Juice made from purple grapes had the most beneficial effect.

Juices made from apples or purple grapes - and the fruit themselves - protect against developing clogged arteries, a study suggests.

Researchers fed hamsters the fruit and juice or water, plus a fatty diet.
The animals who were fed grape juice had the lowest risk of developing artery problems, Molecular Nutrition and Food Research reports.

The University of Montpellier team said the juice’s benefits came from its high levels of phenols - an antioxidant.
Antioxidants in various foods have been regularly cited as being beneficial to heart health.
The French team looked at how juicing affected the phenol content of fruit - because most studies look at raw fruit.

Four glasses a day

They then looked at how being fed various kinds of fruit affected the hamsters’ risk of atherosclerosis - the build-up of fatty plaque deposits in the arteries that can lead to heart attacks or strokes.
The amount of fruit the hamsters consumed was equivalent to three apples or three bunches of grapes daily for a human.

Hamsters given juice drank the equivalent of four glasses daily for a person weighing 70 kilograms (154 pounds).

The apples and grapes had about the same phenol content, while the purple grape juice had 2.5 times more phenols than apple juice.
Compared with animals given water, those given fruit or fruit juice had lower cholesterol levels, less oxidative stress, and less fat accumulation in their aorta, the main vessel supplying oxygenated blood to the body.

Purple grape juice had the strongest effect, followed by purple grapes, apple juice and apples.

The researchers say their findings suggest the amount of phenols contained in a food have a direct effect on its antioxidant properties.
Other antioxidant compounds in the fruits, such as vitamin C and carotenoids, could also contribute to their effects, they added.

The team, led by Kelly Decorde, said their findings “provide encouragement that fruit and fruit juices may have a significant clinical and public health relevance.”

A British nutritionist said: “High levels of antioxidants are recognised as being good for you.”

By utilising short periods of high intensity exercise ( 3 to 5 minutes) interspersed with periods of low level of work lactic acid accumulation can be minimised.
At he high intensity work level increase fat burning occurs with reduction in fat stores. The need is to exercise at the anaerobic level but for periods of short duration thereby obtaining the benefits of reducing fat stores without increasing the risk of a significant metabolic acidosis with its consequences.

Based on the information above it is apparent that the most appropriate training for those patients with cardiovascular disease is one utilising the anaerobic interval.

Use of this level of training is however not without associated risks which may be summarised as follows:

• Complications based on the development of a degree of metabolic acidosis

Such complications are directly proportional to the lactate level.
Higher in the “high risk” patient
Higher in those patients with diabetes or renal failure
Higher in those patients with low fitness levels.
Higher in the obese patient
May result in varying degrees of heart block up to and including complete.

• Metabolic acidosis may occur prior to cardiac arrest in ischaemic patients

• Increased risk of ischaemic changes which may be silent

Silent ischaemia is present in a small but significant number of patients
Whilst most patients will develop associated symptoms these patients do not

• Increased risk of high grade ectopic activity

Ectopic activity can only be detected by cardiac monitoring
Ectopic activity which occurs at rest and disappears during exercise is generally more benign. High Grade ectopic activity may predict future cardiac arrest

• Is associated with biochemical changes including changes in potassium and magnesium levels which are detrimental to the myocardium.

The American Heart Association Heart Association in their scientific statement have provided risk classifications for patients depending on their clinical state and divided patients into four categories:

1 Class A Apparently Healthy Individuals
2 Class B Patients with known cardiac disease but low risk
3. Class C Patients with moderate to high risk of exercise
4 Class D Unstable Disease and activity Restriction.

Class A Apparently Healthy Individuals

Apparently healthy individuals

This classification includes:

1. Children, adolescents, men <45 years, and women <55 years who have no symptoms or known presence of heart disease or major coronary risk factors.
2. Men >45 years and women >55 years who have no symptoms or known presence of heart disease and with >2 major cardiovascular risk factors.
3. Men >45 years and women >55 years who have no symptoms or known presence of heart disease and with ≤major cardiovascular risk factors.

Activity guidelines:

No restrictions other than basic guidelines.

Supervision required:

None.

ECG and blood pressure monitoring:

Not required.

* It is suggested that persons classified as Class A02 and particularly Class A-3 undergo a medical examination and possibly a medically supervised exercise test before engaging in vigorous exercise.

Class B Known Stable Cardiovascular Disease

Presence of known, stable cardiovascular disease with low risk for complications with vigorous exercise, but slightly greater than for apparently healthy individuals

This classification includes individuals with any of the following diagnoses:

1. Coronary artery disease (myocardial infarction, bypass surgery, angioplasty, angina pectoris, abnormal exercise test, and abnormal coronary angiograms) whose condition is stable and who have the clinical characteristics as outlined below.
2. Valvular heart disease, excluding severe valvular stenosis or regurgitation with the clinical characteristics as outlined below.
3. Congenital heart disease; risk stratification for patients with congenital heart disease should be guided by the 27th Bethesda Conference recommendations.
4. Cardiomyopathy: ejection fraction of <30 percent; includes stable patients with heart failure with clinical characteristics as outlined below but not hypertrophic cardiomyopathy or recent myocarditis.
5. Exercise test abnormalities that do not meet any of the high risk criteria outlined in class C below.

Clinical characteristics (must include all of the following)

1. New York Heart Association class 1 or 2. None or slight shortness of breath.
2. Exercise capacity ≤6 METs. Equivalent to walking at 7kilometers/hour.
3. No evidence of congestive heart failure.
4. No evidence of myocardial ischaemia/angina at rest or the exercise test at or below 6 METs.
5. Appropriate rise in systolic blood pressure during exercise.
6. Absence of sustained or non-sustained ventricular tachycardia at rest or with exercise.
7. Ability to satisfactorily self-monitor intensity of activity.

Activity guidelines:

1. Activity should be individualized, with exercise prescription provided by qualified individuals and approved by primary healthcare provided.

Supervision required:

1. Medical supervision during initial prescription session is beneficial.
2. Supervision by appropriate trained nonmedical personnel for other exercise sessions should occur until the individual understands how to monitor his or her activity.
3. Medical personnel should be trained and certified in Advanced Cardiac Life Support. Nonmedical personnel should be trained and certified in Basic Life Support (which includes cardiopulmonary resuscitation).

ECG and blood pressure monitoring:

1. Useful during the early prescription phase of training, usually 6 to 12 sessions.

Adapted from: Fletcher,GF, Balady, GF, Amsterdam EA, et al. Circulation 2001; 104:1694. Copyright © 2001 Lippincott Williams and Wilkins.

Class C Moderate-to-high risk for cardiac complications

Those at moderate-to-high risk for cardiac complications during exercise and/or unable to self-regular activity or to understand recommended activity level.

This classification includes individuals with any of the following diagnoses:

1. Coronary artery disease with the clinical characteristics outlined below.
2. Valvular heart disease, excluding severe valvular stenosis or regurgitation with the clinical characteristics as outlined below.
3. Congenital heart disease; risk stratification for patients with congenital heart disease should be guided by the 27th Bethesda Conference recommendations.
4. Cardiomyopathy: ejection fraction of <30 percent; includes stable patients with heart failure with clinical characteristics as outlined below but not hypertrophic cardiomyopathy or recent myocarditis.
5. Complex ventricular arrhythmias not well controlled.

Clinical characteristics (any of the following)

1. New York Heart Association class 3 or 4. Marked or severe breathlessness at high work or rest.
2. Exercise capacity <6 METs. Unable to walk at 7 kilometres/hour.
3. Angina or ischaemic ST depression at a workload <6 METs.
4. Fall in systolic blood pressure below resting levels during exercise.
5. Non-sustained ventricular tachycardia with exercise.
6. Previous episode of primary cardiac arrest (i.e. cardiac arrest that did not occur in the presence of an acute myocardial infarction or during a cardiac procedure).
7. A medical problem that the physician believes may be life-threatening.

Activity guidelines:

1. Activity should be individualized, with exercise prescription provided by qualified individuals and approved by primary healthcare provided.

Supervision required:

1. Medical supervision during all exercise sessions until safety is established.

ECG and blood pressure monitoring:

1. Continuous during exercise sessions until safety is established, usually ≤12 sessions.

*Class C patients who have successfully completed a series of supervised exercise sessions may be reclassified to Class B providing that the safety of exercise at the prescribed intensity is satisfactorily established by appropriate medical personnel and that the patient has demonstrated the ability to self-monitor.

Adapted from: Fletcher,GF, Balady, GF, Amsterdam EA, et al. Circulation 2001; 104:1694. Copyright © 2001 Lippincott Williams and Wilkins.

Class D. Unstable Disease and Activity Restriction

Unstable disease and activity restriction*

This classification includes individuals with any of the following:

1. Unstable ischaemia.
2. Severe and symptomatic valvular stenosis or regurgitation.
3. Congenital heart disease; criteria for risk that would prohibit exercise conditioning in patients with congenital heart disease should be guided by the 27th Bethesda Conference recommendations.
4. Heart failure that is not compensated.
5. Uncontrolled arrhythmias.
6. Other medical conditions that could be aggravated by exercise.

Activity guidelines:

1. No activity is recommended for conditioning purposes.
2. Attention should be directed to treating the patient and restoring the patient to Class C or better.
3. Daily activities must be prescribed on the basis of individual assessment by the patient’s personal physician.

* Exercise for conditioning purposes is not recommended.

Adapted from: Fletcher,GF, Balady, GF, Amsterdam EA, et al. Circulation 2001; 104:1694. Copyright © 2001 Lippincott Williams and Wilkins.

However, there was little agreement about the best heart disease diet to recommend. For example, 57% of the physicians were aware that fish oil plays a role in heart disease prevention, but only 17% highly recommended dietary consumption of fish.

Coronary artery heart disease signs and symptoms include shortness of breath, irregular or quickened heartbeat, weakness, dizziness, nausea and sweating.

Generally, research concerning the best heart disease diet focuses on coronary artery disease. This is the condition that occurs when plaque builds up in the blood vessels leading to the heart, limiting blood supply and often leading to heart attack or heart failure. Research focuses on this disease because many of the risk factors are considered controllable and because it is considered a global epidemic by the World Health Organization (WHO) with more than 17 million deaths occurring worldwide every year.

The World Health Organization reports that while coronary heart disease signs and symptoms resulting in death and disability are decreasing in many developed countries, there has been an increase in this condition in developing and transitional countries, indicating that socio-economic factors are involved.

The typical Japanese diet has been promoted as the best heart disease diet by some, but interestingly, when Japanese people migrate to the United States, their risk of heart disease increases to the same level as those born in the country. Apparently, diet changes when one moves.

The research concerning the low prevalence of coronary heart disease signs and symptoms in people with high dietary intake of omega-3 fatty acids is nearly thirty years old. Dyerberg-Bang based this supposition on casual observation of Greenlandic Inuit.

A more recent study by the Department of Neurological Surgery at the University of Virginia found that coronary heart disease was present in 26% of Alaskan Eskimos over the age of 55, even though their average daily consumption of omega-3s was about 3-4 grams per day. 1-2 grams per day has been used in research relating to the best heart disease diet and the average American consumes less than a half a gram per day. Only 6% of the Alaskan Eskimos under the age of 55 exhibited coronary heart disease signs and symptoms.

After reading these findings, one may think that the study group is saying that fish is not a factor in the best heart disease diet, but the same group concluded that high consumption of omega-3 fatty acids protects against the development of metabolic syndrome. Metabolic syndrome is a combination of medical problems that increases ones risk for developing heart disease signs and symptoms, as well as diabetes.

There is an enormous amount of information and research relating to the best heart disease diet. It would be impossible to relate all of it to you here in this one article. The American Heart Association publishes an annual recipe book for those who suffer from heart disease signs and symptoms or for those who simply want to maintain a healthy heart. What follows is a synopsis of recommendations made by dietary experts, doctors, scientists and researchers.

The build up of plaque in the coronary arteries is caused by inflammation resulting from LDL (bad) cholesterol irritating the lining of the arteries.

LDL cholesterol can only effectively be removed from the blood stream by HDL (good) cholesterol. Smoking decreases levels of circulating HDL cholesterol. Obesity increases inflammation in the arteries. C-reactive protein, found in most meat, circulating in the blood stream increases inflammation and can be reduced by an increase in consumption of the B vitamins and folic acid.

The best heart disease diet, therefore, can be enhanced by adding natural anti-inflammatories, like those found in mangosteen health supplements and adding B-vitamins and folic acid, also found in mangosteen. LDL cholesterol must be oxidized in order to form into plaque, anti-oxidants prevent this oxidation.

The mangosteen, in particular, contains numerous anti-oxidants. Only available in the form of a puree or juice in most areas of the world, the mangosteen fruit is commonly eaten in Thailand, one of the areas with the lowest number of lost years of healthy life due to coronary heart disease signs and symptoms.

Mike Leuthen is chief editor of http://www.restore-your-health.com Visit us on the web to learn more about heart disease and what you can do to protect yourself.

Working in conjunction with Margaret Bermingham from the Department of Bio-science University of Sydney, they have demonstrated the fact that the “Bad Cholesterol” LDL comes in various particle sizes – from very small dense type B, to relatively speaking larger molecules Type A.

It is these Type B Dense particles which are particularly dangerous and atherogenic.

Their work has shown that the ratio of serum triglyceride to HDL-cholesterol (the good one) correlates with the small dense type B particle in that, if your ratio is greater than two, then all your LDL particles are small dense type B and you are a red hot candidate for a heart attack.

Work in the Heart Disease Prevention centre has shown that by using “Neocardial Exercise” for periods of less than thirty minutes three times a week increases the HDL and reduced the triglyceride caused a highly significant reduction in the ratio in both 145 Primary (p=0.008) and 143 Secondary Prevention (p= 0.0007) patients.

This reduction was sufficient to reduce the ratio to Less then 2 in vast majority of patients within six weeks of commencing the exercise. They further showed that patients with the smallest particles had significantly greater increase in particle size than those who had the largest particles.

This work was initially presented at an American Heart Association Meeting in Honolulu in 2003 in which other significant benefits after six weeks of this form of exercise were discussed.

• Improved physical fitness – men improved by 22%. Women by 33%
Increasing physical fitness lowers the risk of death by 23%
There is a lower risk of developing cardiovascular disease
Fitter people are also 3-6 times less likely to develop diabetes, high blood pressure and metabolic syndrome than those who are unfit

• Lowering Blood Pressure - Both men and women significantly lower blood pressure. (P= Less then 0.0001). On average systolic fell 9mmHg, Diastolic 5mmHg
This effect is greater in patients with hypertension (BP Greater then 140/80mmHg)
Mean fall from 164mmHg systolic to 144mmHg p = Less then 0.0001
Mean fall from 94mmHg diastolic to 80mmHg p = Less then 0.0001

• Beginning Weight Loss - Significant reduction in Body Mass Index
Without dietary restriction in obese or overweight p = Less then 0.0001

Changes in Traditional Biochemical Risk Factors:

Total Cholesterol
Primary Prevention High Risk - 10%*
Low Risk - 4%
Secondary Prevention High Risk -16%*
Low Risk - 4%

LDL cholesterol
Primary Prevention High Risk -11%*
Low Risk - 3%
Secondary Prevention High Risk -9%*
Low Risk - 3%

HDL cholesterol
Primary Prevention High Risk + 7%*
Low Risk + 1%
Secondary Prevention High Risk +10%*
Low Risk + 4%*

Triglycerides
Primary Prevention High Risk - 11%*
Low Risk - 12%*
Secondary Prevention High Risk - 27%*
Low Risk - 15%*

Total cholesterol/HDL
Primary Prevention High Risk –15%*
Low Risk - 5%
Secondary Prevention High Risk – 28%*
Low Risk - 8%*

Non HDL cholesterol
Primary Prevention High Risk -8%
Low Risk - 5%
Secondary Prevention High Risk – 19%*
Low Risk - 5%
* Indicates significant finding

These results after eighteen sessions of exercise over six week’s show a very significant reduction in risk of a cardiac event or second cardiac event.

However, recently newer risk factors have come into contention and the more traditional, whilst still of importance are less relevant.

Many of the older studies excluded a significant number of patients who as they did not have Total cholesterol or LDL-cholesterol abnormalities were excluded by the design of the studies.

These particularly relate to those with low HDL (Less than 1mmol/L) and moderately high triglycerides (Greater then 2mmol/L) and estimates as high as 60% of patients with significant risk factors for coronary artery disease are claimed to have been excluded by inclusion criteria.

Furthermore, whilst in the tightly controlled clinical trial situation patients are cajoled into attending for follow up and clinical investigators plagued by the Clinical Study Nurse to ensure that all records are completed – where at each visit tablet counts are made to ensure patient compliance – pristine results are ensured.

In the clinical practice arena a very different scenario is taking place. Patients who fail to re-attend for an appointment may be black listed and excluded. Where reliance is placed on the patient’s honesty to ensure that all medication is taken appropriately. Where the physician has no idea whether or not the patient has even had the prescription dispensed by a chemist.

In this scenario we find that, in the case of lipid lowering therapy, over 50% of the patients in all countries around the world have not reached their target levels for cholesterol or LDL lowering.

Even when the target may be a modest reduction (eg to attain a cholesterol level Less then 5mmol/L) over 50% of patients cannot make it for whatever reason be it non compliance, too low a dose, drug interaction, non reported side effects or ineffectiveness.

In this situation we find the “experts” or a select committee of effete professors and academics, divorced from the real world of medicine, advocating making the bar even higher (paradoxically by lowering the target level of cholesterol or LDL cholesterol).

These recommendations made simply on the results of tightly controlled pharmaceutically supported multicentre clinical trials; which have no basis in reality.

In one such study if the results were applied to the total population the cost of the particular drug would be over half of the total health budget of that country!

What is the answer?

With the advent of newer risk factors together with the final recognition of the importance of increasing HDL in the prevention of coronary artery disease (even when LDL cholesterol is normal) perhaps some sanity into preventive cardiology may come.

Unfortunately there is no financial gain in life-style change for the Multinational Pharmaceutical Houses – indeed there is the very real possibility of a reduced market for lipid lowering agents.

Governments whilst mouthing platitudes about the importance of exercise, diet, responsible alcohol consumption, smoking and the like are reluctant to dedicate financial support to these ventures.

The health improvement which will be obtained and the consequent savings in medical costs particularly in chronic diseases and hospitalisation are not instantaneous and in all probability in Western Society the government concerned may not be in power.

Recently the Queensland Government introduced a series of television commercials with the object of advancing the cause of eating more fruit and vegetables to the tune of two fruits and five vegetables per day.

Scant respect, if any, was paid to the financial cost of a family of four initiating such a change in eating habits.

My Cardiac Nurse took a visit to a supermarket and fruit store and averaged the price of conforming to the recommendations at a cost of $3.72/day/.person which equals for the family a weekly cost of $104. Hardly a proposition in today’s economic climate!

In fact physical inactivity has been shown to be a greater cause of morbidity and mortality than low fruit and vegetable diet . The cost of three Neocardial Walks/ week is simply cost of the patient’s time.

Whilst the single most beneficial action is to move the sedentary patient into the mild activity Group, if we wish to improve lifestyle and subsequently reduce the financial burden of chronic disease it is necessary to increase the level of activity further.

What Level of Exercise?

Exercising at or above the anaerobic threshold has been shown to be the most appropriate level to improve cardio-respiratory function.

Major problems with exercising at this level for protracted periods are the development of a metabolic acidosis.

Under a state of metabolic acidosis the myocardium does not respond to endogenous or exogenous catecholamines.

Hypokalaemia by the transfer of potassium into the cells promotes dysrhythmia.

Patients with acute myocardial ischaemia develop a metabolic acidosis commensurate with the severity of the ischaemia .

Neocardial Exercise by providing a specific individual exercise prescription allows the patient to exercise at sufficient level to ensure cardiac training effect without developing any significant metabolic acidosis.

This form of exercise can be undertaken irrespective of the patient’s physical condition or level of obesity with improvements in all parameters with results comparable with those fitter and lighter. A Paper submitted for Website Publication September 2006

Dr Tony Neaverson is a Consultant Physician practising as a Preventive Cardiologist in South East Queensland. He is Director of the Heart Disease Prevention Centre at Noosa Hospital. You may e-mail him at neaverson@neocardia.com Further Information on Neocardial Exercise is available www.neocardia.com

Surrounding the dead muscle is a variable sized area of heart muscle at risk of dying because of inadequate oxygen supply – this condition is known as myocardial ischaemia.

The heart rate is under the control of the autonomic nervous systems, which, in the case of the heart, is driven by adrenaline the so-called “flight or fight” hormone.

Adrenaline acts at various sites of the body

- On the sinus node in the heart which controls rate to increase heart rate
- On the bronchial tubes in the lung to cause them to dilate allowing greater flow of air into the lungs
- On the small arteries in the skin and gut to constrict (narrow) reducing blood flow to these areas and making more blood available to the muscles- to fight or fly
- Increases the blood sugar by increasing breakdown of glycogen to glucose, important food for the muscles to contract better.

Whilst increased adrenaline production is common with exercise it also occurs in states of shock, fear, or anger producing gooseflesh and sweating (remember the first time you saw the shower scene in the Hitchcock Movie Psycho).

As well as increasing the heart rate adrenaline may cause cardiac irregularity, increased blood pressure, or palpitations. It is this irregularity which may lead the heart to chaotic beats and finally fibrillation and death.

This is the first symptom of a heart attack in about 20% of people – sudden death – the victim just collapses to the ground. Whilst he may gasp a few breaths he has no cardiac output- no blood is leaving his heart- he is pulseless.

This terminal condition (ventricular fibrillation) is very easily treated by first aid measures and cardiac shock- termed defibrillation. Nowadays many areas which have high populations (or as in aeroplanes, confined areas) have people friendly defibrillators available which only shock patients who have rhythms which are treatable by shock. These machines have easy instructions and any bystander who can read can apply the electrodes and save the patient’s life.

Often people wrongly refer to this cause of death as a massive heart attack- it takes some time (often up to an hour) to die from a massive heart attack. In this case the heart attack causes such significant damage to the main ventricle of the heart as to reduce blood pressure to critically low levels and death results.

Cause of Heart Attacks

The pathological cause of heart attacks is a clot of blood, which forms over an area on the lining of a coronary artery which, is “ready” for a clot to form – this area is termed a vulnerable plaque.
It was previously thought that clots developed on the lining of arterial walls that had become calcified and thickened - it is now known that rarely are these areas the sites of clots.

Calcification and deposition of cholesterol within the arterial wall reduces the lumen size and therefore flow of blood through this section of the artery is likewise reduced. This reduced flow may be sufficient to provide enough oxygen to the heart muscle during rest or light work. However once the heart is required to work harder the blood flow is insufficient to provide enough oxygen to the heart muscle and symptoms follow.

Angina- Pectoris and Decubitus

When the heart muscle receives insufficient oxygen it produces lactic and pyruvic acids and these produces the tightness in the chest known as angina the type of angina which occurs during exercise is termed Angina Pectoris.

The obvious treatment is to reduce the heart work by ceasing whatever activity has caused the heart rate to rise.

Whilst typically angina pectoris occurs as tightness in the chest it may move up into the throat or down one or both arms. Occasionally it may only occur in the teeth or in the back between the shoulder blades. Patients may describe it as a “weight on my chest” or “constriction”. Occasionally the only symptom may be acute breathlessness.

The cardinal feature is the relation to increased heart work and its relief by stopping activity. In addition one should use a trintrin preparation. If pain is present use another dose after five minutes or so and repeat twice.

The treatment of angina is beyond the scope of this article however drugs which reduce the work the heart has to do (like putting a governor on your heart) are most effective and as they block the action of adrenaline are termed betablockers.

Drugs, which dilate the coronary arteries (trintrins), are also helpful. These come as patches, tablets for sucking, sprays for inhalation or as solutions for intravenous use in hospital. These should be used only when the tightness is present and not when you feel giddy or weak as they will reduce blood pressure and may cause you to faint. These also dilate all arteries and therefore may cause headache.

Trintrins are particularly dangerous when used in conjunction with some of the newer drugs for erectile dysfunction eg viagra and these must not be used within 24 hours of each other

Spasm of the coronary arteries may also cause reduction in blood flow to the heart. Everyone has some degree of spasm within their bodies and angina is generally due to mixture of both atheroma and spasm.

However angina, which occurs at rest particularly at night around 2.0am waking the patient, is due to vasospasm and is termed angina decubitus.

The symptoms are similar to angina pectoris but in this case it is spasm of the artery and the treatment is not betablockade therapy but a group of drugs called calcium antagonists. These drugs relieve the spasm of the artery.

Unstable Angina

Should the pain be prolonged and not relieved by rest and trintrin therapy the term unstable angina is used.

In this case the pain is more severe and often associated with an increase in sympathetic overactivity. Symptoms such as sweating, nausea, vomiting, palpitations, faintness or a feeling of wanting to faint (presyncope), or even syncope are common.

This is a medical emergency and an ambulance should be called without delay, as it is impossible to differentiate unstable angina from a heart attack without electrocardiograph and blood studies.

If you believe that you may have this syndrome whilst waiting for the ambulance chew a whole aspirin tablet.

This condition is generally associated with a clot being formed within one of the main coronary arteries and hospitalisation is necessary so that a definitive diagnosis may be made and urgent treatment to protect the heart from damage instituted.

Differential Diagnosis

Angina is often confused with indigestion and many patients rationalise that whilst they may consider the pain could be angina it “simply cannot happen to me’ and it is probably only indigestion or just wind.

One eminent Professor of Cardiology writing in one of the journals described how he waited for eighteen hours before going to Hospital as he thought it “ was simply bad indigestion”. He finished up with bypass surgery!

Indigestion is generally in the pit of the stomach burning in nature, often relieved by belching or by drinking a glass of milk or alkali. It has no relation to exercise, rarely referred to the arms or back, and may come up into throat as a burning sensation. Trintrins have no effect.

Hiatus hernia or oesophageal reflux may mimic vasospastic angina as they both occur at night when the patient is prone.

Silent Ischaemia

Some patients, generally those with high pain thresholds, may have myocardial ischaemia which is entirely asymptomatic.

Rarely patients may be found with classical electrocardiographic changes of a heart attack without remembering anything remotely like the symptoms, which are noted above.

On a treadmill exercise test these patients may develop changes on their cardiograph, which are diagnostic of myocardial ischaemia. They may develop high blood pressure or more dangerous, a fall in blood pressure during exercise without any actual pain.

These patients are very difficult to treat, as, unlike most of us, they do not get chest tightness of pressure before they develop dangerous cardiac abnormalities. These people require invasive or nuclear studies to ascertain the workload that causes trouble. They can then be warned to control their work level.

Heart Failure and Cardiac Irregularities

Patients in their senior years may develop heart failure without any pain or tightness. The Electrocardiographic changes of a previous heart attack are found on routine examination.

Atrial fibrillation, a not uncommon rhythm disturbance, often has myocardial ischaemia as its underlying cause, particularly in the elderly. This irregularity results in a reduction in the output from the left ventricle (stroke volume). As blood continues to fill the ventricle from above the lower output results in the heart becoming distended with blood.

Heart muscle like all other muscles when stretched contracts with greater strength thereby increasing the output. The patient is unaware of anything the matter with his heart until an xray is taken showing an enlarged heart . (Compensated Heart Failure)

However if the reason for the reduction in stroke volume remains then eventually (when the heart cannot enlarge further) pressure within the ventricle rises and is passed backwards through the atrium and on into the pulmonary arterioles causing fluid to move into the air sacs of the lungs and the patients notices increasing shortness of breath breathlessness. (Decompensated Heart Failure)

Summary

- Never take chest pain lightly - you might wake up dead !
- Learn a plan and keep to it.
- It is only at an Emergency Centre that you can get immediate diagnosis.
- Most Heart Attacks who are destined to die do so within the first few hours. Don’t Delay
- Special Treatment to reduce the residual damage to your heart is most effective when given early. Particularly within three hours of the onset of pain.
- You will not be laughed at for going to the Hospital with indigestion
- Remember no one can exclude a Heart Attack from a Severe anginal pain without ECG and blood tests

An authoritative website with information on all aspects of Heart Disease is available on www.neocardia.com

Notes on the author - This is the first of a series of articles on Preventive Medicine by Dr Tony Neaverson MB,BS (Qld) MRCP (London),FRACP, Preventive Cardiologist who is currently Director of the Heart Disease Prevention Centre at Noosa Hospital in South East Queensland.

Arteriosclerosis is the most common type of heart disease. This disease is characterized by a hardening of the arteries, including the coronary arteries, which surround and nourish the heart. Many believe that this process begins early in life. It is so common that it is found present in over half of Americans at death. Though the exact process is unknown, it is understood that the build up of plaque in blood vessels eventually causes the arteries to harden. Thus, the plaque seems to be the precipitating factor. Luckily, this can be controlled through a proper diet and regularly exercise. Eventually the build up is enough that the blood flow becomes seriously constricted. When this happens, the result may be a myocardial infarction, which we commonly call a heart attack. Another possible result of this same problem is when the fatty deposits form a clot that eventually cuts off the blood supply to the heart or some other vital part of the body. These two possibilities amount to the most frequent cause of death for the average American.

Cardiomyopathy is the next most common form of heart disease. This disease takes the form of impaired function of the heart itself. What has happened is that somehow the heart has been damaged and weakened to such an extent that the pumping action is impaired and in the process of compensating the muscle grows larger and larger. As the damage increases the danger of clotting and cardiac arrhythmia increases as well. Cardiomyopathy often results in damage to the heart�s electrical system and is the primary factor in later developing arrhythmias. Many patients with Cardiomyopathy are the prime candidates for heart transplants, which has a chance of saving their lives.

The final form of heart disease is when damage takes place on or near the heart valves themselves. This damage is usually a result of a congenital defect or an infection. Often it is a strep throat infection, which untreated, leads to rheumatic fever and eventually direct damage to the heart valves. Rheumatic fever has been well controlled in the United States but it is still responsible for approximately 7000 deaths per year. As far as congenital defects, it is estimated that only a portion of the 25,000 babies born yearly with heart defects have damage to the heart valves. One known cause is when the mother contracts German measles during late term pregnancy.

Regardless of the type of heart problem encountered it is helpful to know the common warning signs for a heart attack. They are:

- A feeling of pain or slight pressure to the chest or a crushing sensation behind the breastbone. This may radiate to the shoulder, arm or legs.

- The feeling usually lasts for a length of time.

- OTC medication or rest does not reduce the pain though it will respond to a narcotic drug.

- The face often turns ashen gray and a cold sweat develops. Often this is accompanied by nausea and shortness of breath.

- Retching, belching or vomiting may occur which is often confused with indigestion.

IF YOU OR A LOVED ONE EXPERIENCES THESE SYMPTOMS GET TO A DOCTOR!

Ray Kelly is an Exercise Scientist with 15 years experience in the health and fitness industry. Sign up for his Free Exercise and Meal Planner at The Biggest Loser or http://www.free-online-health.com

THE DIRECT CAUSES OF HEART DISEASE

The direct causes of coronary heart disease and heart attack are factors like these:

- Narrowing of blood vessels in the heart and the rest of the body by arteriosclerosis.

- High blood cholesterol level.

- High blood pressure.

- Over-weight.

- Diabetes.

- High level of the amino acid homocystein in the blood.

- High content of low density lipoprotein (LDL) and low content of high density lipoprotein (HDL) in the blood. Lipoprotein is a combination of protein and fatty substances bound together.

- Inflammation in the circulatory system.

- High age.

- Inherited tendencies for high cholesterol levels and heart disease.

- Men have somewhat greater chance of getting heart disease than women.

These factors are interrelated in complicated ways, and are causing or amplifying each other. For example, arteriosclerosis will cause higher blood pressure, and high blood pressure will cause even more arteriosclerosis. Many of these factors are ultimately caused or aggravated by these lifestyle factors:

-A too high consume of fat, cholesterol and sugar.

-Consuming the wrong fat types.

-Lack of fibre, vitamins, minerals and other diet deficiencies.

-Stress at work and in the daily life.

-Smoking.

-Lack of exercise.

Lifestyle adjustments will therefore be the main methods of preventing heart failure.

GENERAL DIET ADVICES

A diet with the aim of preventing heart disease is generally the same as a diet to prevent cancer and other diseases. Here are the general diet advices

- Avoid or reduce the amount of food that are industrially processed, artificially made or heavily fried.

- Eat fish at least every second day. Also eat seafood and fouls.

- Do not eat very much red meat.

- Eat 5 fruits or vegetables each day. Each piece should be of the size of an apple or carrot. They should be raw or carefully boiled so that the nutrients are not washed out.

- Eat full corn bread, full corn cereals, peas, beans and potatoes.

- Eat just a moderate amount of fat.

- Consume cholesterol rich foods like egg, spawn or liver in just moderate amounts.

- Ideally most fat you eat, should be of the type mono-unsaturated. You also need some poly-unsaturated fat of the types omega-3, and omega 6, but not too much of omega-6. The consumption of saturated fat should be moderate.

- In order to achieve right fat balance, much of the fat supply should come from a blending of sources like olive, olive oil, canola oil, nuts, nut oil, sunflower, sunflower oil, linseed oil (flax oil), fish and fish oil.

- Use only a moderate amount of soy oil and corn oil in the diet. Only using such oil types will give you too much poly-unsaturated fat of the omega-6-type.

- Use just a very moderate amount of fat sources like butter, coconut oil and palm oil. A high consumption of these fat sources gives you too much saturated fat.

- Avoid altogether fat that has been chemically altered, giving so-called trans-fat. This type of fat is often found in margarine, cookies, snacks, fast food and other pre-made food.

- Consume just a very moderate amount of sugar, refined flour or refined cereals.

- Consume just a moderate amount of tranquilizers and stimulants like alcohol and caffeine.

- Use just a moderate amount of salt in the food. However, in warm weather and by hard physical work, you will need more salt.

DIET SUPPLEMENTS THAT HELP PREVENT HEART DISEASE

Evidence suggests that it will be helpful to take some supplements of natural substances to prevent heart disease and help to ameliorate already manifest heart problems. These supplements are:

- Omega-3-fatty acids derived from fish and other marine sources, especially the fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) and alfa-linolaeic acid. 1 gram a day of each of these substances may be taken as a supplement. Higher amounts should only be taken under medical supervision, since higher amount of these substances may cause bleeding tendencies, and may suppress the immune system.

- Supplement of vitamin C has been thought to help prevent heart disease, but newer findings cast doubt upon this.

- Vitamin B6 (Pyridoxine), folic acid / folate, vitamin b12 and riboflavin seem to prevent the building up of the substance homocystein in the blood and thereby help prevent heart disease, according to results from research projects.

GET RID OF OVER-WEIGHT

The lifestyle measures listed in this article will also help you loose weight. If these measures are not enough, you should consider engaging in a more specific weight reduction program. You should choose a program that has a moderate fat content philosophy. Some weight reduction programs have a higher fat and low carbohydrate consume philosophy, and those are probably not the best ones to reduce the chance of getting heart disease.

EXERCISE

You should do some exercise of at least half an hour at least every second day. Condition training as vigorous walking, jogging, cycling or swimming is best for reducing the heart attack probability. Muscular building exercises are also of value, especially exercises building leg muscles

STOP SMOKING

If you smoke, stopping or reducing this habit radically will decrease the chance of getting heart problems.

CONTROL DIABETES

If you suffer from diabetes type 1, a good control of the disease by insulin medication and by diet adjustments will help to prevent heart disease.

Many people over the age of 50, and an increasing number of young people suffer from diabetes type 2 because of bad lifestyle. This disease does not necessarily give dramatic symptoms, but the disease increases the chance of getting serious heart problems, and many have the disease without knowing it. This disease can be prevented by the same lifestyle measures depicted above. If you already have got the disease, a more rigorous control of carbohydrate intake is necessary. And sometimes also medication must be used. People over the age of 50 and younger people that do not feel well should find out if they suffer from this condition.

TAKING ASPIRIN

Low doses of acetyl salicylic acid or aspirin prevent heart disease by persons bearing a high risk for heart disease. However, this medication increases the risk of bleeding and should not be used without constant medical supervision. For persons with a low risk of heart disease, the dangers of aspirin will be greater than the benefits.

About the Author:

Knut Holt is an internet consultant and marketer focusing on health items.

TO FIND natural supplements against common diseases, for example: Heart problems, over-weight, acne, hypothyroidism, fatigue, depression, anxiety, hemorrhoids, joint pain, allergies, rheumatism, and respiratory diseases, PLEASE VISIT =>http://www.abicana.com/shop2.htm

For supplements to prevent heart disease and other health problems, PLEASE VISIT =>http://www.abicana.com/shop1.htm

Free to reprint with the author’s name and link.

Ironically, now in our era of affluence and plenty, we have to contend with the health and economic problems of obesity. We have a population in North America that is more than 55% overweight. More than 20% of those overweight are considered obese, a situation which proves to be an economic burden on our Health Care system because of the coronary risk factors associated with obesity. In 2004, total national health expenditure in the USA was $1.9 Trillion or $6,280 per person.

Why is obesity a risk factor for heart disease?

Among obese individuals, triglyceride levels are unusually high, while HDL levels tend to be low; both of these situations are risk factors for heart disease .A recent study involving tissues collected from autopsies of 3000 men (15-34 years old) who had died of external causes (not heart related) identified an association between obesity and coronary atherosclerosis.

Abdominal fat which characterizes obese individuals is also an area of concern. A study of 1300 Finnish men (42-60 years old) suggests that abdominal fat is an independent and major risk factor for coronary events. Several reasons have been suggested for this: a) stomach fat is continually released into the bloodstream in the form of artery-clogging fatty acids; b) abdominal fat also releases compounds that facilitate risk factors such as atherosclerosis, metabolic syndrome and inflammation; c) abdominal fat initiates biochemical events that lead to insulin resistance, a precursor of Type 2 diabetes and heart disease.

Obesity is often a precursor to metabolic syndrome, a dangerous health situation that is manifested through a cluster of symptoms�excess body fat, insulin resistance, low HDL cholesterol, high triglyceride levels and high blood pressure�all risk factors for coronary events. People with metabolic syndrome release immune system messengers called �cytokines� into their bloodstream. Cytokines lead to a communication breakdown between body cells and insulin which leads to excessive insulin production by the pancreas, creating a situation that is a literal �time bomb� for heart disease . In addition, this excessive insulin production can raise fibrinogen concentrations in the bloodstream, thus allowing blood to clot more easily, a situation that is a direct risk factor for heart attacks and strokes.

Because of their size, obese individuals are more often than not sedentary in lifestyle. Inactivity in and of itself is also a coronary risk factor. Data from more than 88,000 women in the Nurses� Health Study shows that a lean sedentary woman had 1.48 greater risks for coronary heart disease than a slightly heavier but physically active woman.

However, the same study also showed that obesity alone is a risk factor, in fact, an even greater risk factor than inactivity because coronary disease risk was highest for women who exercised the least and had the greatest waist-to�hip ratio. The conclusion that obesity itself is a risk factor is also supported by a study of 5881 overweight and obese individuals which showed that being overweight increased the risk of heart disease by 34%, while being obese increased the risk to 104%.

What can we do to help someone we know who is obese or dangerously overweight?

Acknowledgement of the problem is the first step. Very often, individuals are in a state of denial about the seriousness of their weight situation. A visit to the doctor or a healthcare professional who deals with the morbidly obese is essential. So are visits to a nutritionist, fitness consultant and body work therapist. Only then can the individual be presented with options viable and necessary for his or her situation.

In severe cases of obesity, surgery would be part of the solution. Lifestyle changes that include exercise and healthy eating are more than essential. Just as critical are bodywork therapies that can uncover some of the real issues behind addictive eating. Learning to read body cues of hunger, depression, stress is equally important for re-mapping a new life and a whole new cartography of food and consciousness, body and mind.

In Titian�s day, the corpulent body was an idealized figure on canvass, essentially exiled to the realm of the fantastic or the realm of the unjust in a society where hunger was the norm. In our days, the corpulent body has its own tale to tell: a Quasimodo that is both the scourge and product of a culture addicted to perfection.

Copyright 2006 Mary Desaulniers

A lifestyle and weight management consultant, Mary is hosting an Internet Radio show on “Reclaiming The Body’s Wisdom” October 5/06 till January 4/07. Guests include Dr. Bruce Lipton ( The Biology Of Belief), Dr. Lee Pulos ( The Biology Of Empowerment), Dr. John Diamond ( The Diamond Color Meditation) and more. Visit her at http://greatbodyafter50secrets.com

One thing we know for certain is that if you eat a diet that is high in saturated fats like those found in fatty red meats and cooking oils you are going to see an increase in cholesterol which is proven to be a major factor in heart disease. A recent study that was just released states that just being overweight a few pounds can contribute to heart disease, so you might want to start on that diet and exercise program now!

One simple thing that you can do to prevent heart disease is to eat more fish. Salmon, herring and sardines are all excellent sources of Omega 3 essential fatty acids. Many other fish are good for heart health as well, although Omega 3 may help to get your cholesterol down to a healthier level easier. Even red meat lovers can learn to enjoy seafood and nuts for their main sources of protein.

Use monounsaturated fats such as olive oil to protect your heart, olive oil is an ideal choice for cooking, dressing, or even as a dipping sauce.

It is also well documented that eating a diet high in fiber will help to control cholesterol. Whole grain products are very high in fiber and also help to control sugar absorption which will go a long way to keeping your digestive system healthy.

Choosing the right carbohydrates is also important for heart health. You need to avoid high sugar food like candy, pastries, cakes and cookies and eat healthy carbohydrates like whole grain bread and pasta, brown rice, and plenty of vegetables. As a matter of fact fruits and vegetables should be the core of a healthy diet. A simple rule of thumb to avoid processed foods is to do your shopping on the outside aisles of the grocery store.

As far as cooking methods go, frying is a total no-no. Stir frying in olive oil or canola oil is okay but you should never deep fry foods and that goes for eating out as well. Chicken is healthy and good for you if you remove the skin and bake the chicken instead of frying.

Making these changes will take time before they become habits but just remember that eating healthy is essential for a healthy heart and a long life.

Gregg Hall is an author living in Navarre Florida. Find more about this as well as Restaurant Coupons at http://www.saveondiningout.com