Frequently Asked Heart-Health Questions

Heart disease is the highest cause of death in Oklahoma. In fact, of all 50 states, Oklahoma has the third-highest death rate from cardiovascular disease. Keeping your heart healthy is of utmost importance, especially in our state. Dr. Gregory H. Schuchard of INTEGRIS Health Enid commonly sees heart-related issues in patients. He’s shared his insight on some of the most frequently asked questions when it comes to taking care of your heart.

How can I tell if my chest pain is related to my heart, or if it’s just a minor issue?

Chest pain can be caused by many different conditions, both heart (cardiac) and non-heart (not cardiac), and the significance of the problem can vary widely from “life threatening” to “minor” depending on the situation. To make things even more complicated, not all “heart pain” is related to heart artery blockages, but can be caused by less serious conditions such as inflammation of the heart muscle (myocarditis) or heart sac (pericarditis) or even temporary spasms of heart arteries.

Typical heart pain, called angina pectoris, is usually caused by heart artery blockages due to coronary artery disease (CAD). The feeling is often described as a tightness, fullness, pressure, weight, or “elephant on my chest” type of discomfort, brought on or worsened by activity or stress and relieved by rest or nitroglycerin. Unfortunately many patients, especially diabetics and women, often have symptoms that are not “typical” or perceived as “painful.” Those symptoms are shortness of breath, sweating, fatigue or dizziness, or even have no symptoms despite having critical CAD.

So, if you are having chest pain, it is best of be evaluated by your physician who will help you determine if your symptoms are likely to be heart-related or non-heart-related, serious or minor.

Should I keep working out when my chest hurts?

Activity-related or workout-related chest pain is worrisome and should prompt medical evaluation to make sure there isn’t any serious heart problem. In this case, “no pain, no gain” could be life-threatening. As a general precaution, I would recommend stopping the workouts until you are fully evaluated by your physician.

Will cardio strengthen my heart muscles?

Cardio exercise will certainly help improve your exercise capacity and endurance, and will have a beneficial effect on risk factors for heart disease, such as high blood pressure, cholesterol, diabetes and obesity, and can help you stay at or maintain a healthy weight. It can help your heart muscle become a more “efficient” pump and one that is better able to pump blood throughout the body. Individuals who exercise regularly typically will have slower resting heart rates as a result of their more efficient, “stronger” heart muscle. Exercise also may help your heart and body do a better job of removing oxygen from your blood and promote the development of small collateral vessels that may serve as “natural bypasses” if you have a blocked artery.

Aerobic (cardio) activities are important, but don’t forget about the other two major types of physical activity that are beneficial too. Every fitness program should also include muscle-strengthening activity to make your muscles and bones stronger, as well as balance and stretching activities to enhance physical stability and flexibility, which reduces risk of falling and injuries.

Which types of cardio are best for my heart?

The best cardio for your heart is any cardio activity that you will do and enjoy on a regular basis. The most important thing is doing the exercise, rather than the specific type of activity. Everyone has to start somewhere, and even if you have been sedentary for years, today is the day you can begin to make healthy changes in your life. Set a reachable goal, start slow (maybe just walking at first) and work up toward your overall goal by gradually increasing your activity time and intensity. Find a cardio activity that you like and can do, whether it is walking, jogging, swimming, biking or any of the many options available, and get started!

Is running safe for my heart?

Yes, but you have to be reasonable about starting an exercise program. Be cautious and see your physician before starting a program, especially if you have not exercised in the recent past, have any active medical conditions (such as high blood pressure, diabetes, overweight or prior heart event) or are in an age group at higher risk for heart disease. Your physician can advise you regarding your approach to exercise, determine if any testing (such as a stress test) might be appropriate and refer you to a cardiac rehab or exercise specialist, who can provide an exercise “prescription” including target heart rates and workout recommendations.

Is there such a thing as “too much cardio” in terms of heart health?

Current American Heart Association recommendations for adults (age 18-64 years) are summarized below:

• At least 30 minutes of moderate intensity aerobic exercise at least five days per week for a total of 150 minutes OR
• At least 25 minutes of vigorous aerobic activity at least three days per week for a total of 75 minutes or a combination of moderate and vigorous activity AND
• Moderate to high intensity muscle-strengthening activity at least two days per week for additional health benefits

Aerobic activities make you breathe harder and make your heart beat faster. As a guideline, “moderate activity” is an activity that you can do and comfortably talk while you do them, such as walking or riding a bicycle. “Vigorous activity,” such as jogging, swimming or running, for example, takes more effort than moderate activities and you can only say a few words without stopping to catch your breath. Any exercise activity level should also be guided by your age-specific target heart rate aerobic exercise “zone,” which is typically 60-80% of your predicted maximal heart rate (equal to 220 minus your age).

The issue about “too much cardio” has been prompted by research evoked by concern over the safety of long-distance running and competition. Recent studies have shown cardiac biochemical, functional, and possible structural abnormalities in runners following completion of a marathon, but the clinical significance of those findings remains uncertain.

From a practical standpoint, most of us will never reach those levels of exercise and don’t really need to worry about “doing too much cardio.” Any sustained activity at those extreme levels remains a personal choice that is done for reasons other than overall cardiovascular health. My recommendation is to try to meet the suggested guidelines for activity (outlined above), understand that more is not better from a heart standpoint and don’t ignore potentially serious symptoms if you do choose to work out at higher levels of activity.

What are common signs of heart issues while working out?

Fatigue, mild shortness of breath and some sweating are all symptoms you would expect with a good workout. Remember that you should be able to comfortably carry out a conversation with someone during your workout.

Any other symptoms, such as activity-related chest discomfort, severe shortness of breath, rapid or irregular heartbeat, dizziness, lightheadedness or a sensation of fainting, near-fainting or actual black-out spells are NOT NORMAL and should prompt medical evaluation.

Listen to what your body is telling you. Don’t try to “run through” or ignore worrisome symptoms, and be safe – if you have any of these symptoms, see your physician before resuming your exercise program.

I’m training for my first marathon – should I see a cardiologist before I compete?

The short answer is yes, that’s probably a good idea. The long answer is that no one really knows for certain what to recommend in this situation. Cardiac arrest during long-distance races is a very infrequent event, with a recent study finding only 59 cardiac arrest events in 10.9 million runners over a ten-year period.

Yet, the sudden death of a marathon runner can be a shocking experience since many runners are either young and in peak condition or older but without any cardiac symptoms or known heart disease, and marathons are typically high-visibility public sporting events.

The situation is further complicated because of the many different potential causes of the cardiac arrest, such as hypertrophic cardiomyopathy in the younger patients and ischemic heart disease in the older patients. In addition, cardiac testing in the large number of individuals participating is problematic because of testing costs, low overall rates of exercise-related events and high rates of false positive test results in asymptomatic patients.

So, this is one of those situations where there is no clear recommendation. It would be best for each individual to meet with their physician, review their concerns and make an informed and joint decision regarding their potential risk for an event and the need for any pre-marathon cardiac testing.

Know your own heart limits

Each and every heart is unique, so we must all stay in tune with our own symptoms and limitations. If you are worried about a potential heart-related issue, getting evaluated by a physician is always a smart precaution. Find an INTEGRIS hospital near you to make an appointment.

Dr. Schuchard

Gregory H. Schuchard, M.D., FACC, specializes in the diagnosis and treatment of complex cardiac and peripheral vascular disease.

He received his medical degree from the University of Minnesota in Minneapolis and completed a residency in internal medicine at the Mayo Clinic College of Medicine. He went on to complete a fellowship in cardiology at the Medical College of Wisconsin and recently completed a fellowship in interventional cardiology at the University of Connecticut Health Center.

Schuchard is certified by the American Board of Internal Medicine in internal medicine, cardiovascular disease and interventional cardiology. In addition, he is certified in the sub-specialty area of nuclear cardiology by the certification board of nuclear cardiology and endovascular disease by the American Board of Vascular Medicine.

He received the prestigious “fellow” designation as a member of the American College of Cardiology. He is a member of the Society for Cardiovascular Angiography and Interventions and the Doctor’s Mayo Society at the Mayo Clinic.

Schuchard sees patients at the INTEGRIS Heart and Vascular Institute of Northwest Oklahoma by physician referral only. For appointments, please call 580-616-7630.