Tag Archives: cardiovascular disease

Sleep Apnea and Heart Disease, Stroke

Elderly man lost in thought

Plain old snoring can get a little annoying, especially for someone listening to it. But when a snorer repeatedly stops breathing for brief moments, it can lead to cardiovascular problems and potentially be life-threatening.

It’s a condition known as sleep apnea, in which the person may experience pauses in breathing five to 30 times per hour or more during sleep. These episodes wake the sleeper as he or she gasps for air. It prevents restful sleep and is associated with high blood pressure, arrhythmia, stroke and heart failure.

Heart disease is the leading cause of death in the United States, and stroke is also a leading cause of death and disability. High blood pressure is a major risk factor for both.

“The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that,” said Donna Arnett, Ph.D., chair and professor of epidemiology at the School of Public Health at the University of Alabama at Birmingham and the incoming president of the American Heart Association.

A Common Problem
According to Dr. Arnett, one in five adults suffers from at least mild sleep apnea, and it afflicts more men than women. The most common type is obstructive sleep apnea (OSA), when weight on the upper chest and neck contributes to blocking the flow of air. OSA is associated with obesity, which is also a major risk factor for heart disease and stroke. Besides obesity contributing to sleep apnea, sleep deprivation caused by sleep apnea can, in an ongoing unhealthy cycle, lead to further obesity. In OSA the upper airway closes off because the muscles that hold it open lose tone. The more weight, the more loss of tone and the more severe the sleep apnea. Each time the airway closes, there is a pause in breathing.

A less prevalent type of sleep apnea is called central sleep apnea (CSA). In CSA the brain doesn’t send regular signals to the diaphragm to contract and expand. There is limited snoring and it has been associated with brain stem stroke because the brain stem is where the impulse to breathe comes from.

Listen to Those Snoring Complaints
A roommate or sleeping partner of someone with sleep apnea often notices it. “It’s really hard to detect if you live alone, unless you go through a sleep study,” Dr. Arnett said. People with sleep apnea may be more tired during the day and therefore prone to accidents or falling asleep.

Getting Proper Treatment
Through treatment known as continuous positive airway pressure, or CPAP, blood pressure is stabilized. The CPAP device involves wearing a mask while sleeping. It keeps air pressure in the breathing passages so they don’t close down.

In a sleep study, doctors count pauses in breathing to determine whether the patient has mild sleep apnea, characterized by five to 15 episodes per hour; moderate sleep apnea, defined by 15 to 30 per hour; or severe sleep apnea, meaning more than 30 each hour.

It’s certainly possible to have simple, loud snoring without sleep apnea. But with regular snoring, the person continues to inhale and exhale. With sleep apnea, the sleeping person tends to have periods when he or she stops breathing and nothing can be heard. The good news is treatment that keeps the breathing passages open and oxygen flowing can yield fast results, Dr. Arnett said. “Blood pressure comes down really quite quickly.”

Getting Good Rest
If you’re struggling to get a good night’s sleep follow some of these suggestions:

  • Get regular physical activity, but don’t do it right before bed because that gets your adrenaline pumping and can keep you awake.
  • Limit alcohol consumption to one drink per day for women and two drinks for men; too much alcohol interferes with sleep.
  • Avoid caffeine before bed.
  • Develop a pre-bedtime routine such as taking a warm bath, dimming the lights or having some herbal tea.

If you are experiencing symptoms of sleep apnea, be sure to discuss this with your primary care provider. A referral to a pulmonologist may be necessary. At Medical Associates, Dr. Mark K. Janes is Board Certified in sleep medicine and provides diagnosis and treatment of sleep disorders including sleep apnea. Examination of abnormalities of sleep is available with overnight trend oximetry and polysomnography.


Source: www.heart.org


What are we talking about when we talk about heart disease?

By Lance Bezzina, D.O.

As one of the top killers in the United States, “heart disease” is a term that is thrown around quite a bit, especially during Heart Month. Today we’ll discuss the kinds of complications that fall under the umbrella of heart disease and can be treated with cardiothoracic surgery, which involves the treatment of conditions affecting the heart, lungs, esophagus and blood vessels throughout the body.

Medical Associates has the only surgeons in the Dubuque area with the ability to perform these potentially life-saving procedures. In reference to the heart, we commonly perform surgery on aneurysms and heart valves, and we perform bypasses of affected arteries. When we talk about heart disease and the surgeries we perform to treat it, here’s what we’re talking about:

When the heart valves struggle: stenosis
The human heart is divided into four chambers and has four valves working to keep blood moving through it. Stenosis is the term we use when there is a problem with a valve’s ability to open, and the aortic valve most commonly requires surgery for stenosis. Aortic stenosis is a progressive disease, and patients can remain asymptomatic for many years. When symptoms do present, they typically include chest pain (angina), fainting (syncope), difficulty breathing (dyspnea) and heart failure.

Common causes of aortic stenosis are rheumatic fever as a child, calcific degeneration (a common side effect of aging) and a bicuspid aortic valve (the condition of being born with two leaflets of your aortic valve instead of three).

When a blood vessel expands: aneurysms and dissections

A healthy blood vessel has a wall strong enough to resist the pressure of blood flowing through it. Aneurysms occur when the arterial wall is too weak to hold up against the pressure, causing the blood vessel to expand and the wall to grow thinner—like when you blow air into a balloon.

Aneurysms of the aorta most commonly pose a risk to patients if they rupture or dissect. If the blood vessel expands too much and the wall becomes too thin, a rupture or leaking of blood outside the wall of the artery begins. Another complication is called a dissection. The aorta has rings like a tree, and as the aorta gets larger the inner layer can develop a tear and blood can get between these layers and cause heart attacks and strokes, among a host of other problems.

When an artery is blocked: coronary artery disease

Coronary artery disease (CAD) is the current leading cause of death in Americans. CAD develops when cholesterol-filled plaques block arteries that feed blood to the heart, and it can occur in any tissue that is fed by blood. If the disease progresses far enough, it can cause a heart attack. This is the same disease process that causes strokes when the blockages occur in arteries that feed blood to the brain or can cause leg pain if it occurs in the leg arteries.

Medical Associates is proud to be able to perform the cardiovascular surgeries necessary to treat these common forms of heart disease. If at any time you experience chest pain/pressure, left arm or shoulder pain, shortness of breath or you feel faint or weak, you should immediately go to the nearest emergency room. These could all be warnings signs of heart disease, and, if treated promptly, could save your life.

Lance Bezzina D.O. practices at Medical Associates in Dubuque. He is board certified in general and cardiothoracic surgery. He is on staff and performs surgery at Unity Point Health-Finley Hospital and Mercy Medical Center Dubuque. In addition to performing the entire scope of cardiac, thoracic and vascular surgery, he is also department chair for cardiothoracic surgery and director of cardiac rehab at Mercy Medical Center. For an appointment please call 563-584-3445.