Cardiology Articles

Nutrition for a Healthy Heart

Pervez A. Alvi, MD, FACC
HRMG Cardiovascular Institute

Cardiovascular disease is the leading cause of illness and death in this country and obesity is an important risk factor for cardiovascular disease.  The incidence of obesity is at alarming proportions in the US: almost 1/3 of the population being overweight and an additional 1/3 being obese.  Obesity leads to high blood pressure, diabetes, sleep apnea and abnormalities in cholesterol or lipid levels, all of which contribute to the development of plaque and inflammation in your arteries.

The importance of healthy dietary habits cannot be overemphasized.   Over the years, much clinical debate over the virtues of different types of diets has taken place. Diets low in carbohydrates claimed success in weight reduction over the other types including diets high in fats and diets high in proteins.  Ultimately, it became evident that it was not the type or composition of the diet that was important, rather, the caloric intake (portion) that was critical to weight loss.   A heart healthy diet should include all the necessary nutrients needed by the body. Of the total energy, less than 7% should be in the form of fat.  Total cholesterol should be less than 300 mg per day and less than 1% should be trans fat (cookies, pastries, French fries, etc.).

Carbohydrates are important as the immediate source of energy for the body cells (contrary to the common belief that they are bad for you!).  However, an important concept in selecting the right carbohydrate is the "glycemic index," that is, the rapidity with which carbohydrates are absorbed as glucose, thus affecting the insulin level in your body.  Carbohydrates low in glycemic index should be selected, preferably whole grains (whole flour, oats) rather than refined white bread, white rice, pasta etc.   Adequate amount of protein is extremely important for tissue repair and build up.  However, it is important to avoid excessive amounts of red meat and rather select white meat (poultry) or vegetable sources such as lentils.

It is crucial to eat oily fish at least a couple times a week (such as tuna, salmon, and cod).  Fish is a great source of omega 3 fatty acids.   According to studies, eating fish can help decrease heart disease, arrhythmias and sudden cardiac death. It is highly recommended to eat foods that are high in fiber because not only does it help in regularity but also reduces LDL (bad) cholesterol by promoting excretion.  It is recommended that one should take 4-5 servings or more of fruits and vegetables everyday.  Fruits are important source of fiber as well as vitamins and minerals (micronutrients).  Additionally, nuts such as walnuts and almonds are good sources of protein as well as micronutrients.

A healthy lifestyle is equally important to maintain heart health.  It is recommended that 30 minutes of moderately intense physical activity such as brisk walking most days of the week should be included in your schedule.  However, if weight loss is desired, then, you should increase the duration of exercise to at least 60 minutes.  This can be done at different intervals.  Physical activity has tremendous benefits unparalleled by any other measures in primary as well as secondary prevention of heart disease.

Alongside the "do's" for heart health, one should not forget the "don'ts" and they include, but are not limited to, smoking tobacco, drinking alcohol excessively, drinking sweetened soda and physical inactivity/sedentary life style.  Tobacco is injurious to health in many ways including the development of atherosclerosis, inflammation in coronary arteries, and increasing the stickiness of blood platelets.  It also has other injurious effects like the development of chronic lung diseases, lung cancer and ulcerations in the stomach. Moderation in alcohol intake helps protect the heart but excessive intake causes damage to the heart as well as brain, liver and other major parts of the body.

In summary, by following dietary discretion and adopting a healthy life style, you can maintain a healthy cardiovascular system. Go ahead - do the right thing. it might just save your life!

30 Minutes a Day for a Healthy Heart
Edward Ha, MD, Interventional Cardiologist
HRMG Cardiovascular Institute

You see it everywhere: on the news, in the papers, on the TV—we are a nation of couch potatoes, and we need to exercise.   I’m sure that many of you take a look at those images of slim, attractive men and women smiling through their beads of sweat on their brow, and you figure “well, that’s all very well and good…but I can’t be like that”.   While most people understand that exercise is good for the heart, I want to take some time to explain just how exercise improves heart health, to describe what type of exercise will best improve heart health, and to address concerns about the safety of exercise, especially in people who have had heart problems in the past.

Exercise is important in improving many of the ongoing processes that cause heart disease: it lowers LDL (the “bad” cholesterol) 15% for men and 30% for women and increases HDL (“good” cholesterol) from 5% (for men) to 20% (for women). In a study of 50,000 healthy women, daily walking reduced the risk of obesity by 24% and diabetes by 34%.   In a 70,000 person study of postmenopausal women, daily walking reduced the risk of stroke, heart attack, and/or heart-related death by 30-40%. Talk about your “miracle” drug—with virtually no side effects and very low cost!

Well, you might say, it’s easy to say that exercise is good for you, but doing it is not that easy.  Not true! It doesn’t take a lot of exercise to keep your heart healthy.   Light exercise (such as walking 30 minutes a day), gives you just as much benefit as more vigorous activity (see on left).   You don’t have to be a marathon runner to be heart healthy! Instead, be disciplined - 30 minutes of exercise every day: 5 minute warm-up, 5 minute cool down, and 20 minutes of sustained exercise (to the point where you feel it in your breath, but are still able to maintain a conversation)—that should be your goal.

Finally, some might say, isn’t it dangerous for people with heart problems to exercise?   The answer is that failing to exercise is more dangerous to your health than exercise if you have heart problems; that is why the American Heart Association gives cardiac rehabilitation exercise programs a Class I (highest recommendation) for people with a history of heart pain, heart attack, or poor heart function, or recent bypass surgery or stenting.   Cardiac rehabilitation services are available at Hannibal Regional Hospital; if you have had these conditions in the past, you may want to ask your doctor whether you qualify for cardiac rehabilitation services.

You and Your Heart

Richard Valuck, M.D.,

Cardiologist, Hannibal Regional Medical Group


Your heart is a muscle which is about the size of your fist.  It pumps oxygen-rich blood to the different parts of your body.  Most people only think about their heart when something goes wrong.  It is important to remember that heart disease remains the number one killer in the country.  Therefore, knowing your risk factors and taking action  could help you decrease your chance of developing heart disease in the first place. Take a minute to assess your risk factors below.


YES     NO      High Blood Cholesterol

O         O         I often eat foods high in fat or high in cholesterol such as butter, oil, fried foods, and

O         O         My doctor told me I have high cholesterol.

O         O         My total cholesterol is 200mg/dL or higher, my HDL (good cholesterol)           

                       is less than 40 OR I don’t know my cholesterol levels.

O         O         I eat a lot of processed and fast foods.


                        High Blood Pressure

O         O         My blood pressure is above 120/80, OR a health professional has said my                                                  blood pressure is high, OR I don’t know my blood pressure.

O         O         I eat a lot of salty foods and processed convenience foods.

O         O         I am overweight.

O         O         I exercise less than 30 minutes some days OR I don’t exercise.


                        Tobacco Smoke

O         O         I am a cigarette, pipe, or cigar smoker.

O         O         I live or work with people who smoke regularly.

O         O         I quit smoking but got back into the habit.

O         O         I have little motivation to quit smoking.


                        Other Risk Factors

O         O         I have diabetes or a family history of diabetes.

O         O         I am not physically active.

O         O         I don’t do anything regularly to relieve stress.

O         O         I’m a woman on birth control pills who smokes.

O         O         I am a man over 45 years old OR I am a woman over 55 years old.

O         O         My father or brother had a heart attack before age 55; OR my mother or                                                  sister had one before age 65.


The more times you answered “yes” to the above, the greater your chance of developing heart disease.  Learn about your heart and your risk factors and talk to your healthcare provider about them. It might just save your life! 

HEART ATTACK: Do You Know What To Do?

To many people a heart attack is any prolonged episode of chest pain.  However, to a medical professional, "heart attack" is a specific injury to the heart leading to death of heart muscle.  The pain associated with a heart attack can vary from person to person but, most men and women describe a pressure, heaviness, squeezing, or tightness around their chest on either the left or right side and frequently behind the breastbone.   The discomfort usually starts slowly and builds in intensity over several minutes reaching a level which is very severe and sometimes is associated with sweating, shortness of breath, nausea, and weakness, or profound fatigue.

Women with heart attacks often have less typical symptoms, including jaw discomfort, back discomfort and even pain up the sides of the neck and into the lower parts of the ears.  In both men and women the pain associated with a heart attack frequently radiates (moves) to the arms (both left and right arms can be affected) as well as into the pit of the stomach leading to a feeling of indigestion and nausea.

The pain of the heart attack is an indication that a blockage has occurred in one of the blood vessels feeding the heart muscle.  This blockage is most commonly caused by a blood clot formed on a cholesterol plaque within the vessel.  Even after only a few minutes of blockage the loss of oxygen and nutrition supplied to the heart muscle begins to cause permanent damage and because of this, the most important rule for surviving a heart attack is: "Call 911 quickly and get to the hospital as soon as possible."   By using an ambulance, rather than having a loved one drive you to the hospital, you're not only safer, but the emergency medical technicians can nowadays often perform a full electrocardiogram in the ambulance that can speed the diagnosis of your heart attack and shorten the time to give treatment when you arrive at the emergency room.

The only self treatment which you should consider is taking an aspirin as soon as you recognize the possibility that a heart attack is occurring.  Aspirin has actually been shown to improve survival in a heart attack by slowing the development of the clot which is blocking the heart's blood supply.  Lying down and resting quietly can also help by decreasing the workload of the heart and thus decreasing the likelihood of bad rhythms or increasing heart damage brought about by a fast heart rate from the excitement of the heart attack itself.

Modern day treatment of a heart attack requires the treating physician to dissolve or otherwise open the blood clot which is blocking oxygen supply to your heart muscle.  This may require the use of "clot buster medications" in addition to aspirin and other blood thinner agents.  Currently, the safest and most effective method of opening a blocked blood vessel for a heart attack requires emergency heart catheterization with balloon angioplasty.  Immediately opening the blood vessel using a balloon device often followed by a metallic stent to help keep the vessel open gives your heart the best chance for recovery.

No matter what treatment is ultimately chosen for you, the rapid recognition of the symptoms of a possible heart attack and efficient arrival at the hospital is the key to improving survival.  By learning the possible symptoms of a heart attack and acting quickly to reach medical care you truly are making the greatest contribution to saving your own heart and ultimately your own life.