Essential Cardiology: A Guide to Important Principles

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The South Beach Diet has three different phases: two for weight loss and a third for weight maintenance. It's considered the strictest phase because it limits fruit, grains and other higher-carb foods in order to decrease blood sugar and insulin levels, stabilize hunger and reduce cravings. During phase 1, you consume three meals per day composed of lean protein, non-starchy vegetables and small amounts of healthy fat and legumes. In addition, you consume two mandatory snacks per day, preferably a combination of lean protein and vegetables.

This phase begins on day 15 and should be maintained for as many weeks as necessary to achieve your goal weight.

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During phase 2, all foods from phase 1 are allowed, plus limited portions of fruit and "good carbs," such as whole grains and certain types of alcohol. In this stage, although the phase-2 guidelines should be the basis for your lifestyle, occasional treats are allowed and no foods are truly off limits. However, if you overindulge and start putting on weight, Dr. Agatston recommends returning to phase 1 for one to two weeks before returning to phase three. Agatston also recommends regular exercise and provides a three-phase fitness program to accompany the diet phases.

The guidelines on the South Beach Diet website may be different. Although portions aren't limited, the diet recommends slowly consuming a small portion and returning for seconds if you are still hungry. All vegetables are allowed except beets, carrots, corn, turnips, yams, peas, white potatoes and most types of winter squash. You may drink unlimited quantities of these beverages, although drinking your caffeine in moderation is advised.

Certain fatty foods and those high in carbs, including fruits and grains, are not allowed in phase 1. These include:.

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Phase 2 includes all phase 1 foods and gradually adds in higher-carb foods, beginning with one daily serving of fruit and whole grains or starchy vegetables for the first week. On the 14th day of phase 2 and thereafter, you may consume up to three servings of fruit and four servings of whole grains and starchy vegetables per day. An occasional alcoholic drink is also allowed, although choices are limited to light beer and dry wine. Once you've achieved your goal weight, you move to phase three for maintenance.

During this phase, you should generally follow the guidelines from phase 2. Consume 1—3 servings per day. All fresh and frozen fruits are allowed except dates, figs, pineapple, raisins and watermelon. Phase 2 of the South Beach Diet discourages intake of fatty meats, saturated fat and foods high in refined or natural sugar. Try to avoid:. Here are sample meal plans for phase 1 and phase 2 of the South Beach Diet, to give you a snapshot of what a typical day might look like. There are hundreds of recipes available for all three phases of the South Beach Diet, including many with ingredients that are cheap, tasty and easy to find.

There are several benefits of the South Beach diet, including its ability to produce weight loss without hunger. Research, including an analysis of 24 studies, has consistently shown that high-protein, low-carb diets are effective for weight loss 1 , 2 , 3 , 4. Part of this is due to protein's ability to increase your metabolic rate. In addition, protein helps modify hormone levels that reduce hunger and promote fullness, so you end up naturally eating less 5 , 6 , 7.

What's more, gradually adding small amounts of healthy carbs back into your diet may promote continued weight loss in some people and make it easier for them to stick to the diet long-term. In one study, overweight and obese people with metabolic syndrome followed the South Beach Diet for 12 weeks 8. By the end of the study, they had lost 11 pounds 5. They also experienced significant decreases in fasting insulin and an increase in the fullness hormone CCK. The South Beach Diet encourages a high intake of fatty fish like salmon and other foods that fight inflammation, such as leafy greens and cruciferous veggies.

In addition, it recommends dieters regularly consume eggs , nuts, seeds, extra virgin olive oil and other foods that have been shown to protect heart health. The book makes meal planning easy and pleasurable by providing two weeks of sample menus and recipes for each phase. There are also hundreds of recipes available online for phase 1 and phase 2 meals. The main issue is that it may be overly restrictive with respect to the amounts and types of fats allowed. In addition, it allows potentially harmful types of fat, such as soybean oil and safflower oil, which are extremely high in omega-6 fatty acids.

Although it's important to get some omega-6 fats in your diet, if you're like most people, you probably already get far more than you need. In contrast, if you eat a Western Diet, it's likely you get too little of the anti-inflammatory omega-3 fats found in fatty fish like salmon , sardines and mackerel. Consuming a high ratio of omega-6 to omega-3 fats has been linked to inflammation, heart disease and other health problems 9 , 10 , 11 , In contrast, butter and coconut oil aren't included on the South Beach Diet because they are high in saturated fat.

However, coconut oil has been credited with several health benefits, including weight loss, a reduction in belly fat and better heart health markers in overweight and obese adults 13 , In addition, most comprehensive reviews of studies have found no association between saturated fat intake and an increased risk of heart disease 15 , 16 , On the other hand, other large reviews have found that replacing a portion of saturated fat with unsaturated fat could potentially reduce the risk of heart disease 18 , Overall, choosing less processed fat and eating plenty of fish high in omega-3 fats may be more important for heart health than restricting saturated fat.

Table 1. Recommended requirements of a cardio-oncology clinic. With permission from [3]. Cardiology service haemodynamic section Radiation and medical oncology and haematology services. Intensive cardiac care unit Cardiac transplant programme. Multidisciplinary team : cardiologist, radiation and medical oncologist, haematologist, hospital pharmacist, oncology and heart failure nurses, psychologist. Smaller services should be connected to larger regional cardio-oncology services for interventional procedures and complex cases.

CABG, valvular heart surgery, percutaneous revascularisation procedures, non-coronary interventional procedures, electrophysiological studies, cardiac device implantation. Lead cardio-oncology research programmes. The objectives of a C-OT are the optimisation of preventive strategies and the screening for early or late-onset complications, as well as the re-assessment of risk of cardiovascular complications in patients in need of treatment for secondary cancers [7]. Furthermore, those involved with care should be aware that after cancer therapy patients frequently experience atypical CV symptoms — for example, silent ischaemia after mediastinal RT [3].

Every patient at risk should enter a C-O follow-up programme. Good compliance with this programme may be achieved by explaining to patients the potential risks and consequences of cardiotoxicity, and the possibility of its significant reduction with lifestyle measures, adherence to planned controls, and therapy compliance.

General practitioners and nurses should be actively involved in the programme. Specific recommendations about diagnostic tests and the timing for long-term follow-up have been stated in the recent ESC position paper on cancer treatments and CV toxicity [1]. Cardio-oncology is a relatively new subspecialty involving many fields of cardiology. Its relevance is quickly evolving for the increasing population with C-O conditions.

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The organisation of effective C-O services is mandatory to be able to deal with the very difficult clinical problems of these patients; however, there are still many obstacles to implementing CO services which require a solution Table 2. Table 2. Obstacles in implementing cardio-oncology clinics COCs. Our mission: To reduce the burden of cardiovascular disease. All rights reserved. Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version.

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Read your latest personalised notifications Sign in No account yet? Don't miss out Read your latest personalised notifications Ok, got it. Loading quicklinks Cardio-oncology: principles and organisational issues Vol. Thomas M. Topic s : Cardio-Oncology. The reasons are [1]: The progressively ageing population with an increasing incidence of cancer patients and patients with CV diseases CVD and the consequent increase of the prevalence of patients suffering from both conditions.

The increasing survival from cancer and CVD with an increase in the prevalence of these two conditions combined. Most survivors from cancer therapy develop or die from CVD, more than from cancer recurrence. Patients cured for cancer should not die of a CV complication. An adequate and aggressive risk factor control and CV diagnostic work-up strongly enhance survival. CT and RT toxicity may develop many years after treatment. Tight follow-up protocols to avoid long-term cardiac side effects are essential for adequate treatment.

Cancer-cardiac patients may undergo different treatment if managed by a separate approach of care by oncologists or cardiologists, due to a more or less aggressive treatment of the two conditions separately. The best treatment may be achieved if cardiologists and oncologists are interacting properly, building a C-O expert team. Detecting CV effects when potential cardiotoxic agents are used, with particular attention to subclinical signs and symptoms.

Cancer therapy cv toxicities CT toxicity is related to the mechanism of action of the drugs, the doses, the manner of administration, and the underlying predisposing factors such as cardiac conditions, genetic pattern and age, and it can manifest itself immediately or many years after the treatment. Concomitant CT and RT treatments may interfere in toxicity, with mutual potentiation. Acute toxicity may appear very rarely or quite frequently with different drugs.

Also, the incidence of chronic toxicity is variable and may develop over a long period of time.

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Myocardial dysfunction and heart failure HF Myocardial dysfunction due to CT toxicity may be due to cell necrosis Type I toxicity leading to permanent cardiac damage, or due to a cell dysfunction, mainly by biologic drugs Type II toxicity with generally reversible conditions. Coronary artery disease CAD The screening of a pre-existing CAD to guide the choice of CT drugs requires a careful clinical evaluation based on age, gender, history and diagnostic tests for ischaemia.

Arterial hypertension Careful monitoring of blood pressure before beginning CT is a rule. Thromboembolic disease Cancer-related risk factors for venous thromboembolism are: 1 primary site of cancer pancreas, brain, stomach, kidney, lung, lymphoma, myeloma , 2 histology especially adenocarcinoma , 3 advanced stage metastatic , and 4 the initial period after cancer diagnosis. Similar consequences are reported for the aorta. Pericardial disease Several CT drugs predominantly anthracyclines may lead to acute pericarditis; however, this has become uncommon during RT and is usually associated with pericardial or mediastinal tumours.

Pleural effusion In cancer patients, pleural effusion is commonly due to the cancer itself, HF, infections or other causes. Autonomic dysfunction Damage to the cardiac nervous system may be seen after chest RT with sympathovagal imbalance and inappropriate sinus tachycardia, altered heart rate variability and decreased sensibility. Pulmonary hypertension Precapillary pulmonary hypertension is a rare complication of some cancer agents mainly in patients submitted to stem cell bone marrow transplantation treated with dasatinib.

Special populations Paediatric cancer population The lifelong risk of childhood cancer survivors having CV toxicity from cancer therapies is eightfold higher than normal. Elderly cancer population The elderly population is the other group most affected by the cardiotoxicity of cancer therapy, due largely to the prevalence of classic CVD risk factors and CV comorbidities or diabetes. Pregnant women Very little is known about the maternal risk of CT cardiotoxicity. Cardio-oncology services Our group has recently published the rationale, organisation, and implementation of C-O services [3].

This screening may help in selecting the appropriate therapy and is mandatory in the adjuvant setting or for cancers with good prognosis when patients are cured or may survive for a long time and long-term toxicity is not acceptable. Accordingly, the optimal frequency of monitoring should be defined, and the interactions of cancer drugs with pre-existing cardiac drugs e. The optimisation of CV health for cardiac patients and the facilitation of anti-cancer treatment in patients with CV complications are both consequences of this approach.

Cardio-oncology: principles and organisational issues

When it may not be achieved, interdisciplinary discussion to ensure the most efficacious cancer treatment without CV harm is recommended. The dilemma is the balance of continuing versus interrupting anti-cancer therapy, and whether the cancer or CV disease is the major threat for the patients [1]. Applying the best cardiology care may allow continuing or minimising interruptions of essential cancer treatments.

The basics for long-term surveillance programmes for cancer survivors Raise awareness of possible cardiac disease among cancer survivors and provide appropriate follow-up in clinical practice. Instruct patients to report early signs and symptoms of CVD promptly. Due to LV dysfunction and HF potential occurrence even in asymptomatic patients, always programme a periodic screening with cardiac imaging and biomarkers, such as BNP, particularly in those treated with high cumulative doses or those who demonstrated reversible LV dysfunction during cancer treatment.

Investigate any symptom suggestive of HF promptly. Do not discontinue cardioprotective HF therapy but continue it indefinitely even with stable normal systolic LV function as long as no further cancer therapy is planned. Actively look for CAD, ischaemia and vascular disease in patients with a history of mediastinal radiation, even if asymptomatic, starting five years post treatment and then at least every five years thereafter.

Perform ultrasound scanning of the carotid arteries in patients with previous neck irradiation, for the risk of stroke in order to rule out the presence of subclinical carotid stenosis. Conclusions Cardio-oncology is a relatively new subspecialty involving many fields of cardiology. Eur Heart J. Breast cancer during pregnancy: maternal and fetal outcomes. Cancer J. Policy statement on multidisciplinary cancer care.

Eur J Cancer. The cardio-oncology program: a multidisciplinary approach to the care of cancer patients with cardiovascular disease. Can J Cardiol. Ten principles of good interdisciplinary team work. Hum Resour Health.

Essential Cardiology: A Guide to Important Principles Essential Cardiology: A Guide to Important Principles
Essential Cardiology: A Guide to Important Principles Essential Cardiology: A Guide to Important Principles
Essential Cardiology: A Guide to Important Principles Essential Cardiology: A Guide to Important Principles
Essential Cardiology: A Guide to Important Principles Essential Cardiology: A Guide to Important Principles
Essential Cardiology: A Guide to Important Principles Essential Cardiology: A Guide to Important Principles
Essential Cardiology: A Guide to Important Principles Essential Cardiology: A Guide to Important Principles
Essential Cardiology: A Guide to Important Principles Essential Cardiology: A Guide to Important Principles
Essential Cardiology: A Guide to Important Principles Essential Cardiology: A Guide to Important Principles

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