Wednesday, 22. of October 2014
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Live your life...and dose your medication

We have all had them implanted – one or more mechanical replacement heart valves. What minor miracles they are, for without them we would not be alive!

But what do these valves do?

Well, apart from having been implanted in our hearts, in the aortic, mitral, pulmonal or tricuspid positions, they also click: sometimes loudly, sometimes quietly. Most of us can tolerate the clicking, as it means the valve is functioning correctly. In other words: it’s clicking, so I must be alive!

Some people find the clicking harder to accept, however. For them it is a source of mental anguish that they find difficult to overcome. And for some the anguish is so great that they require psychiatric counselling.

And this clicking that sometimes gets on our nerves – especially at night when our thoughts run riot – cannot, unfortunately, be avoided. If, in addition, we have a cardiac arrhythmia and the irregular clicking makes us conscious of it, sleep can become very elusive, with thoughts turning constantly to our heart and our health and inevitably also to what the future has in store for us and for our families.

Should we be doing something for our heart?

What can we do to keep our heart and circulation in good order?
Formerly people with a mechanical replacement heart valve were advised to go easy on their bodies. Nowadays, however, the advice is different. Regular, properly planned exercise of the type that builds up stamina helps strengthen the heart muscle. This type of exercise should be started during rehab and continued afterwards in association with your cardiologist or family doctor. Based on the results of your half-yearly or yearly follow-up examinations, your doctor can decide with you what stresses your body can reasonably withstand.
It depends, of course, on your physical condition and how old you were when you received your replacement heart valve. However, age and physical condition are not valid reasons for not being active.

Many years of experience have shown that regular exercise has a protective effect against imminent cardiovascular disease. American scientific studies have shown that steady physical exercise is more important in the prevention of atherosclerosis (hardening of the arteries) than mere weight loss.

 A piece of advice: get into the habit of taking steady exercise lasting more than four hours per week. Especially suitable are running, jogging, brisk walking and cycling. Remember, though, that your heart rate (pulse) should not exceed 60 to 75% of the maximum for your age, except for short periods. Your cardiologist or family doctor will advise you on the maximum amount of exercise you should be taking.

As we all have our lives to get on with, the aim should be to postpone illnesses until the very “last” years, months and days of our being. This is no mean task in a society that is over-nourished and lacking in exercise.

 With our mechanical replacement heart valve we have received a “shot across the bows” and should be in no doubt as regards the need to change our lifestyle and eating habits.

We know all too well that our bodyweight increases as we age. This is due on the one hand to a genetic, i.e. hereditary predisposition to put on weight; and on the other to certain biological factors. A crucial role is played by the pituitary gland, an organ about the size of a cherry that secretes vital hormones such as growth hormone. From the age of 50 onwards, the production of growth hormone drops to less than one third of what it used to be. The body reacts by increasingly breaking down muscle tissue and building up fatty tissue. This accounts for some of the weight increase. Only some, however, as the act of putting on weight is also an expression of overindulgent eating and lack of exercise.

 A further piece of advice: change your eating habits – adopt a diet containing plenty of roughage, including whole grain products, pulses and soy products. – use vegetable fats for cooking and eat oily fish as well as a good measure of fruit, vegetables and salads.

The effect on INR is only slight. And if at first you do notice small changes, adjust your medication accordingly. You will soon find that even when you make major changes to your diet, you will be able to remain within your individual therapeutic corridor.

To help you lead a satisfying life with your one or more prosthetic heart valves, you just need to consider one thing: ‘WHEN do I intend to change my lifestyle and eating habits?’. Take this to heart. Your life is for the living, and the key is to adapt your dose of oral anticoagulant to suit.

Christian Schaefer, Ratingen/Germany (2003)