Cardiovascular Issues of Polio Survivors Remarks at GINl's Eighth International Post-Polio and Independent Living Conference, June 2000 Rupert D. Mayuga, MD, Assistant Professor of Clinical Medicine/Cardiology, Northwestern University Medical School, Chicago, lllinois

Cardiovascular disease (CVD) CVD signs This finding becomes important is the leading cause of death in Enlarged heart when one considers that many both men and women in the Swelling of the ankles or legs current methods for assessing United States. One of every 2.4 Unusuallexcess weight gain cardiovascular function and fit- deaths is attributable to CVD. Wounds that do not heal well ness include evaluation of para- However, the incidence of CVD meters - such as heart rate, in individuals diagnosed with CVD symptoms blood pressure, heart rate vari- post-polio syndrome is not known. Chest discomfort (pain, pressure, ability, valsalva response, etc. CVD is often a "silent" disease squeezing, heaviness, etc.) especially - all of which require an intact if brought on by exertion and without significant symptoms autonomic system. The study relieved by rest until its life-threatening or cata- results suggest that polio sur- Shortness of breath with minimal strophic sequelae appear sud- vivors in general can use any of exertion or upon lying down denly. All too often, the first a number of standardized tests Palpitation or irregular heart beats manifestation of CVD is sudden for cardiovascular risk assess- death, stroke, or heart attack. Severe dizziness or loss of ment such as the exercise stress c~nsciousness The need to identify individuals test without a decrease in test at increased risk early enough Sudden weakness or paralysis sensitivity, provided that due of one part of the body to alter its catastrophic course consideration of the presence of cannot be overemphasized. Sudden slurring of speech or muscular dysfunction is made. loss of vision For example, an arm ergometer Frequent nocturnal urination C* Are there reasons to suspect may be used instead of a tread- that polio survivors who are experi- Unusual and progressive fatigue mill as the method of providing encing post-polio problems might Leg painldiscomfort with walking the exercise in individuals with be at increased risk for CVD? A WORD OF CAUTION:The symptoms lower extremity weakness. There are also non-exercise types of Yes, certain features such as of CVD overlap with common cardiovascular stress testing such generalized fatigue, generalized symptoms of post-polio syn- as pharmacologic, vasodilator and specific muscle weakness, drome. This presents a problem perfusion stress tests (dipyridamole and joint and/or muscle pain because individuals diagnosed or adenosine stress tests) used may result in physical inactivity with the syndrome may not rec- in conjunction with nuclear imag- - deconditioning, obesity, and ognize cardiovascular symptoms ing, or a dobutamine stress echo dyslipidemia. Polio survivors and think that these may just be test. These are the preferred with respiratory difficulties may a progression or altered mani- tests for those who cannot per- develop hypoxemia (low levels of festation of the post-polio symp- form significant exercise. oxygen). Any of these circum- toms. The resulting delay in stances - deconditioning, obesity, diagnosis can be costly. Also, make certain that blood dyslipidemia , and hy poxemia - pressure, cholesterol/lipid pro- can increase the risk for cardio- + What tests should I have if 1 file, fasting blood sugar (FBS), vascular disease. experience some of the above body weight, and an ECG are symptoms? Furthermore, most polio sur- included in your annual physical vivors are at an age when CVD One study, of practical impor- examination. A chest x-ray would becomes increasingly more likely. tance to polio survivors, evaluat- also be useful periodically to ed the cardiovascular autonomic determine heart size and the sta- 4P What are the common signs function of individuals who had tus of the lungs. More frequent and symptoms of CVD? polio (Borg, 1988) and concluded testing as well as additional spe- that there was no significant cific tests (stress tests, echocardio- dysfunction of autonomic nerves grams, coronary angiograms, despite the presence of progres- etc.) may be needed. sive muscle atrophy. CONTINUED ON PAGE 8 Cardiovascular Issues of Polio- Survivors Although there appears to be d How can I avoid physical investigators found that a care- no large scale studies evaluating deconditioning and becoming fully designed exercise program, whether individuals experienc- overweight? which avoided excessive muscle ing post-polio syndrome are fatigue was able to provide In individuals with identified at increased risk for CVD, it is positive results. post-polio symptoms consistent probably safe to assume that with cardiovascular decondition- Consult your health care profes- there may be increased risk in ing, there has been some hesita- sional for appropriate recom- certain individuals who have the tion in prescribing an exercise mendations. In general, exercise traditional risk factors mentioned program to improve condition- has to be started very gradually above. A study of 64 post-polio ing because of fears that tradi- and at a lower level individually individuals (Agre, 1990) found that tional exercise regimens may tailored to each individual's 66% of the men and 25% of lead to further loss of muscie physical status and needs. Care the women had hyperlipidemia from overuse. The prospect of should be taken not to over- (high lipid concentration) with safely and effectively training exercise. Nutritional counseling men also having low HDL (the PPS subjects was evaluated by is also a useful resource. "good") cholesterol. These find- a number of investigators. All ings underscore the need to actively screen for dyslipidemia and/or hypercholesterolemia (excess cholesterol in the blood; "If we don't know the disease, we don't know less than 200 total cholestrol is that we are at increased risk, and we might desirable). In addition, decon- not do anything about it." ditioning and obesity was found - Rupert 0.Mayuga, MD to be strongly associated with the presence of dyslipidemia. SIGNS AND SYMPTOMS OF A HEART ATTACK Therefore, it is important to OR IMPENDING HEART ATTACK: address these issues. Continuous chest andlor throat discomfort/pressure/pain/heaviness + Since CVD is described as a lasting more than 15 minutes even with rest and even after sub- '3ilent"disease without significant lingual nitroglycerin.This may be associated with shortness of breath, symptoms, what are some of the sweating, dizziness, and palpitations. Discomfort may radiate to the risks factors that are of major left arm or jaw. importance to everyone with or Immediately proceed to the nearest emergency room without a history of polio? or call the paramedics (91 1). Risk factors include cigarette If you have no severe allergies to aspirin, chew one tablet of regular smoking, hypertension (high 325 mg. aspirin.This can help immediately by preventing or delaying blood pressure), elevated LDL further accumulation of blood clot in the arteries of the heart. In the cholesterol (the "bad" choles- emergency room, you can be given powerful clot dissolving medica- terol; less than 100 is optimal), tions or, if the facilities are available, emergency coronary angioplasty low HDL cholesterol (the "good" (a means of re-opening a blocked artery using a small balloon at the cholesterol; 60 or more is opti- tip of a catheter) can be performed.These procedures can prevent an mal), diabetes, male gender, impending heart attack or reduce the size of a heart attack that has post-menopausal women, family already started, thus reducing significantly the risk of dying as well history of premature coronary as the risk of future complications. heart disease, the presence of peripheral arterial occlusive dis- Remember, emergency coronary angioplasty is only effective if the ease, and, last but not least, blocked coronary artery causing the heart attack can be opened obesity and physical inactivity. within the first few (preferably less than three) hours of the onset of chest discomfort. The presence of multiple risk factors results in more than just Do not delay in getting to the ERI additive risk.