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Monthly Archives: March 2014

Physical Activity and Your Health

Dr. Vincent CaraccioloAccording to the Centers for Disease Control and Prevention (CDC), 60% of Americans are not meeting the recommended levels of physical activity. Fully 16% of Americans are not active at all. Overall, women tend to be less active than men, and older people are less likely to get regular physical activity than younger individuals.

In a recent article published in Circulation: Journal of the American Heart Association, researchers from the Harvard Medical School released data from the 10-year Women’s Health study that showed moderate exercise reduced the risk of heart disease by 27% to 41%. the study was performed on 27,055 participants.

The mechanism of benefit was shown to be largely due to the reduction of LDL (bad cholesterol), raising HDL (good cholesterol) and reducing inflammation.

It is well-known that inflammation leads to the release of molecules called cytokines that can cause damage to the blood vessels in the heart and throughout the body. Cholesterol tends to deposit at these damaged sites, leading to plaque. the damaged vessels containing increased cholesterol deposits are the sites where platelets attach to blood vessels. These clumps of platelets can break off and completely block the blood vessel as it narrows downstream. In the coronary arteries, this leads to an acute heart attack; in the brain, it causes either a major or a minor stroke.

As little as two hours of brisk walking every week was sufficient to lower the risk of major cardiac events dramatically. Can you imagine that if all you do is walk briskly for 17 minutes daily, your risk of heart disease will go down by 40%? Regular physical activity is defined as about 30 minutes of moderate activity (preferably all days of the week) can reduce the risk of heart disease. One can lower your chances of having a stroke, colon cancer, high blood pressure, diabetes and other medical problems.

If you’re also trying to manage your weight and prevent gradual, unhealthy weight gain, try to get 60 minutes of moderate to vigorous-intensity activity on most days of the week. At the same time, watch your calorie intake. Take in only enough calories to maintain your weight. I often counsel my patients to eat no more than 350 calories a meal four to six times a day. Most of our bodies cannot metabolize more than this amount so large meals that many of us are used to will cause us to store weight and develop fatty tissue.

I often share the following scenario with my patients:

Patient A – Eats two large meals daily of 750 calories each – totalling 1500 calories.

Patient B – Eats five small meals of 300 calories each about 2-3 hours apart – totalling 1500 calories.

Q: Who will lose weight?

A: Patient B

By eating only the calories the body can burn, patient B will likely lose weight coupled with regular physical activity. Unfortunately, Patient A is unable to burn the extra 450 calories they eat at each meal and that totals 900 extra calories daily. 1 pound is about 3500 calories. In about 4 days, a person can gain an unwanted pound of weight eating this way and it can be exacerbated if they are physically inactive.

Another example: A 200 pound person who keeps on eating the same amount of calories, but walks briskly each day for 1.5 miles, will lose about 14 pounds in one year. Staying active will also help to keep the weight off. Second, you can eat fewer calories and be more active. This is the best way to lose weight, since you’re more likely to be successful by combining a healthful, lower-calorie diet with physical activity.

For example, a 200 pound person who consumes 250 fewer calories per day, and begins to walk briskly for 1.5 miles each day will lose about 40 pounds in one year.

As you can see, about 2/3 of weight loss is attributed to diet, but we need physical activity to help us stave off medical problems including heart disease.

Heart Disease

Heart disease occurs when the arteries that supply blood to the heart muscle become hardened and narrowed, due to a buildup of plaque on the arteries’ inner walls. Plaque is the accumulation of fat, cholesterol and other substances. As plaque continues to build up in the arteries, blood flow to the heart is reduced. Heart disease can lead to a heart attack. A heart attack happens when a cholesterol-rich plaque bursts and releases its contents into the bloodstream. This causes a blood clot to form over the plaque, totally blocking blood flow through the artery and preventing vital oxygen and nutrients from getting to the heart. A heart attack can cause permanent damage to the heart muscle. Some people aren’t too concerned about heart disease because they think it can be cured with surgery.

This is a myth. Heart disease is a lifelong condition. It’s true that certain procedures can help blood and oxygen flow more easily to the heart. But the arteries remain damaged, which means you are still more likely to have a heart attack. What’s more, the condition of you blood vessels will steadily worsen unless you make changes in your daily habits and control other factors that increase risk.

You have control.

Physical inactivity is one of several major risk factors for heart disease that you can do something about. The others are:

  • Smoking. People who smoke are up to six times more likely to suffer a heart attack than non-smokers, and the risk increases with the number of cigarettes smoked each day.
  • High Blood Pressure. Also known as hypertension, high blood pressure increases your risk of heart disease, stroke, kidney disease, and congestive heart failure.
  • High Blood Cholesterol. High Blood Cholesterol can lead to the buildup of plaque in your arteries, which raises the risk of a heart attack. Starting at age 20, everyone should have their cholesterol levels checked by means of a blood test called a “lipoprotein profile”. You can lower high blood cholesterol by getting regular physical activity, eating less saturated fat and trans fat, and managing your weight. In some cases, medication is also needed.
  • Overweight. If you are overweight or obese, you are more likely to develop heart disease even if you have no other risk factors. Ask your doctor to help you determine whether you need to lose weight for your health. The good news: Losing just 5-10% of your current weight will help to lower your risk of heart disease and many other medical disorders.
  • Diabetes greatly increases your risk for heart disease, stroke, and other serious diseases. Ask your doctor whether you should be tested for it. Many people at high risk for diabetes can prevent or delay the disease by reducing calories as part of a healthy eating plan, and by becoming more physically active.

Taking Precautions

Some people should get medical advice before starting, or significantly increasing physical activity. Check with your doctor first if you:

  • Are over 40 years old and not used to moderately energetic activity.
  • Currently have a heart condition, have developed chest pain within the last month, or have had a heart attack. (Also see the section, “After a Heart Attack”)
  • Have a parent or sibling who developed heart disease at an early age.
  • Have any other chronic health problem or risk factors for a chronic disease.
  • Tend to easily lose your balance or become dizzy.
  • Feel extremely breathless after mild exertion.
  • Are on any type of medication.

While physical activity can strengthen the heart, some types of activity may worsen existing heart problems. Warning signals include sudden dizziness, cold sweat, paleness, fainting, extreme breathlessness, or pain or pressure in your upper body. These symptoms may occur during, or just after, an activity. Ignoring these signals and continuing your activity may lead to serious heart problems. Instead, call your doctor right away.

Overall, it is best to get regular comprehensive evaluations to help understand how best to incorporate the right type of exercies in your life to help reduce your risk of heart disease and other illnesses.

Vincent Caracciolo, MD, FACC
First Coast Heart & Vascular Center, PA

Carotid Artery Disease

Carotid Artery Disease: Symptoms, Diagnosis, Treatment and Prevention – Advancing Treatment of Stroke and TIA

What are the carotid arteries?

The carotid arteries are the blood vessels that carry oxygen-rich blood away from the heart to the head and brain. Located on each side of the neck, these arteries can easily be felt pulsating by placing your fingers gently on either side of your windpipe. The carotid arteries are essential as they supply blood to the large front part of the brain.

Another smaller set of arteries, the vertebral arteries, are located along the back of the neck adjacent to the spine, and supply blood to the back of the brain.

What is carotid artery disease?

Carotid artery disease is defined by the narrowing or blockage of this artery due to plaque build-up. The process that blocks these arteries is called atherosclerosis. The slow build-up of plaque is caused by high blood pressure, diabetes, tobacco use, high blood cholesterol, and other modifiable and none-modifiable risk factors.

Over time, this narrowing may eventually become so severe that blockages decrease blood flow to the brain and may cause a stroke. A stroke can also occur if a piece of plaque or a blood clot breaks off from the wall of the carotid artery and travels to the smaller arteries of the brain.

Brain cells deprived of fresh blood for more than a few minutes will be damaged, a condition known as “ischemia” or the brain cells may die, a condition known as “infarction”. When blood flow to the brain is blocked, the result is sometimes called “an ischemic event”. This could be  stroke, which is permanent loss of brain function, or a transient ischemic attack (or TIA), which implies a temporary alteration of brain function. Brain damage can be permanent if this event lasts for more than 3 to 6 hours.

Stroke can also occur from causes other than carotid artery disease, for example, from heart disease (heart valve problems, heart failure, PFO or patent foramen ovale which is a hole in the heart or atrial fibrillation) or if bleeding occurs in brain tissue. Nevertheless, carotid artery disease is one of the most common causes of stroke. According to the National Stroke Council, more than half of the strokes in the United States occur because of carotid artery disease.

What are the symptoms of carotid artery disease?

For many individuals, the first obvious sign often is a TIA or mini-stroke. Symptoms for a stroke or TIA are similar and may include blurring, dimming, or loss of vision; tingling around the mouth, difficulty with speech, the inability to normally move an arm or leg, the inability to feel (numbness) in a part of the body, and rarely, a sudden or severe headache. The difference between a stroke and a TIA is that the symptoms of a TIA are not permanent and can last from a few minutes to 24 hours. A TIA is a very powerful warning sign; although the symptoms may resolve completely, the occurrence of a TIA offers and individual who is at risk of a permanent stroke an extra opportunity to take action. However, a TIA should still be treated as a medical emergency.

How is carotid artery disease diagnosed?

The diagnosis of carotid artery disease is usually based on the performance of an ultrasound study of the neck arteries. Alternatively, the artery can be visualized by a magnetic resonance angiogram (MRA), CTA scan angiography or standard angiogram.

How is carotid artery disease treated?

Treatment for carotid artery disease normally consists of normalization of those risk factors that cause artery blockages, specific medications (usually antiplatelet medications, cholesterol medications), and sometimes requires either carotid artery angioplasty and/or stent, or by a surgical procedure (CEA=Carotid Endarterectomy). Anyone with any degree of narrowing of a cortid artery, or with any history of stroke or TIA, should quit use of all tobacco products, control their high blood pressure, normalize their blood cholesterol and blood sugar by diet and medications, and exercise regularly.

Your doctor may prescribe a daily antiplatelet medication, such as aspirin, Plavix, Aggrenox or Warfarin to reduce clot formation. The choice of medications is best made by your own physician. Individuals with severe blockages of the carotid artery (usually greater than 70 percent blockage) may be recommended CEA. During this procedure, the plaque from inside the artery wall will be surgically removed and the blood flow restored to normal. CEA procedure can be performed through a small incision, and in some cases under regional anesthesia. Most patients can go home the morning after the surgery. Recovering from surgery is usually rapid and people can quickly resume their normal activities without any restirctions. CEA entails general anesthesia albeit small but there will be a scar in the neck, and will still need to be hospitalized for a day. Risks associated with traditional surgery are the usual anesthesia type risks, mild increase in occurrence of heart attacks, hematoma in the neck, small risk for stroke or TIA, risk for paralysis of vocal cord or laryngeal nerve palsy, infection or cellulitis in the incision site, etc.

A new “nonsurgical” endovascular treatment uses angioplasty and stents to open blocked carotid arteries. This procedure’s safety and efficacy has been tested in both high risk and standard risk patients, and is equivalent and non-inferior to traditional carotid artery surgery and does NOT involve general anesthesia, scar, or any risk to vocal cord paralysis or laryngeal nerve palsy. There are fewer heart attacks with stents in high and traditional (moderate) risk patients. The rest of the risks of this procedure are basically the same as traditional surgery.

Carotid Stent procedure
(CS) involves the placement of a small flexible tube in to an artery from the groin. The catheter is then directed to the neck to reach the carotid artery blockage. A balloon pushes open the artery wall and a stent (small metallic coil) is often left to keep the artery open. We have always used the latest in equipment and technology including the embolic protection devices. Centers that do this procedure have been selected by a rigorous process. First Coast Heart & Vascular Center physicians have a long history of performing CS procedure and have been among the leading physicians in many carotid clinical trials with excellent results. Each center must be CMS approved for this procedure. It must be realized that the number of procedures done by a physician matter in outcome. High volume centers, like Memorial Hospital Jacksonville, and high volume operators will have the lowest complications.

Prevention of Carotid Artery Disease

Stay healthy through exercise and proper nutrition and take all medications as your doctor prescribes. If you have risk factors for carotid artery disease, you should talk with your healthcare professional. If you have any symptoms, see help immediately as minutes are critical to your health.

Choosing a Doctor for a Stenting Procedure

When a patient is a candidate for the carotid stenting procedure, there are certain criteria to consider. Patients need to know how many carotid stenting procedures a physician has performed and look for experienced doctors who have completed at least 100 procedures with low complication rates. A doctor should be knowledgeable and using all types of embolic protection devices. These devices are used to prevent debris or clots from traveling to the brain during the procedure and causing TIA or stroke. Dr. Van Crisco and Dr. Michael Seawell at First Coast Heart & Vascular Center  have been involved in hundreds of carotid angioplasty and stent procedures. First Coast Heart & Vascular works as a team, we provide an extra level of expertise, discussing complicated cases with one another to achieve the best possible result for each patient. Along with our commitment to excellence comes a low incidence of complications — we have a rate of complications that is less than the national average.

Post-Operative Patient Care

First Coast Heart & Vascular Center willingly shares the most up-to-date scientific knowledge about cardiovascular topics with other physicians in the community through educational lectures and by permitting doctors from other practices to observe various surgical procedures. being asked by another doctor for our help with a procedure or with their patient is a high compliment, and we are glad to assist.

Follow-up care is an essential component of First Coast Heart & Vascular Center’s patient care. The practice offers accredited vascular technologists, along with an accredited vascular lab, to monitor patients for restenosis and progression of the disease.

At-risk patients are urged to see their primary care doctors for yearly full exam including listening to the neck for carotid bruits (Bruit-noise made in part by a blocked or tortuous artery). This is a potentially life-saving step. Early detection of severe disease can allow us to address the condition before it causes TIA, stroke, or death.