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02/23/2021

Feb. 1 – Mar. 1: Black History Month

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Heart Health: A Close-To-The-Heart Scare

By Jenni Roberts, MSN, APN, ACNP-C, TeamHealth Regional Advanced Practice Clinician Director, Northeast Group, Emergency Department Nurse Practitioner

On Christmas Eve 1998, I received a message from a 52-year-old male. “I keep having these ‘twinges’ in my chest when I walk to my car. I’ve only noticed this outside, so I don’t think it’s anything. It goes away after a few minutes when I get inside.” He had no shortness of breath, and denied chest pain at any time. I evaluated his risk factors for heart disease. He had no significant past medical history besides being 40 pounds overweight, did not go to the doctor regularly, was not on any medication, never smoked, rarely consumed alcohol and was married with five children. His family history was positive for heart disease. His father died of a heart attack at 73. His brother had a heart attack in his 40s and died of a stroke at 51.

I recommended that he go to the emergency department (ED) for a chest pain evaluation, which he adamantly refused to do. He was seen as an outpatient by cardiology on December 27, had an abnormal stress test and underwent an angiogram, which found he had four vessel disease. Following this significant finding multiple stents were placed.

That patient was my dad, who waited to report his symptoms to me until we came over to dinner that Christmas Eve. On Christmas Day I was working in the ICU, waiting for the first cardiologist to walk through those double doors to beg him/her to see my dad as soon as possible. I was lucky enough to encounter a newer member of a well-known practice, who was able to expedite care and save either life or function. Dr. Kinn’s report was that he did not believe my dad would have survived the next two weeks without treatment and that he had considered emergency bypass instead of stent placement due to the severity of the disease.

My dad had undiagnosed hypertension and high cholesterol. He began to exercise for the first time in his life; he lost 40 pounds. He was less successful at diet modification; he grew up in a dairy family and still refuses to eat any vegetables except salad. His idea of a healthy dinner is a Lean Pocket. He manages stress through activity with golf, pickle ball, and runs two miles a day. He does not sleep well. He does have regular medical care, annually seeing the cardiologist who walked into the ICU Christmas Day. This has led to much improved management of his risk factors. He also has routine stress testing and has not had any further progression or stent occlusion.

Several years after my dad’s incident I had a patient in the ED, also 52 years old. She had been having chest pain for a few days and had a family history of heart disease. She also had no medical history and did not smoke or regularly consume alcohol. Her cholesterol had last been checked just over a year prior and was in normal range. She noticed her chest pain seemed worse during her routine three mile run. She called her primary doctor who advised her to be seen in the ED. The on-call cardiologist took her to the cath lab after an equivocal stress test. He came back to the ED a short while later. “Clean coronaries,” he reported. “She runs three miles every day. Clean coronaries. Her chest pain is not cardiac.”

His words have never left my mind. Both people were the same age, with similar risk factors besides obesity. My patient took her health and family history seriously, and my dad – at the time – did not.

Tips for caring for your heart

February is American Heart Month, a perfect time for each of us to consider the differences in these two stories. While heart disease is not quite so simple, changing basic habits to care for your heart is not difficult. These simple steps may improve your health.

  1. Understand and mitigate your risks. See your doctor. You cannot treat your hypertension or dyslipidemia until you are aware of the issue.
  2. Eat a healthy diet. Make food your friend and not your enemy. Begin risk factor modification with healthy food, using medication as further support. Fast food is never a good choice on a regular basis.
  3. Exercise regularly. “Clean coronaries!” Know your target heart rate and set a goal to exercise to that rate for a set time each day. Move more.
  4. Quit smoking. Was that too subtle? QUIT SMOKING.
  5. Sleep well – play hard and rest hard. Shift work makes getting good sleep more challenging but not impossible. Find that balance.
  6. Manage your stress. Another benefit of activity is stress management, but at some point in all of our lives, we need a little extra help. Know your resources ahead of that crisis time. Explore TeamHealth’s resources − webinars, podcasts, blogs and other programs − that were created to help clinicians navigate the emotional challenges of the pandemic. TeamHealth clinicians can access free confidential counseling and other resources designed to help those who are struggling with financial, family, burnout and other issues created by the pandemic or other life circumstances.

Enjoy holidays, birthdays, and other celebrations, but please don’t lose (or abuse) your heart!