Cardiology

What is Cholesterol?

What is Cholesterol?

Cholesterol is a form of fat that your body uses for different things.  A few of these things are hormones, vitamin D, as well as other materials.  These are used to help digest food.

Here are 2 different types of cholesterol.  One is a form of beneficial cholesterol and the other is damaging cholesterol. The beneficial cholesterol is called HDL (High Density Lipoprotein) and the damaging cholesterol is named LDL (Low Density Lipoprotein).

Our bodies use cholesterol to maintain living cells.  These cells produce Estrogen in addition to Testosterone.  Cholesterol is carried through the blood by proteins. These proteins allow the cholesterol to piggy back in order to get it to the organs to be used or discarded.  Once it reaches the liver, it becomes lipids.  This is where it becomes HDL/LDL.  Most of our cholesterol is produced from the liver.  Cholesterol that comes from what we eat is absorbed by the liver.  The liver then releases it as our body needs it. The liver also helps to get rid of unwanted or needed cholesterol. The rest is from what we eat.  Some examples of dietary cholesterol are from foods like fish, poultry, calf liver, etc.  Foods that don’t have cholesterol are broccoli, cauliflower, green beans, plus any plant that can be consumed.

cholesterol

Not all cholesterol is harmful.  In fact, the benefits of cholesterol are that it makes a waxy coating that covers the outside of nerves.  Since our bodies make all the cholesterol it needs, there is really no reason to add foods into our diets that include cholesterol.  As a guideline, no more than 200 milligrams of cholesterol needs to be eaten a day.  The types of cholesterol that is beneficial to us are monounsaturated polyunsaturated food.  Intake of polyunsaturated food needs to be only 20% of our total intake per day at the most.  An excellent source of polyunsaturated food is sunflower oil, corn oil, and safflower oil.  Canola oil and olive oil are sources of Monounsaturated fat.

Not all foods that help cholesterol levels have to be bland with no seasoning or lack of flavor which produces food that is not appetizing.  There are several internet sites that have fantastic recipes for anyone’s taste.  This includes those people that are particularly picky about food. The best part is the recipes are not time consuming. There are great crock pot recipes for those who are always on the run.

The risks of high/low HDL /LDL:

Believe it or not, whether you are male or female has an influence on how Believe it or not, whether you are male or female has an influence on how our body deals with Cholesterol.  Women actually run a higher risk than men to have an issue with destructive cholesterol.  When males and females are young, there HDL /LDL are very similar.  As boys mature they start producing more testosterone.  This causes their HDL to drop.  Women on the other hand produce estrogen.  This causes the HDL to rise.  On average women HDL is a little higher than men.  This changes when the woman reaches the age when they no longer menstruate.  At this point the HDL levels are similar to men.  The LDL levels in women are made up of larger fragments after they stop menstruating.  Before this event happens, the fragments are smaller.  Smaller fragments bind together more easily than large ones.  Women who take medicine to prevent pregnancy cause HDL to rise, which subsequently the LDL is lower. On the other hand there is a medicine that makes the HDL to go down as well as LDL to rise.  Talking to a doctor will help decide what method is best.  Each case is different.  This also depends on any other medicines the woman is taking.

If a person has high levels of LDL, that person is at risk of serious health problems.  This can result in heart disease, stroke, and the breakdown of the arteries. This happens because of a substance called plaque that builds up inside the arteries which chokes the blood flow.  This can also cause blood clots.  When these blood clots get big enough, it blows out the artery. Low levels of LDL are desired in order to reduce these health deficits.  The only way to know if your cholesterol needs to be controlled is by blood test.  Here are cases of what are advantageous, unhealthy, as well as optimal levels of cholesterol; 

High cholesterol is 240 or higher.

Borderline-high is 200 – 239.

Best are less than 200.

 

There are three blood tests that are used to watch Cholesterol numbers.  These are a Fasting cholesterol test, a direct cholesterol test, including simple cholesterol test.  Here is a breakdown of how each of these tests is accomplished in addition to how they are done.  The fasting test is done nine to twelve hours since the last meal has been eaten.  This is the most complete test.  It looks for HDL, LDL, as well as triglycerides.  Triglycerides are fats in the blood that provide the body with energy.  The direct cholesterol test measures only the LDL level.  This test can be done anytime.  There is no need to go without eating.  A simple cholesterol test processes HDL/LDL levels.  This test can also be performed anytime. This may be done even if the person has just eaten.

Video of Cholesterol

What are the symptoms of High Cholesterol?

High cholesterol is a silent killer.  Unless the person has regular blood drawings to monitor HDL/LDL levels, there is no way to know if the ratio is out of whack.  More than likely the person will have a heart attack first.  Strokes are caused by the plaque building up in the arteries that supply the limbs along with the brain of oxygen.  The best way to avoid health issues concerning cholesterol is to have regular checkups in addition to a healthy diet.

Treatment Possibilities

A change in diet is a respectable start to helping reduce your cholesterol.  Here are some great ideas to start with.  Seafood at a minimum of twice a week is preferred.  Any dark green leaf vegetable helps reduce the cholesterol in the blood.  Evaporated or condensed milk with no fat or low fat, is an option for cooking.  Meat that is not red also helps cut down the cholesterol points.  Just because you need to change your diet because of cholesterol, doesn’t mean you have to give up desserts.  Fresh fruit, fat free microwave popcorn, sherbet, plus sorbets are all worthy choices.  Surprisingly, strawberries do a great job in lowering destructive cholesterol.  Strawberries are great by themselves, but have you ever thought of adding them to a salad?  Be creative; see what ideas you can come up with for this amazing fruit. You can purchase strawberries fresh from the grocer, or even dehydrated.  Dehydrated strawberries are great as a topping in smoothies.  They also make a great snack.  A great idea is to purchase a dehydrator which allows you to dry them out yourself.  This is the least expensive way in the long run then purchasing strawberries already dried.  Strawberries also have other great health advantages.  They are low in calories which is an excellent source of fiber.  Changing habits in the way you live, also help correct cholesterol problems.  An example of changing life habits are increasing exercise, stop smoking, in combination with of course meal planning.  There are a number of sites to help get started with these changes.  Every little bit will help in other health problems.

There are a few misunderstandings about cholesterol.  Just because your beneficial cholesterol is in the best range, doesn’t mean you shouldn’t be careful.  There are a lot of factors to keep in mind.  If you have other health problems, this will increase your chances of having heart issues.  Some of these medical problems include family history, diabetes, high blood pressure, as well as any previous heart problems.  There is also a misconception that only our elders have a problem controlling cholesterol levels.  As a matter of fact, testing should actually begin by age twenty.  Where there is family history of this problem is a clue to start monitoring it as early as early teenagers.  Your ethnic background may also put you at risk.  A persons’ ethnic makeup can affect how the body processes cholesterol.  It has not been specifically identified why this happens.

If a person cannot control the cholesterol levels by diet, there is another option.  There are several medications on the market to help regulate the cholesterol levels.  The prescription medicines are preferably the last choice if cholesterol numbers are still too high.  These medicines are used to grab the cholesterol your body cannot use.  These drugs are called Statins.  This type of medication has other benefits too.  One of which is to take away inflammation from your body.  This is helpful news for people that suffer from asthma plus C.O.P.D (Chronic Obstructive Pulmonary Disorder). Another benefit of taking this type of medicine is that readings show they could possibly help the immune system.  Also it may help slow down the progress of Alzheimer’s.   It has also been discovered that Statins help reduce the risk of Cataracts.  This is when a cloudy substance covers the eye which can affect vision.  Another advantage is it reduces blood pressure.

There is one medication that helps stop the cholesterol from being consumed by the body.  It’s called an absorption inhibitor.  This medicine actually keeps the cholesterol from getting into the circulation.  Not much is really known about this drug.

Some choices to consider are over the counter remedies.  For example, Omega-3, fiber enhancements, garlic, also products made with soy, whole grains, including fish oil in order to help bring down cholesterol.  This is an indication to do a combination of medication and a change of diet if cholesterol levels are out of control.  Also making changes to physical well-being with exercise is beneficial. Not everyone is able to do extensive exercises.  A short walk, bicycle riding, and swimming are worthy places to start with an exercise program.  Swimming is the best choice for no impact and great heart exercise. People that smoke, are diabetic, and have had prior heart attacks, all increase the risk of having a heart attack, another heart attack, or even a stroke.

There are differences between medicine that is prescribed and those bought of grocery store shelves.  The main difference is that the supplements are approved by the Food, Drug Administration.  If there are several complaints about a product, it will be pulled off the shelf.  It is the company that makes these products, responsibility to make sure the labels contain the correct information, have not been exposed to contaminants, which are made in a sanitary facility.  Prescription medicines have to meet higher standards.  It is the company’s responsibly to prove that it is safe, what it accomplishes, plus any side effects that are related to the pill.  The other major difference between over the counter remedies as well as prescription expense.  In most scenarios the over the counter supplement is greatly cheaper.  This is a factor for most people.  The drawback is that the supplement may not be a high enough dose to achieve the desired levels of HDL/LDL.

Conclusion

It is very important that a person with a family history of heart disease, stroke maintain healthy diets, exercise, are necessary way of life changes.  The changes to your life include weight loss including quitting smoking.  Cholesterol problems can also be hereditary.  Your inherited characteristics may keep cells from eliminating LDL cholesterol from your blood capably or cause your liver to create too much cholesterol.  In some cases it is necessary to add a medication to help control levels of HDL/LDL.  Everyone should keep their physician informed of any family history of heart disease.  Before changing your diet, taking over the counter remedies, including starting an exercise routine, it is best to talk to your doctor to make sure you are not physically causing harm to yourself.  Some products may have negative effects with other medicines.  This would be completely counterproductive. Trust in your doctors’ advice.  He or she is there to help you not hurt you.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

Click here for PDF

We welcome your comments at the end of the article.
The Team Manager Web Diseases

 

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Peripheral Vascular Disease

Peripheral vascular diseases lead to a reduced blood flow through peripheral blood vessels. The physiologic effects of altered blood flow depend on the extent to which tissue demands exceed the supply of oxygen and nutrients available. Tissues then fall prey to ischemia, become malnourished, and ultimately die unless adequate blood flow is restored.

  • What is Peripheral Vascular Disease?
  • What are the different types of peripheral vascular disease?
  • What are the diagnostic assessments used to detect peripheral vascular diseases?
  • What are the recommended medications?
  • What other health teachings are important to a person with peripheral vascular disease?

peripheral vascular disease

What is Peripheral Vascular Disease?

Peripheral vascular disease refers to a group of medical conditions that affects the blood vessels of the lower extremities. It involves the arterial and venous blood systems. Peripheral vascular disease is very common in the elderly or diabetic individuals.

What are the different types of peripheral vascular disease?

Types of peripheral vascular disease are:

  • Arterial Thrombosis and Embolism

-   A thrombus (blood clot) adheres to the vessel wall. Acute arterial thrombi occur where there is injury to an arterial wall, sluggish flow, or plaque formation secondary to atherosclerotic changes.

-   Other causes of arterial thrombosis are polycythemia, dehydration, and repeated arterial needle sticks. If a thrombus breaks off and travels, it becomes an embolism that occludes an arterial vessel that is too small to allow it to pass. Some of the causes of an arterial embolism are dysrhythmias, prosthetic heart valves, and rheumatic heart disease.

-   Watch out for the “six P’s” in detecting signs and symptoms of arterial embolism:

  • Pain
  • Pallor (pale color)
  • Pulselessness (diminished or absent color)
  • Parasthesias (altered local sensation)
  • Paralysis (weakness or inability to move extremity)
  • Poikilothermia (body temperature that varies with environment)
  • Peripheral Arterial Disease

-   Disorders that interrupt or impede arterial peripheral blood flow due to vessel compression, vasospasm, and/or structural defects in the vessel wall. It is sometimes referred to as lower extremity arterial disease (LEAD).

-   Primarily caused by atherosclerosis (local accumulation of lipid and fibrous tissue along the intimal layer of an artery making it narrow and affects blood flow). Other reasons attributed to the development of peripheral arterial disease are trauma, embolism, thrombosis, vasospasm, inflammation, or autoimmunity.

-   Chronic arterial obstruction leads to inadequate oxygenation of the tissues causing intermittent claudication, which is ischemic muscle pain precipitated by a predictable amount of exercise and relived by rest.

-   The person may complain of aching, cramping, fatigue or weakness in the legs that is relived by rest. There will be coldness and paleness with a cyanotic (bluish) color on elevation. Peripheral pulses may be diminished or absent. Nails may be thickened and opaque. The skin on the legs may be shiny with sparse hair growth. In advanced stages, ulcers may be present on the lower extremities in areas affected by reduced circulation with deep pale base and demarcated edges. These ulcers are painful.

  • Raynaud’s Disease

-   A vasoconstrictive and vasospactic response causing ischemia from exposure to cold and stress. It occurs more often in women who live in cold climates.

-   Other causes of the vasospastic attack are caffeine ingestion, tobacco use, and emotional stress.

-   It primarily affects the hands but can also occur in the feet, ears, or nose. To be diagnosed with Raynaud’s disease, the patient must experience intermittent attacks of ischemia for at least 2 years.

-   Symptoms common to Raynaud’s disease is the classic triphasic color changes (pallor, cyanosis [bluish], and rubor [redness]) with accompanying  reduction in skin temperature. Pain is also present and tends to intensify as the disease progress. The skin of the fingertips may thicken and nails may become brittle.

  • Buerger’s Disease

-   A recurring inflammation of small and medium arteries and veins of the lower extremities.

-   The disease, also known as thromboangiitis obliterans, is usually the result of occlusion of the vessels by thrombus formation. The cause is unknown, but heavy cigarette smoking is a major contributing factor. Some studies indicate an autoimmune response to tobacco products as a possible cause. The disorder is more prevalent in young men between the ages of 25 and 40 years.

-   The initial signs and symptoms are usually evident as color changes (bluish)in a toe or finger and a feeling of coldness in the affected limb. There is also pain as the nerves are also inflamed. Ischemic ulcers and gangrene formation are common complications as the condition worsens.

  • Aortic Aneurysm

-   An aneurysm is a bulging, ballooning, or dilation at a weakened point of an artery. Aortic aneurysm is a localized dilation or outpouching of a weakened area in the aorta that is classified by region as thoracic or abdominal, or as dissecting.

-   Aneurysms occur more often in men and their incidence increases with age.

-   The major risk factor for the development of aneurysm is atherosclerosis.

-   The danger about aneurysm is that it is undetectable (asymptomatic) until it ruptures. Signs and symptoms include back pain, flank pain, abdominal fullness, nausea, pulsating mass in the abdomen, severe sudden back pain with rupture, and shock from blood loss. Other symptoms to consider are dysphagia (difficulty in swallowing), dyspnea (difficulty in breathing), cough when pressing on the esophagus or laryngeal nerve.

-   For a dissecting aneurysm, the pain can be described as “tearing” or “ripping” in the anterior chest or the back. Pain may extend to teh shoulder, epigastric area, or abdomen. Possible syncope (fainting) and paralysis of lower extremities may be present.

  • Varicose Veins

-   Vein(s) are elongated, tortuous, dilated, palpable veins because of blood pooling in the lower extremities.

-   The exact cause is unknown; however, the condition tends to be familial or those with a positive family history of varicosities. They are also common in women over 35, those who are obese, pregnant, and those who stand for long periods of time.

-   The cause of varicose veins is attributed to incompetent valves within the veins can cause blockage of blood flow and lead to dilated veins.

-   The person may complain of aching, heaviness, itching, swelling, and unsightly appearance to the leg(s)

  • Venous Insufficiency

-   Damaged or aging valves within the veins interfere with blood return to the heart, causing pooling of blood in the lower extremities. Chronic venous insufficiency can lead to venous stasis ulcers.

-   Causes of venous insufficiency include: prolonged venous hypertension, after thrombus formation or when valves are not functioning correctly, which may result from:

  • Prolonged sitting/standing (teachers, waitresses, nurses, office workers)
  • Pregnancy and obesity
  • Signs of venous insufficiency include:
    • Edema of the lower legs that may extend to the knee
    • Thick, coarse, brownish skin around the ankles and feet
    • Stasis ulcers, usually in the malleolar area (ruddy base, uneven edges)

     

Video of Peripheral Vascular diseases

What are the diagnostic assessments used to detect peripheral vascular diseases?

There are several diagnostic procedures to help the physician diagnose the type of peripheral vascular disease.

  1. Doppler ultrasound: Measures the velocity of blood flow through a vessel and emits an audible signal; when arterial palpation is difficult or impossible because of occlusive disease, a Doppler can be useful in determining blood flow; a palpable pulse and a Doppler pulse are not equivalent and should not be used interchangeably.
  2. Plethysmography: Records biologic changes in volume in apportion of the body associated with cardiac contractions or in response to pneumatic venous occlusion; can detect and quantify vascular disease on the basis of changes in pulse contour, blood pressure, or arterial/venous blood flow.
  3. Digital intravenous angiography : utilizing computer technology, visualization of blood vessels occur after IV injection of contrast material; allows for small peripheral venous injections of contrast medium, compared with large doses that must be injected via arterial cannulation.
  4. Venography: injection of radiopaque dye into veins; serial x-rays are taken to detect deep vein thrombosis and incompetent valves.
  5. Angiography: injection of radiopaque dye into arteries to detect plaques, occlusions, injury, etc.
  6. Ankle-brachial index (ABI): most commonly used parameter for overall evaluation of extremity status; ankle pressure normally is the same or slightly higher than brachial systolic pressure; expected ABI is 0.8 to 1.0
  7. Computed tomography: allows for visualization of the arterial wall and its structures; used in the diagnosis of abdominal aortic aneurysm (AAA) and postoperative vascular complications such as graft occlusion and hemorrhage.
  8. Magnetic resonance imaging (MRI): uses magnetic fields rather than radiation; used with angiography to detect abnormalities, especially in people who are unable to have dye injected.

What are the recommended medications?

For every type of peripheral vascular disease, there is a specific medication that the physician may recommend. Remember, medications need physician’s prescription and instructions before taking them. Don’t self-medicate or take advices from friends to take certain medications even if they have the same presenting problems.

For the purpose of presentation, the following medications are intended to treat or manage peripheral vascular diseases:

  • Pentoxifylline – decreases blood viscosity to increase blood flow to the microcirculation and tissues of the extremities
  • Cilostazol – inhibits platelet aggregation and enhances vasodilation
  • Aspirin and Clopidrogel – inhibits platelet aggregation
  • Calcium channel blockers – to ease vasospasm
  • Analgesics (NSAIDS) – to reduce pain and relieve inflammation
  • Heparin and warfarin – anti-coagulant therapy; inhibits clotting factors that would extend thrombus formation; will not induce thrombolysis but prevents clot extension
  • Streptokinase and alteplase – thrombolytic therapy; dissolve blood clots by imitating natural enzymatic processes
  • Topical agents, such as hydrocortisone, antifungals, or zinc oxide – to treat skin ulcers
  • Oral or IV antibiotics – when skin ulcers become infected or cellulitis occurs.
  • Sclerosing agents – may be used to occlude blood flow in a vein, causing disappearance of the varicosity; this may be followed up with use of compression bandage for a short period of time

What other health teachings are important to a person with peripheral vascular disease?

            Individuals with peripheral vascular diseases need to conform to several health behaviours in order to help promote healing and preventing further complications in the future. The following health teachings can help meet this goal. It is imperative that while teaching them these points, special attention should be placed to the rationale of each action as well.

  • Stop smoking. Nicotine in all tobacco products causes vasospasm, which impedes peripheral circulation.
  • Lose weight and eat a low-fat diet. Obesity places more weight on the lower extremities and pose a threat for problems in movement, thus causing blood pooling and the possibility of blood clot formation and trauma to the vessel walls.
  • Do not cross legs while sitting. Crossing the legs causes compression of vessels with subsequent impediment of circulation, resulting in venous stasis.
  • Elevate feet at rest, but not above heart level. Elevation of extremities counteracts gravity, promotes venous return, and prevents venous stasis.
  • Do not stand or sit for long periods of time. Prolonged standing still or sitting promotes venous stasis.
  • Do not wear restrictive clothing. Constrictive clothing and accessories impede circulation and promote venous stasis.
  • Keep affected extremity warm but never apply direct heat. Warmth promotes arterial flow by preventing the vasoconstriction effects of chilling.
  • Inspect feet daily and keep them clean and dry. Neutral soaps and lotions prevent drying and cracking of skin; avoid lotion between toes as the increased moisture can lead to maceration of tissue.
  • Avoid walking barefoot; wear proper-fitting shoes. Protective shoes and padding prevent foot injuries and blisters.
  • Avoid mechanical or thermal injury to the legs and feet. Scratching and rubbing can cause skin abrasions and bacterial invasion.
  • Begin and maintain an exercise and walking program. Walking promotes venous return by activating the “muscle pump.”
  • Notify healthcare provider of any changes in color, sensation, temperature, or pulses in extremities.
  • Counsel in ways to avoid emotional upsets; stress management. Emotional stress causes peripheral vasoconstriction by stimulating the sympathetic nervous system.

Education for Anticoagulant Therapy

                  For persons taking anticoagulant medications, the following health teachings are important:

  • Wear a medical identification bracelet.
  • Take medication at approximately the same time each day.
  • Stress the importance of routine lab work.
  • Do not use aspirin-containing products or non-steroidal anti-inflammatory drugs (NSAIDs).
  • Avoid trauma.
  • Shave with an electric razor.
  • Use a soft toothbrush.
  • Report possible adverse side effects immediately to healthcare provider;

-   Any bleeding that does not stop within several minutes.

-   Unusual bleeding anywhere else in the body.

-   Weakness or dizziness.

 

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

Click here for PDF

We welcome your comments at the end of the article.
The Team Manager Web Diseases

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1 comment - What do you think?  Posted by Katherine B. - April 11, 2013 at 10:12

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