Heart Failure

People with type 2 diabetes cannot absorb sugar and convert it to a form that can be stored and used for energy. Instead, sugar continues to circulate in their blood.

Many of us know that cholesterol, blood sugar, blood pressure, body-mass index and smoking are modifiable risk factors for heart disease. If you smoke or have high levels of the other risk factors, you will need to make lifestyle changes and/or take medications to prevent a heart attack. But these measures don't always stop a serious cardiac event fromoccurring.

Whether to continue taking clopidogrel with aspirin over the long term is a different issue. Aspirin alone can increase the risk of bleeding, and this risk increases with the combination of medications. Low-dose aspirin plus clopidogrel or other anti-platelet drug is recommended for up to one year after MI. Continuing the combination beyond that point is not common practice in all patients, since the increased bleeding risk may outweigh the benefits. However, the combination may be continued in certain patients, including those who received a left main artery stent, complex overlapping or branch-point stents, recurrent MI, in-stent clots or vascular events such as a transient ischemic attack while on aspirin alone. Even in these situations, an individuals bleeding risk needs to be considered to ensure safety.

Each year, about 1 million people in this country receive a pacemaker to regulate their slowing heart rate. These pacemakers are implanted in a pocket of tissue under the skin and send electrical pulses down a lead (wire) inserted into the heart muscle. Pockets can be a source of infection, which then spreads into the bloodstream via the lead and can infect the heart.

Patients with heart failure with preserved ejection fraction (HFpEF) find their ability to walk and carry out the American Journal of Medicine suggests lack of vitamin D may be partly responsible. Vitamin D is thought to play a role in cardiovascular and muscle function, but its relationship with exercise capacity has been unknown. Researchers measured vitamin D levels in 112 HFpEF patients and 37 matched controls, all of whom took a six-minute walk test and had their peak oxygen capacity measured. Vitamin D levels were found to be significantly lower in HFpEF patients than in controls. More than 90 percent of HFpEF patients had insufficient vitamin D levels or were frankly deficient. These low levels were associated with more severe exercise intolerance. This study laid the groundwork for a randomized, controlled clinical trial to evaluate whether vitamin D supplementation could be effective in improving exercise tolerance.

Immediate testing is done to determine whether or not a heart attack has occurred. These include an electrocardiogram (ECG) and a blood test for troponin, a protein that spills into the blood when heart muscle dies. If the troponin test is negative, a heart attack has likely not yet occurred. These patients are given several types of medication to prevent their condition from deteriorating.

How involved a patient wants to be in music therapy depends on their diagnosis and whether they sing or play an instrument. Many simply want to listen to music. For these patients, the music therapist will select works likely to be therapeutic. When McFee sees the potential to help improve a patients medical condition, she encourages them to participate in music-making using an instrument on her cart that doesnt require special training or talent to play.

How involved a patient wants to be in music therapy depends on their diagnosis and whether they sing or play an instrument. Many simply want to listen to music. For these patients, the music therapist will select works likely to be therapeutic. When McFee sees the potential to help improve a patients medical condition, she encourages them to participate in music-making using an instrument on her cart that doesnt require special training or talent to play.

Cleveland Clinic offers heart-failure education classes designed to teach patients and their families what they need to know about the condition, its progression, its impact on day-to-day life and its medications. Ask your cardiologist if theres a similar program in your area. If not, ask for information in writing.

I have met patients who were first diagnosed as having a respiratory issue. Over time, when their symptoms did not improve with appropriate treatment, heart failure was entertained as a diagnosis, says Cleveland Clinic heart failure specialist Miriam Jacob, MD.

If you have risk factors for cardiovascular disease, or have been diagnosed with heart or vascular disease, what are you doing to lessen the likelihood you will suffer a heart attack or stroke? Are you eating a heart-healthy diet and exercising? Keeping your blood pressure, blood sugar and cholesterol levels under control? Have you tossed your cigarettes to thecurb?

Patients with type 1 diabetes require multiple insulin injections a day. This can make it difficult to keep blood glucose levels within the ideal range. Now theres a smartphone app that can help. The Guardian Connect continuous glucose monitoring system works hand-in-hand with the Sugar:IQ app to analyze how patients glucose levels are responding in real time to food intake, insulin and other variables. Data are sent to the cloud for processing, and the information is returned to the app for viewing on an iPhone. The system helps patients identify foods and habits that cause their glucose to spike, as well as times of the day or week when glucose levels fluctuate. This allows them to adjust their insulin use accordingly. In a pilot study, patients using the system spent 33 minutes more per day in the ideal glucose range and had one less hyperglycemic event per month. When the Sugar:IQ app explained the dangers of hypoglycemia, the number of hypoglycemic events dropped in more than half of app users. The system, which has been approved by the U.S. Food and Drug Administration (FDA), is now being retooled for Android users.