I<\/span>used to drive a \u201969 VW Beetle. It eventually stopped running right. I took it to the mechanic. \u201cWhat\u2019s wrong with it?\u201d I asked. \u201cIt\u2019s got engine trouble,\u201d he said. No, really?<\/p>\n My mechanic telling me that my car had engine trouble was about as useful as a doctor telling you that you have \u201cheart failure.\u201d If your heart is not running as well as your body needs it to, then your heart is failing you. That may be the most important thing you are ever told, and the most useless. If your heart isn\u2019t working right, it definitely matters why.<\/p>\n If your heart isn\u2019t working as efficiently as it should, then blood doesn\u2019t flow as well as your body wants it to. More importantly, blood doesn\u2019t flow to your brain as well as your brain needs it to.<\/p>\n A stroke is a cerebrovascular accident. That is, brain damage from not getting blood to the brain. Even worse, vascular dementia is what happens to the brain when it chronically does not get adequate blood flow.<\/p>\n Vascular dementia is the chronic brain damage that results from inadequate or interrupted blood flow to the brain.<\/p>\n The brain does not suck blood up from the body. The heart pumps it there. If you want to get adequate blood flow to the brain, you have to keep the heart working well.<\/p>\n Healthy brains require healthy hearts. You must maintain good blood flow to the brain.<\/p>\n We need to keep our pumps working. Fortunately, there are only so many ways that a heart can be damaged or become inefficient. We know who the usual suspects are, and we know how to round them up. Most of these things, in fact, are entirely predictable.<\/p>\n There is (almost) no such thing as heart disease. It is just natural aging.<\/p>\n Don\u2019t get me wrong. Mother Nature always wins, but when it comes to the heart, aging is largely predictable, measurable, and manageable.<\/p>\n Hearts naturally become less efficient over time, even if you don\u2019t have overt heart disease.<\/p>\n If your body or brain needs more blood than your heart is giving it, then you have inefficient circulation. This doesn\u2019t mean you have had a heart attack. It doesn\u2019t mean you have heart damage. It doesn\u2019t have to mean you have heart failure.<\/p>\n Old School<\/strong>: Heart failure means you are swollen and breathless with a weak heart, and you need to see a cardiologist who will give you pills to breathe better. Dementia means that your brain doesn\u2019t work. You should see a neurologist, who can tell you what to expect.<\/p>\n New School:<\/strong> The heart works to support the brain. When the heart is not working well, blood flow suffers, and the brain will eventually suffer, leading to strokes, brain damage, and dementia.<\/p>\n To protect the brain, you have to understand the health of your heart and your circulation, and do everything you can to keep blood flowing to your brain.<\/p>\n To understand the health and efficiency of your heart, it is helpful to think about the most common factors related to aging that affect the heart and lead to heart disease. Everyone has at least three things that will affect the heart over time:<\/p>\n 1. Blocked arteries (atherosclerosis, heart attacks, coronary artery disease)\n2. High blood pressure (hypertension)\n3. Heart rate and rhythm (slow heart rate, also called \u201cbradycardia\u201d and AFib)<\/p>\n Many people get atherosclerosis with age. Everyone can have hypertension with age. Everyone can have a slower and irregular heart with age. (Heart valves can also be a problem, but this is a more variable, individual issue that you\u2019ll need to talk to your cardiologist about.) Understanding the processes of aging give us the opportunity to stay healthy.<\/p>\n Not only can we prevent strokes, we can manage our aging and largely prevent heart failure as well. Preventing heart failure is very good for the brain (and the heart!).<\/p>\n So, to keep a heart and brain healthy, it is useful to think of the aging-related factors that will affect you.<\/p>\n The coronary arteries are the arteries that feed the heart. The heart pumps blood to every part of the body, including itself. The coronary arteries sit on top of the heart like a crown (that\u2019s how they get their name, like \u201ccoronation\u201d\u2014get it?). We already mentioned that 100,000 heartbeats a day cause a lot of wear and tear on arteries. Age leads to chronic vascular inflammation, which leads to plaque growth.<\/p>\n The coronary arteries that feed the heart are actually pretty small\u2014barely more than \u00bc inch (3\u20134 mm) across. It does not take all that much plaque to begin blocking an artery. When a coronary artery is blocked, the heart muscle downstream waiting for blood starts to die. When it happens suddenly, we call it a heart attack.<\/p>\n You do not have to have a heart attack to damage the heart this way. If your arteries are chronically blocked, or partially blocked, you can slowly starve your heart muscle and damage it. The net result is a weak heart muscle.<\/p>\n This is what most people think of as heart disease\u2014blocked arteries and damaged heart muscle. If enough muscle is damaged, the heart becomes weak. A weak heart cannot pump blood to the brain well.<\/p>\n Blocked coronary arteries are the traditional cause of a weak heart and heart failure.<\/p>\n You can have a weak heart without dramatic symptoms (see the universal heart symptoms in the preceding chapter). You can have partially blocked arteries with no symptoms at all.<\/p>\n If you don\u2019t want a weak heart from blocked coronary arteries, then don\u2019t get coronary artery disease. That means don\u2019t let plaque build up. The same steps that prevent plaque in the carotid arteries prevent plaque everywhere. Take a statin. Take something to prevent clots.\nFunny, preventing heart attacks is simple compared to preventing strokes.<\/p>\n Age stiffens arteries. Arteries are the pipes that carry blood. Stiffer pipes mean higher blood pressure. Higher blood pressure means more cardiac work. More cardiac work means the heart muscle will become thicker and stiffer. A thick, stiff heart can be very inefficient.<\/p>\n Before blood is pumped out of the heart and into the body, the heart has to fill with blood. The heart must relax in order to fill with blood. But high blood pressure and age makes a heart stiff, which means it has trouble relaxing to fill. If the heart doesn\u2019t fill with blood, there\u2019s no blood to pump out, no matter how strong the heart is.<\/p>\n The issue is blood flow. We need blood to flow to carry oxygen to the brain. A stiff heart has trouble generating good blood flow.<\/p>\n You see, blood pressure is a number, not a disease. The issue is the health of our heart and our arteries.<\/p>\n The challenge, of course, is that we measure blood pressure. We can\u2019t easily measure blood flow. But our blood pressure represents how hard it is to maintain blood flow, how stiff our arteries are, and how much work our heart is doing. If we chronically overwork our heart, we will have heart failure from a stiff heart due to blood pressure.<\/p>\n High blood pressure will lead to a stiff heart and heart failure, even though the heart may be strong.<\/p>\n So, if you don\u2019t want to have heart failure from high blood pressure, be aggressive in preventing the aging of your arteries (exercise, don\u2019t smoke, reduce salt) and talk with your doctor about medication to control blood pressure and maintain vascular health.<\/p>\n It is pretty well known that we don\u2019t want to get plaque in our arteries because it can damage our heart, and we don\u2019t want to have untreated high blood pressure because that can damage the heart. What is less well known is that we don\u2019t want our heart to beat too fast, too slow, or too irregular as that can create problems for our heart as well.<\/p>\n Heart rate is also called \u201cpulse.\u201d It is the number of times per minute that our heart beats. A typical, average heart rate is 60\u201380 beats per minute (bpm). Heart rate and blood pressure are not the same thing. For the most part, they are independent.<\/p>\n Heart rhythm is the pattern in which the heart beats. A normal rhythm is called a sinus rhythm. An abnormal rhythm is also called an arrhythmia. The most common abnormal rhythm is AFib. AFib can be fast (have a high rate) or be slow (have a low rate). The pattern of AFib is always irregular regardless of the rate.<\/p>\n Recall: AFib is very common if we live long enough. When most people first have AFib, the heart tends to race. That is, the heart rate is high, and the heart beats really fast. If a heart beats fast continuously for weeks or months, it will weaken and dilate or stretch-out and enlarge. That will give you heart failure and poor blood flow.<\/p>\n A continuously fast heart rate can cause a heart to weaken and dilate. This can happen with AFib.<\/p>\n Less commonly, the irregularity alone will weaken the heart, even if it is not beating too fast. These are the folks who may benefit from aggressively preventing AFib. Irregularity always makes blood flow less efficiently, even if the heart is not weak.<\/p>\n Fast heart rates are a problem. Irregular heart rhythms are a problem. But what may be the most common problem is a slow heart rate. How much blood we circulate is known as our cardiac output. Cardiac output is simply how much blood our heart pumps with each heartbeat times how many heartbeats we have: Cardiac output = (volume of a heartbeat) x (heart rate).<\/p>\n Our blood flow depends heavily (but not exclusively) on our heart rate.<\/p>\n When we are young, our heart rate may reflect fitness. All my athletic friends, especially the runners, are fond of bragging about how slow their heart rate is. The bicyclists are even worse (because they both brag and wear spandex).<\/p>\n When we are fit, our body, especially our muscles, are very efficient and do not need much blood flow. Since they do not need much blood flow, the heart does not have to circulate much, especially when we are resting. Thus, young athletes can have very slow heart rates.<\/p>\n Good for them.<\/p>\n When they get older, the heart rate naturally slows down just because they are older, not because they got more fit.<\/p>\n When we are young, the heart rate can be slow because we are athletic. When we are older, the heart rate is slow because we are older, not because we are athletic.<\/p>\n Athletes with slow hearts often have a lot of trouble when they are over 65 because their hearts are too slow for what their bodies need. First, think of that formula: Cardiac output = (volume of a heart beat) x (heart rate). If the rate goes down, the volume has to go up to maintain a steady blood flow. If the volume goes up too much, the heart will stretch, and that leads to heart failure.<\/p>\n Even simpler than that, if your heart is too slow, you are simply not circulating as much blood. This is a very important point that is often overlooked. A slow heart rate means less blood is flowing. That means the brain gets less blood. Over time, the brain slowly suffers. This is one of the key drivers of senility, or vascular dementia.\nA heart rate that is too slow can be a cause of vascular dementia.<\/p>\n The major trouble with this is that the changes can happen very gradually. No one notices until you realize that your spouse is just not the same person they used to be. It can take years.<\/p>\n Old School:<\/strong> A slow heart rate is a good sign of fitness and health. Unless someone has fainted, you never need to worry about a slow heart rate.<\/p>\n New School:<\/strong> Aging alone will slow a heart. Blood flow depends upon our heart beating, and if it beats too slowly, the heart and brain will suffer. A slow heart from age alone can lead to heart failure, brain damage, and dementia. A slow heart in a young person may be desirable, but in an older person, it will eventually be a problem.<\/p>\n We did mention that a slow heart rate also encourages AFib. AFib creates another issue. When you have AFib (and currently 6 million Americans are in AFib all of the time), it is important to control the heart rate. If the heart rate is too fast, the heart can weaken. So, we use all sorts of medications to slow down the AFib.<\/p>\n The problem is that AFib is irregularly irregular. The vast majority of the time we may have a perfectly reasonable heart rate, but on occasion, the heart skips beats and pauses. During a pause, the heart is not beating at all. We all have the occasional skipped beats, or pauses. The pause is usually less than two seconds long, and we rarely notice it.<\/p>\n In AFib, many people experience longer pauses that happen more frequently. If you have a three- to four-second pause without a heartbeat, you might faint (without warning). What\u2019s more, that\u2019s three to four seconds without good blood flow to your brain. You can only do that so much before your brain suffers.<\/p>\n The heart can pause, and not beat, especially when we are in AFib.<\/p>\n This can happen even if we have a normal or fast tempo most of the time. You might be surprised at how often your heart is not beating. It\u2019s not a good thing, and you often won\u2019t feel it.<\/p>\n If you have too slow a heart rate, or too many pauses without a heartbeat, you will damage your brain from lack of blood flow.<\/p>\n For better or worse, the brain damage is usually subtle at first. True brain damage takes a lot of time. This does give us plenty of time to recognize the issue and prevent problems.<\/p>\n There is no pill for a slow heart rate. There is no diet or exercise that will restore the tempo of your heart when it is too slow. You can, however, get a pacemaker when you need one.<\/p>\n The problems from a slow heart can be prevented with a pacemaker.<\/p>\n Nowadays, pacemakers are easy. It is a quick outpatient procedure that involves little more than some local numbing medicine and a few stitches. Yes, I implant pacemakers, so I am biased. I know how easy it is to get one, and I know how much better people can feel when they have one. I know that it is easier to get a pacemaker than a root canal, and it\u2019s covered by insurance.<\/p>\n As a matter of fact, all of my 100-year-old patients, except one, have a pacemaker. I have a lot of 100-year-old patients. My oldest patient is still sharp as a tack at 106, and as I said before, she still complains that no one will dance with her.<\/p>\n We all want to keep a healthy brain. To keep a healthy brain, we must keep a healthy heart. To keep a healthy heart, we must avoid or prevent heart damage. We must not let plaque build up in our coronary arteries, which will starve the heart of blood and damage it. We must not allow our arteries to get so stiff that our blood pressure rises and overworks our hearts so that it no longer pumps blood well.<\/p>\n We have to remember that age changes things. Our bodies work differently at 70 than they did at 17. We need to keep blood flowing to our brains. We need to have a strong heartbeat, and we need to have enough of them.<\/p>\n You can prevent a stroke …<\/p>\n","protected":false},"author":3,"featured_media":9231,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[113,114],"tags":[],"class_list":["post-9207","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-fall-2019","category-fall-2019-columns"],"acf":[],"_links":{"self":[{"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/posts\/9207","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/comments?post=9207"}],"version-history":[{"count":7,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/posts\/9207\/revisions"}],"predecessor-version":[{"id":9608,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/posts\/9207\/revisions\/9608"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/media\/9231"}],"wp:attachment":[{"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/media?parent=9207"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/categories?post=9207"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthyaging.net\/magazine\/wp-json\/wp\/v2\/tags?post=9207"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}Your brain depends upon your heart\u2019s efficiency.<\/h3>\n
Blocked Arteries<\/h3>\n
High Blood Pressure<\/h3>\n
Blood flow matters more than blood pressure.<\/h3>\n
Heart Rate and Rhythm<\/h3>\n
A slow heart can lead to heart failure.<\/h3>\n
Find out more. Read, You Can Prevent a Stroke<\/em> <\/a>(RosettaBooks, July 30, 2019).\nJoshua Yamamoto, MD is co-author of the newly published You Can Prevent a Stroke<\/a> (RosettaBooks, July 30, 2019).<\/h5>\n","protected":false},"excerpt":{"rendered":"