Good Information for the heart patient




Exercise and Hypertension





Frequency: on most, preferably all, days of the week



Type: primarily endurance physical activity supplemented by resistance exercise


Exercise risk for cardiovascular event




Exercising with heart disease







Symptoms to be alert for include these.

How Laughter Impacts Your Heart Health

When is the last time you had a good guttural laugh? You know the kind, where you feel like you are short of breath, your stomach and face muscles feel sore, the kind that puts a smile on your face when you think of it later?  This kind of laughing has similar effects on the body as exercise does, lowering blood pressure, reducing stress hormones,  and burning calories.

There are some claims that children laugh more than 300 times a day, whereas adults laugh less than 20 times a day.  Studies have shown people with heart disease responded less humorously to everyday life situations.  They generally laughed less, even in positive situations, and they displayed more anger and hostility. Other studies have shown higher instances of conditions such as heart disease and dementia among those who live in isolation. Many who are socially isolated don’t get the opportunity each day to smile and laugh.  If you struggle with social isolation, challenge yourself to find a way to laugh. It may be laughing at yourself, watching a funny movie, doing laughing exercises, joining a laughing group,or  finding laughs on the internet. Challenge yourself to laugh.

Here are a couple of links to videos of laughing exercises:

Laughing Workout

Laughter Exercises

Do You Know Your Heart’s Ejection Fraction?

Today I ran into a young woman I assisted in Cardiac Rehabilitation after she had a heart incident. One of the first things she said to me with a smile on her face was that her ejection fraction had increased from 15% to 55%. This means her heart essentially is functioning within normal limits of 50%-70%  in it’s pumping ability. She went on to tell me she was off to go snowshoeing in the woods. I was so proud, as working with patients over time you learn and share a lot about your lives, and for her this was huge!


When the heart beats, it contracts or squeezes and then relaxes. During heart contraction, it pushes the blood within the pumping chamber  out. When your heart relaxes, the chambers or ventricles refill with blood. No matter how forceful the contraction, it doesn’t empty all of the blood out of a ventricle. The term “ejection fraction” refers to the percentage of blood that’s pumped out of a filled ventricle with each heartbeat.

A normal LV ejection fraction is 55 to 70 percent. The ejection fraction may decrease if:

  • A heart attack has damaged the heart muscle such that it cannot forcefully contract
  • The valves of the heart are not working properly
  • Blood pressure has been uncontrolled  for a long period of time
  •  Weakness of the heart muscle, such as dilated cardiomyopathy

I get great gratification in this patient announcing this for another reason. I have a history of arguing with cardiologist about teaching patients their heart’s condition by reading their medical reports with them. As part of the intake to cardiac rehabilitation the charts are reviewed so both the patients and the clinicians have a solid understanding of their heart condition and the plan to manage the heart condition. Many patients enter rehabilitation with their last echo cardiogram or other studies showing the patient has a severely reduced ejection fraction. Some people will always have a reduced ejection fraction and others will recover depending on the severity of condition. A late presenting large heart attack may have permanently reduced pumping ability of the heart, where as a stent placed early in a heart attack may improve within a very short time. Other conditions slowly change over time, getting better or worse these include hearts that have cardiomyopathy, or pacemakers.

I believe heart patient’s understanding of their ejection fraction an important part of managing their health. The cardiologist was worried I would scare his patients.  The cardiologist  felt people would psychologically not improve if they knew their ejection fraction was low.  Many people with a reduced ejection fraction will not have any significant functional limitations or symptoms. I have worked with people with ejection fractions in the 8-10% who can function pretty normal including performing weight or resistance training exercises. On the other hand some folks with an ejection fraction of 30-40% can feel symptoms of fatigue or shortness of breath with mild exertion.

For many through building structured exercise they can improve the muscular strength of their body thus reducing the effort the heart has to work to meet the demands for oxygenated blood. Exercise does improve the ejection fraction in many studies, but if it doesn’t it still  improves the functional ability and quality of life of most individuals. Cardiac Rehabilitation programs often will note  an improvement in patients  ejection fraction. It is typical to undergo echo cardiogram studies approximately three month post intervention or event. I believe it is more of an insurance reimbursement issue which makes  most scheduling occur at 3 months post, but also gives the heart time to recover and medical management to be fully effective, and this is typically how long a cardiac rehabilitation program lasts.

When the overeager patient comes in and wants to give themselves a workout equivalent to a stress test on their first few sessions  of cardiac rehabilitation to prove to themselves they are ok,  we will  use information such as their ejection fraction to determine  and educate how much effort they should safely perform.  Then there is the  scared patient who has been living with a reduced ejection fraction and had short of breath and  gets a bi-ventricular pacemaker  the cardiac rehabilitation staff encourages them to increase their workloads as their ejection fraction is likely much improved and now can feel safe pushing the intensity. Reviewing this information with you healthcare provider can help you to understand your heart and any limitations it may have.

Read more about ejection fraction here

Calf Pain: It can be serious


Symptoms of blood clot in leg

This is called Deep Vein Thrombosis  or DVT


  • Swelling of the leg or along a vein in the leg
  • Red or discolored skin on the leg

Pulmonary Embolism


  • Unexplained shortness of breath
  • Pain with deep breathing
  • Coughing up blood




Blood clots can form in your body’s deep veins if:


For Prevention measures to avoid blood clots click here

Symptoms of Peripheral Artery Disease


Signs and symptoms of P.A.D. include:

  • Weak or absent pulses in the legs or feet
  • A pale or bluish color to the skin
  • A lower temperature in one leg compared to the other leg
  • Erectile dysfunction, especially among men who have diabetes
  • Pain with walking or climbing stairs



Learn more about Peripheral Artery Disease

Overuse Symptoms


old shoes



Muscle Cramping


Leg cramps occur when the muscle suddenly and forcefully contracts.


What causes a leg cramp?

  • Muscle fatigue
  • Heavy exercising
  • Dehydration
  • High weight (not necessarily obesity)
  • Electrolyte imbalances
  • Medications (statins, prednisone, lasix…)


Sources: National Heart Lung and Blood Institute