Health Topics A-Z

Health Topics by Category

Health Topics for Cardiovascular Health

UI Heart and Vascular Care

Cardiovascular Diseases



    

Cardiac Rehabilitation Guide

Exercise

Stress Management

Eating for Heart Health

Smoking

References

Awards, Reviews, and Comments Book

  • Introduction

    • We created this booklet to help you and your family understand your heart disease and help you make informed choices for adopting a "heart-healthy" lifestyle. We don't limit our recommendations to you, the cardiac (heart) patient. We encourage your entire family to practice these habits - just as the CHAMPS staff does!

    There is a life beyond angina, heart attack (myocardial infarction), cardiac procedures (angioplasty, valvuloplasty), and cardiac surgery (coronary artery bypass, valve replacement). The choices you make in living with heart disease are yours. Our goal is to help make your lifestyle adjustments become enjoyable habits and reduce any physical limitations you currently may have. You may even exceed activities you participated in prior to your cardiac event.

    The team of professionals you will be working with consists of physicians, nurses, physical therapists, dietitians, exercise physiologists, social workers, and psychologists. When needed, additional supporting individuals are available to you. They include pharmacists, occupational therapists, and a vocational counseling.

    Your questions are important to us. As you read through this book and questions arise, please address them to one of the CHAMPS team members.

    We hope you have an enjoyable, educational, and enlightening experience with us in CHAMPS!

    "If you want to live a long and happy life, get a chronic disease and manage it."
          — Oliver Wendall Holmes

  • To the Cardiac Family

    • Throughout the hospitalization of your family member, it may have seemed that all of the care and concern was focused on your loved one. While few would begrudge this attention, what is often overlooked are the needs of you, the patient's support system. As the family member, it is normal for you to experience a profound sense of loss or grief as you realize that in many ways your life will never be the same again. Many of you will view your lifestyle as threatened, creating within you a variety of emotions such as anger, fear, anxiety or depression.

    You are the most important person in the life of our patient. That makes you pretty important to us as well. At the University of Iowa, we strive to treat not only the cardiac patient, but the entire family. While we may spend the majority of our time serving the very real needs of your spouse, we recognize that you too have special needs.

    This booklet contains information not only for your loved one, but also for you. Our staff is committed to the needs of the family, and we encourage you to share your concerns with us. We hope to hear from you in the near future.

  • Treatment

    • Coronary Artery Disease does not have to end in death or disability. You can alter the course of the disease through diet, exercise, stress management, medication, angioplasty, or by-pass surgery.

    CHAMPS
    CHAMPS offers you a more permanent way of treating coronary artery disease by helping you make positive lifestyle changes. We help you identify your risk factors and what you can do to prevent progression of your coronary artery disease or, better yet, promote regression of the disease.

    Inpatient Phase
    The first phase takes place in the hospital. By helping you out of bed as soon as we can, by having you walk as much as safely possible, and by helping you understand your disease, your medications, and when your symptoms warrant a call to your doctor are all factors we hope to accomplish during your hospital stay.

    • Make sure you have a list of your medications and you know when to take them and what they are for. Your nurse will help you with this.
    • What are your activity restrictions? Ask your CHAMPS team member, doctor, or nurse.
      • When you can drive
      • When you can resume sexual activities
      • Where you will be going to Outpatient Cardiac Rehabilitation

    If I don't hear from my Outpatient Cardiac Rehabilitation site within one week after I am discharged, I will call them at the hospital where I have been referred. If that is the University of Iowa Hospitals and Clinics, call CHAMPS at 319-356 4652!

    Outpatient Phase
    Participation in an outpatient cardiac rehabilitation program is one of the most beneficial things that patients with heart problems can do for themselves. All you need is a physician's referral. Check with your insurance company or ask your CHAMPS team member for advice on coverage. Expect to participate in the outpatient phase for 6-12 weeks. You will be glad you did!

    The outpatient phase is where everything will come together for you. What may have been overwhelming in the hospital, will now, in the outpatient phase, be manageable for you. You and your family will learn all the ways to manage your heart disease from nutrition education to stress management to exercise training. You will condition your body and heart in a safe, ECG monitored environment that is supervised by specially trained professionals.

    Use this book for a guide and resource as you go through this Phase.

    Maintenance Phase
    After you have completed the outpatient phase, you may begin the long-term maintenance program. It is a non-ECG monitored program in which you will be independent, yet our expert staff is always present in case you need us. Insurance usually doesn't cover the maintenance program. However, we have reduced our expenses and your costs so that it is comparable in cost to a health club.

  • Understanding Heart Disease

    • To understand your heart problem, it helps to know a little about the structure and function of the heart. In this section, we hope to answer the following questions:

    • Where is my heart located?
    • What is its purpose?
    • How is the heart supplied with oxygen and nutrients?
    • What do the terms angina and myocardial infarction mean and how do they differ?

    Figure 1. The heart and major structures

    The heart (figure 1 ) can be described as a right and left sided pump that is positioned in the center of your chest and extends into the left side of your chest. The bottom of your heart sits just above the diaphragm and your lungs surround the heart on the sides. The right side receives blood (that is depleted of oxygen) from your body then pumps it forward into your lungs. The left side of your heart receives blood from your lungs (now enriched with oxygen) and pumps it back to your muscles, brain, kidneys, etc On the average your heart circulates 8-10 quarts of blood per minute. Despite this enormous blood flow through it, the heart is unable to obtain the oxygen and nutrients needed to function from this source of blood. Three major arteries (right coronary artery, left circumflex, left anterior descending) arise from the aorta which is the major blood vessel leaving the left side of the heart. These arteries then branch out supplying oxygen and nutrients to various regions of your heart. The location of the arteries are Illustrated in figure 2.

    Figure 2. The coronary arteries.

    The movement of blood through the heart is dependent, in part, on its four valves (tricuspid, mitral, pulmonary, aortic) (see figure 1). They are located between the atria (blood receiving chambers) and the ventricles (major pumping chambers); and between the ventricles and the blood vessels leaving the heart (on the right side this is the pulmonary artery, on the left side is the aorta).

    To coordinate the heart's pumping, it has a built in electrical conduction system. The heart is a muscle and, like other muscles, it contracts (shortens) when stimulated. The heart is unlike other muscles in that it can self generate impulses to stimulate itself along with surrounding muscle cells. The electrical system of the heart keeps its chambers beating in rhythmic sequence so blood is continually pumped through it to all parts of the body.

  • Coronary Artery Disease

    • The heart can work when it is nourished and has sufficient oxygen. However, there is a very common disease claiming more lives than any other in our country that prevents nutrients and oxygen from reaching the heart muscle and structures. That disease is known as Coronary Artery Disease (CAD). In CAD, the coronary arteries narrow and may eventually close. The process often responsible for this is atherosclerosis, a build up of fatty deposits in the walls of the arteries. Over time, this makes the arterial walls hard and thick, reducing the amount of blood that can pass through them (figure 3). When the heart muscle doesn't get enough blood, it is deprived of oxygen and nutrients. If this situation continues, the heart muscle will be damaged. The amount of damage depends on the location of and the degree of blockage. Angina pectoris and myocardial infarction are two consequences of CAD.

    Figure 3. Graphic illustration of a longitudinal section of a coronary artery illustrating plaque build-up and narrowing of the lumen.

    American Heart Association Information

  • Risk Factors for Coronary Artery Disease

    • Scientific and populations studies show that certain traits and lifestyle habits increase the risk of coronary artery disease (CAD). These danger signs are called "Risk Factors." There are two types, modifiable and non-modifiable. Modifiable risk factors can be changed (modified) and the non-modifiable cannot. As you read the risk factors below, circle "yes" if they apply to you, and "no" if they do not.

    Non Modifiable Risk Factors:
    Yes No
    		Advancing Age
    The older you are the more likely it is that plaque has built up.
    If you are a woman 55 years or older circle "yes."
    If you are a man 45 years or older circle "yes."
    Yes No
    		Post Menopausal Female
    After menopause a woman's rate of heart attacks "catch up" to that of a man's. If you are a post-menopausal (natural or ovaries removed by surgery or premature less than 35 years old without hormone replacement therapy) female, circle "yes."
    Yes No
    		Heredity
    If you have first-degree relatives (biological parents, siblings and/or off-spring) with heart disease or stroke, and if those male relatives were younger than 55 and female relatives were younger than 65, circle "yes."

    Major Modifiable Risk Factors:
    Increased blood cholesterol levels, specifically a high concentration of low-density lipoprotein (LDL) cholesterol or a low concentration of high-density cholesterol (HDL) cholesterol, increase risk of coronary artery disease (CAD).
    Yes No
    		High Cholesterol
    If your total cholesterol level is above 200 mg/dL, circle "yes."
    Yes No
    		High LDL (bad cholesterol)
    If your LDL is above 70 mg/dL, circle "yes."
    Following a low fat, low cholesterol diet will help change this problem. In addition, your doctor may recommend medication to improve your lipid profile.
    Yes No
    		Low HDL
    If your HDL is less than 40 mg/dL, circle "yes."
    Exercise and smoking cessation will both help increase this level. Alcohol also increases the HDL, but because alcohol is related to other health problems (high triglycerides, hypertension, liver problems), we do not recommend you start drinking alcohol if you do not already drink. If you are already drinking, limit the amount to two drinks per day, providing your triglycerides are normal, you are not hypertensive, and you do not have other conditions that alcohol would aggravate. The goal is to have the HDL as high as possible over 40.
    Yes No
    		Triglycerides
    If your triglycerides are greater than 150 mg/dL, circle "yes."
    Triglycerides are the most common form of fat found in food. Decreasing the amount of fat in your diet, restricting simple carbohydrates, decreasing alcoholic beverages, increasing the amount of starch and high fiber foods, and reducing your body weight are several ways you can reduce your triglyceride levels.
    Yes No
    		High Blood Pressure
    Circle "yes" if your blood pressure is above 139/89. If your blood pressure is 120/80 or higher, it is on the high end of normal and you are advised to keep a close watch on it.
    - OR -
    If you are a diabetic and your blood pressure is higher than 130/85, circle "yes."
    Normal blood pressure for anyone 18 years or older is 119/79 or lower. Increased blood pressure causes the heart to pump against increased resistance, eventually leading to overgrowth of the heart muscle. If you have high blood pressure, reducing your sodium intake, losing weight, exercising, decreasing alcohol intake and seeing your doctor about prescribing medication will help control it.
    Yes No
    		Cigarette Smoking
    The nicotine in cigarette smoke causes your coronary arteries to constrict. Cigarettes also cause the blood to clot and the carbon monoxide decreases the amount of oxygen the blood can carry. The only way to reduce this risk and to stop this damage to your heart is to stop and stay away from others who smoke. A major reduction in coronary heart disease occurs even within the first year after stopping smoking. Being around environmental smoke greater than one hour a day also increases your risk for CAD by 40-50%.
    Yes No
    		Diabetes
    Increased blood sugar levels in a diabetic cause an increase in triglycerides and LDL and a decrease in HDL. A diabetic who controls his/ her blood sugar level will minimize adverse changes in the lipid profile.

    Other Modifiable Risk Factors:
    Yes No
    		Stress
    Personal and job-related stress is common today. It's difficult to define and measure stress; however, studies suggest that certain people respond to stress in ways that tend to increase their blood pressure and heart rate. Both of these increase the workload placed on your heart, which increases the oxygen demands of the heart. Over time, chronic stress can, for some people, contribute to the development of coronary artery disease. Circle "yes" if you feel your lifestyle is stressful.
    Yes No
    		Overweight/Obesity
    Obesity is defined as being 20% or more over your ideal body weight. Obesity causes an additional strain on the heart since there is more body mass requiring blood. Obesity is linked with high cholesterol, high blood pressure, and an increased heart size. To reduce this risk, follow a low fat diet and maintain a reasonable body weight. Circle "yes" if you are overweight.
    WEIGHT STANDARDS (based on Body Mass Index [BMI])
    HEIGHT
    in.    		 BMI 19
    lbs.    		 BMI 24
    lbs.    		 BMI 30
    lbs.    		 BMI 35
    lbs.

    		HEALTHY RANGE

    4' 10" 91 115 143 167
    5' 0" 97 123 153 179
    5' 2" 104 131 164 191
    5' 4" 111 140 174 204
    5' 6" 118 148 156 216
    5' 8" 125 158 197 230
    5' 10" 132 167 209 243
    6' 0" 140 177 221 258
    6' 2" 148 186 233 272
    6' 4" 156 197 246 287
    Yes No
    		Physical Inactivity
    The heart, like any other muscle; needs to be exercised to function properly. Exercise will favorably affect all the other risk factors. Numerous studies have found that lack of exercise not only increases the risk of cardiovascular disease, but also cancer, osteoporosis and other diseases. Follow the exercise program your CHAMPS team has developed for you. Exercise can reduce your blood pressure, decrease the urge to eat and smoke, facilitate a positive outlook on life, reduce stress, and make your heart and other muscles work more effectively and efficiently. Circle "yes" if you exercise less than 30 minutes a day, 3 days per week.
    Yes No
    		Metabolic Syndrome
    Many people have a specific combination of risk factors, referred to as the metabolic syndrome. If you have 3 or more of the following items, you have metabolic syndrome and have an increased risk of developing a heart problem. Circle "Yes" if you have metabolic syndrome.
    • Abdominal obesity (waist circumference):
      • Men: greater than 40 inches
      • Women: greater than 35 inches
    • Triglycerides greater than 150 mg/dL
    • HDL cholesterol:
      • Men: less than 40 mg/dL
      • Women: less than 50 mg/dL
    • Blood pressure greater than 130/85.
    • Fasting glucose 110-125 mg/dL
  • Medications

    • ACE Inhibitors
    Benazepril (Lotensin); Captopril (Capoten); Enalapril (Vasotec); Lisinopril (Prinivil/Zestril);Fosinopril (Monopril)

    ACE inhibitors are taken by mouth to treat high blood pressure and slow disease progression of congestive heart failure.
    Used for: Chronic hypertension, congestive heart failure, and kidney protection in diabetics.
    Side effects: These symptoms may occur: Cough, diarrhea, headache, loss of taste, nausea, unusual tiredness.
    Report these symptoms to your doctor: Difficult breathing (sudden); fever and chills or sore throat; swelling of face, mouth, hands, or feet; dizziness; fainting; skin rash; chest pain.
    *This drug may cause potassium to accumulate in excess quantities in your body. Signs of too much potassium include: confusion, irregular heartbeat, tingling in hands, feet or lips, weakness or heaviness of the legs.
    Notes: Check with your doctor if you have severe or continuing vomiting or diarrhea. This may cause you to lose too much water and lead to low blood pressure. Dizziness, lightheadedness, or fainting may occur after the first dose, especially if you have been taking a diuretic (water pill). This medication will not cure your high blood pressure, but will help control it.

    Angiotensin-II Receptor Blockers (ARB)
    Losartan (Cozaar); Irbesartan;(Avapro)Valsartan (Diovan);Candasartan (Atacand)

    Angiotensin-II receptor blockers are taken by mouth to treat high blood pressure.
    Used for: Chronic hypertension, congestive heart failure
    Side effects: These symptoms may occur: Headache, diarrhea, loss of taste, nausea, unusual tiredness.
    Report these symptoms to your doctor: Difficult breathing (sudden); fever and chills or sore throat; swelling of face, mouth, hands, or feet; dizziness; fainting; skin rash; chest pain.
    *This drug may cause potassium to accumulate in excess quantities in your body. Signs of too much potassium include: confusion, irregular heartbeat, tingling in hands, feet or lips, weakness or heaviness of the legs.
    Notes: Check with your doctor if you have severe or continuing vomiting or diarrhea. This may cause you to lose too much water and lead to low blood pressure. Dizziness, lightheadedness, or fainting may occur after the first dose, especially if you have been taking a diuretic (water pill). This medication will not cure your high blood pressure, but will help control it.

    HmgCoA Reductase Inhibitors (Statins)
    Lovastatin (Mevacor); Pravastatin (Pravachol); Simvastatin (Zocor);
    Fluvastatin (Lescol); Atorvastatin (Lipitor); Rosuvstatin(Crestor)

    These drugs help slow the progression of coronary atherosclerosis by decreasing cholesterol and stabilizing harmful plaque.
    Used for: Lowering total and LDL cholesterol, increasing HDL (good) cholesterol, and preventing heart attacks.
    Side effects: These symptoms may occur: Dizziness, headache, muscle weakness, insomnia, blurred vision, heartburn, liver dysfunction, pancreatitis, rashes, nausea.
    Report these symptoms to your doctor: Prolonged muscle pain and weakness.
    *Your doctor may want to check liver function tests (LFTs) periodically while on this medication.
    Notes: Take medication exactly as prescribed, do not skip doses or double up on missed doses. Medication helps control but does not cure elevated cholesterol levels. Taking with food may decrease stomach problems such as nausea. Medication works best when taken in the evening.

    Fibrates
    Gemfibrozil (Lopid); Fenofibrate (Tricor)

    These medications are used to lower cholesterol specifically triglycerides.
    Used for: Lowering total and LDL cholesterol, increasing HDL (good cholesterol), and preventing heart attacks.
    Side effects: These symptoms may occur:  Upset stomach, runny nose, sore throat, headache, nausea, and diarrhea.
    Report these symptoms to your doctor:  Prolonged muscle pain and weakness,  dark-colored urine or pale stools, sudden and sever stomach pain, yellowing of the skin, a red skin rash, chest pain, trouble breathing.
    Notes: Take medication exactly as prescribed, do not skip doses or double up on missed doses.  Medication helps control but does not cure elevated cholesterol levels.  Medication is best tolerated with a meal or 30 minutes before or after a meal.  Medication should be avoided in pregnancy or while breast-feeding.

    Bile Acid Sequestrants
    Colesevelam (Welchol); Colestipol (Colestid); Cholestyramine Resin (Questran)

    These drugs help to lower cholesterol.
    Used for: Lowering total cholesterol by binding to cholesterol in the gastrointestinal tract (GI) and preventing heart attacks.
    Side effects: These symptoms may occur:  Constipation, fatigue, upset stomach, prolonged muscle pain and weakness.
    Notes: Take medication exactly as prescribed, do not skip doses or double up on missed doses.  Medication helps control but does not cure elevated cholesterol levels.  Medications should be taken with a meal and plenty of fluids.  You should avoid taking other medications up to 3 hours before or after this medication.  Powders need to be thoroughly mixed in 6 ounces of a non-carbonated beverage.

    Zetia
    ( Ezetimbe)

    This drug helps to lower cholesterol in patients unable to meet LDL goals on statin therapy or unable to tolerate statins.
    Used for: Lowering total and LDL cholesterol, and preventing heart attacks.  Often used in addition to statin therapy or for patients unable to tolerate statins.
    Side effects: These symptoms may occur:  Dizziness, headache, diarrhea, stomach pain, stuffy or runny nose, sneezing, coughing, fatigue.
    Report these symptoms to your doctor:  Chest pain, prolonged muscle pain and weakness.
    *Your doctor may want to check liver function test (LFT's) periodically if you are taking this medication with a statin.
    Notes: Take medication exactly as prescribed, do not skip doses or double up on missed doses.  Medication helps control but does not cure elevated cholesterol levels.  Medication may be taken with out regards to food but should be taken at the same time every day.  Medication should be avoided in pregnancy or while breast feeding.

    Beta Blockers
    Metoprolol (Lopressor); Atenolol (Tenormin); Carvedilol (Coreg); Propranolol (Inderal); Nadolol (Corgard); Pindolol (Visken); Timolol (Blocadren)

    This medication is used in the treatment of high blood pressure, relief of angina pectoris (chest pain), and prevention of repeat heart attacks in patients recovering from an initial heart attack.
    Used for: Hypertension, chest pain, abnormal heart rhythms and heart failure.
    Side effects: these symptoms may occur: Cold hands and feet, diarrhea, drowsiness, dry eyes, mouth or skin, nausea, numbness or tingling of fingers or toes, unusual tiredness or weakness.
    Report these symptoms to your doctor: Dizziness, lightheadedness, unusually slow pulse (<50 beats per minute), breathing difficulty, mental confusion, depression, reduced alertness, fever, sore throat, skin rash.
    *If you have asthma or COPD, make sure your doctor is aware so they can prescribe the appropriate beta blocker with your disease.
    Notes: Do not stop taking this medication without checking with your doctor first. He/she may want to gradually reduce the amount you are taking before stopping the medication. Abrupt discontinuation can be harmful.  Make sure you know how you react to this medicine before you drive, use machines, or do other jobs that require you to be alert.

    Calcium Channel Blockers
    Diltiazem (Cardizem);

    This medication is used to relieve and control angina (chest pain) and to treat high blood pressure. They are effective in dilating coronary arteries and preventing artery spasms.
    Used for: Chest pain caused by coronary artery spasms or exertion, abnormal heart rhythms, hypertension.
    Side effects: These symptoms may occur: Dizziness, lightheadedness, flushing and the feeling of warmth, headache, nausea, unusual tiredness.
    Report these symptoms to your doctor: breathing difficulty, coughing, irregular or slow heartbeat, skin rash, swelling of ankles, feet or lower legs, tender or swollen gums, chest pain, fainting.
    Notes: Stopping this drug suddenly may bring on attacks of chest pain. Consult your physician or pharmacist before consuming alcohol.
    Amlodipine (Norvasc)
    Used for: Chest pain caused by coronary artery spasms or exertion, high blood pressure.
    Side effects: These symptoms may occur: Dizziness, lightheadedness, flushing and the feeling of warmth, headache, nausea, unusual tiredness.
    Report these symptoms to your doctor: breathing difficulty, coughing, irregular or slow heartbeat, skin rash, swelling of ankles, feet or lower legs, tender or swollen gums, chest pain, fainting.
    Notes: Stopping this drug suddenly may bring on attacks of chest pain. Consult your physician or pharmacist before consuming alcohol.

    Oral Nitrates
    Isosorbide dinitrate (Isordil); Isosorbide mononitrate (Imdur); Nitroglycerin

    These drugs improve the supply of blood and oxygen to the heart. They are termed anti-anginal because they relax smooth muscle of blood vessels causing them to dilate.
    Used for: Acute chest pain (sublingual nitroglycerin), prevention of chest pain.
    Side effects: These symptoms may occur: Dizziness, lightheadedness, fainting, flushing of the face and neck, headache, nausea and vomiting, rapid heartbeat, restlessness.
    Report these symptoms to your doctor: Skin rash.
    Notes: Do not stop using this medication suddenly. Consult your pharmacist or physician before consuming alcohol. You may get a headache for a short time at first or with high doses. If you are not sure if chest pain is heart related, taking a dose of this medicine will not harm you. Sit down before taking it as it may make you lightheaded by lowering your blood pressure. If your chest pain is not relieved by three sublingual nitroglycerin tablets taken five minutes apart, call an ambulance to take you to the hospital.

    Anti-arrhythmics
    Amiodarone (Cordarone)

    This medication is used to treat several kinds of heart rhythm abnormalities including fast atrial or ventricular rates.
    Used for: Abnormal heart rhythms.
    Side effects: These symptoms may occur: Headache, loss of appetite, nausea and vomiting, bitter or metallic taste, impotence, flushing, dizziness, photosensitivity.
    Report these symptoms to your doctor: Cough, fever, shortness of breath, fast or irregular heartbeat, lightheadedness, fainting, trembling hands, numbness or tingling in fingers or toes, low blood pressure, nervousness, intolerance to hot or cold temperatures, sweating, weight gain/loss, blurred vision or seeing blue-green halos on objects, blue-gray skin discoloration.
    Notes: Physicians will attempt to use lowest doses possible because the drug will remain in the body for months after discontinuation. Skin sensitivity to sunlight is a common effect and appropriate precautions should be taken.
    Dofetilide (Tikosyn)
    Used for: Abnormal heart rhythms.
    Side effects: These symptoms may occur: Headache, dizziness, chest pain, nausea, diarrhea, shortness of breath, respiratory infection.
    Report these symptoms to your doctor: irregular heartbeats, fainting, lightheadedness.
    Notes: This drug can cause electrical conduction disturbances within the heart. Initially it is closely monitored with an EKG. Pharmacies must be registered and trained specially to dispense this medication. Physicians must be specially registered and trained to prescribe this medication.

    Diuretics
    Furosemide (Lasix); Bumetanide (Bumex); Chlorothiazide (Diuril); Hydrochlorothiazide (Hydrodiuril); Chlorthalidone; Metolazone (Zaroxolyn)

    These drugs are used to treat high blood pressure and remove excess fluid that causes congestion that worsens heart failure. They reduce the amount of water in the body by increasing urination.
    Used for: Edema (swelling), hypertension.
    Side effects: These symptoms may occur: Dizziness and lightheadedness when standing up, increases sensitivity of skin to sunlight, diarrhea, loss of appetite.
    Report these symptoms to your doctor: Flank or stomach pain with nausea and vomiting, unusual bleeding or bruising, yellowing of eyes or skin.
    Notes: This drug could cause you to lose potassium from your body. You may want to eat or drink foods high in potassium, or take a potassium supplement. Discuss diet changes with your doctor. Signs of too much potassium loss: Dry mouth, increased thirst, irregular heartbeats, mood changes, muscle cramps, nausea, vomiting, unusual tiredness or weakness, weak pulse.

    Adrenocorticoids
    Cortisone; Dexamethasone; Hydrocortisone; Prednisone; Triamcinolone

    Adrenocorticoids are produced naturally by the body and are necessary to maintain good health. Cortisone-like medications are used also to provide relief for inflamed areas of the body.
    Used for: Organ transplants, inflammation.
    Side effects: These symptoms may occur: Increase in appetite, indigestion, nervousness, restlessness, insomnia, weight gain.
    Report these symptoms to your doctor: Decreased vision, frequent urination, increased thirst, skin rash, acne, back or rib pain, fever or sore throat, bloody or black tarry stools, stomach burning or pain, puffy face, continuing infections, irregular heartbeats, mood changes, muscle cramps or weakness, seeing light-halos, swelling of feet, unusual tiredness, menstrual problems.
    Notes: Tell you doctor that you are using this medicine before having any vaccination, other immunizations, or skin tests, before surgery or emergency treatment, or if you have an infection or injury. After you stop using this medication, side effects may continue for a short time.

    Digoxin
    (Lanoxin)

    This drug improves the strength and efficiency of the heart. It controls the rate of the heartbeat which leads to better blood circulation and reduced swelling of the hands and ankles.
    Used for: Congestive heart failure, abnormal heart rhythms.
    Side effects: Report these symptoms to your doctor: Loss of appetite, lower abdominal pain, nausea, vomiting, unusual tiredness or weakness, unusually slow or uneven pulse rate, blurred or yellow vision with halos, diarrhea, mental depression, drowsiness, headache, skin rash or hives.
    Notes: Watch for signs of overdose. The amount of medication needed to help most people is very close to the amount that can cause an overdose. Do not switch brands of digoxin unless directed so by your physician. Do not take cough, cold, sinus preparations, diarrhea medications, laxatives, antacids, asthma remedies, or diet medications unless directed by your physician due to potential interactions.

    Milrinone
    (Primacor)

    This is intravenous medication that improves the efficiency of the heart in people who have congestive heart failure. Used when other drugs such as digoxin, diuretics, and vasodilators don't work.
    Used for: Congestive heart failure.
    Side effects: Report these symptoms to your doctor: Headache, tremors, chest pain, tightness in chest, shortness of breath.
    Notes: This drug is usually given by IV and under close observation of a nurse. This drug has been added to the list due to the fact of its common use in patients with congestive heart failure who do not respond to other drugs.

    Aldosterone Receptor Antagonists
    Spironolactone (Aldactone); Eplerenone (Inspra)

    These drugs are diuretics and antihypertensive agents. Commonly used to treat high blood pressure. They decreases the water in the body by increasing the amount of urination. These drugs can decrease mortality in patients with congestive heart failure.
    Used for: Edema (swelling) associated with congestive heart failure, hypertension.
    Side effects: These symptoms may occur: Breast tenderness, enlarged breasts in men, unusual vaginal bleeding, impotence, drowsiness, dry mouth, increased thirst, lack of energy, nausea, vomiting, stomach cramps, headache, and diarrhea.
    Report these symptoms to your doctor: Fever, irregular heartbeat, numbness in hands and feet and lips, mental confusion, shortness of breath, skin rash or itching, unexplained anxiety, unusual tiredness, weakness or heaviness of the legs.
    Notes: Unlike some diuretics these drugs do not cause loss of potassium so supplements are not usually necessary. Salt substitutes and low-salt milk may contain potassium so do not use them unless instructed to do so by your doctor. Take with meals to decrease stomach irritation.

    Warfarin
    (Coumadin)

    This drug prevents blood clotting by preventing the action of vitamin K in the liver. Clots formed from heart disease may present as a stroke.
    Used for: Clots in a vein or a clot that has traveled to the lung, mitral valve disease, atrial fibrillation, prosthetic heart valve, prevention of blood clots after a heart attack.
    Side effects: Bleeding, skin rash, liver damage.
    Notes: This may be prescribed for a blood clot or after bypass surgery or heart attack. *This drug requires close monitoring by a health care professional, dietary changes, and routine blood tests to maximize effectiveness and reduce the chance of a major bleed. There are also numerous drug interactions associated with warfarin.

    Aspirin
    (Bayer, Ecotrin, ECASA, Astrin)

    Aspirin is a pain reliever, reduces fever and inflammation, and prevents blood clotting.
    Used for: Mild pain, fever, arthritis, stroke, transient ischemic attack (TIA = "mini-stroke"), prevention of clots in people with heart attacks or chest pain.
    Side effects: These symptoms may occur: Thirst, fever, dimness of vision.
    Report these symptoms to your doctor: Bloody or black tarry stools, stomach ulcers, asthma-like symptoms.
    Notes: none

    Clopidogrel
    (Plavix)

    This medication prevents platelets from adhering together and forming clots. Unlike aspirin, this does not have anti-inflammatory properties.
    Used for: Prevents clots post stroke or post heart attack and coronary stents.
    Side effects: These symptoms may occur: Stomach pain, joint pain, back pain, dizziness, fever or chills, headache, anxiety, diarrhea, unusual tiredness, nausea, skin rash.
    Report these symptoms to your doctor: Chest pain, large bruises, bleeding, cough or sore throat, irregular heartbeat, swelling of feet or legs, fainting.
    Notes: This medication prevents some types of clots from forming, but does not treat pre-existing clots. Commonly taken for one to three months initially.

    Hydralazine
    (Apresoline)

    This medication decreases blood pressure by acting directly on the smooth muscle of the arteries.
    Used for: Hypertension, congestive heart failure.
    Side effects: These symptoms may occur: Loss of appetite, headache, diarrhea, nausea or vomiting, fast heartbeat, shortness of breath, lightheadedness.
    Report these symptoms to your doctor: Skin rash or itching, chest pain, numbness or tingling in hands or feet, swelling of lower legs and feet, muscle pain or weakness, skin blisters, fever or sore throat.
    Notes: This medication is sometimes used in combination with isosorbide to treat heart failure in patients intolerant to ACE inhibitors.

Exercise

  • Exercise to a Healthier Heart

    • Why Exercise is Important
    You may already have been treated for coronary artery disease (CAD), the narrowing of the arteries that supply oxygen rich blood to the heart, or have been told that you are at risk for developing CAD. No doubt you are concerned about finding ways to improve the health of your heart. A number of risk factors contribute to the likelihood of developing CAD. One risk factor is a sedentary lifestyle and a major preventive measure is to exercise. Fortunately, a cardiac rehabilitation program can safely help get you started on an exercise program. Your doctor can advise you about starting a program while you are in the hospital (Inpatient Phase), after your discharge (Outpatient Phase), or beginning a program in your community.

    The Benefits of Exercise
    Exercise offers both psychological and physical benefits:

    • Helps your heart and lungs work more efficiently. In time, you will have a lower resting heart rate and blood pressure, and your cardiovascular system will not be as physically stressed.
    • Builds your stamina for other physical activities at work, leisure, or at home.
    • Assists you in handling stress and depression.
    • Improves your sense of well-being.
    • Improves your quality of sleep.
    • Improves your mental sharpness and energy state.
    • Aids in your weight management by burning calories, reducing fat stores, increasing muscle mass and decreasing appetite. An added advantage of increasing your muscle mass is that calories are burned more readily.
    • Increases your insulin sensitivity, thereby improving blood glucose tolerance.
    • Provides a constructive way of utilizing your time, especially when you are trying to change lifestyle patterns such as smoking.
    • Improves your quality of life. This means exercise can actually improve your day-to-day life so that you can pack more activity and productivity into every day and feel good doing it.

    The Best Type of Exercise
    Fitness means a healthy balance between body composition, muscular strength and endurance, flexibility and cardiovascular endurance. Cardiovascular endurance is primarily achieved by doing aerobic forms of activities. The term aerobic means the body uses oxygen to produce the energy needed for the activity. This form of exercise is continuous, long lasting, rhythmic and repetitive, and involving large muscle groups.

    Examples:

    • brisk walking
    • jogging
    • bicycling
    • swimming
    • cross country skiing
    • hiking
    • canoeing
    • stationary cycling
    • dancing
    • (aerobic) dance
    • jumping rope
    • rowing
    • elliptical training

    Resistive exercise or activities that are short in duration (less than 10 minutes) and of high intensity, are considered anaerobic. This is not a desired way of improving cardiovascular endurance. Their emphasis is in developing speed and strength. Examples include weigh/lifting, racquet sports and basketball.

    The best fitness programs combine elements of both endurance and strength.

  • MET Chart

    • A MET or metabolic equivalent is the amount of energy used by the body to perform a physical activity or daily task. At rest, the average person has an oxygen consumption of 1 MET (or 3.5 ml/kg-min). MET values increase as more activity is performed.

    Any activity in the ______ MET category you should tolerate easily.

    1. For an 8 hour work day, you shouldbe able to perform activities in the _____ MET occupational category.

    2. For exercise, recreation and activities of daily living (ADL) lasting one jour or less, you should be able to tolerate activities in the _____ MET category.

    3. Lifting, pushing or pulling may cause a rapid increase in your heart rate and blood pressure. Do not lift more than _____ pounds. Do not strain or hold your breath at any time. In general, activity involving the arms is more stressful to your cardiovascular system than leg exercise because your arm muscles are smaller and less efficient than your leg muscles.

    METs Exercise Recreational Occupational Activities of DL
    1.5-2.0 METs Strolling 1-1.5 mph
    1 miles in 40-60min    		 Knitting; Playing cards; Sewing; Watching TV Desk work; Driving auto/truck; Sitting doing light assembly; Typing; Using hand tools; writing Brushing hair/teeth, Light housework, Making bed; Partial bath; Polishing furniture; Washing clothes
    2.0-3.0 METs Walking, level 2.0-2.5 mph,
    1 mile in 24-30min
    Cycling, level outdoors-5mph    		 Horseback riding (walk); Light golf (power cart); Playing musical instrument; Shuffleboard; Woodworking Bartending; Crane operation; Standing doing light or medium assembly; TV/auto/car repair; Working heavy lever Cooking; Driving car; Ironing; riding lawn mower; Scrubbing floor; walls, cars, windows; Showering; Sweeping; Tub bath
    3.0-4.0 METs Walking 3.0-4.0 mph,
    1 mile in 15-20min
    Cycling, outdoors

    5.5 mph    		 Billiards; Bowling; Canoeing; Croquet; Fly fishing; Golf (pulling cart); Shopping; Volleyball (non-competitive) Baling hay; Driving heavy truck; heavy machine assembly; Janitorial work; Light welding; Operating large levers; Plastering; Plumbing; Stocking shelves Cleaning windows; Climbing stairs (slowly); General House work; Kneeling; Light work; Packing/unpacking; Power lawn mowing (light); Sexual intercourse; Stocking shelves; Vacuuming
    4.0-5.0 METs Walking 3.5-4.0 mph
    1 mile in 15-17 min
    Cycling, 8 mph
    Calesthenics
    Swimming (20 yd/min)    		 Ballet; Dancing; Gardening (how, weeding, digging), Golf (carrying clubs); Table tennis; Tennis (doubles); Volleyball Building interior of house; Carrying trays/dishes; Farm work (sporadic); House painting, Lifting, carrying objects(20-40 lb); Light carpentry; Mechanic work Raking leaves, shoveling light loads
    5.0-6.0 METs Walking
    4.0-4.5 mph
    1 mile in 13-15 min
    Biking, 10 mph    		 Canoeing (4m/hr); Gardening (digging); Skating (ice/roller); Social/square dancing; Softball/baseball (non-game); Stream fishing Handyman work (moving, shoveling); Heavy Carpentry; Putting in sidewalk Raking leaves, shoveling light loads
    6.0-7.0 METs Walking/jogging,
    4.0-5.0 mph
    1 mile in 12-13 min
    Biking, 11 mph
    Swimming (breaststroke)    		 Backpacking (light); Badminton; Hiking; Hunting; Horseback riding (trot), Skiing (cross country 2.5 mph); Skiing (light downhill); quare dancing; Tennis (singles) Exterior home building; Lifting, carrying objects (45-64 lb); Shoveling (10/min, 9 lb); Splitting wood Lawn mowing (push mower); Snow shoveling (light snow)
    7.0-8.0 METs Walking, 5 mph
    1 mile in 12 min
    Biking (outdoors) 12 mph
    Swimming (backstroke), 40 yd/min    		 Badminton (competitive); Basketball (non-game); Canoeing (5 mph); golf (carrying bag); Horseback (gallop); Skiing (downhill, vigorous) Ascending stairs with 17 lb load; Lifting, carrying (65-84 lb); Moving heavy furniture; Sawing
    8.0-9.0 METs Jog/run 5.5 mph
    Biking (outdoors) 13 mph
    Swimming (breaststroke) 40 yd/min
    Rowing machine; Rope jumping (60-80 skips/min)    		 Basketball (non-game); Handball/squash/racquetball; Mountain climbing; Soccer (non-team); Touch football; Tour skiing Lifting, carrying (85-100 lb); Moving heavy furniture (moving van work); Shoveling (14 lb scoops, 10 scoops/min); Using heavy tools
    9.0-10.0 METs Jog/run, 6 mph
    1 mile in 10 min    		 Football (competitive); sledding/tobogganing Heavy labor; Lumberjack; Shoveling (16 lb scoops) Ascending stairs carrying 54 lb
    11.0+ METs Run 7 mph (11.5 METs)
    8 mph (13.5 METs)    		 Competitive sports: Basketball, Handball, Racquet, Rowing
  • Your Personal Exercise Prescription

    • How Do I Get Started?
    For many people, exercise is an enjoyable part of the recovery process. You will feel good about your exercise program if you are sure it is safe for your heart, which is why you need a personal exercise prescription. Your prescription will cover four important aspects of an exercise program:

    • Mode or type of exercise that you will do
    • Frequency or how often you should exercise
    • Duration or how long you should exercise
    • Intensity or how hard you should exercise

    Mode
    The type of exercise you do is called the mode. As was discussed earlier, aerobic exercise is best for improving cardiovascular fitness and preventing heart disease. The CHAMPS staff member will tell you what kind of exercise to do. This may include walking or stationary biking at home and using a treadmill, stationary bicycle ergometer, Air Dyne bike, arm ergometer, recumbent stepper, or elliptical trainer in our exercise laboratory. The staff will instruct you in how to correctly use the equipment.

    Frequency
    Exercise must be done regularly in order for you to receive the benefits discussed earlier. You should exercise at least 5 times a week, up to 7 days per week for cardiovascular fitness and weight loss. You can allow your muscles one or two days a week to rest. Try not to miss more than one day at a time.

    _________ times per day or week

    Duration
    Your exercise prescription will include how long you should exercise. You may start exercising only a few minutes a day. As you get stronger, you can build up to 30-60 minutes of continuous exercise. The duration will include a warm up, training, and cool down.

    Warm up.
    Warm up is a term used to describe a variety of activities that prepare the body for exercise. It can include stretching and light exercise and should last 5-10 minutes.

    Training.
    This is the period of exercise which you will be working your hardest in your target heart rate zone. The duration of training will last from 20-45 minutes.

    Cool down.
    The cool down phase of exercise prevents blood from pooling in the lower extremities, which can reduce blood return to the heart. Such a reduction can cause a drop in blood pressure, lightheadedness, fainting and abnormal heart rhythms. Cool down exercises also allow circulation to be maintained, promoting the removal of waste products associated with the development of muscle soreness. Cool down should last 5 to 10 minutes.


    		 Warm-up Training Cool-Down








    Intensity
    The CHAMPS staff will help you understand the intensity or how hard you should exercise and help you adopt a comfortable level of effort. The intensity can be based on your heart rate or a certain level of exertion.

    Target Heart Rate
    There is a certain intensity or vigorousness of exercise which is enough to condition the heart muscle and cardiovascular system leading to physical fitness, but is not overly strenuous. This is a target zone. Your target heart rate may be based on the results of your treadmill test or your exercise tolerance evaluated in the exercise laboratory.

    Target Heart Rate:

    beats/minute
    RPE (see scale)

    Mode Warm-Up Training Cool-Down
    Treadmill (mph, %)


    Recumbent Stepper (level)


    Bike (Watts/kps)


    Airdyne (level)


    Other


    Walking Speed = Mph or Mins/mile

    METS
    A MET, which stands for metabolic equivalents, is the amount of energy used by the body to perform an activity. One MET corresponds to the amount of energy used when sitting at rest. The intensity of exercise can be based on a certain MET level. MET values increase as more strenuous activity is performed. The CHAMPS staff will tell you what MET level you should be able to tolerate for exercise, work and recreation.

    Rating of Perceived Exertion (RPE)
    This scale is used to estimate the degree of effort for an exercise or activity. This rating should be your total amount of exertion combining all sensations and feelings of physical stress, effort and fatigue.

    RPE Scale
    6
    7 Very, very light
    8
    9 Very light
    10
    11 Fairly light
    12
    13 Somewhat hard
    14
    15 Hard
    16
    17 Very Hard
    18
    19 Very, very hard
    20

    How to Check Your Heart Rate or Pulse
    Once you start exercising, check your pulse regularly. Practice this before you start your exercise program.

    • Place your first two fingers on the thumb side of the wrist.
    • Count your pulse for ten seconds; begin counting with zero.
    • Multiply by six to get your heart rate per minute or look at the chart below. You will be asked to take your pulse at rest and during peak exercise.

    Heart Rate Conversions

    Beats/10 sec. Beats/min.
    9 54
    10 60
    11 66
    12 72
    13 78
    14 84
    15 90
    16 96
    17 102
    18 108
    19 114
    20 120
    21 126
    22 132
    23 138
    24 144
    25 150
    26 156
    27 162
    28 168
    29 174

    Warnings of Exercise Intolerance

    • Excessive fatigue
    • Chest discomfort
    • Shortness of breath
    • Irregular pulse
    • Nausea or vomiting
    • Lightheadedness
    • Pain in teeth, jaw, neck, shoulders, arms, or back
    • Headache
    • Dizziness
    • Unusual joint or muscle pain

    If you develop any of these symptoms during exercise or activity, let your CHAMPS staff know. If you are at home, discontinue exercising and, if symptoms persist, inform your physician. You should not exercise if you have forgotten to take your medication, if you are ill, or have a fever.

    Exercising with a fever places an unnecessary strain on your heart. When you exercise, more than 70 percent of your energy is changed into heat. To keep your body from totally overheating, your heart must pump large amounts of blood from your overheated muscles to your skin, where the heat is released.

    Another major problem to contend with is dehydration, one of the major unpleasant effects of a fever. Exercising under these conditions can drive your body temperature up even further. This can lead to fatigue, symptoms of heat exhaustion including dizziness, nausea, blurred vision, and even stroke. The unconditioned or inexperienced exerciser can be especially susceptible to the harmful effects of a fever.

    Even exercising when you have a cold is not recommended. Your body has to work extra hard to fight off the viral infection. The demands placed on your body by exercise simply compound the problem. Another factor which should be considered is when cold viruses invade your muscles, your strength and endurance are reduced. As a result, you increase your risk of being injured when you exercise with a cold. A viral infection also makes your muscles use oxygen less efficiently, thereby causing you to fatigue more quickly.

  • Special Considerations in Exercise Testing

    • Environmental Considerations
    Do I need to adjust my exercise program when the environmental conditions change?

    Yes, exposure to extremes of heat, cold, and high altitude, and air pollution alters physiological responses to exercise and impairs physical performance.

    Exercising in the Heat
    Exercising in warm weather or environments can be safe if you know how to adjust your exercise program or physical activity to the conditions. It is important to note that serious heat illness is more likely to occur in people who are overexerting and not as well conditioned.

    When exercising, you are exposed to external and internal heat. External heat comes from a combination of environmental temperature and humidity, known as the heat index . Humidity decreases the effectiveness of sweat evaporation to cool you. Heat radiation from surfaces such as pavement, concrete, or sand may make you feel hotter.

    With exercise, internal heat production increases as much as 15 to 20 times more than resting levels. This is dependent on fitness levels, body surface, exercise parameters (intensity and duration, clothing worn, and state of hydration.)

    Sweating is important and is controlled by the thermostat in your brain, the hypothalamus, which senses body temperature rise and sends signals to dilate blood vessels near the body surface. Approximately 85% of heat loss is through sweat. Adequate fluid intake allows the body to maintain a cooling balance through sweating.

    When your body fails to regulate its internal temperature, you can suffer from heat cramps, heat fatigue, heat exhaustion or heat stroke. Be aware of these symptoms:

    Heat Cramps:
    Cramps in the legs, arms and stomach. To treat, stop exercising, cool down, massage the cramps, and drink plenty of fluids (avoid salt). The body's thermoregulatory responses are intact.

    Heat Fatigue:
    Weakness, dizziness, headache, rapid pulse and low blood pressure. The body still sweats but contains less fluid. To treat, stop exercising, get out of the heat, and apply ice packs to your armpits and groin area.

    Heat Exhaustion:
    More pronounced weakness and dizziness; cold, clammy skin; headache, mental confusion, rapid, weak pulse, and a temperature as high as 104 degrees. The body is unable to regulate heat. Hospitalization/intravenous fluids and cooling measures are required.

    Heat Stroke:
    The body loses its ability to sweat, with the temperature rising as high as 106 degrees. Symptoms include the following: disorientation, loss of coordination, hot dry skin with no sweating, rapid pulse, vomiting, diarrhea, and unconsciousness. Immediate cooling and hospitalization is required.

    Heat and Humidity (Heat Index)
    Relative Humidity Air Temperature (Degrees Fahrenheit)

    		80 85 90 95 100 105 110 115 120
    30%
    		84 * 90 * 9 * 104 ** 113 ** 123 *** 135 *** 148
    40%
    		86 * 93 * 101 ** 110 ** 123 *** 137 *** 151
    50%
    		88 * 96 ** 107 ** 120 *** 135 *** 150

    60%
    		* 90 * 100 ** 114 *** 132 *** 149


    70%
    		* 93 ** 106 ** 124 *** 144



    80%
    		* 97 ** 113 *** 136




    90%
    		* 102 ** 122





    100% * 91 ** 108






    * Risk of heat exhaustion
    ** Risk of heat stroke
    *** High risk of heat stroke

    Chart numbers represent perceived temperature

    Common Sense Tips for Exercising in the Heat

    • Allow 14 days for your body to acclimate if you are in a new environment. Reduce the intensity of your exercise by half of your regular exercise intensity and then slowly increase it over a 2 week period.
    • Drink plenty of fluids. Clear urine and a full bladder every 2 to 3 hours indicate adequate hydration.
    • Avoid caffeine and alcohol, which act as diuretics. Also avoid carbonated or sugary drinks, because they might slow fluid absorption.
    • Do not wait till you are thirsty to drink. Drink as often as you can before your workout, and try to drink 5 to 10 ounces of water every 15 minutes while exercising.
    • Exercise during the coolest part of the day before 10 A.M. or after 6 P.M.
    • Pay attention to the heat index, the combination of heat and humidity.
    • Exercise on cool surfaces like grass or white concrete instead of black pavement.
    • Wear light colored, breathable clothing such as cotton. Dress in layers.
    • In humid weather when the sweat is not evaporating, carry a towel to wipe the sweat away.
    • If you start to feel the effects of heat illness, stop your workout, seek shade and start drinking fluids.
    • If you take medication, check with your doctor before exercising. Some medicines can interfere with the body's ability to regulate its internal temperature.

    Exercising in Cold Weather
    Howling winds and freezing temperatures do not mean you have to give up outdoor exercise until spring. When you are prepared for it, outdoor winter exercise can be healthy and invigorating.

    Hypothermia is a drop in body temperature and can be potentially fatal. Death usually is the result of heart failure.

    In colder temperatures, the heart tolerates less exertion because the body reacts to cold by constricting small arteries. This reduces the loss of body heat by shifting the warm blood away from the skin surface. When this natural phenomenon occurs the heart must work harder to pump blood through the narrowed arteries. The extra load on the heart decreases its capacity to respond to exercise. Inhalation of cold air and exposure of the hands to cold may cause reflexive coronary artery constriction, reducing the supply of oxygen containing blood to the heart muscle. In either case, angina may be felt.

    Wind, snow, rain, and cold temperatures are all factors that can steal your body heat. Wind serves to remove the layer of air your body has heated. (See wind chill chart below.)

    Remember, you still have the capacity to sweat when you are working out in the cold. Cotton absorbs moisture, which cools the body. Instead, use as the first layer fabrics that help moisture evaporate by drawing it away from the body, such as silk, nylon or polypropylene. A cotton material can serve as the second layer to absorb the moisture. Wool is also a good material to wear because it is warm even when wet.

    Cold and Wind (Wind Chill)
    Wind (mph) Thermometer Reading (Degrees Fahrenheit)

    		50 40 30 20 10 0 -10 -20 -30 -40 -50

    		(Equivalent temperature Degrees Fahrenheit)
    * 5 * 48 * 37 * 27 * 16 * 6 * -5 * -15 ** -26 ** -36 ** -47 ** -57
    * 10 * 40 * 28 * 16 * 4 * -9 * -24 ** -33 ** -46 ** -58 ** -70 *** -83
    * 15 * 36 * 22 * 9 * -5 * -18 ** -32 ** -45 ** -58 ** -72 *** -85 *** -99
    * 20 * 32 * 18 * 4 * -10 ** -25 ** -39 ** -53 ** -67 *** -82 *** -96 *** -110
    * 25 * 30 * 16 * 0 * -15 ** -29 ** -44 ** -59 *** -74 *** -88 *** -104 *** -118
    * 30 * 28 * 13 * -2 * -18 ** -33 ** -48 ** -63 *** -79 *** -94 *** -109 *** -125
    * 35 * 27 * 11 * -4 * -20 ** -35 ** -51 ** -67 *** -82 *** -98 *** -113 *** -129
    * 40 * 26 * 10 * -6 * -21 ** -37 ** -53 ** -69 *** -85 *** -100 *** -115 *** -132
    * Minimal Risk ** Increasing Risk *** Great Risk

    Common Sense Tips for Exercising in the Cold

    • When outdoors, avoid sudden exertion. Warm up first. In cold weather, the muscles take longer to stretch out.
    • Wear layers, and jackets that can be unzipped or buttoned. This will allow excess heat to dissipate without you having to remove your clothing in cold weather.
    • Wear a hat and scarf. As much as 40% of the body's heat can be lost through the head. Keeping the hands and feet warm will also prevent heat loss. Wool socks and heavy shoes are essential.
    • Avoid alcoholic beverages before going outside in the cold. The initial sensation of warmth is caused by surface blood vessels dilating which is drawing warmth away from the body's vital organs.
    • Go inside and get warmed up when cold.
    • Cover your mouth, nose and throat. When the temperature drops so does the amount of moisture in the air. When breathing in cold air, some will have a reflex coronary artery constriction, that may result in angina.
    • Cover your hands with mittens or gloves whether shoveling snow or going out to start the car. Certain individuals experience reflexive coronary artery constriction that may cause angina.

    Exercise and Air Pollution
    Although air pollution may not be as much of a problem in rural areas, it is a major problem in most large metropolitan areas. Your lungs may be exposed to pollutants such as ozone, carbon monoxide, sulfur dioxide, and sulfuric acid. Exercisers breathe more heavily and will more likely inhale more pollutants than nonexercisers. Some common symptoms experienced include dizziness, shortness of breath, throat irritation, difficulty breathing, and excessive coughing during or immediately after the workout. Those with asthma, other lung disorders, or heart disease will be more vulnerable to experiencing these symptoms.

    Even though air pollutants will have different effects on the body, they all reduce the body's ability to utilize oxygen. Almost all the oxygen in one's body is transported through the blood by hemoglobin. Carbon monoxide, for example, which is emitted from car exhaust, has a much greater attraction to hemoglobin than oxygen. Therefore, when there are high concentrations of carbon monoxide, the oxygen supply to the body is reduced, which greatly reduces your working capacity.

    Common Sense Tips for Exercising in Polluted Air

    • Minimize exposure by exercising in the early morning or evening hours.
    • Avoid exercise on heavily congested streets or between 12 noon and 4 P.M.
    • Air currents can disperse pollutants, so it is better for you to exercise in open, windy locations.
    • If there is an air pollution alert in your area, try to work indoors.
    • If you cannot avoid exercising in pollution, keep your workouts light and short. Wear a protective mask, covering nose and mouth, to decrease the percentage of polluted air breathed.
    • If you suffer from asthma or lung disease, in addition to your heart disease, try scheduling your workouts indoors until pollution levels drop.

    Exercise and Altitude Changes
    Iowa's elevation ranges from 480 feet (Osceola County) to 1670 feet (Lee County) above sea level. Its elevation does not present a problem when exercising. But if you vacation in an area that is at a higher altitude you should be aware that your exercise or working capacity is inversely related to the altitude. In other words, the higher the altitude, the lower your ability to work at the same intensity level. This is because the pressure exerted by oxygen at high altitudes is less than at sea level. As a result, it is more difficult for the body to deliver oxygen to the working muscles. At an altitude of 7500 feet above sea level, your ability to obtain oxygen is diminished by 12.5 percent.

    Acute mountain sickness can be acquired at altitudes greater than 5000 feet above sea level, so you need to be aware of its symptoms. They include headache, unusual shortness of breath at rest or with exertion, malaise, loss of appetite, nausea or vomiting, abdominal pain, and / or diarrhea. These symptoms also often occur when you are rapidly ascending to a higher altitude.

    Common Sense Tips When Exercising at Increased Altitudes

    • Travel is safe between the altitudes of 3000 to 9000 feet above sea level for most individuals. Because of your cardiac condition, you should consult with your CHAMPS staff and physician before traveling to higher altitudes.
    • Reduce the intensity of your exercise workout and be conservative for the first several days of exercising in higher altitudes. Pay attention to your RPE. The body starts to adapt to the stress of a particular altitude and it partially acclimatizes after 2 to 3 weeks.

    Exercise and Fluid Replacement
    The body has about 2.5 million sweat glands. Because the total body is composed of 60% water and the muscles 70% water, drinking fluids is vital for digestion, tissue building, lubrication and temperature control.

    Exercise increases the body's metabolic rate and its production of energy. The total amount of heat produced depends upon both the intensity (how hard) and duration (how long) of the exercise bout. The harder you work the faster the rate of heat production, while the longer you exercise the greater the total heat produced. Humans have several avenues of heat loss available to them: conduction, convection, radiation and evaporation. Evaporation involves heat loss through the vaporization of sweat. Sweat is primarily water but it does include a number of important electrolytes (such as sodium and chloride). Typically, when substances are lost via sweat, it is more important to replace water than electrolytes. This is true especially when competing or vigorously working out for long periods of time. The composition of the replacement drink and what quantities and intervals the fluids should be consumed are especially important if you are vigorously exercising for more than an hour.

    Ways to prevent excessive fluid losses are allowing yourself to accommodate to the environment. Training itself will increase blood volume, thus reducing the impact of dehydration on blood volume. In addition, training in the heat produces an earlier onset of sweating during exercise thus fostering cooling, and results in a more dilute sweat, thereby conserving electrolytes.

    Common Sense Tips with Exercising Related to Fluid Replacement

    • Note color of urine. Darker color may indicate the onset of dehydration and the need to replenish fluids.
    • Avoid carbonated drinks, which can cause gastrointestinal distress and may decrease the volume of fluids consumed.
    • Avoid beverages containing alcohol or caffeine. They are diuretics and tend to contribute to fluid loss.
    • An optimal fluid replacement beverage should taste good, stimulate fluid absorption, maintain proper fluid balance in the body, and energize working muscles.
    • Water is a good source of replenishment for exercise lasting less than one hour.
    • Keep in mind that the thirst mechanism is not precise. By the time you feel thirsty, you are probably well on the way to becoming dehydrated. Fluid replacement is just as important in cold weather.

    For the more competitive exerciser

    • Drink 16 ounces of a cold beverage (40-50 degrees F) thirty minutes before competition.
    • The beverage should contain 6-8% carbohydrate and less than 280 mg sodium and less than 200 mg of potassium per quart.
    • Drink 6-8 ounces of the beverage at 10-15 minute intervals during the competition.
  • Sex and Heart Disease

    • The myths surrounding sex and heart disease are numerous. One of the most common is that sex often brings on a heart attack or sudden death. To the contrary! According to the American Heart Association, the risk is very low. In fact, the physical demands of sex are mild and comparable to briskly walking up two flights of stairs.

    There should be a short recovery period before resuming sex. Usually a patient can resume sexual activities within four weeks after a heart attack or two to three weeks after leaving the hospital from heart surgery. The CHAMPS staff and your physician are available to answer questions concerning earlier or later resumption of sexual activity.

    • If you have heart disease, have had a heart attack, or have undergone heart surgery, the American Heart Association recommends you keep these important guidelines in mind:
    • If you are not sure whether you are ready for sex, ask your doctor to give you an exercise test to check your physical capacity.
    • Improve and maintain good physical condition.
    • Choose a time when you are rested, relaxed and free from the stressful feelings brought on by the day's schedules and responsibilities.
    • Wait one to three hours after eating a full meal.
    • Select familiar, peaceful setting that is free from interruptions.
    • Take medicine as prescribed by the doctor.
  • Activity Log

    • Exercise:
    Aerobic exercise is the best kind of exercise to improve your cardiopulmonary fitness. The exercise should be long lasting and continuous rather than a short burst of maximum effort.

    Warm up:
    It is important to prepare the body for exercise. This includes stretching, calisthenics and lower intensity aerobic exercise than the training intensity.

    Training:
    Use RPE Scale, target heart rate and specified training intensities.

    Cool down:
    Cool down is important to prevent muscle soreness and a drop in blood pressure, which can lead to light headedness, fainting, abnormal heart rhythms. Use a lower intensity than the training intensity.

    Frequency (How often)

    ____________ times per day or week

    Duration (How long or how many minutes)

    Warm-Up Training Cool-Down









    Intensity: (How hard)

    Target Heart Rate: beats/minute
    RPE (see scale)

    Mode Warm-Up Training Cool-Down
    Treadmill (mph/%)


    Stairmaster (level)


    Bike (watts/kps)


    Airdyne (level)


    Other


    Walking Speed = mph or minutes/mile

    Points to Remember

    1. Your workout schedule will be dependent on the following:
      • personal preference
      • job and family responsibilities
      • availability of exercise facilities and weather
      • energy state and time of day
    2. Regardless of your daily obligations or priorities it is important to your mental and physical health to find time for activity. Think in terms of functional, formal or recreational activities. Listed below are some examples.

      Activity Functional Formal Recreational
      Walking Up stairs
      While pushing a cart
      While mowing lawn
      On errands
      With the dog      		 With a club
      On a treadmill
      In a race      		 While golfing
      On a hike
      In the park
      Swimming While taking lessons
      While teaching lessons      		 Laps in a pool
      In aqua aerobics
      With a club      		 While snorkeling
      While scuba diving
      Water volleyball
      Pool games
      Bicycling To work
      On errands      		 Exercise bike
      With a club
      In a race      		 On a tour
      On RAGBRAI
      In the mountains
      At the park
      With family in neighborhood
      Dancing While teaching dance or aerobic dance
      While taking lessons      		 In aerobic/dance classes
      Home with a video tape      		 At night club
      Dance hall
      Celebration
      Social gatherings
  • Maintaining the enthusiasm and keeping with an exercise program will be challenging. Ways to help this include:
    • Set realistic goals.
    • Reward yourself.
    • Identify a support system.
    • Allow a day or two break when you are feeling signs of "burnout."
    • Consider it a relapse not a failure if you do get out of a regular exercise pattern.
    • Vary the activity to facilitate training and prevent boredom.
    • Involve your family and friends.
  • Flexibility

    • These exercises enhance your ability to move the various parts of your body through a full range of motion. The safest exercises involve static stretching, taking the body part to a position at which you feel the stretch without feeling pain then holding the stretch. Stretch all major muscles before and especially after your aerobic workout when your muscles are warm and more resilient.

    Stretching Exercises

    • Muscle stretching not only prevents muscle injury, but also "primes" the muscle for the appropriate exercise.
    • Stretching should be done in a comfortable position, the motion slow with gradual pressure applied.
    • The stretch tension should subside as you hold it.
    • Be consistent with stretching exercises. They can be done anytime, but are a MUST before and after exercises.
    • Concentrate on the muscle group being stretched, as well as your breathing. Breathing should be slow and relaxed.
    • Begin holding stretch for 10-15 seconds and progress until you can maintain stretch for at least 30 seconds. Repeat 2-3 times.

    Achilles Tendon and Calf


    a.
    • Stand facing wall. Place palms flat on wall. Keep feet turned slightly inward. Feet about shoulder width apart.
    • Bend right knee while the left leg is straight behind you keep left heel flat on the floor.
    • Slowly move your hips forward, keeping low back flat. Stretch should be felt in left calf.

    b.
    • Same position as above. Lower hips downward as you slightly bend your knee. Stretch should be felt in left Achilles tendon.

    Quadriceps


    a.
    • Lie on your stomach with head down.
    • With right hand, pull right foot toward buttocks.
    • Stretch should be felt on front of thigh.

    b. Can also be done in sidelying position OR

    c.

    • Stand facing table, wall, or chair for support.
    • Bend right knee behind you, push pelvis out.
      Tip: Women reach with your opposite hand to protect knee

    Hamstrings


    a.
    • Lie on, back.
    • Hold left leg just below knee and pull to chest.

    b. If tolerated, straighten leg. NOTE: If no stretch is felt, bring knee closer to chest and straighten knee.

    c.

    • Sit on floor with left leg straight with ankle flexed (toes up) and right leg bent with foot resting against left inner thigh.
    • Lean upper torso toward left leg, bending at hip.
    • Stretch should be felt in the back of the thigh and lower back.

    Alternate form (hamstrings)

    d.

    • Sit at edge of chair with good curve of spine (no slumping).
    • Straighten one leg in front of you while maintaining spinal position.
    • Pull toes towards face

    Adductor


    • Stand with feet apart.
    • Turn right foot slightly outward, bend right knee over right foot until stretch is felt in inner thigh on left. Knees should not pass the toes.

    Triceps


    • With arms overhead, hold right elbow with left hand.
    • Gently pull the elbow behind your head, creating a stretch on back of upper arm.

    Posterior Shoulder


    • Pull right bent elbow across the chest toward your opposite shoulder with left hand at elbow. Feel stretch in back of shoulder.

    Anterior Shoulder


    • Clasp fingers behind back.
    • Rotate elbows in and lift arms up and out while extending chest.
    • Feel stretch in front of shoulders.
  • Strength Training

    • As previously discussed, resistive training is a part of a complete exercise program. Strength training can be done with free weights, weight equipment, theraband or calisthenics as long as you have resistance against your muscles, joints and tendons. In cardiac rehabilitation, we have chosen to exercise major arm muscles, which are not always challenged with day-to-day activities. Modifications will be made for those who have arthritis or other joint irritations. Consult your cardiac rehabilitation staff if there are other muscle groups, which you would like to challenge, especially in your home environment.

    Upper Body Strengthening Program

    Guidelines:
    • Lift weight within pain free range (especially if there is tendonitis).
    • Concentrate on the muscle groups being exercised. Technique is more important. The movement should be slow and controlled.
    • Avoid holding your breath and avoid straining. You should not begin to feel fatigue until the last 2 to 3 repetitions of each set.
    • Remember there are different ways to strengthen the same muscle groups. The exercises listed below were selected based on comfort and safety.
    • The amount of weight, repetitions and sets is selected based on your present strength, goals, and exercise tolerance.
    • Unless otherwise instructed, begin with 8 to 12 repetitions. Advance from 1 to 3 sets. Begin with 1 to 2 pounds and progress weight by 1 to 2 pounds. Because different muscle groups will be exercised, different weights will most likely be used.
    • Pause for 30 seconds between each set and each different exercise.

    Stress Management

    • What is Stress?

      • Being aware of your stress is the first and most important step in controlling it.

      So, What is STRESS?
      How one views/feels about a situation or event.

      Everyone views events and situations differently. What causes stress for you may or may not be a source of stress for another.

      Perception of a threat.
      The way you think/feel about a situation is what causes you stress. You may feel that this event could be adverse to you or those you care about.

      A stimulus that increases your level of alertness.
      Awareness can be considered a positive (EUSTRESS) or a negative (DISTRESS) stress.

      MYTHS

      • All stress is bad As discussed earlier, there are two types of stress. A positive stress is necessary to get us motivated. Without it, not much would be accomplished. Striking the right balance is absolutely necessary to being productive and energetic. Too much or too little stress can create more stressful situations or intensify those we are already dealing with.
      • Stress is avoidable Situations that need to be dealt with are around us everyday. We cannot control the outside world, only how we react.
      • There is nothing I can do about it We can all do something about our stress. While it's true we cannot control all situations, we can control our reactions and learn ways to anticipate and manage stress that comes our way.

      4 Types of Stress

      • Survival Allows reaction of body to escape/deal with potentially hazardous situations
      • Internal Stress Created by self through "thinking" about situations/events. Can also be physiological stress, such as, illness, exercise, fever, etc.
      • Environmental Stressor that comes from an outside source that is beyond your control
      • Lifestyle How you live, eat, sleep, procrastinate, etc can all bring about stress

      Effects of Stress
      Stress affects us all in many ways. Stress will increase the body functions. Heart Rate, Blood Pressure, Breathing rate, Temperature and the rate at which the body uses energy are a few examples. If this increase in function continues over a long period of time the body will start to feel the effects. **Think of a car running at a very high RPM that is never brought down. What would happen to that engine over time? Our bodies respond in a very similar way. If we are constantly running in overdrive, our bodies will begin to breakdown in much the same way as a car engine.

      Some of the conditions that can be brought on or exacerbated by stress are: High blood pressure (hypertension), High cholesterol (dyslipidemia), and increases in blood sugar (glucose) levels. People with high levels of stress are also more prone to develop colds and other minor illnesses. High levels of stress also make it more difficult to recover from illness.

      Stress can cause the heart to, unnecessarily, work harder than needed to deliver blood. Heart patients and those with an increased risk of developing heart disease should learn to manage their stress for these reasons.

      Stress Warning Signs

      The body can react in many ways to stress. It is important for you to become aware of any symptoms you may have. The following list is a brief list of some of the common warning signs.

      Anxiety Confusion
      Clenching jaw Grinding teeth
      Depression Frustration
      Hyperactivity Aggressiveness
      Upset stomach Fatigue
      Headaches Changes in sleep patterns
      Changes in appetite Quick temper
      Muscle tension/aches Dry mouth
      Lethargy Increases in sweating

      This list is very limited when compared to symptoms that can be experienced under stress. Please make note of any signs you experience and add to the list.

      The 4 Step Approach
      Following this simple approach can control quick on-set of stress quickly and effectively. When something "stresses" you:

      1. STOP
      Avoid the automatic reaction (many times we react without thinking and this usually makes the situation worse).

      2. BREATHE
      Take a deep breath. Totally expand the rib cage and fill the lungs, then slowly exhale - give the body time to slow down.

      3. REFLECT
      Look back on the situation and think about it step-by-step. This will allow you to see clearly what it was that caused stress. Also, this gives you time to see what the outcome of the situation actually was (not just what could have been).

      4. CHOOSE
      Choose an appropriate response that will help to alleviate the stress and make the situation better.

    • Managing Stress

      • Multiple methods can be used to help manage and control daily stress. The first step is to become aware of your stress and its symptoms. Until you are aware that stress is present you cannot begin to control it or its symptoms.

      Anticipating stress is a great way to get a grip before stress hits you. The following are five ways to help anticipate your stress.

      • Rehearsal Practicing a situation before it occurs can help you feel more comfortable and better prepare you for a situation. (Example- Public speaking)
      • Planned responses Knowing what may cause you stress can give you time to choose, in advance, a proper response. (Example- You are trying to quit smoking and you will be around those you used to smoke with. What will you say/do when offered a cigarette?)
      • Avoidance Avoiding situations or events that have caused you stress in the past can be key in controlling stress. Avoidance should only be used if you and/or the situation will actually be better because of it.
      • Reduce importance Put things into perspective. Ask yourself if this is going to matter tomorrow, next month, next year? Learn to use your energy for things that really MATTER.
      • Reduce uncertainty Ask questions. Not knowing can be a huge factor in the amount of worrying that is done. Do research, learn what is to come.

      Managing stress once it hits is another skill that must be practiced. Remember, stress will always be there. It is how we deal with it that will make all the difference.

      Use Rational thinking - looking at what actually is happening or has been done in order to shut out thoughts of "what could be". Positive thinking/self talk can help to control the doubt. Relaxation methods are another way of managing stress. There are many methods out there. You must try and find the ones that work best for you. Some examples are:

      Deep breathing Imagery
      Body Scan Focus of thought
      Yoga Mindfulness
      Time Management Exercise
      Hobbies Journal writing

      Having a good Attitude can also make all the difference. Looking at a situation or event with a positive and open mind will help control stress that may otherwise be created internally. Having an Action Plan will also allow you to contain, control and eliminate anything that may come your way.

      Relaxation Response
      Relaxation response of the body is just the opposite of the stress response. Relaxation (which ever techniques you might use) will help to slow the body back down and allow it and your mind to work properly again. Eliciting the relaxation response takes practice and dedication. It is not something that comes easily to most people, but diligence and practice will allow you to eventually elicit the relaxation response without thinking about it.

    Eating for Heart Health

    • Eating for Heart Health

      • Introduction
      Basic to any heart healthy way of living is a heart healthy way of eating. The purpose of this section is to help you begin a new way of eating that will improve your health and well-being.

      During a CHAMPS appointment, a dietitian will evaluate your nutritional health status, give specific diet recommendations, and help you set nutrition-related goals. Weekly nutrition classes are a forum for group discussion, a place to share and learn ideas from other CHAMPS participants, and an opportunity to stay current on nutrition issues. Dietitians provide information to help put heart healthy nutrition guidelines into useful, easy-to-understand terms. The classes are offered Monday afternoons and Wednesday mornings.

      Nutrition and Weight Management
      Attaining a reasonable weight is important because excess weight can increase your risk of heart disease, hypertension, diabetes and other chronic diseases. The CHAMPS team will measure your height and weight to determine a healthy weight and, if necessary, set a reasonable goal weight.

      A healthful weight management method is one that balances nutrition and exercise. The following suggestions are designed moderate food intake and promote and weight management.

      • Keep a food diary. Record foods and beverages in specific amounts. Note times and situations.
      • Do nothing else while eating. It's easy to overeat when distracted.
      • Put down your eating utensil between bites.
      • When 3/4 of the meal is eaten, stop for five minutes. If in 5 minutes you are still hungry, continue eating. If no longer hungry, stop!
      • Divide your portions in half before eating so you can have a second meal.
      • Use smaller plates so portions look large.
      • Shop for food on a full stomach and with a list.
      • Keep healthy snacks handy. Keep high calorie snacks out of sight.
      • Don't serve family style. By not having bowls of food on the table, you are less likely to reach for second helpings.
      • Avoid nibbling on leftover food.

      If weight loss or a low body weight are a problem:

      • Eat six small meals per day.
      • Eat nutrient and calorie-dense foods
      • Ask the dietitian about nutritional supplements

      A safe and successful weight management plan focuses on positive lifestyle changes. Set yourself up for success by making small changes. You will feel good about your immediate success and be motivated to make more changes. Stay positive and reward yourself for each accomplished goal.

      Heart Healthy Diet
      A heart healthy diet is made up of a variety of whole grains, vegetables, fruits, low-and non-fat dairy products, lean meats and mostly unsaturated fats. It contains few sweets and limits high sodium foods. The following sections address these topics.

      Eat whole grains, legumes, vegetables and fruits.

      High fiber foods
      Studies indicate health benefits associated with consuming up to 35g. fiber daily. Of this, 10-25g should be soluble fiber. Good sources of soluble fiber are: oats, citrus fruits, pears, apples, berries, prunes, apricots, brussel sprouts, cabbage, sweet potatoes, carrots, legumes. Regular consumption of high fiber foods is associated with decreased cholesterol and blood glucose levels.

      Look for color to find antioxidants/phytochemicals/flavonoids
      Considerable evidence shows that oxidants are involved in the development and expression of coronary heart disease and antioxidants may contribute to disease resistance. Examples of antioxidants and phytochemicals are Vit.C, Vitamin E and beta-carotene. High antioxidant intake has been associated with lower disease risk. Study on antioxidant supplementation is in process.

      The American Heart Association doesn't recommend using antioxidant vitamin supplements until more complete data are available. Examples of food sources of antioxidants are as follows.

      • Vitamin C: fruits (especially citrus) and vegetables, including green and red peppers, tomatoes, potatoes, and green leafy varieties (like spinach and collard greens).
      • Vitamin E: vegetable oils (like soybean, corn, and safflower) and vegetable oil products (like margarine), whole grains, wheat germ, nuts and seeds, and green, leafy vegetables
      • Beta-Carotene: yellow-orange fruits (like cantaloupe) and vegetables (like carrots) and green, leafy vegetables.
      • Lycopene: tomatoes, tomato products, watermelon, pink grapefruit
      • Allicin: garlic, onion, chives, leeks
      • Lignans: flaxseed, berries, whole grains
      • Resveratrol: grapes, berries, peanuts, red wine
      • Ellagic Acid: raspberries, strawberries, blueberries, walnuts, pomegranates
      • Catechins: black and green tea, wine, apples
      • Isothiocyanates: broccoli, cauliflower, brussel sprouts
      • Phytic Acid: wheat bran
      • Isoflavones: tofu, soybeans, soymilk, tempeh, textured soy protein
      • Lutein: kale, greens, spinach, Swiss chard, red pepper, Romaine lettuce
      • Limonin: citrus fruits

      Be aware of plant stanols
      Studies suggest consuming plant stanols can help lower LDL. The National Cholesterol Education Program suggests 2,000mg plant stanols/day. Plant stanols are added to margarines, such as Benecol and Take Control, as well as Minute Maid's Health Wise orange juice. Natural food sources are: nuts, legumes, seeds and cooking oils. Most people get 200-300mg/day from oils. Following is a brief summary of foods and amounts of plant stanols:

      • 3 Tbsp Benecol margarine = 2,000mg
      • 2 Tbsp Take Control margarine = 2,000 mg
      • 16oz. Health Wise Orange Juice = 2,000mg
      • 1/2c. legumes = 248mg
      • 1/4c. peanuts = 85mg
      • 1 Tbsp. corn oil = 134mg
      • 1 oz. seeds = 142-200 mg

      Consider adding soy products
      Studies indicate soyfoods may help reduce heart disease. The FDA recommends 25g soy protein daily as part of a heart healthy diet. The following is a list of soyfoods and their protein content.

      • 1/4c. firm tofu — 10g soy protein
      • 1/2c. silken tofu — 9g
      • 2 soy breakfast links — 12g
      • 1 soy-based burger — 10-12g
      • 8oz. soymilk — 7g
      • 1 soy protein bar — 14g
      • 1/2c cooked soybeans — 14g
      • 1/2c tempeh(fermented tofu) — 16g
      • 1/4c roasted soy nuts — 17g

      Monitor Your Dietary Fat
      Our body needs fat. Fat serves as the storage substance for the body's extra calories. It fills the fat cells, or adipose tissue, that help insulate the body. Fats also are an important energy source.

      Healthy skin and hair are maintained by fat. Fat helps in the absorption, and transport through the bloodstream of the fat-soluble vitamins A, D, E, and K.

      Diets high in saturated and trans fats increase risk for heart disease. Diets that contain some mono- and polyunsaturated fats promote heart health. Moderation of all fat is important.

      Whatever your lifestyle preference, a dietitian can help you establish a plan to adjust fat intake to recommended levels. The American Heart Association recommends a diet with less than 30% of calories from fat, less than 10% saturated fat. It suggests 5-8 total fat servings per day and encourages choosing foods low in saturated and trans fats, as well as cholesterol.

      The National Cholesterol Education Program recommends a diet with 25-35% of calories from fat. It suggests up to 20% of calories as monounsaturated, up to 10% polyunsaturated and less than 7% saturated.

      Choose unsaturated fats most often
      As noted above, it is not only the amount of fat in the diet, but also the type of fat, that is important. Saturated fats tend to increase blood cholesterol levels. Polyunsaturated and monounsaturated fats tend to decrease blood cholesterol levels when substituted for saturated fats. Choose polyunsaturated and monounsaturated over saturated fats. Sources of these fats are listed below.

      Polyunsaturated Fat (up to 10% of calories) Monounsaturated Fat (up to 20% of calories) Saturated Fat (up to 10% of calories)
      • Corn Oil
      • Soybean Oil
      • Safflower Oil
      • Sesame Oil/seeds
      • Cottonseed Oil
      • Sunflower Oil/seeds
      • Olive Oil
      • Peanut Oil
      • Canola Oil
      • Pecans
      • Almonds
      • Cashews
      • Black walnuts
      • Avacado/guacamole
      • Peanuts/peanut butter
      • Butter
      • Cream
      • Whole Milk
      • Ice Cream
      • Cheese
      • Meat Marbling
      • Coconut
      • Palm Kernel Oil
      • Palm Oil
      • Hydrogenated Fat
      • Cocoa Butter

      Consider Sources of Trans Fats
      Trans fats are another type of fat that may increase total cholesterol and LDL cholesterol levels. Trans fats also may decrease HDL cholesterol levels. Trans fats result from vegetable oil processing. Trans fats are found in margarine, shortening and products made from these. Major dietary sources are: cakes, cookies, crackers, pies breads, animal products and margarine. The American Heart Association recommends choosing margarine with no more than 2g saturated fat per serving and with liquid vegetable oil as the first ingredient. On food labels, look for grams of trans fats listed under saturated fats. This is a sample label from the FDA, showing how a food label will look with a trans fat listing.

      Consume foods rich in Omega 3 Fatty Acids
      Omega 3 Fatty Acids (fish oils) are a type of polyunsaturated fatty acid found in the oils of fish and shellfish, flaxseed, tofu, walnuts, canola oil and soybean oil. Omega three fatty acids are found in greatest amounts in fatty fish such as salmon, mackerel, herring, sardines, and whitefish. Research has shown that fish oils may be beneficial in decreasing triglycerides. Their effect on cholesterol is undetermined. The AHA suggests incorporating fish into 2-3 meals per week. Those with high triglycerides may benefit from supplementation of 2-4gm eicosapentaenoic acid and docosahexaenoic acid per day, but talk with a physician first. High intake can cause excessive bleeding.

      Eat Fewer High Cholesterol Foods
      Cholesterol is a fat-like waxy substance that is used by your body to produce hormones and other vital substances. The body manufactures cholesterol, about 600 mg per day, for its needs. However, cholesterol also is present in foods of animal origin. Dietary cholesterol tends to increase blood cholesterol levels. The AHA and NCEP recommend an intake of 200 to 300 mg of cholesterol per day. Americans typically consume 450-500 mg of cholesterol each day. Compare the following foods to find those high in cholesterol.

      Food Item Servings Chol. (mg) Sat. fat (g)
      Caviar 3 oz. 499 3.5 g
      Kidney, beef 3 oz. 242 1.0
      Liver, beef 3 oz. 301 1.6
      Heart, beef 3 oz. 119 1.5
      Shrimp, steamed 3 oz. 166 0.2
      Pork, top loin 3 oz. 49 3.2
      Beef, top sirloin 3 oz. 76 2.7
      Chicken, skinless breast 3 oz. 73 0.9
      Egg, Yolk, large 1 213 9.6
      Egg, White, large 1 0 0
      Cheddar Cheese 1 oz. 15 3.0
      Swiss Cheese 1 oz. 30 6.0
      2% Milk 1 cup 20 3.0
      Skim Milk 1 cup 5 0
      Butter 1 tsp. 11 2.5
      Margarine, stick 1 tsp. 0 0.5-1.0
      Margarine, tub 1 tsp. 0 0-0.5
      Cod 3 oz. 40 0.1
      Salmon 3 oz. 54 2.1
      Cereal, most dry ? cup 0 0
      Fruit
      		0 0
      Vegetables
      		0 0

      Modify Your Sodium Intake
      Sodium is a mineral which helps your body maintain water balance. Too much sodium in the diet may cause fluid retention, which makes the heart work harder to pump blood. This can increase your blood pressure. Your body needs 500 mg of sodium per day. The average American intake is 3 to 7 gm (3,000 to 7,000 mg) per day. The AHA recommends a sodium intake of < 3000 mg for healthy Americans. To lower your intake:

      • Avoid salting your food at the table.
      • Opt for salt free cooking.
      • Eat fewer commercially prepared foods.
      • Be conscious of selections when eating out.

      High Sodium Foods

      • Canned Soup*
      • Canned Vegetables*
      • Canned Tomato Products*
      • Canned fish, meat
      • Processed meats, such as ham, hot dogs, bacon, sausage, lunch-meat
      • Pickled items, such as olives, pickles, and sauerkraut
      • Boxed items, such as macaroni and cheese, potato and rice side dishes
      • Seasonings such as garlic salt, onion salt, celery salt, some lemon peppers
      • Sauces, such as soy, Worcestershire, barbeque*
      • Individually frozen chicken breasts
      • Marinated meat products
      • Cheese and cheese spreads*
      • Bouillons*
      *some reduced sodium, low sodium or no-added salt versions are available

      Tip: Learn to use herbs and spices in cooking. Starting guideline: use about 1/4 tsp. of dried or 3/4 tsp. of fresh spice per pound of meat.

      Moderate Your Alcohol Intake
      Despite the recent publicity about the benefits of alcohol for heart disease, overindulgence can cause many problems. Outweighing the possible positive effect on heart disease are the real risks of excess alcohol ingestion. Excess alcohol intake can increase triglycerides and blood pressure, cause liver damage, and impair coordination, which may lead to falls and accidents. Alcohol contains a lot of calories with no nutritional value. Therefore, alcohol in moderation is an acceptable part of your diet plan. For men, "moderate drinking" is no more than 2 drinks per day. For women, no more than 1 drink per day is recommended.

      Count as one Drink

      • 12 oz beer
      • 5 oz wine
      • 1.5 oz hard liquor (80 proof)

      Caffeine
      Caffeine has many metabolic effects. For example,

    • Caffeine stimulates the central nervous system.
    • Caffeine releases free fatty acids from adipose (fatty) tissue.
    • Caffeine affects the kidneys, increasing urination, which can lead to dehydration.\

    Caffeine is in coffee, tea, soft drinks, chocolate and some nuts. Whether high caffeine intake increases the risk of coronary heart disease is still under study. Moderate caffeine intake, such as 1-2 cups coffee per day, doesn't seem to be harmful.

  • Food Labeling

    • Use Food Labels Effectively
    Reading food labels can help make a trip to the grocery store less mind-boggling. The following information, from the FDA, describes how to effectively read and use the information on food labels.

    The nutrition facts panel has two parts:
    The main section contains product-specific information. The bottom footnote provides general information about certain nutrients.

    Be aware of the serving size:
    Compare the serving size to how much you actually eat. The size of the serving on the food package influences all the nutrient amounts listed on the top part of the label.

    Look at calories and their sources:
    Calories provide a measure of how much energy you get from a serving of this food. The label tells you how many calories per serving and how many of these from fat. Trans fats will be listed on food labels by 2006.

    Nutrients listed on the label:
    Look at the top section in the sample nutrition label. It shows nutrients that are important for your health and separates them into two main groups: those to limit and those important to health.

    The nutrients listed first are the ones Americans generally eat in adequate amounts, or even too much. Eating too much fat, saturated fat, trans fat, and cholesterol, or sodium may increase your risk of certain chronic diseases, like heart disease, some cancers, or high blood pressure. Eating too many calories is linked to overweight and obesity.

    Americans often don't get enough dietary fiber, vitamin A, vitamin C, calcium, and iron in their diets. Eating enough of these nutrients can improve your health and help reduce the risk of some diseases and conditions. For example, getting enough calcium can reduce the risk of osteoporosis, in which bones become brittle and break as one ages.

    Percent Daily Value tells you whether the nutrients in a serving of food contribute a lot or a little to your total daily diet. Percent daily values are based on recommendations for a 2,000 calorie diet. You can use the %DV as a frame of reference. Try to limit your total daily intake of fat, saturated fat, sodium, and cholesterol to less than 100%DV. Try to get 100% of essential nutrients like calcium, iron, and vitamins A and C as well as other components such as dietary fiber. Here's a general guideline: 5%DV or less is low and 20%DV or more is high.

    The footnote: The footnote shows general dietary advice for all Americans.

    Many food labels have nutrition claims. The FDA has specific definitions for these:

    • Free: Contains none or only negligible amounts of fat, saturated fat, cholesterol, sodium, sugar, and/or calories.
    • Low Fat: 3 gm or fewer per serving.
    • Lower Saturated Fat: No more than 1 gm/serving.
    • Low Sodium: Fewer than 140 mg per serving.
    • Very Low Sodium: Fewer than 35 mg/serving.
    • Low Cholesterol: Fewer than 20 mg/serving.
    • Low Calorie: 40 calories or fewer per serving.
    • Lean: Fewer than 10 gm fat. Fewer than 4 gm saturated fat, and fewer than 95 mg cholesterol per serving.
    • Extra Lean: Fewer than 5 mg of fat, fewer than 2 9 saturated fat, and fewer than 95 mg cholesterol per serving.
    • High: Contains 20% or more of daily value for a particular nutrient.
    • Reduced: Products has been nutritionally altered and contains 25% less of a nutrient.
    • Less: Food contains 25% less of a nutrient than a comparable food. For example, pretzels contain 25% less fat than potato chips.
    • Light: a) Calories have been reduced by at least a third, b) Sodium content of a food reduced by at least 50%, and c) refer to texture and/or a color as long as it is spelled out. Note: When applied to a meal a main dish, light means the dish is low in fat or calories.
    • % Fat Free: Used only on foods that are low fat. Fat free to begin with, reflect the amount of the foods weight that is fat free.
  • Heart Healthy Recipe Substitutions

    • Eating the low fat, low cholesterol and no-added-salt way does not necessarily mean that your favorite recipes have to be avoided. Try these simple substitutions for heart healthy fare.

    To Lower Fat and Cholesterol

    1 whole egg 2 egg whites or 1/4 cup egg substitute or 1 egg white and 1 teaspoon vegetable oil*
    Scrambled egg whites: 2 egg whites, 1 Tbs. non fat dry milk, 4 drops yellow food coloring
    1 cup butter, lard or shortening 1 cup margarine** or 2/3 to 3/4 cup vegetable oil or Molly McButter / Butter Buds for seasoning vegetables, baked potatoes, etc.
    1 cup vegetable oil 1 cup applesauce
    1 cup whole milk 1 cup skim milk
    1 cup light cream 1 cup evaporated skim milk or 3 tablespoons vegetable oil and skim milk to equal 1 cup
    1 cup heavy cream 1 cup evaporated skim milk or 2/3 cup skim milk and 1/3 cup vegetable oil

    If your recipe calls for: Use this:
    1 cup sour cream 1 cup plain non fat yogurt or 1 cup nonfat cottage cheese plus 2 teaspoons lemon juice or 1/2 cup dry cottage cheese, 1 Tbs. lemon juice, 1/4 tsp. onion powder, 1/2 cup skim milk, or fat free sour cream
    1 ounce cheese 1 ounce skim milk cheese or part skim milk cheese containing 5 (or less) grams of fat per ounce, or a fat free cheese, use up to 1/2 oz. of a strong-flavored cheese
    Cream cheese "Light" cream cheese containing grams of fat per ounce, or a fat free cream cheese
    Creamed cottage cheese Nonfat or 1% milk fat cottage cheese
    1 tablespoon salad dressing or mayonnaise 1 tablespoon reduced or fat-free mayonnaise or salad dressing or thin creamy dressing with non-fat plain yogurt or fat-free salad dressing or mayonnaise
    Fat for sauteing, stir frying or broiling Use 1/2 the amount of fat or water or vegetable spray at low heat
    Regular ground beef extra lean ground beef and/or rinse in hot water after frying
    Chicken with skin Remove skin from chicken before eating
    Deep-fried meats, poultry & fish Broil, bake, braise, poach or grill lean meats, poultry and fish
    Sauteed vegetables Steamed or microwaved vegetables
    Gravy Low fat gravy: let meat broth stand in refrigerator overnight or put ice cubes in broth to collect fat. Skim off fat. Use 1 Tbs. com starch to thicken 1 cup.
    2 strips bacon ***1 ounce lean Canadian bacon or 1 ounce lean ham
    1 cup all purpose white flour 3/4 cup all purpose white flour plus 1/4 cup bran or 1/2 cup all purpose white flour plus 1/2 cup whole wheat flour (to increase fiber)
    1 ounce baking chocolate 3 tablespoons powdered cocoa plus 1 tablespoon vegetable oil
    White rice Brown or wild rice (to increase fiber)
    Ice cream Sorbet, sherbet, low fat frozen yogurt or light ice cream
    Luncheon meats ***92% or more fat free luncheon meats
    Salt Cut total amount in half in bread recipes. Take out of other recipes. Increase amount of other spices to enhance flavor. Many spice blends available.

    *Acceptable vegetable oils: safflower, corn, soybeans, sesame, olive, canola.
    **Acceptable margarine: contains liquid polyunsaturated oil (corn, soybean, safflower, sunflower) as the first ingredient and have twice as much polyunsaturated fat as saturated fat.
    ***High in sodium.
    Caution: Fat free products used in baked dishes may require adjustment of other ingredient.

  • Heart Healthy Cook Books

    • Cooking Light Magazine
    Subscription Assistance 1-800-336-0125
    Monthly or Biannually

    Taste of Home's Light and Tasty Magazine
    Subscription Assistance 1-800-344-6913
    Bimonthly

    National Heart, Lung and Blood Institute
    Keep the Beat Heart Healthy Recipes
    U.S. Department of Health and Human Services, 2003

    The American Heart Association
    Low-Salt Cookbook: A Complete Guide to Reducing Sodium and Fat in the Diet, 2nd Edition
    ClarksonPotter Publishers, New York, 2001

    Eater's Choice: A Food Lover's Guide to Lower Cholesterol and
    Eater's Choice Low-Fat Cookbook: Eat Your Way to Thinness & Good Health
    Ron Goor, Ph.D. and Nancy Goor
    Houghton Mifflin, 1987, 1999

    Cooking Vegetarian
    Vesanto Melina, RD & Joseph Forest
    John Wiley & Sons, Inc., 1998

    American Heart Association
    Quick and Easy Cookbook
    Times Books, A Division of Random House Inc., 1998

    American Heart Association
    Low-Fat, Low-Cholesterol Cookbook, 2nd Edition
    Random House, Inc., 1998

    American Heart Association
    Around the World Cookbook: Healthy Recipes with International Flavor
    Times Books, A division of Random House, Inc., 199

    Books:

    365 Days of Healthy Eating
    American Dietetic Association
    Roberta Larson Duyff, MS, RD, FADA, CFCS, 2003

    Complete Food and Nutrition Guide
    American Dietetic Association
    Roberta Larson Duyff, MS, RD, FADA, CFCS, 2002

    The Way to Eat
    David L. Katz, MD, MPH, FACPM and Maura H. Gonzalez, MS, RD, 2002

    The DASH Diet for Hypertension
    Lower your Blood Pressure in 14 Days-Without Drugs
    Thomas Moore, MD; Laura Svetkey, MD; Pao-Hwa Lin, PhD; Njeri Karanja, PhD; with Mark Jenkins, 2001

    Websites:

    Smoking

    • Options for Smoking Cessation

      • If you quit smoking during your hospitalization, congratulations! You have achieved a great accomplishment. You also have taken advantage of the most successful method of smoking cessation. By quitting during hospitalization, you have the greatest chance of long-term smoking cessation success.

      If you continue to smoke, you simply must quit. The CHAMPS staff will help you quit by providing you the guidance and support you will need and helping you choose a method to quit.

      Options for Smoking Cessation

      Cold Turkey
      This method simply has you abruptly stop smoking cigarettes. Many quitters have used this method and have been very successful. Other smokers have tried this method many times before they were successful. The success rate varies greatly with this method.

      Things to think about:

      • You can manage this process alone.
      • It is a one step process.
      • The cost is very little.
      • You must be highly committed to your goal of quitting.
      • Withdrawal symptoms (such as headache, irritability, or trouble sleeping) may be severe for some, especially if you smoke a cigarette with high levels of nicotine.

      Nicotine Fading
      With this method, you are taught how to reduce the nicotine level of cigarettes smoked by 30/60/90 percent over a three-week period. During the fourth week, you stop smoking completely. Your CHAMPS staff member or doctor will help you decide which cigarette brands will be smoked over these three weeks by using a chart that is printed by the Federal Trade Commission. This chart is helpful because most cigarette labels do not list the nicotine content. This method helps reduce the chances of withdrawal symptoms becoming severe. It has a 30% success rate after 12 months.

      Things to think about:

      • It is easy to follow.
      • It is inexpensive.
      • You must have a high level of motivation.

      Nicorette Gum
      The gum is a substitute source of nicotine and reduces the withdrawal symptoms during the quitting process. Gum is prescribed by a doctor. Often you need to chew 10-12 pieces of gum each day over a three to six month period. You slowly reduce the amount of gum chewed each day during the last few weeks of the therapy. This method has a 20% success rate after 12 months.

      Things to think about:

      • You can manage this process alone.
      • You must have a high level of motivation.
      • You must stop smoking when using the gum.
      • Minor side effects include lightheadedness, nausea, sore mouth, sore throat, hiccups and excess amount of saliva.
      • The gum is not recommended if you are pregnant, have had a heart attack or other heart problems, or if you have certain joint diseases of the jaw.
      • If you are a long time smoker, you may have a greater chance of becoming dependent on the gum. The cost for three months of therapy is about $225.00. Most insurance, including Title 19 and Medicare, do not cover the cost of the gum.

      Nicotine Skin Patch
      The skin patch is also a substitute source of nicotine and reduces the withdrawal symptoms during the quitting process. The patch is prescribed by a doctor. The dosage is prescribed based upon the number of cigarettes smoked in a day. The patch is worn for 10 or 12 weeks. The patch is a good choice for you if you have a strong addiction to nicotine and are smoking a cigarette that has a high nicotine content. There is a 50% success rate at the end of a three-month period.

      Things to think about:

      • One patch is applied every 24 hours.
      • You must have a high level of motivation.
      • You must stop smoking cigarettes when you use the patch.
      • Common side effects are skin redness when the patch is removed and restless sleep.
      • If you are pregnant, the patch is not recommended.
      • If you have heart disease, use of the patch must be closely monitored by the CHAMPS staff.
      • The cost is about $100.00 for four weeks. Most people need to use the patch for a total of 8-10 weeks. Most insurance, including Title 19 and Medicare do not cover the cost of the patch.
      • All of these options are most successful when combined with a support group based smoking cessation program that discusses stress management, weight control, effects of social pressure and tips for resisting the temptation to light up. There are many smoking cessation programs available, including those sponsored by the American Lung Association and the American Cancer Society.

      Nicotine Inhaler
      The inhaler is a substitute source of nicotine and reduces the withdrawal symptoms during the quitting process. To use the nicotine inhaler, you insert a foil wrapper nicotine cartridge into a tube that looks like a fat white cigarette. The inhaler is prescribed by a doctor. Each puff of the inhaler contains 8 to 10 times less nicotine than a puff of a cigarette and none of the dangerous tar and other toxins that cigarettes contain. The dosage ranges from using the inhaler intensively for 5 minutes 24 to 48 times a day gradually tapering off after 3 months.

      Things to think about:

      • You must stop smoking cigarettes when you use the inhaler
      • Common side effects include mouth or throat irritation and cough
      • If you are pregnant or breastfeeding, the inhaler is not recommended
      • The cost is about $160 for 2-4 weeks depending on dosage
      • The inhaler provides the sensation in the back of the throat similar to the feeling of inhaling a cigarette, and the ritual of bringing hand to mouth that many smoker report they miss when trying to quit.

      Zyban
      This is the first nicotine-free pill which can be prescribed by your doctor. In clinical trials, it has been proven to reduce withdrawal symptoms and the urge to smoke in some patients. You first set a quit date, then start taking Zyban and project that you'll reach your date within 2 weeks. Your doctor may recommend for you to continue taking Zyban for 7-12 weeks and attend a support group for long-term success.

      Things to think about:

      • You must have a strong desire to quit.
      • It takes about one week for the levels of Zyban to be effective, so you should plan a quit date during the second week of therapy.
      • Do not smoke at any time if you are using a nicotine patch or other product along with Zyban. It is possible to get too much nicotine and have serious side effects.
      • If you are pregnant or breastfeeding, Zyban is not recommended.
      • Zyban may affect other medications that you are taking, therefore, you should make sure your doctor is aware of all prescription and over-the-counter medications you take before you begin.
      • A day of Zyban costs about the same as a pack of cigarettes. Most medical insurance does not cover the cost. The lowest recommended and shortest length of therapy averages about $125.44.
      • All of these options are most successful when combined with a support group-based smoking cessation program that discusses stress management, weight control, effects of social pressure and tips for resisting the temptation to light up. There are many smoking cessation programs available, including those sponsored by the American Lung Association and the American Cancer Society.
    • Facts, Effects, and Pros and Cons of Smoking

    • Challenge-to-Quit Questionnaire

      • Please check "

    		YES" if you anticipate the following to be a challenge in your quest to quit smoking. If you do not anticipate a problem, check "no".

    I anticipate a possible problem toward achieving my goal of smoking cessation in the following circumstances:

    YES NO When offered a cigarette...
    YES NO When seeing others smoking...
    YES NO When feeling tense...
    YES NO When feeling bored...
    YES NO When feeling good...
    YES NO When feeling depressed...
    YES NO When confronted with withdrawal symptoms...
    YES NO When craving for a cigarette...
    YES NO When getting up in the morning...
    YES NO When finished eating...
    YES NO When drinking coffee/tea...
    YES NO When at work...
    YES NO When busy...
    YES NO When taking a break...
    YES NO When out with friends...
    YES NO When drinking alcohol...
    YES NO When feeling angry...
    YES NO When feeling uncomfortable with others...
  • Why Do You Smoke?

    • Here are some statements made by people to describe what they get out of smoking cigarettes. How often do you feel this way when smoking?

    Circle one number from each statement.

    1 = NEVER
    2 = SELDOM
    3 = OCCASIONALLY
    4 = FREQUENTLY
    5 = ALWAYS
    A) I smoke cigarettes in order to keep myself from slowing down. 1 2 3 4 5
    B) Handling a cigarette is a part of the enjoyment of smoking it. 1 2 3 4 5
    C) Smoking cigarettes is pleasant and relaxing. 1 2 3 4 5
    D) I light up a cigarette when I feel angry about something. 1 2 3 4 5
    E) When I run out of cigarettes, I find it almost unbearable until I can get them. 1 2 3 4 5
    F) I smoke cigarettes automatically without even being aware of it. 1 2 3 4 5
    G) I smoke cigarettes to perk myself up. 1 2 3 4 5
    H) Part of the enjoyment of smoking a cigarette comes from the steps I take to light up. 1 2 3 4 5
    I) I find cigarettes pleasurable. 1 2 3 4 5
    J) When I feel uncomfortable or upset about something, I light up a cigarette. 1 2 3 4 5
    K) I am very much aware of the fact when I am not smoking a cigarette. 1 2 3 4 5
    L) I light up a cigarette without realizing I still have one burning in the ashtray. 1 2 3 4 5
    M) I smoke cigarettes to give me a "lift." 1 2 3 4 5
    N) When I smoke a cigarette, part of the enjoyment is watching the smoke as I exhale it. 1 2 3 4 5
    O) I want a cigarette most when I am comfortable and relaxed. 1 2 3 4 5
    P) When I feel "blue" or want to take my mind off cares and worries, I smoke cigarettes. 1 2 3 4 5
    Q) I get a real gnawing hunger for a cigarette when I haven't smoked for a while. 1 2 3 4 5
    R) I've found a cigarette in my mouth and didn't remember putting it there. 1 2 3 4 5

    How to score:

    • Enter the numbers you have circled to the questions in the spaces below putting the number you have circled to question A by line A, to Question B by line B, etc.
    • Total the three scores on each line to get your totals. For example, the sum of your scores over lines A, G, and M gives your score on Simulation, lines B, H, and N give the score on Handling, etc.
    A_____   +   G_____   +   M_____   =   _____   Stimulation
    B_____   +   H_____   +   N_____   =   _____   Handling
    C_____   +   I_____   +   O_____   =   _____   Pleasurable Relaxation
    D_____   +   J_____   +   P_____   =   _____   Crutch: Tension Reduction
    E_____   +   K_____   +   Q_____   =   _____   Craving: Psychological Addiction
    F_____   +   L_____   +   R_____   =   _____   Habit

    Scores can vary from 3 to 15. Any score 11 and above is high; any score 7 and below is low. See the following information for more details.

    Test Results:

     

  • What Kind of Smoker Are You?

    • What kind of smoker are you? What do you get out of smoking? What does it do for you?
    This test is designed to provide you with a score on each of six factors that describe many people's smoking. Your smoking may be characterized by only one of these factors or by a combination of factors. In any event, this test will help you identify what you use smoking for and what kind of satisfaction you think you get from smoking.

    The six factors measured by this test describe one or another way of experiencing or managing certain kinds of feelings. Three of these feelings represent the positive feelings people get from smoking; 1) a sense of increased energy or stimulation; 2) the satisfaction of handling or manipulating things; and 3) the enhancing or pleasurable feelings accompanying a state of well being. The fourth is a decrease in negative feelings due to the reduction of tension, anxiety, anger, shame, etc. The fifth is a complex pattern of increasing and decreasing "craving" for a cigarette, and represents a psychological addiction to cigarettes. The sixth is habit: smoking takes place in the absence of feeling - purely automatic smoking.

    A score of 11 or above on any factor indicates that this factor is an important source of satisfaction for you. The higher your score (15 is the highest), the more important a particular factor is in your smoking and the more useful the discussion of that factor can be in your attempt to quit.

    A few words of warning: If you give up smoking, you may have to learn to get along without the satisfaction that smoking gives you. Either that, or you will have to find some more acceptable ways of getting this satisfaction. In either case, you need to know just what it is that you get out of smoking before you can decide either to forgo the satisfaction it gives you or to find another way to achieve it.

    1. Stimulation
      If you score high or fairly high on this factor, it means that you are one of those smokers who is stimulated by the cigarettes - you feel that it helps wake you up, organize your energies, and keep you going. If you try to give up smoking, you may want a safe substitute: a brisk walk or moderate exercise, for example, whenever you feel the urge to smoke.
    2. Handling
      Handling things can be satisfying, but there are many ways to keep your hands busy without lighting up or playing with a cigarette. Why not toy with a pen or pencil? Or try doodling. Or play with a coin, a piece of jewelry, or some other harmless object. There are plastic cigarettes if you can trust yourself not to light it.
    3. Accentuation of pleasure - pleasurable relaxation
      It is not always easy to find out whether you use the cigarette to feel good, that is, get real, honest pleasure out of smoking (Factor 3), or to keep from feeling so bad (Factor 4). About two-thirds of smokers score high or fairly high on accentuation of pleasure, and about half of those also score as high or higher on reduction of negative feelings. Those who get real pleasure out of smoking often find that the honest consideration of the harmful effects of their habit is enough to help them quit. They substitute eating, drinking, social activities, and physical activities - within reasonable bounds - and find they do not seriously miss their cigarette.
    4. Reduction of negative feelings, or "crutch"
      Many smokers use the cigarette as a kind of crutch in moments of stress or discomfort, and on occasion it may work; the cigarette is sometimes used as a tranquilizer. But the heavy smokers, the persons who try to handle severe personal problems by smoking many times a day, are apt to discover that cigarettes do not help them deal with their problems effectively. When it comes to quitting, these kinds of smoker may find it easy to stop when everything is going well, but may be tempted to start again in a time of crisis. Again, physical exercise, eating, drinking, or social activity - all in moderation - may serve as useful substitutes for cigarettes, even in times of tension. The choice of substitute depends on what will achieve the same effect without having any appreciable risk.
    5. "Craving," or psychological addiction
      Quitting smoking is difficult for people who score high on this factor. For them, the craving for the next cigarette begins to build the moment they put one out, so tapering off is not likely to work. They must go "cold turkey".
      It may be helpful for these types of smokers to smoke more than usual for a day or two, so that the taste for cigarettes is spoiled, and to isolate themselves completely from cigarettes until the craving is gone. Giving up cigarettes may be difficult and cause so much discomfort that once they do quit, they would find it easy to resist the temptation to go back to smoking because they know that some day they will have to go through the same agony again.
    6. Habit
      These smokers no longer gain much satisfaction from cigarettes. They just light them up frequently without even realizing that they are doing so. They may find it easy to quit and stay off it, if they can break the habit patterns that they have built up. Cutting down gradually may be quite effective as there is a change in the way the cigarettes are smoked and the conditions under which they are smoked. The key to success is gaining awareness of each cigarette that you smoke. This can be done by asking yourself, "Do I really want this cigarette?" You may be surprised at how much you do not want it.

    Summary of Test
    If you do not score high on any of the six factors, chances are that you do not smoke very much or have not been smoking for many years. If so, giving up smoking - and staying off - should be easier.

    If you score high on several categories, you apparently get several kinds of satisfaction from smoking and will have to find several solutions. Certain combinations of scores may indicate that giving up smoking will be especially difficult. Those who score high on both Factor 4 and Factor 5, reduction of negative feelings and craving, may have a particularly hard time in quitting smoking and in staying off. However, there are ways to do it; many smokers represented by this combination have been able to quit.

    Others who score high on Factors 4 and 5 may find it useful to change their patterns of smoking and cut down at the same time. They can try to smoke fewer cigarettes, smoke them only halfway down, use low-tar-and-nicotine cigarettes, and inhale less often and less deeply. After several months of this temporary solution, they may find it easier to stop completely.

    You must make two important decisions:

    • Whether to try to do without the satisfaction you get from smoking or find an appropriate, less hazardous substitute
    • Whether to try to cut out cigarettes all at once or to taper off.

    Your scores should guide you in making both of these decisions.

  • Steps to Follow When You Feel the Urge to Smoke

    • When you feel an urge to smoke, follow these steps:

    1. STOP - Learn to say "STOP!" to yourself.
    2. THINK - Think of why you want to quit and tell yourself that you can wait the urge out.
    3. DO - Take action by doing something else. Possible activities are those that keep your hands busy. Move or get up to remove yourself from the tempting situation. Talk to an understanding friend. Sigh, yawn, or breathe deeply. Avoid tempting situations, wherever you can. Do something else instead of smoking.

    Helpful hints

    • Practice Stop-Think-Do each day for one week. Start today...
    • Postpone smoking some cigarettes each day for 15 minutes. Rehearse "Stop-Think-Do" in your head and with smoking urges.
    • Throw out your cigarettes the night before your targeted quit date...This means toss your matches, lighters, and ashtrays too!
    • It's the morning of your stop date...You are a new non-smoker. Reward yourself each day and then each week. Be good to yourself. Avoid boredom, conflict, alcohol, and those who smoke in front of you.
    • If you slip...Regain control! Learn from the slip and then forget it. Keep trying and you will succeed.

    References

    This information is written primarily for patients.

    Awards, Reviews, and Comments Book

    Comments:

    • August 17, 2003 - Iowa CHAMPS: Cardiac Rehabilitation Guide - "As a non-medical person who has been very fortunate to have enjoyed good health I was very pleased with the easy-to-read and informative literature on heart disease." - T.S., Canada

    Last Reviewed 2005

    Source:

    Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

     

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