in yo sterol puts you Having high chole e, which can increase your seas risk for heart di stroke risk. at even some s have shown th rol may lower n Recent studie ste ole ch al rm no in cholesterolindividuals with e by taking certa their risk for strok ions. lowering medicat

C, If you are DIABETI advice ’s or ct do follow your 6 your blood carefully to get control. sugar level under reased risk inc s puts you at an aving diabete nH for stroke.

e in your Include exercis daily routine.

7

brisk walk,

of exercise – a n improve ven a little bit nE or yard work – ca im sw e, rid k. le bicyc stroke ris may reduce your your health and

stroke

ur s of quitting, yo meone ithin five year nW me as that of so sa risk may be the ed. ok sm r ve ne who

4

Know your CHOLESTEROL number.

OHOL, If you drink ALC .

ERATION D do so in MO one

of wine, beer or ur risk rinking a glass nD y lower yo drink each day ma

dical mixed d there is no me for stroke, provide ohol. alc ink should not dr reason that you ase your can actually incre eavy drinking nH risk for stroke. it can interohol is a drug – n Remember alc king, and ta e ar u yo s ug act with other dr o much. to ink dr u l if yo alcohol is harmfu

8

Maintain a M (salt), lower sodiu lower fat DIET. ur diet, in yo

on salt and fat more y cutting down nB od pressure and y lower your blo oke. you ma er your risk for str importantly, low

if you Ask your doctor on ti la have Circu 9 lems (blood flow) probfor stroke. ur risk which increase yo ol it. your doctor to contr If you do, work with

ck arteries, ty deposits can blo your brain. to art he ur yo from which carry blood cause stroke. this blockage can If left untreated,

fat n A build-up of

3

strokeTypes Understanding the Different Types of Stroke

Stroke is the fourth leading cause of death in the United States and the leading cause of adult disability. It kills almost 130,000 people every year.* More than seven million people in the United States today have survived a stroke and 15 to 20 percent of them are permanently disabled.* Though these numbers are high, we are making some progress.

Major advances in medical treatment and diagnosis, plus increased public awareness and more emphasis on reducing the major risk factors (smoking, high cholesterol, high blood pressure, physical inactivity) are responsible. *Sources: www.CDC.com and www.stroke.org

Transient Ischemic Attack (TIA) If an artery leading to the brain, or inside the brain, becomes blocked for a short period of time, the blood flow to an area of the brain slows or stops.

This lack of blood and oxygen can cause a Transient Ischemic Attack (TIA) or ministroke, with symptoms such as numbness, trouble speaking, and loss of balance or coordination. It is common for these symptoms to last for a very short period of time and then disappear.

While TIAs cause no permanent brain damage, they are a serious warning sign of stroke and should not be ignored.

Ischemic Stroke There are two types of ischemic strokes: embolic and thrombotic. In an embolic stroke, a blood 4

clot or plaque fragment forms somewhere in the body (usually the heart or in the large arteries leading to the brain) and moves through the bloodstream to the brain. Once in the brain, the clot blocks a blood vessel and leads to a stroke.

A thrombotic stroke is a blood clot that does not travel but forms inside an artery which supplies blood to the brain. The clot may interrupt the blood flow and cause a stroke.

Hemorrhagic Stroke Strokes caused by a bursting blood vessel in the brain that spills blood into the brain are called hemorrhagic strokes. High blood pressure and brain aneurysms can both cause the blood vessel to be weak and possibly cause this type of stroke. An intracerebral hemorrhage, a

type of hemorrhagic stroke, is caused when a burst blood vessel bleeds into the brain. High blood pressure, also called hypertension, is the most common cause of this type of stroke.

The bleeding causes brain cells to die, and that part of the brain no longer works correctly. In a subarachnoid hemorrhage, the other type of hemorrhagic stroke, a blood vessel bursts in the brain and blood pours into the area around the outside of the brain. This bleeding may increase pressure in the brain, injuring brain cells. This type of stroke has many possible causes, but is usually the result of a burst aneurysm. An aneurysm is a weak spot on the wall of an artery that may balloon out, forming a thin-walled bubble. As it gets bigger, the aneurysm gets weaker and can burst, leaking blood into or outside of the brain.

strokeAttack Face

Am I Really Having a Stroke or Brain Attack?

Face

Arms

Speech

Time

Arms

Know the Stroke Symptoms…

think FAST! Face

Arms

Speech F = FACE

Face

Speech

Time

Ask the person to smile.

Does one side of the face droop?

FACIAL WEAKNESS

Arms

SPEECH PROBLEMS Face TIME IS CRUCIAL

ARM WEAKNESS

Time

Arms

Speech

Speech

Time A = ARM

Ask the person to raise both arms. Does one arm drift downward?

IAL WEAKNESS

ARM WEAKNESS

Arms

SPEECH PROBLEMS Face TIME IS CRUCIAL Time

Speech

RM WEAKNESS

ECH PROBLEMS

Time

SPEECH PROBLEMS

S = SPEECH

Speech

Ask the person to repeat a simple sentence.

Arms Are the words slurred? Can the patient repeat the sentence correctly?

TIME IS CRUCIAL Time

T = TIME

TIME IS CRUCIAL

Speech

If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast.

Brain cells are dying.

Time

Other symptoms may include: n Sudden numbness or weakness of the

face, arm or leg, especially on one side of the body

nS udden confusion, trouble speaking or

understanding

n Sudden trouble seeing in one or both eyes nS udden trouble walking, dizziness, loss

of balance or coordination

nS udden severe headache with no known

Never deny you don’t feel well. When stroke symptoms occur, it’s often accompanied by confusion, worry, and outright denial. If you have any questions, or the slightest concern, call 911. Or go immediately to the hospital – but do not drive yourself!

Don’t Delay Treatment Every stroke is a life-threatening emergency. The most important weapon you have against stroke or brain attack is time. Very often, precious minutes are lost because symptoms were denied. New treatment techniques can actually reduce the amount of damage suffered, if you are treated on time. Time is critical. To receive treatment your stroke must be quickly diagnosed.

Don’t Die of Embarrassment There is no reason to let embarrassment prevent you from seeking immediate treatment for suspected stroke symptoms – even if it does not turn out to be a stroke.

Turn to Methodist Healthcare for Stroke Services Methodist Healthcare’s certified stroke center hospitals provide complete emergency treatment for stroke patients around the clock. Our hospitals are strategically located to help meet your stroke care needs when immediate access to these services can mean the difference between life or death. We know that the sooner you seek treatment, the better your chances of avoiding a stroke or Methodist Healthcare minimizing its effects. *

cause

Certified Stroke Center Hospitals

Methodist Healthcare’s Tele-Stroke Network Using the latest innovative internet technologies, Methodist Healthcare brings outstanding stroke care services to communities that need 24/7/365 acute stroke neurology coverage. Neurologists who practice at and/or partner with Methodist Healthcare are joined remotely to any hospital by a telemedicine communication system which allows consultation with emergency department physicians within rural or otherwise remote hospitals. The Tele-Stroke network works together with Methodist AirCare™ helicopter transport service allowing Methodist Healthcare to reach out beyond our county to help those in surrounding rural communities should a patient need immediate transport to a Methodist Healthcare certified stroke center facility for emergency stroke treatment.

Methodist Hospital 7700 Floyd Curl Dr. 210-575-4444

Methodist Stone Oak Hospital 1139 E. Sonterra Blvd.

210-638-2000

Northeast Methodist Hospital A Campus of Methodist Hospital

12412 Judson Rd. 210-757-5009

Methodist Boerne Emergency Center

A Department of Methodist Hospital

Metropolitan Methodist Hospital

134 Menger Springs Rd. Boerne, TX 830-331-3000

1310 McCullough Ave. 210-757-2280

*Joint Commission Certified Stroke Centers

A Campus of Methodist Hospital

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strokeCare Treating Stroke

Stroke symptoms reflect the area of the brain that is lacking blood flow. Symptoms often start suddenly, but can also begin gradually.

In the hospital emergency room, testing will determine if your symptoms were caused by a stroke or other medical problem.

If you have had a stroke, treatment will vary depending on whether an artery is blocked or a blood vessel has ruptured.

Many clinical trials have led to advances in the prevention and treatment of stroke. For example, a clot-dissolving drug known as tissue plasminogen activator (tPA) is a major advancement in the treatment of stroke or brain attack. When it is given soon after an ischemic stroke starts, it can reduce disability and death.

Unfortunately, this treatment isnâ&#x20AC;&#x2122;t used as often as it could be because many people do not seek care quickly enough.

Prior to administering tPA, a doctor must test to assure that an ischemic stroke has occurred. All testing and administration of the medication must be done within three hours of the onset of symptoms.

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Treatment The goal of treatment is to prevent further brain damage. The treatment plan is based on whether the stroke is caused by blockage of blood flow or if it is caused by bleeding from a burst blood vessel in the brain.

If the stroke is caused by blockage, the treatment may include: n Medications that maintain your blood pressure n Medications that thin the blood n Medications that help dissolve clots n Medications that reduce the brain swelling n Surgery that removes the plaque from the inside of the blood vessels of the arteries going to the brain If the stroke was caused by bleeding, the treatment may include: n Medications that lower your blood pressure n Medications that maintain your normal blood clotting n Medications that prevent or reverse brain swelling n Blocking off the bleeding vessels with a balloon or coil n Surgery to remove the blood in the brain or decrease the pressure n Surgery to fix the broken blood vessels

Testing Blood Tests: nC HOLESTEROL levels can be evaluated by

performing a simple blood test. nC LOTTING STUDIES can be done to evaluate

the ability of your blood to clot. After the stroke, these tests may be ordered to monitor the effectiveness of medication used to help prevent further strokes.

Blood Flow Tests: nB LOOD PRESSURE is monitored routinely to

assure it is at safe levels. nU LTRASOUND IMAGING is a painless, nonin-

vasive test in which sound waves above the range of human hearing are sent into the neck. Echoes bounce off the moving blood and tissue in the artery and can be formed into an image.

Electrical Activity Tests: nE KG or ELECTROCARDIOGRAM is used to

Recent advances in technology provide for many methods of stroke testing. These tests range from traditional use of blood pressure measurement to technology that can help doctors see the affected area of the brain and define the problem. Your physician will decide which tests will be most helpful.

determine the pattern of your heartbeat. Often, strokes are related to an irregular heart rhythm known as atrial fibrillation. Due to this abnormal rhythm, blood clots, known as emboli, often flow from the heart to the brain. nE VOKED RESPONSE TEST is a diagnostic

procedure that provides a measurement of the brain’s ability to process and react to different sensory stimuli. The response from different parts of the body can indicate abnormal areas of the brain.

imaging

images are very helpful for quick location of affected brain areas. n NUCLEAR MEDICINE BRAIN SCAN uses

an isotope to follow the blood flow through vessels in the neck and brain. Areas of the brain

Brain imaging tests help localize the stroke by examining the blood vessels within the brain.

Typically these tests are performed right away to determine if emergency treatment with a clotbusting drug can be given. These drugs can be used most effectively if the patient’s stroke symptoms began less than three hours before.

nM RI or MAGNETIC RESONANCE IMAGING is

nC T or COMPUTERIZED AXIAL TOMOGRAPHIC

age. Due to its high level of sensitivity, MRI is

SCAN uses imaging equipment to generate a brain scan. A CT scan can help determine whether a stroke has occurred and identifies the type of stroke as Ischemic (result of blockage) or Hemorrhagic (result of bleeding).

particularly useful when the stroke involves small

n PERFUSION CT scan provides color images

displaying brain blood flow changes. Color

that absorb the isotope are identified as active brain cells. an advanced diagnostic tool that uses strong magnets to create detail for precisely locating a stroke and determining the amount of dam-

blood vessels. nM RA or MAGNETIC RESONANCE

ANGIOGRAPHY is a noninvasive technology used for imaging cerebral blood vessels in the brain. MRA detects any blockage of the large blood vessels within the brain or in the neck

leading to the brain. nA RTERIOGRAPHY is an image of the carotid or

vertebral artery taken while a special dye is injected into an artery in the leg or the arm through a small tube. The doctor can see if there is any narrowing caused by plaque as the dye speeds through the artery. Sometimes the dye also outlines the arteries inside the brain. nD SA OR DIGITAL SUBTRACTION

ANGIOGRAPHY provides an image of the brain’s major blood vessels. A small tube is inserted into a major artery of the leg and dye is injected and allowed to circulate in the blood stream. As the dye is circulating, an imaging machine quickly takes a series of pictures of the head and neck. The images track the movement of the contrast dye as it moves through the brain’s blood vessels. This technique allows the doctor to identify and localize the source of the stroke.

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strokeMend Is There Life After Stroke?

The impact of every stroke is very individual. After a stroke, performing even routine activities may be difficult. Having difficulty speaking, seeing or coordinating your movements can be unsettling. To cope, you will need patience and the support of those around you. You may even need a physical therapist, occupational therapist or speech therapist to help you relearn the skills you’ve lost. Recovery also depends on an individual’s dedication to setting and meeting goals. With such dedication, rehabilitation makes it possible for many stroke patients to lead independent and productive lives.

POSITIVE ATTITUDE: Your attitude can contribute to or hinder the rate of your recovery. A positive attitude will help your overall well-being.

LIFESTYLE CHANGES: If you have had a stroke, it is vitally important for you to begin making changes in your lifestyle.

Knowing your risk factors and what caused the stroke are just the beginning. You must then alter those factors that contributed to your condition. Reducing risk factors through lifestyle changes may lessen the chances of another stroke.

BEHAVIORAL CHANGES: A stroke affects the brain, causing changes in behavior and emotions. Depending on what part of the brain was injured, the type and severity of the injury, and the person’s previous personality and behavior, each stroke survivor will act differently. The most significant recovery often occurs in the first three to six months.

EMOTIONAL CHANGES: After a stroke, partial loss of emotional control is common. Stroke survivors may swing from laughing to crying for no apparent reason. Crying seems to be the most frequent occurrence. Sometimes stroke survivors cry because they are depressed. Just becoming aware of your feelings can help you cope with emotional swings. It is important to know, and then to continue to remind yourself, that emotional difficulties are normal during the healing process.

SENSORY DEPRIVATION: Stroke survivors may experience impaired senses of vision, hearing, touch or pressure. This loss of signals from the outside world can result in irritability, confusion, restlessness, and sometimes even delusions or hallucinations.

SAFETY PROMOTION: As the stroke survivor’s mobility increases, so does the risk for falling. Fall prevention includes checking the home for hazards such as area rugs, unsafe placement of furniture or inadequate lighting. A stroke survivor may use assistive devices, wheelchairs and grab bars in the bathroom for safety.

RIGHT BRAIN VERSUS LEFT BRAIN INJURY: A right-sided 8

injury to your brain causes left-sided paralysis, memory problems, visual limitations, and an impulsive behavior style. People with leftsided paralysis often judge their abilities and safety poorly. They may act too quickly as if unaware of their physical changes.

They may have trouble expressing words and feelings, which can lead to misunderstandings and poor communication. A left-sided injury to your brain causes right-sided paralysis, speech/language problems, memory deficits and a cautious or hesitant behavioral style. Aphasia may cause trouble with speaking, understanding speech, reading or writing.

RESUMING VALUED ACTIVITIES: Although you may have a disability from your stroke you can use adaptive devices to continue to enjoy your favorite pastimes and resume leisure and recreational activities.

REHABILITATION: Rehabilitation starts as

soon as possible after the stroke. Your rehabilitation therapist can help you develop a realistic plan for returning to work. You may be able to modify your work environment, return to your job, set up an office at home or train for another job. By working with you and the people close to you, your rehabilitation team will help you regain as much of your independence as possible within your physical limits. Rehabilitation may start in the hospital and continue after you leave, with either home health personnel visiting your home or you may go to a rehabilitation center on an outpatient basis. Sometimes it is necessary to stay in a rehabilitation center or nursing home until you regain the strength to go home. In these facilities, you usually receive your therapy every day and have people available around the clock to help you. Rehabilitation staff are trained in determining physical limitations and developing comprehensive plans for recovery.

To cope, you will need patience and the support of those around you. You may need a physical therapist, occupational therapist and speech therapist to regain your skills.

Occupational therapists help you relearn daily tasks, such as dressing and eating. Physical therapists help you move more easily and get about safely.

Speech therapists help you improve language skills and swallowing ability.

Methodist Healthcare

Inpatient Rehabilitation Centers

Methodist Healthcare Rehabilitation Centers provide acute inpatient rehabilitation services with a patient and family centered approach. Our centers are conveniently located throughout San Antonio at four different Methodist Hospital campuses (see below). These hospitalbased programs offer all the advantages and peace of mind that come with being in a full-service hospital that can meet all your health care needs.

Rehabilitation helps patients recovering from a stroke regain their ability to return to activities of daily living by adapting to a new way of life, and restoring function to return to the highest quality of life possible.

The rehabilitation team consists of physical, occupational and speech therapists, rehabilitation nurses, case managers and physicians. In collaboration with patients and their loved ones, we work together to create a treatment plan that focuses on potential, not limitations. Upon completion of the rehabilitation program, the team will assist in making arrangements for equipment, medical care or other services that can enhance your return to independence.

MEDICATIONS: If your doctor prescribes medicine for you, itâ&#x20AC;&#x2122;s essential that you take it regularly and properly. You may have to take more than one medicine, especially if you have several chronic conditions such as high blood pressure.

Taking each medicine on time will help ensure your problems remain under control. Make sure your doctor is aware of any supplements you are taking, such as vitamins, herbs and over-the-counter drugs.

KNOW YOUR MEDICINES: You should know as much as possible about all the medicines prescribed for you.

Your doctor or pharmacist will be able to help you understand the following: Name of medicine (brand and generic), strength of medicine, why you need to take the medicine, will the medicine react with any other medicines or foods, when to take the medicine, how to take the medicine (with food, between meals, with water only, etc.) any known side effects to watch for, activities to avoid while taking the medicine, how long should you take the medicine (finish the entire prescription, or as long as symptoms last), and will the medicine react with any herbal supplements and vitamins you may be taking.

FOLLOW UP APPOINTMENTS: After a stroke survivor returns to the community, regular follow up appointments are usually scheduled with the doctor and sometimes with rehabilitation professionals. The purpose of followup is to check on the stroke survivorâ&#x20AC;&#x2122;s medical condition and ability to use the skills learned in rehabilitation. It is also important to check on how well the stroke survivor and family are adjusting.

Methodist Healthcare Inpatient Rehabilitation Centers Methodist Texsan Hospital

Methodist Specialty and Transplant Hospital

A Campus of Methodist Hospital

6700 IH-10 West San Antonio, Texas 78201

For more information about rehabilitation services,

Metropolitan Methodist Hospital

Northeast Methodist Hospital

A Campus of Methodist Hospital

A Campus of Methodist Hospital

A Campus of Methodist Hospital

8026 Floyd Curl Drive San Antonio, Texas 78229

1310 McCullough Avenue San Antonio, Texas 78212

12412 Judson Road San Antonio, Texas 78229

call 210-785-5999 or visit www.MethodistInpatientRehab.com 9

strokeDefense How to Prevent Recurrent Stroke or Brain Attack After experiencing a stroke, survivors and their families usually concentrate their efforts on rehabilitation and recovery. However, preventing another (or recurring) stroke from happening is also a critical consideration. Of the estimated 750,000 Americans who experience a stroke each year, 5 to 14 percent will have an additional stroke within one year. Within the next five years, stroke will recur in 24 percent of women and 42 percent of men.

Stroke prevention is also important to those who have experienced Transient Ischemic Attacks (TIAs). TIAs are a serious warning sign of an impending stroke. Up to 35 percent of people who experience a TIA are expected to have a stroke.

And most of these will occur in the first few days to weeks after the TIA. However, many recurrent strokes and TIAs can be prevented through lifestyle changes, surgery, medicine, or a combination of all three methods.

Everyone has some stroke risk, but making simple lifestyle changes may reduce risk of a first or recurrent stroke.

These simple lifestyle changes can greatly reduce your chance of having a stroke: 1. Know your BLOOD PRESSURE. If it is high, work with you doctor to lower it.

2. F ind out if you have ATRIAL FIBRILLATION. If you do, work with your doctor to manage it.

3. If you SMOKE, STOP. 4. If you drink ALCOHOL, do so in moderation.

5. Know your CHOLESTEROL number. If it is high, work with your doctor to control it.

ÂŽ

n Talking to your Physician (page 18) nT he DASH Diet and Mediterranean Diet

(page 19-21)

6. I f you have DIABETES, follow your doctorâ&#x20AC;&#x2122;s advice carefully to get your blood sugar level under control.

nC hoosing a Weight Management

7. Include EXERCISE in your daily routine.

nP rescription for an Active Lifestyle:

8. Maintain a lower sodium (salt), lower fat DIET. 9. A sk your doctor if you have CIRCULATION (blood flow) problems which increase your risk for stroke. If so, work with your doctor to control them.

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See HeartMatters for information on the following topics:

Program (page 22) Move More, Sit Less (page 23) nR elaxation Can be Good for

Your Health (page 23)

e strokeHelp Methodist Healthcare is the #1 Choice for Stroke Care

The Joint Commission, an organization devoted to developing and evaluating the highest health care standards, has designated Methodist Hospital and its campuses at Metropolitan Methodist Hospital and Northeast Methodist Hospital as well as Methodist Stone Oak Hospital, as Primary Stroke Centers.

Methodist Healthcare Stroke Center certified hospitals use evidence-based care as the foundation for the treatment of stroke patients. This care involves Deep Vein Thrombosis (blood clot) therapy, antithrombotic treatment, anticoagulation treatment for patients with atrial fibrillation, screening for elevated cholesterol levels, a swallowing evaluation, smoking cessation, stroke education and a rehabilitation plan which may include physical therapy, speech therapy and occupational therapy.

When Time is Brain,

You’re in Experienced Hands at Methodist Primary Stroke Center Certified Hospitals At Methodist Healthcare, you have access to: n Neurology nurses, certified in stroke care by the National Institutes of Health n Surgical services team dedicated to neurosurgery patients n Rehabilitation team with extensive experience in physical, occupational and

speech therapy n Radiology services team, experts in areas of special procedures, Magnetic

Resonance Imaging (MRI), Computerized Tomography (CT), and Gamma Knife® treatment n E mergency Department staff with extensive experience in treating

patients with stroke symptoms n Our team also includes a PhD -prepared Neuro Clinical Nurse Specialist,

who also represents Methodist Healthcare on the board of the American Association of Neurosciences Nurses

Experienced and Innovative Medical Team

STROKE ALERT

Action Plan — Moments Count Emergency Medical Service providers are very important to your stroke care. Methodist Healthcare has a continued partnership with EMS providers and other ambulance services to ensure proper transportation of patients who meet the stroke alert action plan. Patients who meet the needs of urgent stroke care are delivered to Methodist Healthcare Primary Stroke Center hospitals for immediate evaluation and treatment.

Strokes Strike Fast Think Methodist First

In addition to our highly responsive emergency services staff, within Methodist Healthcare we have a 24/7 medical team that includes a wide range of neurology specialists: n Emergency Physicians n Neuro Interventional Radiologists – available to treat intra-arterial

thrombolysis, mechanical clot retrieval and coil treatment for aneurysms n Vascular Surgeons – for any urgent vascular interventions n Neurosurgeons n Neurologists – available for consultations regarding administration of tPA

(tissue plasminogen activator), a clot busting drug approved for use in certain patients having a stroke. The drug must be administered within a three-hour period from onset of symptoms of an ischemic stroke. Timely administration of tPA can reduce loss of physical and mental functioning that strokes can cause.

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