Summer Tips for Patients with CAD

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Summer can be a challenging time for patients affected with Cardio-vascular Diseases (CVDs) as high temperatures and humidity greatly stress the cardiovascular system and can prove particularly challenging for patients with Coronary Artery Disease (CAD), the leading killer amongst the CVDs. This risk is amplified for those with comorbid conditions, such as diabetes.

Summer temperatures can be challenging even for younger adults without cardiovascular issues, while patients with pre-existing conditions, such as CAD, are at a significant risk of possible medical emergencies due to their body’s compromised ability to cope with hot weather. Studies have shown that exposure to high temperatures results in an increase in daily hospitalisation rates for CAD sufferers and that periods of especially high temperatures (heat waves) lead to higher CAD-related mortality [1,2]. Furthermore, certain studies have shown a more direct correlation between the negative effects of high temperatures (i.e. heat stroke) and cardiovascular health – individuals with a history of heat stroke are at a greater risk for CAD [3].

General Guidelines for CAD Patients

Patients with CAD and most other CVDs in general should avoid exposure to high temperatures whenever possible or at least undertake steps to minimize the negative effects on their bodies – i.e. keep cool by whatever means possible, drink plenty of fluids, eat light etc. We have compiled a handy list of tips and recommendations that you can convey to your patients on how to best prepare for summer months if you have CAD.

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Tips to convey to your patients with CAD to keep them safe during the summer:

  • Avoid strenuous physical activity in hot weather. This goes without saying, but patients should not be discouraged to exercise as it has many benefits, besides those linked directly to CAD. Suggest exercising (or doing chores outside the house) in the mornings or evenings, when temperatures are usually lower,
  • Keep your home cool. Patients with CAD or other CVDs should maintain cool residence, either through air conditioning or by opening the windows and doors in the mornings and evenings,
  • If you have to travel by car or other mode of transportation, start in the morning or evening. Temperatures are usually lower then and there is lower temperature difference between outside and the vehicle’s air-conditioned cabin,
  • Educate your patients about possible side effects of medications for CAD. Beta blockers slow the heartbeat, limiting the heart’s ability to circulate blood fast enough to provide adequate heat exchange in hot conditions. There are also other medications for treating non-cardiovascular issues that can cause issues. Some antidepressants and antihistamines interfere with perspiration, thus elevating the risk of heat exhaustion and heat stroke,
  • Drink adequate amounts of fluids. Patients should be instructed to drink more fluids than usually (in comparison with periods of temperate temperatures), particularly if they are older (over 65 years of age) since the elderly have an altered thirst sense [4],
  • Avoid alcohol and caffeine. These can both amplify already present dehydration,
  • Eat light. Patients, not just those with CAD or other CVDs, should eat light, cold foods such as salads and fruits (unless the patient is also diabetic), which also contribute to hydration, and avoid fatty, high-calorie dishes,
  • Wear light, loose-fitting clothes. For easier cooling, and
  • Stock up on medications. Talk to your patients about their supplies of medications, especially if they are going on holidays abroad, as the particular medications they are prescribed might not be available there.

Special Care for Patients with CAD and Diabetes

Diabetes comes with its own set of hot weather-related challenges in addition to those already connected with CAD. But, they both overlap on the need for adequate fluid intake with the distinction that dehydration has a worse effect on diabetics as it disturbs the blood glucose levels.

Additional recommendations for patients with diabetes and CAD:

  • Keep insulin, glucagon kits and insulin pumps cool. High temperatures can damage sensitive equipment and/or render the medication unusable,
  • Test blood sugar level more frequently. Loss of fluids through perspiration disturbs the blood glucose level necessitating more frequent testing,
  • Take special care of feet. For some patients walking around in shoes that offer inadequate protection or even barefoot might be tempting in hot weather, but you should warn them about the possibility of skin injury and subsequent infections, and
  • Take extra care of wounds. Patients with diabetic foot ulcers should be instructed to change bandages more frequently as they are usually rendered dirty faster in hot weather (sweat, possible dirt from outdoor activities etc.) than would normally be the case.
THE EFFECT OF DIABETES ON ABI

References:

[1] https://heart.bmj.com/content/104/8/673

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786924/

[3] https://www.ejinme.com/article/S0953-6205(18)30387-X/pdf

[4] https://www.ncbi.nlm.nih.gov/pubmed/11528342