A healthy heart is central to overall good health. Embracing a healthy lifestyle at any age can prevent heart disease and lower your risk for a heart attack or stroke. You are never too old or too young to begin taking care of your heart. True, the younger you begin making healthy choices, the longer you can reap the benefits. But swapping good habits for bad to promote good health can make a difference, even if you’ve already suffered a heart attack.

Choosing healthier foods and exercising are two of the best ways to contribute to good heart health. There are additional things you can do to lower your risk for heart disease. Things that put you at higher risk for heart disease include

• Smoking
• High blood pressure
• Obesity/being overweight
• High cholesterol levels
• Inactivity (no exercise)
• Family history of heart disease (especially a parent or sibling)

The good news is that it is possible to decrease your risk by making changes in the way you live your life. Even if you have a family history of heart disease, the power of prevention is on your side.

Path to improved health

You are in direct control over many things that can influence your heart health. It’s up to you to choose how seriously you take this responsibility. Some people find it easy to adopt a healthy lifestyle. Others will do so only after being diagnosed with a symptom of heart disease, like high blood pressure, or high cholesterol.

Whatever your inspiration, the benefits of a healthy heart are worth the effort. In fact, your entire body will be better for it. Good overall health can also protect you from type 2 diabetes, asthma, joint pain, and other chronic diseases and conditions. It can even reduce your risk for cancer. Additionally, a healthy lifestyle that includes eating healthy foods and getting regular exercise has been proven to boost your mood. You’ll have more energy and an a healthy way of managing your stress.

If you aren’t sure where to begin, try adding just one healthy aspect to your life for now. As you feel that you are gaining control, try adding another, then another. Pretty soon, you’ll feel empowered instead of overwhelmed.

Make healthy food choices

Balance is the key to eating healthy long-term. Your diet should consist mainly of fruits, vegetables, whole grains, nuts, and lean proteins. If you eat this way most of the time, you’ll be able to indulge occasionally

Allowing yourself to eat something you crave from time to time is important. So do not feel guilty about treating yourself as a reward for eating healthy. Just make sure that you aren’t treating yourself too often.

As you choose your vegetables, keep color in mind. A colorful plate with plenty of red, orange, yellow, and dark-green vegetables provides the vitamins and minerals you need.

Cut down on or even eliminate heavily processed foods. Heavily processed foods are the boxed and packaged foods, especially those that are ready to eat (think crackers, potato chips, and mac and cheese, even drive-through foods). Also, look for foods low in sodium (salt). Remember, canned foods contain a lot of sodium.

Drink water instead of soda and energy drinks. There is an incredible amount of sugar in soda and energy drinks. Drinking water in place of these can significantly impact your health for the better. Aim for drinking at least 8, 8-ounce glasses of water each day.

Watch your weight

Being obese or overweight is not healthy. The more weight you gain, the higher your body mass index (BMI). Your BMI is a measure of your body fat based on your height and weight. The higher your BMI, the higher your risk for high blood pressure, high cholesterol, and high blood sugar levels. Being obese also puts you at risk for breathing problems, gallbladder disease, liver disease, and even cancer.

Making healthy food choices in combination with an exercise program is the best way to lose weight. Even a small amount of weight loss can make a big difference in your health. According to the American Heart Association (AHA), losing just 5% to 10% of your body weight can reduce your risk for having a heart attack or stroke.

Be active

You don’t have to be a member of a gym or buy fancy equipment to exercise. The key is just to get up and move. Go for a walk. Take the stairs at work. Do some push-ups or sit-ups. Dance. The U.S. Department of Health and Human Services recommends at least 2 hours and 30 minutes of moderate aerobic activity for adults each week plus 2 days of strength training each week. Children should get at least an hour of activity every day. They should also get more intensive exercise at least 3 days a week that increases their heart rate.

Aerobic exercise has a direct effect on your heart. Your heart is a muscle and exercise strengthens it. A strong heart can more efficiently pump blood to deliver oxygen and nutrients to other parts of your body. Exercise can lower your risk for developing plaque in your arteries. Plaque is a waxy substance that can clog arteries and reduce blood flow to your heart. If plaque builds up too much, it can even block the artery. This is what causes a heart attack.

Know your numbers

Every adult should know their blood pressure and cholesterol level. Beginning at age 18, you should have your blood pressure checked at least every 3 to 5 years. There are often no symptoms associated with high blood pressure. The best way to know for sure is to check.

Young adults who are age 20 and older and who smoke or have a family history of heart disease should have regular cholesterol screenings. Otherwise, women should begin having regular cholesterol checks when they are 45. Men should begin them at age 35. If you have been diagnosed with high blood pressure or high cholesterol, you should also be screened for diabetes.

Stop smoking

No new news here. Smoking is bad for you. It causes cancer. It damages your lungs. It’s also terrible for your heart. Smoking increases your risk for heart disease. It damages the lining of your arteries. There are numerous studies that provide evidence that smoking cigarettes is a major cause of coronary heart disease, which leads to heart attacks

If you currently smoke, it’s a great time to stop. There are medicines that can help as well as other “quit smoking” tools such as nicotine gum and patches. Vaping is not a tool to help you quit, so don’t trade smoking for vaping. Ask your doctor to recommend a resource. Try to steer clear of secondhand smoke as well.

Don’t take gums for granted

Many people don’t know that there is a link between oral health and heart disease. In fact, periodontal disease (gum disease) has been associated with other health issues, including premature birth, arthritis, and diabetes

It is not clear whether heart disease causes gum disease or vice versa. Some medical professionals believe the bacteria that cause gum disease spread from the mouth through the body. As they spread, they make inflammation worse. This increased inflammation can trigger or worsen inflammatory conditions like heart disease. Preventing gum disease can help with your overall health. Regular brushing, flossing, and dental checkups are the best way to keep oral health in check.

If you already have gum disease, you should schedule regular cleanings with a periodontist (a dentist who specializes in gum disease and oral inflammation). There is strong evidence that controlling gum disease can help reduce your risk for heart disease

Stop stressing

Managing your stress can reduce your risk of heart attack and stroke. Stress is often associated with high blood pressure. Chronic stress exposes your body to elevated levels of stress hormones, which also is not healthy

Everyone deals with stress differently. The way you react to it can directly impact your health. There are breathing exercises that can help you process stress. Meditation has also proven to be an effective way to manage stress. Exercise is also a great way to deal with it. Poor ways to react to stress are to smoke, to drink alcohol, or to let it interfere with sleep

Things to consider

Heart disease is consistently a leading cause of death in the United States. Heart disease often leads to heart attack or stroke

Heart attack

A heart attack (also called a myocardial infarction) occurs when blood flow to the heart is blocked. This blockage is caused by a buildup of plaque (fat and cholesterol). During a heart attack, part of the heart muscle is damaged, sometimes destroyed.

Heart attacks can be deadly. If you are having a heart attack, the quicker you get medical care, the more likely you are to survive. Treatment for a heart attack varies. Depending on the severity of the attack, your doctor may need to perform surgery. During surgery, they will attempt to clear or repair the blocked artery. Your doctor may also prescribe medicines to thin your blood and lower blood pressure

Stroke

A stroke occurs when blood supply to the brain is blocked. This can happen when a vein is blocked or when it bursts. The blockage interrupts the delivery of oxygen to the brain, which causes brain cells to die

Strokes can be deadly. If you are having a stroke, the quicker you get medical care, the more likely you are to survive. Also, quick medical care can help prevent side effects of having a stroke. Side effects include temporary or permanent paralysis and speech problems. Treatment for stroke depends on the type of stroke. In some instances, surgery is required. Other times, a stroke responds to medications

When to see a doctor

Depending on your age, you should be receiving regular screenings from your doctor for blood pressure and cholesterol level. These are two indicators of heart disease. If you have been diagnosed with heart disease, your doctor will prescribe a treatment plan that includes a healthy lifestyle. It also will likely include prescription medications to help control cholesterol or high blood pressure.

If you believe you are having a heart attack or stroke, you should call 911 immediately. Heart attack symptoms vary in men and women. Talk to your doctor about the signs of heart attack most often present in men and those most often present in women. Regardless, common heart attack signs include

• Chest discomfort­– This can be pressure, tightness, squeezing, or pain in the center of your chest. It usually lasts for more than a few minutes. Sometimes it goes away and comes back.
• Pain in one or both arms– Sometimes this pain isn’t limited to your arms. You may feel pain in your jaw, neck, back, or stomach. This will come on suddenly and may feel like indigestion.
• Shortness of breath
• Cold sweat
• Dizziness

Stroke symptoms are often more easily recognizable than those for a heart attack. According to the AHA, here is how to spot a stroke F.A.S.T.:

• Face drooping– Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
• Arm weakness– Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• Speech difficulty– Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
• Time to call 911– If someone shows any of these symptoms, even if the symptoms go away, call 911 and get the person to the hospital immediately. Check the time so you’ll know when the first symptoms appeared.

Questions to ask your doctor

• Can I inherit heart disease?
• At what age do I need to begin taking my heart health seriously?
• What is the best indicator of heart disease?
• What are the symptoms in men? What are the symptoms in women?
• Can I really prevent heart disease?
• What is the best way assess my heart health?
• How can I stop smoking?
• What is the safest exercise for me to do?

Resources

Centers for Disease Control and Prevention: Prevent Heart Disease

National Institutes of Health: What is a Heart Attack?

U.S. Department of Health and Human Services: Keep Your Heart Healthy

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What is homocysteine?

Homocysteine is an amino acid (a building block of protein) that is produced in the body.

How is a high homocysteine level harmful?

High homocysteine levels in the blood can damage the lining of the arteries. High levels may also make the blood clot more easily than it should. This can increase the risk of blood vessel blockages. A clot inside your blood vessel is called a thrombus. A thrombus can travel in the bloodstream. From there, it can get stuck in your:

• Lungs (called a pulmonary embolism)
• Brain (which can cause a stroke)
• Heart (which can cause a heart attack)

Some people have very high levels of homocysteine. They are at an increased risk for heart disease.

What causes a high homocysteine level?

Homocysteine is normally changed into other amino acids for use by the body. Vitamin B helps your body use the homocysteine. If your homocysteine level is too high, you may not be getting enough B vitamins.

Most people who have a high homocysteine level don’t get enough folate (also called folic acid), vitamin B6, or vitamin B12 in their diet. Replacing these vitamins often helps return the homocysteine level to normal. Other possible causes of a high homocysteine level include:

• Low levels of thyroid hormone
• Kidney disease
• Psoriasis
• Some medicines
• When the condition is common in your family

How is the homocysteine level measured?

Homocysteine is measured using a simple blood test. Your doctor will order the test only if they suspect you have high levels. If your homocysteine level is too high, you need to lower it. This is especially important if you have blockages in your blood vessels. Sometimes your doctor may take a watchful waiting approach. This means they will monitor your level closely but not take steps to lower it. Your doctor may do this if you have no other major risk factors for cardiovascular disease and you don’t have atherosclerosis (a buildup of plaque in your arteries). If your homocysteine level increases further, you may need to lower it.

No studies have shown that lowering homocysteine levels helps reduce strokes, heart attacks, or other cardiovascular conditions. But a high homocysteine level is a risk for heart disease. So, it’s a good idea to lower it if you can.

Path to improved health

How can I lower a high homocysteine level?

Eating more fruits and vegetables can help lower your homocysteine level. Leafy green vegetables such as spinach are good sources of folate. Other good sources of folate include:

• Many breakfast cereals
• Fortified grain products
• Lentils
• Asparagus
• Most beans

You may need to increase the amount of vitamin B-6 in your diet. Foods that are rich in vitamin B-6 include:

• Fortified breakfast cereals
• Potatoes
• Bananas
• Garbanzo beans (chickpeas)
• Chicken

You also may need to increase the amount of vitamin B-12 you eat. Good sources of vitamin B-12 include:

• Dairy products
• Organ meats (such as liver)
• Beef
• Some types of fish

Adjusting your diet may not be enough to lower your homocysteine level. If it’s not, your doctor may suggest that you take a folate supplement. You may also need to take a vitamin B-6 and vitamin B-12 supplement.

Things to consider

If you start taking folate or vitamin B supplements, you should have your homocysteine level rechecked after 8 weeks. If your homocysteine level remains high, your doctor may have you try a higher dose. You may need to have some tests to see if you have another health condition that causes high homocysteine levels. If you have had a high homocysteine level, you may need to have your level checked more regularly (2 or 3 times a year).

Questions to ask your doctor

• What is causing my homocysteine level to be high?
• Could a high level be the sign of another condition?
• Can I lower my homocysteine level through diet alone?
• Should I take a supplement?
• Can I ask my doctor to check my homocysteine level even if I have no symptoms?

Resources

National Institutes of Health, MedlinePlus: Homocysteine Test

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Are you at high risk for heart disease? Take a moment to consider your lifestyle, family history, and general health. You and your doctor can use this information to tackle potential problems and maybe even lower your risk.

Path to Improved Health

The following factors may impact your risk of heart disease.

Age

Men older than 45 years of age and women older than 55 years of age (or who have gone through menopause) are at greater risk for heart disease. Also, the rates of heart attack over the last 20 years have been increasing for women 35 to 54 years of age.

Family history

It is important for you to know what diseases and conditions run in your family and to tell your doctor. Talk to your parents, grandparents, siblings, aunts, and uncles. Ask them who in your family has had a heart attack, stroke, or other serious health problem. With this information, your doctor can recommend the best kinds of screening tests and preventive treatments.

Cholesterol

If you don’t know your cholesterol level, ask your doctor if you should have it checked. There are good (HDL cholesterol) and bad (LDL cholesterol) types. To reduce and prevent high levels of bad cholesterol, eat a healthy diet and exercise regularly. Some people who have high cholesterol levels may also need to take medicine to keep their levels under control.

Blood pressure

If your blood pressure is high, there are things you can do to lower it. Try:

• Losing weight
• Exercising
• Not smoking
• Cutting down on sodium (salt)
• Cutting down on alcohol

Many people may also need to take medicine to control their blood pressure.

Smoking

Quitting smoking is the single best change you can make for your health. Talk to your family doctor about how to quit and stay tobacco-free. If you live with a smoker, breathing their smoke can also affect your health. Encourage the smoker to quit.

Diet

A healthy diet includes vegetables, fruits, lean meats, fish, beans, whole grains, and healthy fats. Limit the amount of processed foods (such as hot dogs), white flour (such as crackers and white bread), and sweet or sugary foods (such as soda and dessert foods) you eat. You may also need to avoid foods that are high in sodium, which can increase blood pressure. Sodium is found in table salt and many prepared foods, especially canned foods.

Although some research suggests alcohol can help protect against heart disease, moderation is the key. Limit how much alcohol you drink. This means no more than one alcoholic drink per day for women, and two alcoholic drinks a day for men.

The Mediterranean Diet is one good example of a heart-healthy diet that follows these guidelines. If you have questions about making changes to your diet, talk to your doctor. They can help you make better choices or refer you to a dietician.

Weight

Being overweight puts extra strain on your heart and blood vessels. A healthy diet with portion control, wise food choices, and regular exercise can help you lose weight gradually and safely. It can also help you keep it off. Talk to your doctor about the best ways for you to lose weight.

Exercise

Exercise can help prevent heart disease and many other health problems. You’ll also feel better and help keep your weight under control if you exercise regularly. If you haven’t exercised for a while or have health problems, talk to your doctor before you start an exercise program. Exercising 30 to 60 minutes, 4 to 6 times a week is a good goal, but any amount is better than none.

Things to Consider

Heart disease can lead to heart attack or stroke. Often there are warning signs of heart disease. These can include elevated “bad” cholesterol levels and high blood pressure. But these warning signs don’t always have symptoms. That is why it is important to work with your doctor to assess your risk.

Questions to Ask Your Doctor

• What are the warning signs for heart disease?
• Is my blood pressure in the normal range?
• Do I have high cholesterol levels?
• Can I be at risk for heart disease even if I have no family history of heart disease?
• How often should I be monitored for heart disease?

Resources

American Heart Association: What is Cardiovascular Disease?

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Many people monitor their blood pressure at home. They often do this to manage or treat a certain health condition. If you monitor your blood pressure at home, keep a record or log of the measurements. The record shows your doctor how your blood pressure changes throughout the day. If you take medicines to control your blood pressure, it will help document if they are working. Measuring your blood pressure at home is a good way to actively manage your health.

Path to improved well being

What equipment do I need to measure my blood pressure at home?

To measure your blood pressure at home, you can use either an aneroid (manual) monitor or digital monitor. Choose the type of monitor that best meets your needs. Look at the following features when you select a monitor.

• Size: The right cuff size is very important. The cuff size you need is based on the size of your arm. You can ask the doctor, nurse, or pharmacist to help you. Blood pressure readings can be wrong if your cuff is the wrong size.
• Price: Cost may be a key factor. Home blood pressure units vary in price. You may want to shop around to find the best deal. Keep in mind that pricey units may not be the best or most accurate.
• Display: The numbers on the monitor should be easy for you to read.
• Sound: You must be able to hear your heartbeat through the stethoscope (if checking manually).

Tests show that finger and wrist devices do not always provide correct measurements. These devices are sensitive to placement and body temperature. They also are expensive and can cost more than $100.

Aneroid monitor

The aneroid monitor manually checks your blood pressure. It has a gauge that you read by looking at a pointer on the dial. The cuff goes around your upper arm, and you squeeze a rubber bulb to inflate it by hand.

Aneroid monitors often cost less than digital monitors. They range in price from about $20 to $40. The cuff has a built-in stethoscope. You don’t need to buy a separate one. The unit may have a feature that makes it easy to put the cuff on with one hand. It also is portable and can be carried easily from one place to another.

There are some drawbacks to the aneroid monitor. It is a complex device that can be damaged easily and become less accurate. The device may be hard to use if it doesn’t have a metal ring to tighten the cuff. This is what makes it easier to put on the cuff. Additionally, the rubber bulb that inflates the cuff may be hard to squeeze. This type of monitor may not be best for hearing-impaired people, because of the need to listen to your heartbeat through the stethoscope.

Digital monitor

Digital monitors are more popular for measuring blood pressure. They often are easier to use than aneroid units. The digital monitor has a gauge and stethoscope in one unit. It also has an error indicator. The blood pressure reading displays on a small screen. This may be easier to read than a dial. Some units even have a paper printout that gives you a record of the reading.

Inflation of the cuff is either automatic or manual, depending on the model. Deflation is automatic. Digital monitors are good for hearing-impaired patients, since there is no need to listen to your heartbeat through the stethoscope.

There are some drawbacks to the digital monitor. Body movements or an irregular heart rate can affect its accuracy. Some models only work on the left arm. This can make them hard for some patients to use. Digital monitors are more expensive. They range in price from about $30 to more than $100. They also require batteries.

How do I know if my monitor is accurate or if I am using it correctly?

Once you buy your device, have your doctor check it for accuracy. They should check your monitor once a year. On your own, periodically check the tubing for cracks and leaks. Proper care and storage are necessary. Make sure the tubing is not twisted when you store it. Keep it away from heat.

Ask your doctor or nurse to teach you how to use your blood pressure monitor correctly. This will help you achieve good results in controlling your blood pressure.

How do I measure my blood pressure?

Before you check your blood pressure, you should:

• Wait 30 minutes after eating or using caffeine, alcohol, or tobacco products.
• Go to the bathroom and empty your bladder.
• Rest for 3 to 5 minutes and do not talk.
• Sit in a comfortable position, with your legs and ankles uncrossed and your back supported.
• Elevate your left arm to the level of your heart. Place it on a table or desk and sit still.
• Wrap the cuff around the upper part of your bare arm. The cuff should be smooth and snug. There should be enough room for you to slip one fingertip under the cuff.
• Check the placement of the cuff. The bottom edge of it should be 1 inch above the crease of your elbow.

Below are the steps to take to use an aneroid monitor.

• Put the stethoscope earpieces into your ears. The earpieces should face forward, toward your eyes.
• Place the stethoscope disk on the crease of your inside elbow.
• Inflate the cuff by squeezing the rubber bulb. Keep squeezing until the pointer on the dial reaches 30 to 40 points higher than your last systolic reading. The systolic reading is the top number of blood pressure. Inflate the cuff at a rapid rate, not just a little at a time. Inflating the cuff too slowly will cause a false reading.
• Slightly loosen the valve on the unit and slowly let some air out of the cuff. Deflate the cuff by 2 to 3 millimeters per second. If you loosen the valve too much, you won’t be able to measure your blood pressure.
• As you let the air out of the cuff, you will begin to hear your heartbeat. Listen carefully for the first sound. Check the blood pressure reading by looking at the pointer on the dial. This number is your systolic pressure.
• Continue to deflate the cuff. Listen to your heartbeat. You will hear your heartbeat stop at some point. Check the reading on the dial. This number is your diastolic pressure.
• Write down the measurement in your record. The systolic pressure goes in front of the diastolic pressure. For example, 120/80.
• If you need to repeat the measurement, wait 2 to 3 minutes before starting.

Below are the steps to take to use a digital monitor.

• Turn the power on to start the unit.
• On the automatic models, the cuff will inflate by itself with a push of a button. On the manual models, you have to inflate the cuff. You do this by squeezing the rubber bulb at a rapid rate.
• After the cuff inflates, the automatic device will slowly let air out.
• Look at the display screen to get your blood pressure reading. It will show your systolic and diastolic pressures. Write down the measurement in your record. The systolic pressure goes in front of the diastolic pressure. For example, 120/80.
• Press the exhaust button to release all of the air from the cuff.
• If you need to repeat the measurement, wait 2 to 3 minutes before starting.

Things to consider

What does my blood pressure reading mean?

Normal blood pressure is 120/80 or lower. High blood pressure is 140/90 or higher. If your blood pressure is between 120/80 and 140/90, you may have something called prehypertension. This means that you are at risk for high blood pressure.

If you have diabetes or kidney disease, high blood pressure ranges may be lower than for other people. Or, if you are older than 65, goal blood pressure may be higher. Talk to your doctor about what is considered high blood pressure for you. 

Medical terms

Monitoring your blood pressure at home can be confusing. Below is a list of terms that are helpful to know.

• Blood pressure: The force of blood against the walls of the artery.
• Hypertension: High blood pressure.
• Hypotension: Low blood pressure.
• Brachialartery: A blood vessel that goes from your shoulder to below your elbow. You measure your blood pressure in this artery.
• Systolic pressure: The highest pressure in an artery when your heart is pumping blood to your body.
• Diastolic pressure: The lowest pressure in an artery when your heart is at rest.
• Blood pressure measurement: A calculation of both the systolic and diastolic  It is written or displayed with the systolic number first and the diastolic pressure second. For example, 120/80. This is a normal blood pressure reading.

When to see the doctor

The doctor should check your monitor at least once a year. This ensures that the measurements are accurate.

Only a doctor can diagnose you with high blood pressure. A diagnosis requires multiple readings, so keeping a log is important. You should also log the time of day you you’re your blood pressure. Contact your doctor if you have high readings for several days. Be sure to take your blood pressure log with you to the visit.

Hypotension is low blood pressure. This occurs when your systolic pressure is consistently below 90 or is 25 points below your normal reading. Contact your doctor if you have low readings. Hypotension can be a sign of shock, which is life threatening. Call your doctor right away if you are dizzy or lightheaded.

Questions to ask your doctor

• Why do I need to monitor my blood pressure at home?
• How often do I need to measure my blood pressure?
• What type of monitor should I use?
• What do my blood pressure readings mean?
• What is considered a normal blood pressure for me?
• What should I do if my readings are abnormal?
• Are there any lifestyle changes I can make to help manage my blood pressure?
• Do I need to take medicine to manage my blood pressure?
• What other things can affect a blood pressure reading?

Resources

American Heart Association: Monitoring Your Blood Pressure at Home

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An abdominal ultrasound is an imaging test. It allows your doctor to look inside your abdomen (often referred to as your stomach or belly) without surgery. The abdomen is the part of your body that contains your stomach, large and small intestines, pancreas, liver, and gallbladder. It contains blood vessels, including the main artery that supplies blood from your heart (aorta), the large vein that carries blood to your heart (inferior vena cava) and all of its branches. Also, it contains muscles and your spine.

An abdominal ultrasound is safe. The test may cause only mild discomfort. It is performed on people of all ages. A trained medical technician moves a handheld device (called a wand) across your belly. The wand is connected to an ultrasound machine. As the technician moves the wand across your belly, it produces high-frequency sound waves. Those sound waves create real-time images and video of the inside of your belly. The images look similar to an X-ray. However, ultrasound picks up things that aren’t seen by an X-ray.

Before starting the process, the technician will apply a small amount of a clear gel to your stomach. This helps the wand move easily. The gel may feel cold.

Path to improved well being

Abdominal ultrasounds are performed on people who have unexplained abdominal pain or have had abdominal injuries. When you arrive for your ultrasound, you will be asked to undress and put on a light gown. You’ll lie on your back next to the ultrasound machine. A technician will apply the gel onto your abdomen and spread it around using the wand. The technician will watch the images as they appear on a nearby monitor. They will record the images for the doctor to review. The test typically takes less than 30 minutes to complete. You will not get results from the technician. They will send the images to your doctor to review. Your doctor’s office will contact you with the results.

An abdominal ultrasound is one of the primary tests used to find an abdominal aortic aneurysm. This is a medical condition that causes the artery that supplies blood to the lower part of your body to bulge. On rare occasions, the bulge can burst (called an abdominal aortic rupture). This can be dangerous, even deadly. When it bursts, it can cause internal bleeding and requires immediate medical attention.

Men who smoke or used to smoke are at a higher risk of having an aortic aneurysm. This is especially true for men over the age of 65. If you are a male who has ever smoked, and are between the ages of 65-75, talk to your doctor about an abdominal ultrasound to determine your risk for this condition. Others at risk for an aortic aneurysm include people who are white, have a family history of a thickening of artery walls, have high blood pressure, have had an aneurysm in another artery, or are severely obese. If you are having an abdominal ultrasound for an aortic aneurysm, your doctor may have you fast (no food or liquid, except water) for 8 to 12 hours before your test. Having food and liquids in your stomach or urine in your bladder makes it difficult for the technician to see inside your abdomen. Other reasons your doctor may order this test include:

• To locate the cause of a kidney infection
• To diagnose and track tumor growth and cancer
• To diagnose or treat fluid buildup in your abdomen
• To check the swelling of organs inside the abdomen
• To examine the damage from an injury to your spleen
• To locate kidney or gallbladder stones
• To determine the cause of abnormal liver or kidney blood tests
• To check for unexplained causes of fever
• To guide a biopsy procedure (using a needle to take a sample of a tumor or tissue from your abdomen)

Things to consider

Your doctor will examine you before deciding if you should have an abdominal ultrasound. Ultrasounds do not expose you to radiation. You may have some mild discomfort as the wand is moved over the area of your abdominal pain.

An abdominal ultrasound is less effective on people who are severely obese. Excess fat and tissue will block the technician’s view of organs and arteries. If your doctor recommends an abdominal ultrasound for your liver, gallbladder, spleen, or pancreas, eating a fatty meal before the test will limit the technician’s view of those organs.

Questions to ask your doctor

• Why would my doctor choose an abdominal ultrasound over an X-ray or a CT scan?
• Will an abdominal ultrasound expose my insides to anything harmful?
• If the technician finds that I have excess air inside my stomach or organs, will I be asked to return at another time?
• Can this be done in my doctor’s office?

Resources

National Institutes of Health, MedlinePlus: Abdominal Ultrasound

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Blood pressure is the amount of force that your blood puts on your artery walls as it moves through your body. High blood pressure (also called hypertension) occurs when your blood moves through your arteries at a higher pressure than normal. Many different things can cause high blood pressure. If your blood pressure gets too high or stays high for a long time, it can cause health problems. That is why it is important to treat high blood pressure. Medicines are one of the most common methods of treatment.

Path to improved health

There are many types of medicine used to treat high blood pressure. Your doctor will decide which type of medicine is right for you. These are the most common:

• ACE inhibitors (angiotensin-converting enzyme inhibitors) keep your body from making the hormone angiotensin II. This hormone causes blood vessels to narrow. This type of medicine relaxes your blood vessels and opens them up.
• Alpha blockers help relax your blood vessels by reducing nerve impulses. This allows your blood to pass through more easily.
• Angiotensin II receptor blockers (ARBs) block the effects of the hormone angiotensin II. This hormone causes blood vessels to narrow. This type of medicine allows your blood vessels to stay open.
• Beta blockers make the heart beat slower so that blood passes through your blood vessels with less force.
• Calcium channel blockers (CCBs) prevent calcium from entering the cells of your heart and arteries. This helps keep your blood vessels from contracting with extra force.
• Central agonists reduce the nerve impulses that cause the blood vessels to tense up or contract. They work the same way as alpha and beta blockers, but they follow a different nerve pathway.
• Diuretics (water pills) help your body get rid of extra sodium (salt) and water. This reduces the amount of fluid flowing through your blood vessels and lowers your blood pressure. These will make you urinate more.
• Vasodilators (blood vessel dilators) relax the muscles in the blood vessel walls. This causes the blood vessels to widen (dilate) so blood can flow through better.

Things to consider

All medicines can have side effects. Some possible side effects of high blood pressure medicines include:

• Chest pain, heart palpitations (the feeling that your heart is racing), or arrhythmia (irregular heartbeat)
• Cough, fever, congestion, upper respiratory tract infection, or flu-like symptoms
• Diarrhea or constipation
• Dizziness or lightheadedness
• Headache
• Nausea
• Nervousness or anxiety
• Problems with erections and sexual function
• Skin rash
• Tiredness, weakness, drowsiness, or lethargy (lack of energy)
• Unintended weight loss or gain
• Vomiting

Tell your doctor as soon as possible if your side effects become severe or bothersome.

What about medicine interactions?

If you use 2 or more medicines at the same time, the way your body processes each one can change. When this happens, the risk of side effects from each medicine increases. Each medicine may not work the way it should. Be sure your doctor knows all the medicines you are taking. These include prescription and over-the-counter medicines, vitamins, and herbal supplements.

Also ask your doctor whether you need to avoid any foods or drinks while using your blood pressure medicine. For example, people taking certain CCBs may need to avoid eating grapefruit or drinking grapefruit juice.

Questions to ask your doctor

• What type of blood pressure medicine is best for me?
• How does this medicine work?
• What are the side effects of this medicine?
• How long will I need to take this medicine?
• Are there any lifestyle changes I can make to lower my blood pressure?

Resources

American Heart Association: What You Should Know About High Blood Pressure and Medications

U.S. National Library of Medicine, MedlinePlus: Blood Pressure Medicines

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An electrocardiogram (also known as an EKG or ECG) is a painless test that measures the electrical activity of your heart. It records this activity as short, wavy lines that dip up and down on graph paper. The size and shape of these dips can reveal many things about the health of your heart.

Your doctor may order an EKG for several reasons. They may order the test to see if you have heart disease or heart damage. An EKG can be used to see if medications are affecting your heart. Your doctor also may use an EKG to check on any implanted heart equipment (a pacemaker, for example) you have.

An EKG is used to diagnose:

• Arrhythmia – A heartbeat that’s too fast, too slow, or irregular.
• Cardiomyopathy – A heart muscle that is too thick or parts of the heart that are too large.
• Congenital heart defects – Birth defects of the heart.
• Coronary heart disease – Lack of blood flow to the heart muscle.
• Heart attack – Damage to the heart caused from a blocked artery.
• Heart failure – A heart that is not pumping with enough force.
• Heart valve disease – Problems with the heart valves.
• Pericarditis – Inflammation of the sac surrounding the heart.

An EKG will determine if your heart beats normally by measuring any abnormality in heart rate or rhythm. If you’re healthy, your heartbeat should be consistent and even.

Path to improved health

If your doctor determines that you should have an EKG, the test will take place either in the doctor’s office or at a hospital. A technician typically performs the test.

The technician may ask you to change into a hospital gown. After changing, you’ll be asked to lie on an exam table or on a bed. The technician will attach 12 to 15 electrodes (stickers) to your chest, arms, and legs using stickers. The stickers may be cold but will not hurt when they are attached to your skin. Sometimes, the technician may have to shave or clip your body hair to make the electrodes stick to your body the way they should.

Once the electrodes are attached, the test will begin. These electrodes can detect the electrical currents of your heart, using your body’s natural electrical system. The EKG machine will record the impulses that make your heartbeat. These impulses will create the wavy lines on the graph paper.

EKGs are painless. The only challenge, especially for children, will be lying completely still for the test. A standard test will usually last only a few minutes. During the test, you can breathe normally. Depending on what the doctor is looking for, the technician may ask you to hold your breath for a short time during the test.

The results of the EKG will be available immediately. If you had your EKG in the doctor’s office, your doctor may go over your results with you right then. Typically, though, your doctor will also have cardiologist (a doctor who specializes in heart health) review your results, too.

Things to consider

An abnormal result on your EKG does not always mean that your health is in danger. It could mean that your heart has a normal variation to its rhythm. This does not affect your health.

Other times, an abnormal EKG can be a sign of a true medical emergency. For example, EKGs can reveal if you’ve had or are having a heart attack.

A heart problem may not always show up on an EKG. If you believe that there is something wrong with your heart even after a normal result on your EKG, discuss your concerns with your doctor. You may also want to get a second opinion.

Questions to ask your doctor

• Why are you ordering an EKG?
• How long will my EKG take?
• Can I take my regular medication before my EKG appointment?
• Can I have an EKG if I am pregnant?
• When will you have my results?
• Will you notify me of my test results even if they are normal?
• Will you have to put my small child to sleep for the EKG?

Resources

American Heart Association: Electrocardiogram (ECG or EKG)

National Heart, Lung, and Blood Institute: Electrocardiogram

National Institutes of Health, MedlinePlus: Electrocardiogram

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A cardioverter-defibrillator (ICD) is a type of medical implant device. It tracks and treats an irregular heartbeat (arrhythmia). It sends an electric current through your heart when needed. The ICD is smaller than a cell phone. It has two main parts: a pulse generator and a lead (wire). The pulse generator monitors your heartbeat. It is like a small computer that runs on a battery. The lead goes from the pulse generator to the inside of your heart. It sends signals and electric currents between your heart and the pulse generator. Some people need multiple leads with their ICD.

Path to improved well being

Your doctor may recommend an ICD to treat your irregular heartbeat. There are many different types of arrhythmias. Treatment depends on what kind you have. An ICD is one form of treatment. You may need an ICD if you have or are at high risk of a life-threatening ventricular arrhythmia. Examples include ventricular tachycardia and ventricular fibrillation. Having a previous heart attack, heart disease, or cardiac arrest are other reasons you may need an ICD.

Ventricular tachycardia is when the bottom chambers of your heart (the ventricles) beat too fast. When this happens, your heart has a hard time pumping blood. As a result, your body and brain don’t get enough blood. This is life threatening.

Ventricular fibrillation is when the bottom chambers of your heart (the ventricles) beat too fast and unevenly. The heart flutters, and little or no blood is pumped to your body and brain. Someone who has this type of arrhythmia is at risk of passing out. Treatment is required within minutes in order to prevent death.

How is an ICD implanted?

A doctor or surgeon implants an ICD during minor surgery. The pulse generator is placed under your collarbone on the left or right side of your chest, or in your abdomen (stomach area). It can go in a “pocket” under your skin or in a muscle. The doctor inserts one end of the lead (wire) into a vein that goes to your heart. They move the wire through the vein until it reaches the heart. The other end of the wire gets attached to the pulse generator. Once it is implanted, the doctor programs and tests the ICD to treat your heart rhythm problem. The process requires a short hospital stay.

How does an ICD work?

The ICD’s job is to quickly recognize and stop problems. It does this by keeping track of your heart rhythm at all times. If your heartbeat becomes irregular, the ICD delivers the treatment. Your doctor can program the ICD to do several things.

• Pacing: For mild ventricular tachycardia, the ICD can deliver several pacing signals in a row. These signals cause your heart to return to a normal rhythm.
• Cardioversion: This is used if pacing doesn’t work. Cardioversion sends a mild shock to your heart to stop the fast heartbeat.
• Defibrillation: For ventricular fibrillation, the ICD sends a stronger shock. This can stop the fast rhythm and help the heartbeat go back to normal.
• Pacemaker: The ICD can detect when your heart beats too slow. It can act like a pacemaker and bring your heart rate up to normal.

What does treatment with an ICD feel like?

When the ICD delivers pacing or acts as a pacemaker, you may not feel anything. This is because little energy is used. Some people feel fluttering in their chest. However, there is no pain or discomfort. Cardioversion is stronger. It can feel like a thump in your chest.

Defibrillation is the strongest. Most people say it feels like being kicked in the chest. It often happens all of a sudden. It lasts less than a second. It can make you upset or anxious afterward. However, it’s important to remember that it probably saved your life.

Things to consider

An ICD does not cure an arrhythmia or heart disease. It manages your condition(s) and helps prevent cardiac arrest and death. In addition to ICD, your doctor may prescribe medicine. Follow all instructions and tell your doctor what other medicines you take. Ask your doctor for an ICD wallet ID card. It is important that you carry this at all times. You will need this when you travel and in case of an emergency.

How will an ICD affect my lifestyle?

After you get an ICD, you will need to limit activity. This allows your body to adjust and heal properly. You can slowly go back to your regular lifestyle. Ask your doctor when it is safe to drive a car again. It will vary based on your condition and the local laws. You can expect to be back to normal after a month.

You need to stay away from machines that could interfere with your ICD. Do not work near strong magnetic or electrical fields. The ICD is safe around most home power tools and electric appliances, including microwave ovens. However, make sure that all electric items are properly grounded and in good repair. Your doctor can help you understand what to avoid when you have an ICD. Machines, devices, or procedures that may cause interference include:

• Security metal detectors
• Magnets
• Power-generating equipment
• Some power tools and electronic devices
• Electric fences and transformer boxes
• Electronic mattresses or pillows
• Anti-theft systems
• Cell phones
• Magnetic resonance imaging (MRI)
• Therapeutic radiation
• Electrolysis (electric hair removal)

When to see a doctor

Your doctor should test your ICD at regular checkups. Its generator battery can last 5 to 7 years. It can be replaced in outpatient surgery.

Getting an ICD may cause new emotions or depression. Talk to your family and a doctor if this happens to you. The doctor can recommend counseling or a support group.

Questions to ask your doctor

• Once I have an ICD will I always need it?
• How do I care for my wound after ICD surgery?
• How long after getting an ICD can I return to my normal activities?
• Can I drive?
• Can I have sex?
• Can I play video games and use electronics?
• Will I know when a shock is coming?
• How do I know if my ICD is working or not?

Resources

National Institutes of Health, MedlinePlus: Implantable cardioverter-defibrillator

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If you’ve had a heart attack, your doctor has probably prescribed medicines you’ll need to take for a long time. These medicines:

• Help improve blood flow to your heart
• Prevent blood clotting
• Reduce your risk of having more heart problems in the future

Path to improved health

Below is information about medicines that are commonly prescribed to treat heart attack. This includes their benefits, risks, and side effects. If you have questions or concerns about the medicines you’re taking, talk to your doctor.

ACE inhibitors

ACE inhibitors can improve how your heart pumps, making it pump more effectively. This type of medicine improves blood flow by helping to dilate (open) your arteries. It also lowers your blood pressure.

If you have acute coronary syndrome (ACS), your doctor may want you to take an ACE inhibitor. Having ACS means that you have reduced blood flow to the heart. It could be caused by a variety of conditions. One ACE inhibitor might be all the medicine you need. Or your doctor may prescribe one in combination with other medicines. These could include a diuretic or a beta blocker.

Side effects: ACE inhibitors don’t usually cause troublesome side effects. The most common side effect is a dry cough. More rare side effects include:

• Dizziness
• Reduced appetite
• Fatigue (feeling out of energy)
• Problems with your kidneys
• An increase in the level of potassium in the blood

Risks: Because ACE inhibitors can cause birth defects, pregnant women shouldn’t take this medicine.

In rare cases, ACE inhibitors can lead to a serious allergic reaction. This reaction can cause swelling in certain areas of the body. It’s more common in black people and people who smoke. It can be life-threatening. You should get immediate medical attention if you experience swelling after taking an ACE inhibitor.

Aspirin

Your doctor may want you to take a low dose of aspirin each day if you have already had a heart attack. Aspirin helps keep your blood from forming clots. Blood clots can clog the arteries that carry blood and oxygen to the heart. Blockages in these arteries increase your risk of having a heart attack or stroke.

Side effects: Common side effects of aspirin include nausea and upset stomach. Rarely, some people feel nervous or have difficulty falling asleep when taking aspirin. Call your doctor if your symptoms are bothersome.

Risks: Aspirin is not for everyone. Aspirin can increase your risk of stomach ulcers. It can also cause bleeding in your stomach and intestines. Doctors prescribe a low dose of aspirin for people who have ACS. The dosage is usually between 81 and 162 mg per day. The low dose provides the same benefits as a higher dose. But there is less risk of internal bleeding.

Talk to your doctor about the risks and benefits of aspirin therapy. They will prescribe the aspirin dose that’s right for you and tell you how to take it.

Beta blockers

Beta blockers lower the heart rate and blood pressure. They help improve blood flow to the heart, reduce chest pain, and prevent more damage to the heart. Your doctor may want you to take a beta blocker alone. Or they may want you to take it in combination with other medicines. These could include a diuretic or an ACE inhibitor.

Side effects: The side effects of beta blockers tend to be mild. Common side effects include cold hands, fatigue, dizziness, and weakness. Less common side effects include shortness of breath, difficulty sleeping, depression, and decreased sex drive.

Risks: Not all beta blockers are safe for people. Beta blockers are not recommended for people who have asthma. This type of medicine can trigger severe asthma attacks.

Beta blockers may make it difficult for people with diabetes to recognize signs of low blood sugar. One of these signs is rapid heartbeat. If you have diabetes, your doctor will probably tell you to check your blood sugar often.

Stopping beta blockers abruptly increases the risk of heart problems. If you need to stop taking a beta blocker, it’s important to stop gradually. Follow your doctor’s instructions carefully.

Antiplatelets

Antiplatelet medicines help prevent blood clots. They don’t allow certain cells in the blood (called platelets) to clump together. This reduces the risk of blockages in the coronary arteries that can lead to heart attack and stroke. They’re sometimes prescribed along with aspirin therapy.

Side effects: Some common side effects of antiplatelet medicines include:

• Nausea
• Upset stomach
• Stomach pain
• Diarrhea
• Itching
• Rash

Talk to your doctor if you experience side effects while taking this medicine.

Risks: Because antiplatelet drugs prevent blood clotting, they can increase the risk of serious bleeding in some people.

Diuretics

Diuretics (water pills) help the body get rid of extra sodium (salt) and fluid. They reduce the amount of fluid flowing through your blood vessels. This lowers your blood pressure. Diuretics are commonly prescribed to treat high blood pressure. They are sometimes used in combination with beta blockers and ACE inhibitors.

Side effects: Common side effects of diuretics include:

• Increased urination
• Increased thirst
• Fatigue
• Muscle cramps
• Low blood pressure

Less common side effects include increased blood sugar, increased cholesterol, irregular menstrual periods in women, and impotence in men.

Risks: People who take diuretics can have too much or too little potassium in their blood. This depends on the type of diuretic they take.

Statins

Statins are used to lower “bad” cholesterol (LDL) levels. They may also help increase “good” cholesterol (HDL) levels. Most people who take statins will take this type of medicine for the rest of their lives.

Side effects: Muscle pain is the most common side effect of statins. The pain can be mild or severe. Less common side effects include nausea, diarrhea, gas, and constipation. People who take statins may also get a rash. This side effect is more common when a statin is taken in combination with niacin. This is another medicine used to lower cholesterol levels.

You’re at higher risk of having side effects from statins if you:

• Are a woman
• Are age 65 or older
• Have liver or kidney disease
• Have type 1 or type 2 diabetes
• Take several types of medicine

Some people may feel discouraged by the side effects caused by statins. However, the side effects are not usually life-threatening. Your doctor can help you find ways to manage them. If you’re worried about side effects, talk to your doctor about the risks and benefits of taking statins.

Risks: In some people, statins can cause liver damage.

Anticoagulants (blood thinners)

Blood thinners don’t actually thin the blood. They decrease the ability of the blood to clot. This helps prevent clots from forming in the blood vessels. It also may prevent clots from becoming larger. Large clots can cause more serious problems.

Side Effects: The most significant side effect of blood thinners is bleeding. Your blood doesn’t clot as easily. If you cut or injure yourself, you’ll bleed more than normal. The risk of bleeding being a major event is low.

Blood thinners can cause interactions. These could be with some foods, prescription medicines, or over-the-counter supplements. Less serious side effects include:

• Swelling at the injection site
• Diarrhea, vomiting, or inability to eat
• Fever
• Heavier than normal menstrual periods or bleeding between periods

Risks: Some people who take blood thinners are more at risk of having bleeding problems. These include people who:

• Are older than 75
• Take other blood-thinning medicines
• Have high blood pressure
• Have cancer
• Have problems with their kidneys or liver

Be sure to tell your doctor about any other medicines or supplements you take. Tell other health care providers that you are taking a blood thinner.

Things to consider

All medicines can cause side effects. They also can carry risks for certain people. Always tell your doctor about any medicines you take. Tell them about any side effects you’re experiencing. Make sure they know your full medical history so they can prescribe the best medicine for you.

Questions to ask your doctor

• What is the best medicine for me?
• Should I take more than one medicine after having a heart attack?
• Am I at risk for complications from any of these medicines?
• What types of side effects can I expect from the medicines you are prescribing?

Resources

National Heart, Lung, and Blood Institute: Heart Attack

National Institutes of Health, MedlinePlus: Heart Attack

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