Lifestyle changes

The first option is an easy one, and something everyone should do regardless of their blood pressure reading: Lower sodium (salt) in your diet. While this mineral is needed by your body, it’s not needed in the amounts that most Americans consume.

“We know that eating a lot of sodium can increase your blood pressure over time,” said Matthew J. Sousa, M.D., interventional cardiologist, Norton Heart & Vascular Institute. “Instead of using salt to flavor what you eat, look at different spices that can add some zest, and try sodium-free marinades on meat. Pay special attention to processed and packaged foods you purchase, as some have a great deal of sodium.

“While the guideline is 2,300 mg of sodium per day total, a better aim is 1,500 mg a day if you want to reduce blood pressure.”

While reducing sodium alone can help with blood pressure, a few other things also help, according to Dr. Sousa:

• Exercise regularly: Aerobic exercise and strength training have been shown to lower blood pressure.
• Lose weight: When your weight increases, so does your blood pressure. A larger waistline also increases your risk for high blood pressure.
• Quit smoking: Smoking raises blood pressure.
• Limit alcohol: Alcohol can raise blood pressure, so it’s best to quit drinking. If you do consume alcohol, set your limit to no more than one drink per day for women and two drinks per day for men.

“Making these lifestyle changes can really lower your blood pressure, and you may not need to do anything else,” Dr. Sousa said.

Adding medication

If diet, exercise and weight changes do not improve your blood pressure, your provider may recommend medications.

“Different medications are available to help by reducing extra water and sodium in your system, lowering your heart rate, or relaxing or opening blood vessels,” Dr. Sousa said. “Your provider will look at your age, blood pressure reading and other health indicators to determine what type of medication may work best.

“It may take trying different medications to determine what works best in your body, but they can work quickly and effectively to lower blood pressure.”

Renal denervation procedure

Some people continue to have high blood pressure despite using medications and making lifestyle changes.

Norton Heart & Vascular Institute now has a new option called renal denervation, which calms overactive nerves near the kidneys that can cause high blood pressure.

“We take a very thin tube into the artery that goes to the kidney and send electrical pulses to calm those nerves,” Dr. Sousa said. “It’s a simple, minimally invasive procedure that only requires minimal sedation, and the patient can usually go home the same day.” Norton Heart & Vascular Institute is the first in Kentucky and Southern Indiana to offer the Symplicity Spyral renal denervation (RDN) system.

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For some patients with high blood pressure, the nerves near the kidneys can become overactive. Applying radiofrequency energy to these nerves can help calm them, thereby reducing blood pressure. The new Symplicity Spyral renal denervation (RDN) system is the only one of its kind offered in the United States.

“We take a very thin tube into the artery that goes to the kidney and send electrical pulses to calm those nerves,” said Matthew J. Sousa, M.D., interventional cardiologist, Norton Heart & Vascular Institute. “It’s a simple, minimally invasive procedure that only requires minimal sedation, and the patient can usually go home the same day.”

Elevated blood pressure is a reading above 120/80 mmHg. For some people, blood pressure can reach a seriously elevated level categorized as advanced hypertension. Advanced hypertension, or Stage 2 hypertension, is defined as systolic (the top number) blood pressure of 140 mmHg or higher, or a diastolic (the bottom number) blood pressure of 90 mmHg or higher. This level of high blood pressure requires serious medical attention. If left untreated, stage 2 hypertension can lead to stroke, heart attack and serious damage to the kidneys, eyes and brain.

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Heart attack symptoms in women are often more subtle than those in men, making them easier to overlook or confuse with other health issues. Unlike the stereotypical crushing chest pain associated with heart attacks, women’s heart attack symptoms can resemble the flu, heartburn or even an ulcer.

“It is critical that women understand what a heart attack can feel like for them, so they get immediate medical care,” said Li Zhou, M.D., Ph.D., medical director of the Norton Heart & Vascular Institute Women’s Heart Program. “Any delay in seeking treatment can result in more damage to the heart muscle and can be life-threatening.”

Subtle signs: How heart attack symptoms in women differ

In general, heart attack symptoms in women may not include severe chest pain. Instead, women may experience:

• Unusual fatigue or exhaustion
• Nausea or vomiting
• Stomach pain, indigestion or heartburn
• Dizziness or lightheadedness
• Shortness of breath
• Breaking into a cold sweat
• Pain in the jaw, neck or upper back
• Pressure or pain in the chest that may come and go

These symptoms can go unnoticed or can be mistaken for less serious conditions, such as anxiety, gastrointestinal issues or muscle pain.

Almost 1 in 3 heart attack patients experience no chest pain at all — and this is more common among women. This is sometimes called a silent heart attack.

When to seek help for heart attack symptoms

If you suspect you are having a heart attack, do not wait. Call 911 immediately or have someone take you to the nearest emergency room.

While waiting for emergency services:

• Take nitroglycerin if it’s been prescribed by your doctor.
• Take aspirin only if a medical professional has previously advised you to do so — as it may interact with other medications.

Key differences in heart attack symptoms: Women vs. men

There are notable differences in how heart attacks present in men and women. Men often report pain and numbness in the left arm or side of the chest. In contrast, women may feel pain on the right side, in the back or not in the chest at all.

In some cases, chest pain in women is caused by microvascular disease — a condition affecting the small arteries of the heart rather than a typical blockage. This condition often is linked to diabetes, high blood pressure or inherited heart disease.

Other conditions that can mimic heart attack symptoms in women

Several other health issues can resemble heart attack symptoms in women, including:

• Panic attacks: Often mistaken for heart attacks, panic attacks can cause chest pain, rapid heartbeat, shortness of breath and a feeling of dread. These episodes typically involve sharp, stabbing pain that lasts only a few seconds and is localized.
• Gastroesophageal reflux disease (GERD): Symptoms like acid reflux can cause burning chest pain that mimics a heart attack.
• Muscle strain: Especially in the chest or back, muscle injury can cause pain during movement or deep breathing.
• Stroke: Weakness in the arms or an inability to raise both arms evenly could indicate a stroke rather than a heart attack.

Risk factors for heart attack in women

• Smoking is a greater risk factor for heart disease in women than it is in men. 
• Not being active is a major risk factor for heart disease.
• Emotional stress and depression may affect women’s hearts more than men’s. Experiencing these can make it difficult to be active or make healthy choices. 
• Diabetes increases your heart attack risk. Women with diabetes are more likely to develop heart disease than are men with diabetes. Diabetes damages the blood vessels and can change the way people feel pain, so you may be at a higher risk for silent heart attack.
• Menopause causes drops in estrogen, which increase the risk of developing small vessel heart disease.
• Pregnancy complications, including high blood pressure (preeclampsia) or diabetes during pregnancy, can increase women’s long-term risk of high blood pressure and diabetes.
• Family history of early heart disease may be a greater risk factor in women than in men.
• Other health conditions, such as autoimmune diseases or inflammatory conditions, can increase the risk of heart attack. 

Heart attacks during and after pregnancy

Although rare, heart attacks during pregnancy or shortly afterward can occur. A common cause is spontaneous coronary artery dissection, a condition where a tear forms in a coronary artery, disrupting blood flow to the heart.

Awareness of heart attack symptoms in women

Heart disease is the leading cause of death in women in the United States. According to the Centers for Disease Control and Prevention, more than 267,000 women die from heart attacks each year. Understanding heart attack symptoms in women — and how they may differ from men’s — can be lifesaving. If something doesn’t feel right, trust your instincts and seek immediate medical care.

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Cassandra and Carlton Moore prepared to welcome their third child in late August. This was another milestone in their love story that started when the two first met at Noe Middle School in Louisville. They have been together for nearly 30 years. Having had two babies already, they thought they knew what to expect as they headed for the hospital for a planned cesarean section.

Everything was going as just as planned, until it wasn’t. Baby girl Indigo arrived, and Carlton took a quick peek. When he looked toward Cassandra, he saw she was no longer awake.

Monitors started beeping, and the staff began working together to save Cassandra’s life, doing chest compressions to try to resuscitate her. Teams from throughout the hospital poured in, delivering blood and medications and assisting in any way possible.

Cassandra had experienced an amniotic fluid embolism, where amniotic fluid enters the bloodstream. The cause is not known, but it’s extremely serious and life-threatening. It can happen without warning, and very few people survive.

“An amniotic fluid embolism is not a common event, but when it happens, it’s devastating and it’s hard for everyone,” said Maria R. Schweichler, M.D., an OB/GYN with Norton Women’s Care who is Cassandra’s obstetrician. “We knew instantly what had happened and began chest compressions.”

After 20 minutes, Cassandra’s heart started again, and she was transferred to the intensive care unit (ICU) — where her heart stopped again. This time the team worked again to revive her. The team at Norton Women’s & Children’s Hospital did not give up. Cassandra also experienced a stroke, and her heart was beginning to fail.

“You can’t wrap your mind around the situation,” Carlton said. “Thinking what could happen but not wanting to …”

“We kept chest compressions going until we were able to get enough blood and platelets in her that she had a pulse,” Dr. Schweichler said. “We just all took turns and rotated. Everyone was amazing.

“Everyone said, ‘She’s healthy; she’s young. We can save her.’ And that’s how everybody felt. So we just kept doing it.”

After 40 minutes, Cassandra’s heart started again.

The advanced heart failure team from Norton Heart & Vascular Institute arrived to help the Norton Healthcare Adult Transport Team take Cassandra to Norton Audubon Hospital. There, she was placed on extracorporeal membrane oxygenation (ECMO), a machine that takes over for the heart and lungs and allows the body to heal. She also needed dialysis to help her kidneys regain function.

Cassandra’s condition was grave.

“It is hard to describe how sick she was,” said Maroun M. Ghossein, M.D., a pulmonary critical care physician with Norton Pulmonary Specialists. “I think it’s best to describe it on a scale of 1 to 10, and she was well off the scale.”

“She was definitely the sickest person in Louisville that day,” said Bassel Alkhalil, M.D., cardiologist with the Norton Heart & Vascular Institute Advanced Heart Failure & Recovery Program. “We were really worried that she would not be herself if and when she woke up.”

Over the next three weeks, Dr. Schweichler and others from the team at Norton Women’s & Children’s Hospital continued to visit and provide support and encouragement. The Norton Audubon Hospital ICU team went above and beyond, learning how to help Cassandra. Carlton knew that Cassandra, who is both an occupational therapist and a lactation consultant, wanted to be able to breastfeed their daughter.

“We had nurses who had never had a child before, and they’re [saying], ‘Show me what I’m doing,” said Sandy Corbin, R.N., a registered nurse in the Norton Audubon Hospital ICU. “We had communication with Norton Women & Children’s Hospital lactation consultants. We learned how to help Cassandra pump. We helped with skin-to-skin contact, even when Cassandra was still on ECMO.

“When I saw Cassandra move her hand, gently cupping Indigo’s head, I knew she was there,” Sandy said.

After a few weeks, Cassandra regained consciousness. At first, she began moving and opening her eyes. Then she began focusing and looking around.

“Just all of a sudden the light turned on and, you could see her personality starting to come back,” Dr. Alkhalil said.

“When we were able to, we got Cassandra up and took her outside in a special chair,” Sandy said. “When she moved into our medical ICU from the cardiac ICU, we knew she was going to be there awhile, so we put her in one of the front rooms that has the big windows that look out over top of the park, and you have more trees and scenery. We needed as much stimulation as we could for her.”

In all, more than 20 different departments between the two hospitals worked to save Cassandra.

“It is an army of people who took care of her,” Dr. Alkhalil said. “Medicine has become so specialized, and the human body is so complex, but one person, one discipline, one service is not enough. So you really need all the expertise to take care of those patients.”

After five weeks, Cassandra was able to start rehabilitation. After eight weeks, she was home with her family.

The Moores now have a new outlook on life.

“When I think about it, I’m in disbelief that I was able to get through all of that. It’s thanks to so many people who offered support — the teams at the hospitals and my family,” Cassandra said. “I’m so thankful for everything.”

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To appreciate her aspirations, you have to appreciate her incredible health journey, one that began suddenly with a massive heart attack in October 2015.

“I never had any indications,” said Terrie, now a peppy, 74-year-old, semiretired schoolteacher. “I thought I was healthy.”

Terrie survived a second heart attack a few days later while waiting for initial complications to improve before undergoing triple-bypass heart surgery. Following surgery, she remained unconscious for three weeks due to additional setbacks. Eventually, Terrie would need her left foot and part of her left leg to be amputated, as a result of weakened blood flow during her recovery. According to Terri, her family wasn’t sure she would survive.

Nearly 10 years later, she’s alive and thriving, thanks to an incredible team of physicians and therapists, which includes the cardiac rehabilitation team at Norton King’s Daughters’ Health in Madison, Indiana.

“The staff encourages you and holds you accountable,” Terrie said. “It’s comforting to know they are tracking your heart rate and blood pressure. They are always willing to answer questions and check on you; it’s such a huge benefit.”

When Terrie first began cardiac rehabilitation in January 2016, nearly four months after her heart attack, her initial ejection fraction — or EF as she calls it — was only 30%. Ejection fraction is one indicator of the heart’s efficiency at pumping blood. Through Terrie’s hard work and continuous effort, her heart’s ejection fraction is now 50% to 55%, which Terrie described as “low normal” for someone her age.  After barely being able to exercise for six minutes initially, she now attends cardiac rehab twice a week for 45 minutes.

“Even if I was disciplined enough to keep exercising on my own, it’s a huge benefit coming here,” Terrie said.

She continues in the maintenance phase, or Phase 3, of cardiac rehabilitation at Norton King’s Daughters’ Health.

“The team becomes like family. You also get to encourage other people and get encouragement from them,” Terrie said. “It was a long journey for me; maybe I can help someone else.”

Throughout her stints in physical therapy, which included learning how to use her prosthetic foot and leg, Terrie cherished her local access to heart care.

“I doubt I would have driven somewhere two or three times a week,” she said. “Having local care makes all the difference. The people are wonderful.”

Jared Rogers, exercise physiologist, and Nancy Gibson, a cardiovascular technician, both with the rehab program in Madison, “are great,” according to Terrie.

Jared sees firsthand the difference cardiac rehab makes in the lives of heart patients.  Initially, patients complete Phase 1, which focuses on regaining strength and conditioning. Phase 2 helps patients transition to independence, which is the goal of the cardiac rehab program. Phase 3 is a self-pay option for patients who simply want to maintain their success. 

“Patients like the social atmosphere and building relationships,” Jared said. “We want to help patients understand that it takes a lifestyle change to be successful. It’s rewarding to see patients reach their goals and make improvements. We want them to be independent.”

Steven L. Vorhies, M.D., is a family medicine specialist at Norton Community Medical Associates and is Terrie’s primary care physician. He praised Terrie’s mental fortitude as a reason for her success.

“Her mental approach to recovery … is remarkable,” Dr. Vorhies said. “Her rehab helped her immensely.  She set a goal to be active, live her life and do what she wants to do. Her mental attitude is wonderful.  She’s always smiling.”

Today, Terrie enjoys spending time with her husband of 53 years, Curt. Their family consists of three adult children and a grandson, whom Terrie enjoys watching play a variety of sports, including baseball, basketball and football.

“I can do most things I want to do,” Terrie said. “My leg limits me more than my heart.”

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The Aveir DR consists of two leadless pacemakers that are implanted into the upper and lower chambers of the heart. The two pacemakers communicate with each other based on the person’s needs to more effectively regulate heart rhythm. 

“A leadless pacemaker is unique technology that was only available for limited types of patients in the past,” said Sofya Kuznetsov, M.D., electrophysiologist, Norton Heart & Vascular Institute Heart Rhythm Center. “The ability to pace upper and lower chambers in sync was only available with conventional transvenous devices.

“The leadless pacemakers are smaller than an AAA battery and can communicate wirelessly with each other to control the heart’s rhythm. They do not require a surgical incision and avoid potential complications associated with conventional pacemaker leads, such as infection or lead fractures. An additional benefit is quicker recovery and fewer mobility restrictions after the procedure.”

Until now, leadless pacemakers have not allowed a dual chamber option, which is needed by nearly 80% of people needing this kind of treatment.

To schedule an appointment with a Norton Heart & Vascular Institute specialist, call (502) 446-6484 (NHVI).

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Vascular integrity and blood flow

The brain is an energy-intensive organ, accounting for about 20% of the body’s total oxygen demand. The heart supplies oxygenated blood to the brain through a vast network of blood vessels. If the heart or vascular system is compromised, this can limit the brain’s oxygen and nutrient supply, impairing cognitive functions over time. Conditions such as high blood pressure, heart disease and hardening of the arteries can reduce the elasticity of blood vessels or lead to blockages, which may prevent adequate blood flow to the brain. These interruptions, in turn, can lead to brain cell damage, stroke and cognitive impairment.

Research also has shown that high blood pressure, particularly in midlife, is a major contributor to the risk of developing vascular dementia and other forms of cognitive decline. When blood pressure remains consistently elevated, it can damage the small vessels that supply critical areas of the brain responsible for memory and decision-making, causing “silent” ministrokes that impair mental function.

Shared risk factors between heart and brain health

Heart disease and cognitive decline share numerous risk factors, which partly explains their close association. Major factors include high cholesterol, high blood pressure, diabetes, smoking, obesity and physical inactivity. Each of these conditions can damage blood vessels, making it difficult for the heart to maintain proper blood flow, which impacts the brain as well. Additionally, inflammation plays a central role; it damages blood vessels, leading to plaque buildup and narrowing of the arteries, affecting the cardiovascular system as well as cognitive function.

Diabetes has a strong correlation with both heart and brain health. High blood sugar levels can damage blood vessels over time, leading to complications like heart disease and an increased risk of Alzheimer’s disease. Insulin resistance, often associated with diabetes, also may impact the brain’s ability to utilize glucose efficiently, which can lead to impaired cognition.

Lifestyle changes and preventive measures

The good news is that many lifestyle choices that protect the heart also benefit the brain. Regular physical activity, for instance, strengthens the cardiovascular system and improves blood flow to the brain. Exercise has been shown to boost mood, reduce stress and support neurogenesis, the process by which new brain cells are created, particularly in the hippocampus — the brain region associated with memory.

A brain-healthy and heart-healthy diet, such as the Mediterranean diet, which is rich in fruits, vegetables, whole grains and healthy fats, also has been linked to better cognitive outcomes. Foods like fish, nuts and olive oil provide essential nutrients like omega-3 fatty acids and antioxidants, which have anti-inflammatory properties that benefit both heart and brain health.

There are also lifestyle changes you can make to help ward off dementia or other types of cognitive decline. These include the above diet and exercise changes, but also social interaction, stopping smoking and other modifications.

Maintaining a healthy heart is essential for protecting the brain. The connection between these two vital organs is largely based on their shared reliance on a healthy vascular system, along with common risk factors. By focusing on lifestyle adjustments like exercise, balanced nutrition and managing chronic conditions, you can reduce your risk for cardiovascular disease and cognitive decline simultaneously. Through these proactive measures, it’s possible to support both heart health and brain health, promoting a longer, healthier life.

Have concerns about your brain health? Take this short quiz

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Pericarditis is inflammation of the sac-like structure around the heart. The fluid in the sac keeps the heart muscle lubricated and serves as a protective lining. Pericarditis is when an infection settles into that fluid in the sac.

“Pericarditis is relatively rare,” said Li Zhou, M.D., Ph.D., medical director of the Norton Heart & Vascular Institute Women’s Heart Program. “For the most part it is short term, meaning if treated properly, it goes away; however, in some cases it can become recurring, which impacts about 28 people out of every 100,000.”

The most common symptoms of pericarditis is sharp chest pain that gets worse with breathing deeply, lying flat or coughing. Some patients also may experience a dull ache that spreads to the left shoulder or into their neck, mimicking the signs of a heart attack and sending them to the emergency room.

“Pericarditis accounts for about 5% of nonischemic ER visits for chest pain meaning they are having pain in their chest but when diagnosed it is not a heart attack,” Dr. Zhou said. “And in these cases, the patient did the right thing. It is always better to be safe than sorry, and going to the emergency department for unexplained chest pain is always the best thing to do.”

“Pericarditis typically doesn’t just develop on its own,” said Lauren R. Albers, M.D., women’s cardiovascular disease specialist with the Norton Heart & Vascular Institute Women’s Heart Program. “Pericarditis can arise as a result of an acute illness, such as virus like the flu; after a flare-up of an autoimmune disease, such as lupus; or can come about as a result of taking certain medications, for example anti-seizure medications, some anticoagulants/blood thinners or hydralazine, a well-known blood pressure medication.”

Treatment plans can vary

The most common treatment includes high doses of anti-inflammatory medications, which are tapered over several weeks, along with colchicine, a heart medication that supports recovery.

“Abstaining from sports or robust exercise in the early stages of recovery is recommended,” Dr. Albers said. “Elevating the heart rate may exacerbate the inflammation and cause discomfort in the chest, as well as dangerous arrhythmias.”

Treatment can take several weeks, up to three  months, because if not treated fully there is a 30% risk of recurrence in the first 18 months after diagnosis. Once treatment begins and the pain subsides, most patients can return to normal activity, including moderate exercise, while monitoring how they feel.

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Treatment of atrial fibrillation focuses first on controlling the heart rate, and second on using blood thinners where appropriate to reduce the risk of stroke. There are times when restoring normal rhythm may improve outcomes including reducing symptoms. Managing atrial fibrillation requires careful monitoring and appropriate treatment to reduce the risk of serious health issues.

Symptoms of A-fib

In a patient with A-fib, the heart rate is irregular and often faster than normal. In comparison, a normal heart rhythm has a steady and regular heart rate, typically between 60 to 100 beats per minute at rest.

Symptoms of A-fib may include:

1. Irregular heartbeat
2. Heart palpitations
3. Fatigue
4. Dizziness or lightheadedness
5. Shortness of breath
6. Chest pain
7. Weakness
8. Confusion
9. Exercise intolerance
10. Fainting or near-fainting episodes

If you are experiencing any of these symptoms, you should consult a health care provider for proper diagnosis and management. Call 911 if you are experiencing sudden chest pain, weakness, confusion or shortness of breath.

Types of A-fib

1. Paroxysmal atrial fibrillation: This type of A-fib is intermittent and typically resolves on its own within seven days. Episodes may occur occasionally and stop spontaneously.

2. Persistent atrial fibrillation: Persistent A-fib lasts longer than seven days and requires treatment to restore a normal heart rhythm.

3. Long-standing persistent atrial fibrillation: When A-fib continues for over a year, it is classified as long-standing persistent A-fib.

4. Permanent atrial fibrillation: In permanent A-fib, the irregular heartbeat becomes constant, and efforts to restore a normal rhythm have been unsuccessful or deemed unnecessary.

By understanding the different types of A-fib, you and your health care providers can tailor treatment plans to manage your condition effectively.

A-fib blood clot risk

A-fib significantly increases the risk of blood clots forming inside the heart. The irregular and rapid heartbeat in A-fib can cause blood to pool in the atria, which can form blood clots. If a clot dislodges and travels to other parts of the body, it can cause serious health complications, such as stroke or heart attack. Managing your A-fib involves assessing your risk of blood clots and often involves strategies to reduce the risk of blood clots, such as blood-thinning medications, also called anticoagulants.

Living with A-fib

Not unlike an electrician who repairs wiring in your home, a doctor has options when it comes to treating the irregular electrical rhythm of your heart.

According to Kent E. Morris, M.D., electrophysiologist with Norton Heart & Vascular Institute, treatment options for A-fib are not one-size-fits-all and depends on severity of symptoms, associated health conditions, and the impact on quality of life.  A multi-faceted approach tends to work best.

“Risk factor modification is critical for successful treatment of A-fib,” Dr. Morris said. “Maintaining a healthy weight, treating sleep apnea, avoiding excess alcohol intake, and controlling high blood pressure and diabetes can increase the chances of staying in normal rhythm for longer periods of time.”

In addition to addressing risk factors, medications often are the initial treatment. If the medication isn’t effective or if side effects are impacting quality of life, there are other options. Catheter ablation is a minimally invasive technique where a catheter is placed in the heart and used to modify or ablate the abnormal signals that lead to A fib.

“By working together with patients, we can find a solution to living with A-fib,” Dr. Morris said.

A-fib treatment options

There are several common A-fib treatment options available to manage the condition. These include:

1. Medications: Antiarrhythmic drugs can help control the heart’s rate or rhythm, while anticoagulants often are prescribed to reduce the risk of blood clots and stroke.

2. Cardioversion: This procedure involves restoring the heart’s normal rhythm through electrical cardioversion (shock delivered to the chest) or pharmacological cardioversion using medications.

3. Catheter ablation: In cases where medications are ineffective, catheter ablation may be recommended. This minimally invasive procedure creates scarring in the heart to interrupt abnormal signals that trigger A-fib. It is performed using a catheter inserted into a blood vessel in the leg and guided to the heart. The electrophysiologist then carefully destroys malfunctioning tissue creating scar in the problematic areas so they can no longer transmit abnormal signals.

4. Lifestyle changes: Managing A-fib may involve lifestyle modifications such as reducing alcohol and caffeine intake, quitting smoking, maintaining a healthy weight and regular exercise.

5. Surgical Interventions: In certain cases, surgery like the hybrid ablation may be discussed. During hybrid ablation, the heart surgeon treats areas along the outside of the heart, and the electrophysiologist treats inside the heart. This approach can be more effective for patients with more persistent A-fib.

6. Left atrial appendage closure procedure: This procedure might be recommended in certain A fib patients who are not a good long term candidate for blood thinners to reduce the risk of stroke by closing off the left atrial appendage where blood clots commonly form.

If you have A-fib, it is crucial to work closely with your health care providers to determine the most suitable treatment plan, based on your specific condition and medical history.

A-fib vs. atrial flutter

Atrial flutter is a type of abnormal heart rhythm that is closely related to A-fib. Both conditions originate in the atria, the two upper chambers of the heart, and are characterized by irregular heartbeats. While A-fib involves chaotic electrical signals causing the atria to quiver, atrial flutter is characterized by a very rapid but regular beating of the atria.

Patients with atrial flutter are at an increased risk of developing A-fib, and vice versa. Both conditions share some similar risk factors, such as age, high blood pressure, heart disease and obesity. Some treatment options for atrial flutter and A-fib are similar, including some medications, electrical cardioversion, catheter ablation and lifestyle modifications.

Living a fulfilling life with A-fib is possible with the proper treatments and medical support. Making healthy lifestyle choices, following your treatment plan and keeping up with regular visits to your provider can help manage your condition effectively.

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Don’t take poor blood circulation lightly. Your primary care provider can determine whether simple treatment options like regular massages, compression socks, putting your feet up and eating better will remedy the condition.

Some cases of poor blood circulation can be a sign of peripheral artery disease, which if left untreated can damage your feet to the point of amputation and death.

Peripheral artery disease happens when plaque from high cholesterol builds up in arteries in your extremities, usually the legs or feet, making the blood vessel narrow and rigid. Blood clots can break from the plaque buildups causing complications. When this happens close to the heart or brain it can cause heart disease, heart attack and stroke.

Peripheral artery disease can advance to chronic limb-threatening ischemia (CLTI), where poor leg circulation has deteriorated to the point that your foot or part of your leg is at risk of needing amputation.

New treatment can help save limbs at risk of amputation

A new treatment, recently approved by the Food and Drug Administration (FDA), can restore blood flow and reduce risk of amputation for patients who have run out of other options, such as medication or surgery for CLTI. An estimated 1 in 5 patients with CLTI fit this description. CLTI affects up to 4 million Americans, resulting in more than 150,000 major amputations annually in the United States.

CLTI is the most serious form of peripheral artery disease and typically occurs in patients experiencing diabetes, coronary artery disease, obesity, high cholesterol and/or high blood pressure.

The primary surgical treatments to address CLTI symptoms are angioplasty or bypass surgery. In many patients, neither option is feasible because of extensive disease in the target arteries.

The treatment redirects blood flow around a blocked artery in the lower leg so blood can reach the feet. Norton Vascular Surgery, part of Norton Heart & Vascular Institute, is the first provider in Kentucky to offer the procedure.

“We’re thrilled to be able to offer our patients this first-of-its-kind procedure,” said Lauren M. Strait, M.D., vascular surgeon with Norton Heart & Vascular Institute. “It has the potential to greatly improve quality of life by reducing pain, enabling wound healing and, most important of all, preventing amputation.”

With the LimFlow System for transcatheter arterialization of deep veins, catheters are inserted from opposite directions — through a vein on the bottom of the foot, and an artery in the groin. Each is threaded through the blood vessels until they reach the area of the blood clot or other blockage.

At that point, the catheter in the artery pierces the vein, and the LimFlow device connects the two blood vessels. The vein carries oxygenated blood to the foot, then blood flow resumes its normal path back to the heart for recirculation.

Self-expanding stent grafts create a permanent conduit for blood flow from the artery into the vein.

The FDA approved LimFlow in September 2023 following a successful clinical trial.

In that study, published in the New England Journal of Medicine, 105 patients with CLTI underwent the LimFlow procedure. At six months, 76% avoided above-ankle amputation. Wounds were completely healed in 25% of patients and in the process of healing in 51%. No unexpected adverse events were reported.

Peripheral artery disease versus other vascular conditions

Peripheral artery disease and varicose veins are different conditions. Arteries carry oxygen-rich blood away from the heart out to the body, while veins return the depleted blood back to the lungs and heart for recirculation.

While peripheral artery disease is associated with blocked arteries, varicose veins typically are tied to leaking valves in the veins of the legs. Deep vein thrombosis is another condition affecting blood vessels, where clots form in veins far from the heart.

Because peripheral artery disease is caused by an underlying condition of cholesterol plaque buildup, or arteriosclerosis, treatment also means taking care of your risk for heart attack and stroke. If diagnosed early, peripheral artery disease can be managed by quitting smoking, managing diabetes and high blood pressure, lowering cholesterol and triglyceride levels in your blood, taking medication to prevent blood clots and exercising.

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