Penn Heart and Vascular

Penn Heart and Vascular Update

Wednesday, November 18, 2015

How to Start an Exercise Program that Benefits the Heart

Dr. Neel Chokshi, a cardiologist specializing in cardiac risk prevention, cardiovascular fitness and sports cardiology, discusses starting a fitness program and the effect exercise has on the heart.

Exercise can be exhausting, even before you start working out. With ever-changing guidelines and fitness fads, it’s tough to know what’s best for your body. Regardless, the best exercise program is a consistent one. The benefits of staying active have an overwhelmingly positive effect on your overall health and your heart.

Where to begin

Whether you’re at high risk for heart disease or in good health, there are two key things you should do when starting an exercise program.

First, talk with a primary care physician or cardiologist to get a sense of any underlying risk. Although the conversation may be short depending on your medical history, they can advise on questions such as “Is it safe for me to do this?” and “Do I need to have any testing completed beforehand?”

Secondly, a physician can also advise on what type of activities and length of time is appropriate for your age. Recommendations are dramatically different if you're 65 years old and want to start running then if you’re 25 and in relatively good shape.

Getting started

After speaking with a physician, it’s time to start a program. If you haven’t exercised in the past, find something you enjoy and start slowly. Swimming is a great activity to start with because it works your heart and joints. However, don’t expect to do 60 laps your first time. Begin gradually and build up endurance over time.

What are the recommendations?

The American Heart Association recommends the following:

For overall cardiovascular health

  • At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150 minutes OR at least 25 minutes of vigorous aerobic activity 3 days per week for a total of 75 minutes
  • For lowering blood pressure and cholesterol

  • An average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week
  • Benefits for your heart

    The heart is a muscle and gets stronger when leading an active lifestyle. Regular exercise can help:

    • Reduce risk for coronary heart disease - a condition where plaque builds up on the arteries that supply oxygen rich blood to the heart.
    • Lower blood pressure
    • Lower “bad” cholesterol and raise “good” cholesterol
    • Burn calories
    • Build muscle
    • Improve sleep and mental health
    • Lower stress and anxiety

    It’s never too late to start exercising. Even a small increase in activity is a positive change. Start out slow and before you know it you’ll feel better - not just physically but mentally as well.

    Tuesday, November 10, 2015

    Tips to Make a Soup Recipe Heart Healthy

    Fall is here and the drop in temperature signals a desire for warm, comfort foods like soups and stews! Often times, these soul–soothing dishes are chock full of vegetables and can offer heart healthy benefits.

    We wanted to discover exactly what makes a soup recipe healthy, and find ways to make those recipes even healthier. So we asked Fran Burke, registered dietitian at Penn Medicine's Preventive Cardiovascular Medicine Program to give us some tips.

    Added salt

    The bottom line is, don't add additional salt to a soup recipe. If a recipe calls for salt, try experimenting with another spice that compliments the flavors in the soup. Here is a quick guide to herbs and spices that complement particular dishes.

    Make it meatless

    If you are cooking a soup that calls for meat, try omitting it altogether or even cutting the amount in half. This will lower the fat content in the soup.

    Vegetables are always a good addition

    Try adding extra veggies to your soup. It will make it heartier and add extra nutrients at the same time!

    Make your own stock

    Often times, canned broth contains a large amount of sodium. Choose the lower sodium variety or, even better, make your own!

    Warm up with some of these soup recipes!

    Friday, October 30, 2015

    Heart Healthy Tips on Cooking with Herbs and Spices

    Part of following a heart healthy diet is generally making sure that it is low sodium. Using herbs and spices can add zest and enhance the flavor of food cooked without the added salt. When cooking with dried or fresh herbs, try for a subtle effect by using them sparingly.

    A Good Rule of Thumb: In an untested recipe, 1/4 teaspoon of dried herbs should be enough in a dish serving four people. It is always easy to add more if needed. If you can clearly taste the herb, you have probably used too much.

    1/4 teaspoon powdered herb = 1/2 teaspoon dried herb or 2 teaspoons fresh chopped herb
    1 tablespoon onion powder = 1 medium raw onion
    1/8 teaspoon garlic powder = 1 clove fresh garlic

    Here are some useful tips when encorporating these dried and fresh herbs into your cooking:

    • Crush, mince, or finely chop fresh herbs before use.
    • Longer cooking time brings out more flavor, but avoid overcooking. Add herbs during the last hour of long cooked dishes like soup or stew.
    • For uncooked or quick-cooked dishes, either add the herbs several hours before cooking and serving; or steep the herbs in a hot liquid for a few minutes before adding; or moisten the herb in lemon juice or oil and allow to stand one hour before adding to the food.
    • Store dried herbs in a tightly closed container in a cool dark place.

    Flavor Combinations to Spice Up Your Cooking

    Some herbs work particularly well with certain foods or in combination with each other. Use a strong flavored herb with one or more milder ones to give a subtle blend. Use strong and accent groups for leading flavors and combine with blend groups to get the desired effect.

    Types of Herb Flavors

    Types of Herbs Examples
    Strong Herbs Bay leaf, oregano, rosemary, sage, winter savory
    Accent Herbs Basil, dill, marjoram, mint, tarragon, thyme
    Blend Herbs Chervil, chives, parsley, summer savory

    Flavor Combinations for Meats and Eggs

    Type of Protein Complementary Herbs, Spices and Flavors
    Beef Bay leaf, green pepper, chive, pepper, onion, dry mustard, sage, thyme, marjoram, nutmeg, garlic
    Lamb Curry powder, rosemary, mint, mint jelly, garlic, parsley, oregano, basil
    Pork Garlic, sage, marjoram, nutmeg, spiced apple
    Veal Bay leaf, ginger, marjoram, curry, basil, oregano, currant jelly, summer savory
    Fish Dry mustard, paprika, curry, bay leaf, lemon, tomato, dill, green pepper, marjoram, parley, tarragon, thyme.
    Poultry Paprika, thyme, sage, parsley, basil, marjoram, summer savory, ginger,
    Eggs Green pepper, dry mustard, paprika, pepper, curry, chives, parsley, basil, oregano

    Flavor Combinations for Vegetables

    Type of Vegetable Complementary Herbs, Spices and Flavors
    Asparagus Lemon juice, rosemary
    Broccoli Lemon juice, tarragon, thyme, oregano
    Cabbage Mustard, dill seed, caraway seed
    Cauliflower Nutmeg, parsley, chives, basil, dill
    Corn Green pepper, tomatoes
    Green Beans Dill, oregano, marjoram, nutmeg
    Potatoes Parsley, chives, lemon
    Squash Ginger, nutmeg
    Tomatoes Basil, oregano, dill

    Tuesday, October 20, 2015

    These Heart Tests Could Save Your Life

    Coronary calcium scan
    A heart with calcified coronary arteries (top)
    and a heart with healthy arteries (bottom).

    If you’re reading this article, you probably have a decent understanding of your personal risk for cardiovascular disease: Maybe you know it runs in your family, you used to smoke, or your cholesterol levels are slightly higher than your doctor would like — all factors that put you at higher risk for heart attacks and strokes.

    But you probably want to know more, too. After all, having the most comprehensive information about your personal risk for heart disease can help your healthcare team put the most effective plan in place for preventing these conditions.

    At Penn’s Preventive Cardiovascular Program, we offer world-class preventive care by using innovative technologies and imaging to detect heart disease. The following are some of the tests our physicians use to get the most accurate pictures of your personal risk -- some of which are unavailable anywhere else in the Philadelphia region.

    Top Heart Tests

    Genetic Testing for Heart Attack Risk:

    Certain genetic variations in a person’s DNA are linked with an increased risk of heart attacks. Using a sample of your blood, doctors can look for these variations to determine if you’re at an increased risk of heart disease and heart attacks.

    Vascular Ultrasound Screening:

    During this non-invasive test, doctors use the same technology used for sonograms performed on pregnant women. Vascular ultrasound screenings assess your arteries for signs of atherosclerosis, or blocked arteries, by either the accumultation of plaque or thickening of the blood vessel walls.

    Coronary Artery Calcium Scanning:

    Another non-invasive method for determining your risk for having a heart attack. A “heart scan,” or computed tomography CT scan of the heart, evaluates the coronary arteries for a buildup of calcium. Calcium is a marker for atherosclerotic plaque, which causes blocked arteries. Higher coronary artery calcium scores are associated with a higher risk for heart attack.

    Advanced Lipid Laboratory Testing:

    These tests go beyond basic cholesterol testing to provide more information about your blood lipid levels. Analysis of lipids including apolipoproteins A and B, lipoprotein (a), lipoprotein sub-fractions can be used by physicians to diagnose lipid diseases and refine your cardiovascular risk assessment. These tests can help your healthcare team provide the most appropriate treatment options for you.

    Ambulatory 24-hour Blood Pressure Monitoring:

    This test is a valuable tool for diagnosing hypertension because it gives physicians a more accurate look at your blood pressure numbers. The small, portable and automated cuff and monitor device will measure your blood pressure for 24 hours, giving doctors a comprehensive assessment of your blood pressure throughout the day and night.

    Ready to get the most comprehensive picture of your risk for heart disease?

    Wednesday, October 7, 2015

    4 Myths about Heart Murmurs

    Lub DUB. Lub DUB. Lub DUB. Ah, the sweet sound of blood flowing through the heart.

    This rhythmic pattern is the sound of heart valves opening and closing as blood makes its way to the heart. Heart valves make sure blood flows in one direction: toward your lungs.

    When valves are too stiff, too loose, or aren’t formed properly, blood flow may sound more like a swishing or whooshing noise. This is called a heart murmur.

    Heart murmurs are not always a warning sign of danger. But it is important to determine their cause and have them followed.

    Here are 4 common myths about heart murmurs to help you understand this common diagnosis.

    Myth #1: All Heart Murmurs Are The Same.

    All heart murmurs are not equal. They come in two varieties: innocent and abnormal.

    An innocent heart murmur does not cause problems with the heart’s function. It could be related to a condition, often temporary, causing high blood flow through the heart’s valves explains...It may just be related to an area of high blood flow, explains Maureen Julien, MSN, CRNP, lead nurse practitioner for interventional cardiology at Penn Medicine.

    Healthy children often have innocent heart murmurs, she says.

    An abnormal heart murmur is caused by disruption in blood flow stemming from a lesion (disease state?) or defect that has developed, affecting the circulatory system. , says Maureen. In children, congenital defects often cause abnormal heart murmurs, while in adults, the culprit is usually heart valve disease.

    When blood flow is increased, valves must respond. So, it makes sense that conditions that increase blood flow temporarily can also cause heart murmurs, according to the American Heart Association (AHA). The conditions include:

    • Being pregnant
    • High fever
    • Hyperactive thyroid gland
    • Anemia

    While they may be innocent and temporary, having these heart murmurs followed by a medical professional is still important.

    Myth #2: You Can Tell It’s A Murmur Just By Listening.

    Not always. Many times, people are referred to a cardiologist because their primary care physician hears a murmur. But you can’t necessarily—just by listening—diagnose exactly what it is, cautions Maureen.

    Although a heart murmur doesn’t feel like anything, per se, she says the symptoms you may feel are related to the underlying cause.

    A leaky heart valve causing a heart murmur may not be opening and closing properly causing blood to flow backwards in the circulatory system. In turn, your legs, swelling of the belly, and weight gain, says Maureen.

    I’m talking about gaining more than 2 pounds overnight or 5 pounds over the course of the week. That’s a hallmark of heart failure weight gain. It doesn’t usually come from dinner the last couple nights, she explains.

    Other signs and symptoms of a heart murmur can include:

    • Chest pain
    • Fainting
    • Dizzy spells
    • Constant coughing
    • Bluish lips and fingers
    • Inflammation
    • Excessive sweating with little physical exertion
    • Swollen liver
    • Enlarged veins in the neck
    • Poor appetite (in infants)

    Myth #3: All Heart Murmurs Require Treatment.

    Some heart murmurs disappear when children become adults, while others remain with them into adulthood. Innocent heart murmurs do not always require treatment but Maureen stresses that it is still important to have your physician monitor the condition.

    In the cases of abnormal heart murmurs, it often depends on the cause. If other health conditions unrelated to heart disease exist, such as anemia or hyperthyroidism, then treating them should eliminate the heart murmur.

    Myth # 4: Medication Will Repair The Heart Murmur.

    Abnormal congenital heart murmurs may be treated with medicines or surgery. If the cause is heart valve disease, treatment may vary, depending on the severity.

    Patients are hopeful that it can be fixed with medicines alone, and that may not always be the case, Maureen points out. You may initially be treated with medicine—and that may be for years—but it’ll be watched over time, she says.

    If medicine is not successful, then the next step may be surgery to repair or replace a faulty valve.

    Every case is different and it is important to make sure you are comfortable with the care that you are receiving and that your questions are being answered.

    Consulting a physician is your best bet for determining if you have a murmur and how serious it is.

    If your primary physician tells you, “I think I hear a murmur.”, you should see a cardiologist. Do some research and get a referral from your physician, or find somebody that you’ve heard or read good things about, adds Maureen.

    Murmurs should be paid attention to. They signal that there is a disruption in blood flow and knowing the cause is important even if it turns out to be innocent.

    Are you concerned that your heart murmur may signal something more serious?

    Monday, October 5, 2015

    Frightening Heart Complications from a Common Virus

    An undiagnosed illness

    Tina Frey knew there was something terribly wrong. Over the course of several months, she went from being a busy young mom with a demanding career to struggling with life's most basic activities, like walking and breathing.

    Doctors close to Tina's home couldn't find anything wrong. They were convinced that the cause of her symptoms was the stress of a young working mom. They enouraged her to exercise more - to get back into shape. But the more Tina pushed, the more the sickness pushed back. She was getting worse as time went on.

    "I felt like I was at death's door"

    A normal heart fills up with blood and pumps out
    about 65% of the contents during a single beat.
    This is called the ejection fraction (EF).

    After several months with no improvement, Tina went back to her primary care doctor and urged for thorough testing. A new X-ray showed that Tina's heart was enlarged; she needed a cardiologist.

    At her cardiology appointment, Tina's echocardiogram - a routine test to check the heart – showed a dangerously enlarged heart. Tina was immediately admitted to her local hospital. There, it was discovered that her heart was weak and struggling to pump blood adequately. With an ejection fraction of only 25%, Tina was diagnosed with heart failure. To compensate, her heart tried to fill up with more blood, causing it to stretch and beat faster – a condition known as dilated cardiomyopathy.

    With Tina's condition deteriorating, her local hospital recommended she go to the Heart Failure Program at the Hospital of the University of Pennsylvania. By the time Tina reached Penn, her EF had dropped to 15%. The doctors sprang into action, working to stabilize her heart.

    Tina's road to recovery

    A week later, Tina was strong enough to go home. When she walked out of the hospital, she had a fist-full of medications, a heart healthy lifestyle plan and, most importantly, a LifeVest external defibrillator. This device would shock her heart back into rhythm in the event of a cardiac arrest.

    The diagnosis and treatment plan were daunting, but now there was a team of experts behind her. After months of medication adjustments, Tina felt better and her EF improved. She was monitored closely by the Penn Heart Failure team and over the course of the year she became healthier - slowly feeling like herself again.

    Why did Tina get sick?

    Cardiomyopathy can be caused by a number of different conditions; chemotherapy, uncontrolled blood pressure, pregnancy, heart attack and even genetics. For Tina, the most probable cause was viral. Her son had contracted the coxsackie virus over a year prior to her heart failure diagnosis.

    Nearly a year later, the virus is undetectable in Tina's blood, her EF has improved to 40%, and she is stable enough to start cardiac rehabilitation.

    Tina's message for everyone

    Tina is participating in the 2015 Philly Heart Walk to share an important message. "If I would have gotten treatment sooner, we may have been able to stop or slow down the progression of this disease," says Tina. "I hope that my story can inspire others to be their own advocate, to live heart healthy, to be the change."

    Help Tina share her message. Together, we can make healthier, longer lives possible for everyone.

    Tuesday, September 22, 2015

    Improving Your Health Literacy: 5 Tips for Managing and Treating Heart Disease in the Information Age

    For people diagnosed with heart disease, the search for treatment information often begins in front of a screen.

    “In this information age, patients are going to try to find ways to understand any diagnosis to the best of their ability,” says Lynn Washington, BSN, RN, nurse navigator for cardiac surgery and transitions coordinator for Heart and Vascular Service Line at Penn Medicine.

    Physicians and in-person appointments are no longer the only source of information on one’s health condition. While an online search can yield a wealth of information about heart disease, and give patients the opportunity to research and understand their condition, it is important to know what information you can trust, as well as combine all sources of information to give you a better picture.

    Finding the information you need from reliable sources is part of a skill called health literacy, the Office of Disease Prevention and Health Promotion explains. And while the digital age has changed the way we learn and grow this skill, many in-person sources of education are still very important and helpful.

    Here are 5 tips for managing and treating heart disease in the information age.

    1. Consider The Online Source.

    When it comes to finding reliable health information online, “I would caution everybody on the internet to be aware of who’s providing you with the information,” says Lynn.

    She suggests patients ask themselves, “Is there an agenda in play? Are there multiple ads on the webpage?”

    For information on issues like heart healthy diets, reputable sources such as the American Heart Association can provide useful suggestions for patients.

    2. Turn To The Hospital’s Website.

    “Our own web page,, is relatively easy for patients to navigate,” Lynn says. “It can easily guide patients to the Heart and Vascular Care service page.”

    She adds that, “These sites are usually accessible from myPennMedicine, Penn's patient portal. I always encourage my patients to sign up for the portal because there’s so much reliable information there.”

    3. Talk To Other Patients.

    “As healthcare providers, we can talk all we want about a procedure and how you can anticipate your recovery to go,” Lynn explains. “But—not ever having had heart surgery myself—it’s difficult for me to get into the emotions involved. And there is a large emotional component to this.”

    That’s why Lynn encourages patients to reach out to others, in person or online, who have already had similar experiences. They can “explain what was difficult for them or how they dealt with the nuances of recovery.”

    4. Build A Support Team.

    Of course, in person appointments and explanations from your own physician are extremely important. Your doctor can see the whole picture and how co-existing conditions may relate to your heart disease. Therefore, it is important that the information talked about during your appointments is understood.

    Lynn suggests you also bring a friend or loved one with you to appointments. “Any one person with just two ears cannot absorb all of the information that’s given to them, especially in a life-altering situation like heart surgery,” Lynn says.

    That person can also take notes to help you remember what was discussed and to ask any important questions that may slip your mind.

    “I highly recommend that you have someone who is going to be helping you care for yourself be there. You’re more likely to get all of the information if there are two people there to absorb it,” she explains.

    5. Don’t Be Afraid To Ask Questions.

    "During an appointment, there can be quite a large gap between the expectations of the patient and those of the medical staff," Lynn explains.

    According to Lynn, "patients should not hesitate to guide their providers into telling them what they want to know. I very much encourage patients to tell me what information I can give to them.”

    Lynn acknowledges that this can be difficult if a patient has multiple chronic health conditions. She says that having good coordination between healthcare providers is important. Because these patients "are seen by multiple doctors in multiple specialties, there can be conflicting information provided if you’re just narrowly looking at one condition.”

    “I would love for patients to know how to be their own advocates, and know the right questions to ask every provider they see.”

    Understanding your condition is what health literacy is all about. Gather information from a wide variety of reliable sources and then ask questions to make you feel comfortable. Then use the knowledge you’ve gained to make the decision that is right for you.