All Posts tagged blood pressure

The day after … dealing with life after a heart attack

Blake Wachter, M.D. F.A.C.C.

Blake Wachter, M.D. F.A.C.C.

So, you’ve had a heart attack and you lived to tell about it. Great! Now what?

You were probably told about your medications and how important they are when you left the hospital. Yes, they are very important. Most of the medications are ones you’ll need to take for the rest of your life. Your doctor probably put you on an aspirin, a cholesterol medication called a statin, and likely one or two blood pressure medications. These blood pressure medications are not necessarily for your blood pressure; they’re good for remodeling your heart. Think of them as good medications for your heart health.

If you had a stent (a stent is what is used to open up a blockage in your coronary arteries), then you likely were put on a medication to help keep the stent open. You will need to be on this medication for at least one year (after a year, discuss with your doctor whether it is safe to stop it). You may recognize this medication by their brand names Plavix or Effient. These medications are important for your stent, and if you miss even one dose it could be catastrophic and your stent may close up (so don’t mess with this one). It is important that you do not stop any of your medications without consulting your doctor.

Your daily routine


Now that we have the medications taken care of, there are a couple other items on the agenda including diet and exercise. It’s time to eat healthy! Cut out the fast foods and most restaurant foods. Learn to eat foods with lower cholesterol, lower sodium and less processed foods. Go buy a cook book. Look into the DASH diet – it’s good for high cholesterol, weight loss, heart failure, high blood pressure and diabetes.


After you are discharged you were likely referred to cardiac rehab – GO! That’s important. Don’t sit on the couch and feel sorry for yourself. Get out there and exercise. Lose weight, but more importantly, enjoy your second chance at life!

A note to spouses of heart attack survivors: Don’t wait on your loved one hand and foot – that’s the worst thing you could do! Don’t enable. Instead help them work on exercising more and make sure they go to cardiac rehab.

Bad habit

Now, last but not least: smoking. Yep, we had to talk about it sooner or later. You HAVE TO STOP. Please discuss ways to stop with your doctor. No pills or hypnotic therapy will help if you don’t WANT to stop. Find the motivation and do it. I have helped many patients in my clinic stop smoking by exploring the reasons they smoke in the first place and helping them find substitutions for their behaviors.

Having a heart attack is scary. Surviving one means you have another chance at living. Change your life for the better and eat healthy foods, exercise and stop smoking. Make sure you’re around for your loved ones when they need you and work to prevent another cardiac event in your life.

Dr. Blake Wachter, M.D., PhD, F.A.C.C. is a cardiology specialist at Teton Valley Health Care. She sees patients at the Driggs Health Clinic. To make an appointment or for more information call (208) 354-2302 .


Have a heart to heart, Be Heart Smart

Blake Wachter, M.D. F.A.C.C.

Blake Wachter, M.D. F.A.C.C.

We’re two months into the New Year, and you may have made a resolution to be healthier in 2015.  Or maybe you are looking for ways to feel better. Maybe you’re tired of being tired and out of breath when you attempt simple tasks.

As a cardiologist who specializes in heart failure, I have many patients who come to my clinic with issues such as these. First, I evaluate them for heart disease.  This may include laboratory tests, echocardiograms, or treadmill exercise tests.  The results of these tests may lead to more invasive procedures such as angiograms or cardiothoracic surgery.  Sometimes a serious cardiac or pulmonary condition is not diagnosed, yet the patients continue to have these progressive symptoms.  In all cases, everyone gets the same message from me — Be Heart Smart.

To be heart smart, you have to take a serious look at what you are currently doing with your life. I focus on four areas: Sodium (salt), Calories, Smoking and Exercise. I find that all of these areas are equally hard for patients to gain control of.


Be Heart Smart


Stop. Smoking causes heart disease, pulmonary disease, and many cancers. However, you must want to stop before you can successfully quit. All the medications, classes and support groups won’t help unless you really want to stop smoking. My patients who have successfully quit have found something personal that motivated them to stop.  I often ask them to name five reasons why they like to smoke, then we discuss ways they can achieve the same feeling they get from smoking with other activities.


Cut back. The first step is to educate yourself. Salt does not only come from the shaker; it is a major ingredient in all processed foods. Start reading labels and always remember salt = sodium.

Lowering your sodium intake can reduce your blood pressure, decrease water retention, and help with weight loss.

Find out how much sodium is in your daily diet. You can find just about any food item’s nutritional content online.

Sodium facts:

  • The average American consumes more than 4,000 milligrams of sodium each day.
  • The American Dietary Guideline recommends 2,300 mg per day.
  • I restrict some of my heart failure patients to less than 1,500 mg per day.

Foods high in salt:

  • Fast food anything
  • Gravy
  • Cheese
  • Canned soup
  • Frozen dinners
  • Lunch meats
  • Snack chips
  • Chicken/beef broth
  • Seasoning mixes (steak, grill, etc.)

Of course, you should lose the saltshaker. I instruct many of my patients to avoid going out to restaurants until they know how to cook at home. Go back to the basics and explore a variety of herbs in your cooking: oregano, basil, rosemary, cilantro, chili powder, and many others. If you don’t know what to pick, just smell them in the grocery store; use your nose to choose. Tonight, pick three that you wouldn’t normally have used before and combine them in a chicken dish with a little olive oil and lots of your favorite fresh veggies.


Eat less. To lose weight you need to understand that it is not just a numbers game but also a metabolism game. Be honest with yourself with how much you are eating. Portion control is very important. There are many free phone-based apps now that can help you count your calories and show your progress. If you’re unsure where to start, try the DASH diet, supported by the American Heart Association. I like it because it is cheap and simple. It is not a fad diet. Rather it teaches you how to eat healthy for the rest of your life.


Exercise more. Yes, exercise does help you lose weight but only if you combine it with smart eating habits. Exercise in general is a way make you feel better and become stronger. As you age, your muscles can lose tone and strength, especially if you’ve lived a sedentary life-style. I advise my patients to “sweat” for 20 to 30 minutes a day. Choose an exercise or two you enjoy. For beginners, start out with a modest level of exertion and increase the intensity in 1-minute intervals during your exercise period – interval training.

The Key to Success

My patients who take being heart smart to heart feel better. Once on a routine, they are surprised how much more energy they have. Some have lost weight, a few have stopped smoking, and most have less shortness of breath. They admit it is not easy, but it is worth it.  So talk to your doctor and get busy. Take control of your life. Be Heart Smart.


Dr. Blake Wachter, M.D., PhD, F.A.C.C. is a cardiology specialist at Teton Valley Health Care. She sees patients at the Driggs Health Clinic. To make an appointment or for more information call (208) 354-2302 .


Health ABCs from a PA-C: Cholesterol 101

When you have your blood drawn for lab tests either as prescribed by your doctor or as part of a health fair, one of your options for those draws is blood chemistry profile. With this test you’ll get a good overview picture of your kidney and liver health, blood count and lipid profile. The lipid panel means you’ll get a measure of your HDL (high-density cholesterol), LDL (low-density cholesterol) and triglyceride levels. But what does this mean to you?

Let’s start with the basics. Cholesterol is a waxy, fat-like substance found in your body and many foods. Your body needs it to build healthy cells and function properly. Too much cholesterol can accumulate in your body and cause plaques on your arteries. These plaques can block blood flow causing a heart attack or stroke.

We monitor two main types of cholesterol through blood work. LDL, “bad cholesterol” makes up the majority of the body’s cholesterol. LDL is known as “bad” cholesterol because having high levels can lead to a buildup in the arteries and result in heart disease. HDL, “good cholesterol” absorbs LDL and other cholesterol molecules and carries it back to the liver, which flushes it from the body. High levels of HDL, or “good” cholesterol, reduce the risk of heart disease and stroke.

Here is a list of appropriate blood levels:

Desirable Cholesterol Levels
Total cholesterol Less than 200 mg/dL
LDL (“bad” cholesterol) Less than 100 mg/dL*
HDL (“good” cholesterol) 40 mg/dL or higher
Triglycerides Less than 150 mg/dL


Treatment options for high cholesterol first start with TLC (therapeutic lifestyle changes). The first and most important lifestyle modification we encourage is to maintain a healthy weight. The important thing about weight loss is understanding it isn’t about short-term dietary changes. It’s about a lifestyle that includes healthy eating, regular physical activity, and balancing the number of calories you consume with the number of calories your body uses. Fewer calories in than calories expended is the way to lose weight. To better understand how many calories you need for your body and health concerns, see your primary care provider.  AHA graphic physical activity

Increasing your physical exercise is another lifestyle modification essential to maintaining a healthy heart and keeping your weight stable which in turns prevents chronic illness. Studies have shown that 30 minutes of aerobic activity five times a week is beneficial as primary prevention of heart disease. It is also important to try to maintain your target heart rate while exercising. This can be calculated by counting your pulse for 10 seconds and multiply by 6 to find your beats per minute. You want to stay between 50 to 85 percent of your maximum heart rate. This range is your target heart rate. Your maximum heart rate is 220 minus your age. If you are taking blood pressure medications, your target heart rate may be different, and you should consult your doctor before beginning a new exercise program.

Another way to control high cholesterol is with medications. Statins are a commonly prescribed medication with great value. They have proven to reduce risk of heart attacks and strokes. These medications are essential for people with cholesterol resistant to TLC and/or people with moderate to high levels of cholesterol.

An alternative therapy for people with mild high cholesterol is Red Yeast Rice. Red yeast rice (RYR) is the product of yeast (Monascuspurpureus) grown on rice. It is a dietary staple in some Asian countries. It contains the same compound found in statins, (HMG-CoA) reductase inhibitor. Studies have shown this product to be effective for treatment of hyperlipidemia (high cholesterol). More specifically, decreases in total cholesterol (TC), LDL cholesterol (LDL-C), and triglycerides (TG) have been noted. Consult with your primary care provider to see if this therapy may be beneficial to you.

Hopefully this gives you a better understanding of cholestrol in general and how you can work to keep your cholesterol levels within normal ranges.

Anna Gunderson, PA-C is a nationally certified Physician Assistant. She works at the Driggs and Victor Health Clinics and is currently accepting new patients. Call (208) 354-2302 to make an appointment or visit for more information on the services offered at Teton Valley Health Care.

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