Dr. Manohar is on the Executive Board and part of the Circle of Red membership, and we’re proud to sponsor Go Red For Women and the fight against heart disease.
For more information on the February 25th Go Red For Women event, please visit the Circle Of Red Website.
The Heart and Wellness Institute is recognized as the premier institute in West Michigan for delivering specialized care in Women’s Heart Disease and Prevention.
Heart disease is the #1 killer of men AND women. How can it be prevented and can it be reversed?
In this video, Dr. Prerana Manohar of the Heart and Wellness Institute and other panelists discuss the answers to these questions.
Â
About 85-90% of heart disease is preventable. Many things a person does in the course of a day affects the heart- what is eaten, habits formed (from exercise to smoking), quality of sleep, the environment, and stress. These heart health factors can be controlled and making changes in the necessary areas can certainly prevent and even reverse heart disease and the underlying symptoms.
Experts agree diet plays a very important role in heart, health. “Diet†in this case, simply means what is eaten, not restricting calories. Issues such as high blood pressure, high cholesterol, and diabetes all increase a person’s risk of heart disease. Blood pressure, cholesterol, diabetes, and other food related health issues will be controlled if healthy diet choices are made and the risk of heart disease as a result will be diminished.
Exercise is also very important in having a healthy heart. Dr. Manohar recommends a half hour of exercise every day, even if it is just a brisk walk. And if that’s not feasible, at least a half hour four to five times a week is recommended. For every half hour of exercise done, the risk of heart disease is lowered by 10%.
The quality of sleep a person gets is also an important factor in preventing heart disease. Repeated low oxygen levels, as seen with sleep apnea, have a significant effect on the heart and can even lead to congestive heart failure.
Not only do smoking and second hand smoke have a detrimental effect on the heart, but recent studies have shown a correlation between smog and pollution and the occurrence of coronary artery disease. This is why it is important to NOT smoke, to try and stay away from second hand smoke, and to protect the environment.
Dr. Manohar suggests preventing heart disease and reducing risk by meeting with one’s primary care physician to assess risk and make a plan of action. This should include eating right, exercising regularly, getting good quality sleep, and getting rid of bad habits. Then, the risk factors, plan of action, and actions taken should be reassessed regularly. This action plan and regular assessment will contribute to a healthier heart.
With some lifestyle changes and continuous healthy choices, heart disease risk CAN be reduced and even reversed.
A Cardiolite® stress test is a type of nuclear medicine scan.  During the procedure, pictures of your heart muscles and arteries (blood vessels) are taken. This test shows how your heart performs when it needs to work hard and will likely be done while you exercise, as exercise makes your heart work harder.
Why do I need a Cardiolite® stress test?
This test helps caregivers diagnose coronary artery disease. Coronary artery disease is a condition where the blood vessels that give oxygen-rich blood to your heart muscles become narrow or blocked. The test helps find areas of heart muscle that do not get enough blood supply and can also show areas that have been damaged after a heart attack.
How do I prepare for the test?
Do NOT eat or drink anything except water for 4 hours prior to your appointment.
***If you are diabetic, call The Heart and Wellness Institute for special instructions.
Do NOT have any caffeine for 48 hours prior to your exam.
           NO regular or decaffeinated coffee or tea
           NO chocolate or cocoa in any form
           NO soft drinks
           NO cold medications
            NO medications with caffeine. Phone your pharmacist to check the caffeine content of your medication
Do NOT wear any lotion, perfume, or powder.
Stop taking your beta blockers or calcium channel blockers the day before your test, unless otherwise instructed by your physician.
Please wear flat comfortable shoes which will remain firmly on your feet as you may be walking on the treadmill.
If you are taking any medications please bring them with you.
Bring warm clothing and reading material if desired.
What will happen on the day of my test?
During the test, the physician and technologist will monitor your heart using a machine called an electrocardiograph. Electrodes connected to the electrocardiograph machine will be placed on your chest. Your blood pressure will also be monitored.
An intravenous line (IV) will be placed in your arm. Dobutamine and cardiolite will be given directly through the IV line. The dobutamine will be administered in increasing dosages until a desired heart rate is achieved (similar to how exercise increases your heart rate). Most patients just feel their hearts beating faster. However, if you experience any unusual sensations during the test, it is important to report them to the doctor.
Using the ankle-bachial index to diagnose peripheral arterial disease.
The ankle-brachial index (ABI) is a simple, reliable means for diagnosing PAD. Blood pressure measurements are taken at the arms and ankles using a pencil-shaped ultrasound device called a Doppler. A Doppler instrument produces sound waves (not x-rays) and is considered noninvasive because it does not require the use of needles or catheters. The ABI test is simple enough to be performed in any doctor’s office or vascular laboratory. Not only is the ABI one of the most reliable tests for PAD, it is also the least expensive.
How is the exam given?
You will be asked to lie on your back while standard blood pressure cuffs are placed around your ankles and arms. These cuffs will be inflated briefly above your normal systolic blood pressure. Once the cuffs are deflated, blood pressure measurements are taken using the Doppler instrument. The arm and ankle systolic blood pressure measurements are recorded. Then the ankle systolic pressures are divided by the highest arm pressure to establish an ABI measurement for each leg. The ABI range that is generally considered normal is .95 to 1.2.
How reliable is this exam?
Although the ABI is extremely reliable, this test may not be accurate in all patients. Some patients with long-standing diabetes, kidney disease, or some elderly patients, may have rigid blood vessels. These may be difficult to compress with the blood pressure cuff and, in these patients, the ABI reading may not be accurate.
What other exams will work?
For patients with rigid ankle blood vessels, toe pressure measurements may be taken since toe arteries are rarely rigid. This examination is called a toe brachial index (TBI) and is a calculation based on the systolic blood pressures of the arm and the systolic blood pressures of the toes. The examination is similar to the ABI except that it is performed with a photoplethysmograph (PPG) infrared light sensor and a very small blood pressure cuff placed around the toe. A TBI of .8 or greater is considered normal. Alternatively, a leg arterial ultrasound test can detect PAD if the ABI is not considered reliable.
The ABI Exam
The ABI test is used to document the presence or absence of PAD, and can be performed every year to quickly assess the progression of PAD. The ABI can also determine how severe an individual’s atherosclerosis is and predict the risk of future leg problems (such as development of future leg rest pain, poor healing of foot wounds, need for leg bypass surgery or amputation). It can also predict the risk of future problems from atherosclerosis in other parts of the body (such as heart attack and stroke).
Lower ABI values are associated with a higher risk. In fact, the ABI value can be an accurate predictor for patients with coronary heart disease (such as the blood cholesterol value, coronary calcium score, and C-reactive protein value). An ABI value greater than 0.80 is rarely associated with short-term leg problems such as foot wounds or amputation. Nevertheless, any evidence of PAD (where the ABI measurement is less than 1.00) is associated with future risk of heart attack and/or stroke.
An ABI value between 0.40 – 0.80 is moderately decreased and such patients often experience some symptoms such as pain in the legs. Attention to foot care is extremely important to prevent accidental injury or infection. Again, any evidence of PAD is associated with future risk of heart attack and/or stroke! Serious efforts to keep one’s risk factors under control are essential to keep PAD from getting worse.
An ABI value of less than 0.40 indicates severe PAD. Patients should be extremely careful to avoid any foot injuries. Proper foot care may prevent development of non-healing wounds, rest pain, or even gangrene. Usually, care from a vascular specialist is required. The specialist will evaluate the risk and benefits to improve leg blood flow through surgery or other interventions.
The ABI test approaches 95 percent accuracy in detecting PAD. However, a normal ABI value does not rule out the possibility of PAD for some individuals. Some patients with a normal or near-normal ABI results may have few symptoms suggesting PAD. A treadmill exercise or reactive hyperemia test may be recommended to test further for the disease and the cause of pain.
Taking a closer look at the portion of the aorta in your abdomen using ultrasound technology. Â
This test helps your physician determine if there is blockage, narrowing or an aneurysm (an enlargement or a “bulge”) in your aorta. The aorta is the major artery that carries enriched blood from your heart. Ultrasound is used to obtain images of the aorta and the blood flow within. The test is non-invasive and should cause no significant discomfort.
What is the procedure for an abdominal aorta ultrasound?
An ultrasound device is moved over the abdomen (stomach) to obtain pictures of the aorta. Ultrasound waves are sent into the abdomen using an ultrasound device and ultrasound gel which aids in the transmission of the sound waves. The sound waves are transformed into a picture which allows for assessment of aorta size, shape and blood flow.
How to prepare? The night before:
• Do not eat gas producing foods such as broccoli, cabbage, beans, and fiber rich foods.
• Take Beano or Gas-X (you can obtain this over the counter at your local pharmacy or grocery store).
• Do not eat or drink 12 hours prior to test.
***If you are a diabetic call the office for specific instructions.
Morning of test: • Do not eat.
***If you are a diabetic call the office for specific instructions.
• Take Beano or Gas-X (you can obtain this over the counter at your local pharmacy or grocery store).
• Drink ice water.
• Wear a shirt that can easily be removed. Wear loose fitting clothing.
How long is the test?
The test will take approximately 30 minutes.
What is an echocardiogram?
An echocardiogram, or echo, is an ultrasound of the heart. This is done by obtaining 2 dimensional, Doppler (blood flow) and 3 dimensional images with an ultrasound device. Gel that aids in the transmission of the sound waves is placed on the chest and an ultrasound device is moved over the area. Ultrasound waves are sent into the chest and bounce back to the device and the sound waves are transformed into pictures. These pictures allow the physician to see the structure and size of the heart, movement of the heart muscle, and the flow of blood through the heart chambers.
Why do I need and echocardiogram?
An echocardiogram may help identify the cause of symptoms such as shortness of breath, swelling in the legs or pain in the chest. The test produces pictures of your heart that are used to evaluate your heart valves, heart and heart muscle.
How to prepare?
Wear a shirt that can be easily removed. We will have a gown for you to wear.
Shirt and bra will be removed by women.
No special eating instructions.
How long is the test?
The test will take approximately 45 minutes.
Leading Grand Rapids Cardiologist Dr. Manohar of the Heart and Wellness Institute Tells What Symptoms of Heart Disease are and How You Can Prevent Heart Disease.
To begin, every person should know the classic signs of a heart attack. These symptoms include:
Chest pressure ( pressure located in the mid sternum or left side)
Heavy pain that radiates on the left side of a person’s arm, neck, or shoulder
Shortness of Breath
Breaking out in a sweat
Attention should also be paid to the less typical symptoms such as:
Nausea
Light headedness
Indigestion
Dizziness
Sweats
Passing out
If you have symptoms that are unexplained, you should be evaluated for coronary disease. Coronary disease is the most common disease in the U. S.
Â
Â
Evidence has proven that free radicals can cause damage to a person’s arteries and vascular system.  Dr. Manohar explains that a nutritious, balanced diet has all the benefits of receiving the antioxidants needed for fighting free radicals.Â
Stress and anxiety are also large risk factors. Anxiety should be addressed through your primary care provider.  According to Dr. Manohar, it is vital that we manage our stress. We can accomplish this in a number of ways; through social interaction, meditation, or simply by going for a walk, to name a few.
Aspirin has proven to help reduce a person’s chance of myocardial infarction (heart attack).  Aspirin is beneficial because it prevents blood clots and doesn’t allow the platelets to stick together as well. It is important to check with your primary care provider if you are over the age of 80 as elderly are at risk for bleeding while taking aspirin.
A stent can be an alternative treatment if a person experiences narrowing of an artery. A stent is a small coil that is placed in the artery to keep it propped open, thus improving blood flow.  A stent is a temporary fix, however, and risk modification is more important. Receiving a stent will not benefit a person if s/he continues to make poor lifestyle choices such as smoking or eating poorly.
Dr. Manohar of the Heart and Wellness Institute in Grand Rapids Discusses Who is at Risk for Heart Disease and How it Can be Prevented.
Today’s discussion on Family Health Matters is heart disease.  Dr. Prerana Manohar opens the discussion by stating that heart disease is the leading cause of death among men and women in the nation. This is above all the 13 causes of cancer combined.  Statistics dating from 2005 reveal that 450,000 women died of heart disease while only 250 women died of cancer. This is of particular concern to cardioascular experts.  Lifestyle choices and the fact that we are living longer have, together, increased the prevalence of heart disease.
Â
What many people do not realize is that heart disease is controllable. The leading killers are Atherosclerosis and coronary heart disease, as well as stroke.  A stroke is an indication of Atherosclerosis and the third leading killer in the nation. Although heart disease is preventable, this nation has not come to that realization.  When we do, the occurrence of heart disease will begin to diminish and eventually, will be non-existent. Â
The leading risk factors of heart disease include:
Smoking
High blood pressure
Physical inactivity
Poor body composition
Diabetes
Metabolic syndrome
Genetic makeup
Dr. Manohar adds that stress, anxiety, and depression can double a person’s risk of heart attack. Studies done in women have shown that stress can increase the risk of heart disease as much as 1½ to 2 times. Dr. Manohar concluded that if we minimize stress, then those risk factors will decrease as well.
Cholesterol can also affect the health of your heart. Most people are aware of LDL (lower density lipid) counts; numbers of 150 or lower are typically acceptable. Higher numbers indicate the possibility of plaque development in the arteries, which can lead to heart disease and strokes.Â
Screening for heart disease begins with looking at the common risk factors. Tests can also be run for those who have no obvious symptoms but want to know if they have any heart problems. Although screening for heart disease is still in the infancy stages and there is no one test,  tests such as ultrasounds of carotid arteries or cat scans of the chest are useful in detecting heart disease.  If you are concerned about your risk of heart disease, you can evaluate your risk by:
Receiving screening from your primary care physician
Having measurements such as body mass and blood pressure checked
Getting blood work done
When getting your cholesterol checked, you can ask your doctor to give you a high sensitivity C-reactive protein. This bio marker is not associated with risk of heart attack or stroke. There are also diagnostic studies that can determine if a person is predisposed to coronary disease.  Soon there will be genetic bio markers as well.
Type I diabetes is a high risk factor for the development of heart disease.  The first issue of concern is glucose levels; it is important for a person with diabetes to maintain a well controlled glucose level.  The second area of concern is the inability to exercise; this is not an uncommon problem among diabetics.  Swimming can be an alternative method of cardiovascular exercise for those who have difficulty walking. Emphasis should be placed on controlling blood sugar levels and maintaining a low carbohydrate diet. Canned fruit should be avoided when possible due to the large amount of sugar in this product.
It is never too early to be concerned with heart health and taking deliberate steps to prevent a heart attack. Not all changes are easy, but Dr. Prerana Manohar and the staff of the Heart and Wellness Institute are a valuable support and can help guide you in making healthy lifestyle choices that can positively impact your health. Even if you have already had a heart attack, key measures can help prevent subsequent ones and help an already damaged heart function optimally.
 For those who have already suffered a heart attack, or those at risk, a cardiologist or heart doctor is likely to prescribe a drug therapy which may include:
Blood thinning medications like aspirin
Angiotensin-converting enzyme inhibitors which make the blood flow more easily and reduce the risk of a second heart attack.
Beta blockers are also used by heart doctors to lower the heart rate and blood pressure which reduces the demand on the heart.
Cholesterol- lowering medications such as statins, niacin and fibrates may be prescribed by the cardiologist to help lower cholesterol levels.
Lifestyle choices are key in preventing a heart attack.
Develop healthy eating habits. Your heart doctor can recommend a low fat, low salt diet
If you are overweight, a plan for weight loss can be developed.
Exercise.  Simply taking a brisk walk several times a week can help reduce your risk. Speak to your cardiologist before embarking on a high intensity workout plan.
Control your blood pressure if you have hypertension.
Control your blood sugar if you suffer from diabetes.
Heart and Wellness Institute, Grand Rapids is dedicated to helping you live a happy and healthy life. If you have any questions about heart health or need a cardiologist, please feel free to contact us.
