Heart and Vascular Clinics

04/12/2024

Good morning!

Today our Manhattan office is closed due to the final stage of our renovation. We will be open again on Monday. Please call 785-539-4644 if you need to reach a staff member.

12/18/2023

Peripheral artery disease (also called peripheral arterial disease) is a common condition in which narrowed arteries reduce blood flow to the arms or legs.

In peripheral artery disease (PAD), the legs or arms — usually the legs — don't receive enough blood flow to keep up with demand. This may cause leg pain when walking (claudication) and other symptoms.

Peripheral artery disease is usually a sign of a buildup of fatty deposits in the arteries (atherosclerosis). Atherosclerosis causes narrowing of the arteries that can reduce blood flow in the legs and, sometimes, the arms.

Peripheral artery disease treatment includes exercising, eating a healthy diet and not smoking or using to***co.

Symptoms:
Many people with peripheral artery disease have mild or no symptoms. Some people have leg pain when walking (claudication).

Claudication symptoms include muscle pain or cramping in the legs or arms that begins during exercise and ends with rest. The pain is most commonly felt in the calf. The pain ranges from mild to severe. Severe leg pain may make it hard to walk or do other types of physical activity.

Other peripheral artery disease symptoms may include:

-Coldness in the lower leg or foot, especially when compared with the other side
-Leg numbness or weakness
-No pulse or a weak pulse in the legs or feet
-Painful cramping in one or both of the hips, thighs or calf muscles after certain activities, such as walking or climbing stairs
-Shiny skin on the legs
-Skin color changes on the legs
-Slower growth of the toenails
-Sores on the toes, feet or legs that won't heal
-Pain when using the arms, such as aching and cramping when knitting, writing or doing other manual tasks
-Erectile dysfunction
-Hair loss or slower hair growth on the legs

If peripheral artery disease gets worse, pain may occur during rest or when lying down. The pain may interrupt sleep. Hanging the legs over the edge of the bed or walking may temporarily relieve the pain.

When to see a doctor:
Call your health care provider if you have leg pain, numbness or other symptoms of peripheral artery disease.

Causes:
Peripheral artery disease is often caused by a buildup of fatty, cholesterol-containing deposits (plaques) on artery walls. This process is called atherosclerosis. It reduces blood flow through the arteries.

Atherosclerosis affects arteries throughout the body. When it occurs in the arteries supplying blood to the limbs, it causes peripheral artery disease.

Less common causes of peripheral artery disease include:

-Blood vessel inflammation
-Injury to the arms or legs
-Changes in the muscles or ligaments
-Radiation exposure

Risk factors:
Smoking or having diabetes greatly increases the risk of developing peripheral artery disease.Other things that increase the risk of peripheral artery disease include:

-A family history of peripheral artery disease, heart disease or stroke
-High blood pressure
-High cholesterol
-High levels of an amino acid called homocysteine, which increase the risk for coronary artery disease
-Increasing age, especially after 65 (or after 50 if you have risk factors for atherosclerosis)
-Obesity (a body mass index over 30)

Complications:
Complications of peripheral artery disease caused by atherosclerosis include:

Critical limb ischemia. In this condition, an injury or infection causes tissue to die. Symptoms include open sores on the limbs that don't heal. Treatment may include amputation of the affected limb.

Stroke and heart attack. Plaque buildup in the arteries can also affect the blood vessels in the heart and brain.

Prevention:
The best way to prevent leg pain due to peripheral artery disease is to maintain a healthy lifestyle. That means:

-Don't smoke.
-Control blood sugar.
-Eat foods that are low in saturated fat.
-Get regular exercise — but check with your care provider about what type and how much is best for you.
-Maintain a healthy weight.
-Manage blood pressure and cholesterol.

Learn more about this common blood flow condition that can cause leg pain when walking. Lifestyle changes and medications can help.

12/06/2023

High blood pressure may be experienced as a couple:

Middle-aged and older heterosexual men and women may be more likely to have high blood pressure if their spouse or partner has it, too, according to a large international study.
The study, published Wednesday in the Journal of the American Heart Association, showed that in up to nearly half of older couples in the United States, England, China and India both had high blood pressure, also known as hypertension. The findings highlight the potential for couples-based approaches to hypertension screening and management, researchers said.

"Many people know that high blood pressure is common in middle-aged and older adults, yet we were surprised to find that among many older couples, both husband and wife had high blood pressure," the study's senior author, Dr. Chihua Li, said in a news release. Li is a postdoctoral fellow at the University of Michigan. "For instance, in the U.S., among more than 35% of couples who were ages 50 or older, both had high blood pressure."
Nearly half of all adults in the U.S. have high blood pressure, according to American Heart Association statistics.
Prior studies conducted in small, regional or single-country settings have shown couples may mirror each other's blood pressure status and other diseases. But the new study is the first to look at couples in multiple high- and middle-income countries, co-author Dr. Jithin Sam Varghese said in the release. Varghese is an assistant research professor at the Emory Global Diabetes Research Center at Emory University in Atlanta.

"We wanted to find out if many married couples who often have the same interests, living environment, lifestyle habits and health outcomes may also share high blood pressure," he said.
In the study, researchers analyzed blood pressure measurements for 3,989 couples in the U.S., 1,086 English couples, 6,514 Chinese couples and 22,389 Indian couples. Couples were married or described themselves as partnered and living in the same household. Blood pressure measurements were taken at a single point in time.

Among English couples, the prevalence of both partners having high blood pressure was 47%, compared to nearly 38% of U.S. couples, 21% of Chinese couples and 20% of Indian couples.
But although high blood pressure is more common in the U.S. and England than in China and India, the connection between couples' blood pressure status was stronger in China and India. Compared to women married to men without high blood pressure, women whose husbands had high blood pressure were 9% more likely to have it themselves in the U.S. and England, yet they were 19% more likely in India and 26% more likely in China. The findings were similar for men married to women with and without high blood pressure.

Cultural factors could play a role in the mirrored blood pressure results, study co-author Dr. Peiyi Lu said in the release. Lu is a postdoctoral fellow in epidemiology at Columbia University Mailman School of Public Health in New York City. "In China and India, there's a strong belief in sticking together as a family, so couples might influence each other's health more," Lu said. "In collectivist societies in China and India, couples are expected to depend (on) and support each other, emotionally and instrumentally, so health may be more closely entwined."
Dr. Bethany Barone Gibbs, chair of the department of epidemiology and biostatistics at the School of Public Health at West Virginia University in Morgantown, said the findings suggest that current approaches for controlling hypertension on an individual level may not be adequate. Barone Gibbs, who was not involved with the new research, led the writing panel for a 2021 AHA scientific statement about physical activity's role in managing blood pressure and cholesterol.

Making lifestyle changes, such as increasing physical activity, reducing stress or eating healthier, "may be difficult to achieve and, more importantly, sustain if your spouse or partner are not making changes with you," she said in the release.

If one person in a heterosexual couple has high blood pressure, the other may be more likely to also have the condition, new research suggests.

11/30/2023

Cardiomyopathy

What is cardiomyopathy in adults?
Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. The various types of the disease have many causes, signs and symptoms as well as treatments. In most cases, cardiomyopathy causes the heart muscle to become enlarged, thick or rigid. In rare instances, diseased heart muscle tissue is replaced with scar tissue.

As cardiomyopathy worsens, the heart becomes weaker. The heart becomes less able to pump blood throughout the body and incapable of maintaining a normal electrical rhythm. The result can be heart failure or irregular heartbeats called arrhythmias. A weakened heart also can cause other complications, such as heart valve problems.

The main types of cardiomyopathy are:
-Dilated cardiomyopathy
-Hypertrophic cardiomyopathy
-Restrictive cardiomyopathy
-Arrhythmogenic right ventricular dysplasia
-Transthyretin amyloid cardiomyopathy (ATTR-CM)

Some other types of cardiomyopathy are called “unclassified cardiomyopathy.” Another type is “stress-induced cardiomyopathy,” also known as broken heart syndrome.

Cardiomyopathy can be “acquired” when it develops due to another disease, condition or factor. Or cardiomyopathy can be “inherited” when the gene for the disease is passed on from a parent.

In many cases, the cause of cardiomyopathy isn’t known. This is often the case when it occurs in children.

Cardiomyopathy affects all ages, although certain age groups are more likely to have certain types of cardiomyopathy.

Approaches to treatment
Some cases of cardiomyopathy have no signs or symptoms and need no treatment. In other cases, cardiomyopathy develops quickly with severe symptoms, and serious complications occur. Treatment is required in these instances.

Treatments include lifestyle changes, medications, surgery, implanted devices to correct arrhythmias and other nonsurgical procedures. These treatments can control symptoms, reduce complications and prevent the disease from worsening.

The American Heart Association explains the different types of cardiomyopathy and the causes, signs and symptoms, and treatments of these various diseases of the heart muscle.

11/28/2023

Aortic Aneurysm

What is an aneurysm?
An aneurysm occurs when part of an artery wall weakens, allowing it to abnormally balloon out or widen. The causes of aneurysms are sometimes unknown. Some people are born with them. They can also be hereditary. Aortic disease or an injury may also cause an aneurysm.

An aneurysm occurs when part of an artery wall weakens, allowing it to abnormally balloon out or widen.

The causes of aneurysms are sometimes unknown. Some people are born with them. They can also be hereditary. Aortic disease or an injury may also cause an aneurysm.

A family history of aneurysm may increase your risk for developing an aneurysm. Other risk factors include high blood pressure, high cholesterol and to***co use.

Aneurysms can occur in any artery, but the most common are:

-Aortic aneurysm occurs in the main artery carrying blood from the heart to the body.

-Cerebral aneurysm occurs in an artery of the brain.

-Popliteal artery aneurysm occurs in the artery behind the knee.

-Mesenteric artery aneurysm occurs in the artery that supplies blood to the intestine.

-Splenic artery aneurysm occurs in an artery of the spleen.

Symptoms and diagnosis
Aneurysms can develop over many years and often have no symptoms.

If an aneurysm expands quickly or ruptures, symptoms can vary based on the location and may develop suddenly. Depending on the site of the aneurysm, symptoms can include:

-Headache
-Pain in abdomen or back
-Pulsating abdominal mass
-Blue coloration (cyanosis) of lower extremities
-Dizziness
-Vision changes
-Confusion
-Fatigue
-Hoarseness
-Difficulty swallowing
-High-pitched breathing sound
-Swelling in the neck
-Chest or upper back pain
-Nausea and vomiting
-Sense of impending doom
-Shock (low blood pressure, rapid heart rate, clammy skin, decreased awareness)

Your doctor can use an angiogram, CT scan or ultrasound test to diagnose an aneurysm.

Treatment and prevention:
An aneurysm can become a medical emergency. Call 911 or your local emergency number and seek immediate medical attention if you or someone you know is having aneurysm signs and symptoms.

If you’ve been diagnosed with an unruptured aneurysm, work with your doctor to monitor any changes to the aneurysm. Your condition may require regular checkups depending on the aneurysm’s size and location.

Some aneurysms may require surgery to reinforce the artery wall with a stent. When the aneurysm has ballooned out the side of the blood vessel, a clip or coiling procedure may close off the area.

The American Heart Association explains that an aneurysm occurs when part of an artery wall weakens, allowing it to widen abnormally or balloon out. Some common aneurysms are aortic and cerebral aneurysms.

11/22/2023

Wishing you all a wonderful Thanksgiving Day tomorrow!

11/20/2023

Ideas for keeping Thanksgiving healthy – and happy

The turkey is roasting in the oven. The pies are cooling on the counter. And you may be telling yourself, "Thanksgiving Day is no time to be overly rigid about what I'm eating."

Health experts say – you might have a point.

"I don't want people overthinking their relationship with food during Thanksgiving, when the holiday should be about friends, families, being thankful and counting our blessings," said Dr. Colleen Spees, an associate professor of medical dietetics at Ohio State University College of Medicine in Columbus.

Holidays tend to bring out all-or-nothing attitudes about eating, said Krystal Dunham, a registered dietitian nutritionist in Tulsa, Oklahoma. People are either "YOLO! It's the holidays! I'm going to let all the rules go!" or "It's the holidays, and I'm not touching anything unless it's celery."

"And I think there's a way to exist in the middle," Dunham said.

That middle ground allows for enjoyment, peace of mind and health, she and Spees said. And while some people, including those with diet-related medical conditions such as diabetes, might require more thoughtful planning, everyone can make simple, healthy last-minute choices that enhance the day.

Among their suggestions:

Don't skip breakfast

Eating to prevent overeating might seem counterintuitive, but starving yourself in the morning can lead to trouble later.

"A lot of people get into a habit on holidays of saving room for a big meal," Dunham said. "But a lot of times when we're doing that, we're showing up to a meal over-hungry. So, then we end up eating past the point of comfort, and we're miserable for the rest of the evening."

A simple breakfast – a bowl of cereal or oatmeal with some fruit, or granola and low-fat or nonfat yogurt high in protein – "helps us make more intentional decisions throughout the day," she said.

Think ahead about how you'll eat …

Most of us know what to expect from our family's traditional meals, Spees said. So have a plan for the hurdles. Visualize filling your plate with whole grains and colorful fruits and vegetables, she suggested, as recommended by the American Heart Association and in the federal Dietary Guidelines for Americans.

The basics of healthy eating are the same regardless of the day, Dunham said. Fruits, vegetables and whole grains are full of fiber, which helps regulate blood sugar and has other heart-healthy qualities. "And fiber usually helps us feel fuller a little bit longer," she added.

… and drink

Alcohol can be one of the biggest holiday challenges for adults, Spees said. Once people start drinking, "their inhibitions go out the door, often along with health behaviors."

If drinking is typically part of your holiday celebration, pace yourself by diluting spirits or making wine spritzers, Spees suggested. Instead of downing consecutive cocktails, alternate by drinking water with a little lime in between. You can also try a mocktail, she said, or just fill your glass with unsweetened sparkling water or iced tea. (The federal dietary guidelines say that people who don't drink shouldn't start and that drinking less is better for health than drinking more.)

Don't trick yourself

When it's time to carve the turkey, many prefer white meat because it has less fat.

"People think, 'Oh, I'm choosing a healthy option,' and then they throw gravy all over it," adding saturated fat and sodium, Spees said.

So, keep your focus on the whole plate, Spees emphasized, and keep portions reasonable. You can leave room for a taste of traditional Thanksgiving foods that are salty and fatty, especially if that's outside your usual routine.

"It's OK to have a few bites," Spees said. "You don't need a huge serving."

Room for dessert?

The same thinking applies to dessert, Spees said. If you're going to have pie, make it a small piece, and go easy on the whipped cream. Or opt for fresh fruit instead.

Dunham said it's possible to enjoy desserts without going overboard. But holiday meals highlight another aspect of healthy eating, she said, that goes beyond physical nourishment.

"Cultural foods and traditions are really important," she said. "And I think sometimes cultural foods nourish our bodies and souls just as much as foods do physically."

So, when the sweet potato pie comes around, she'll be having a slice. "It's a Thanksgiving thing for me," she said.

It's one day out of the year, Dunham said. "It's not going to make or break any of the progress that I've made in my health thus far."

Make movement part of the plan

Physical activity, even a little bit, is a good idea any day. It can lower cholesterol and blood pressure, help maintain a healthy weight and lower your risk of having a heart attack or stroke.

A little group exercise can shift the day's focus in a fun and healthy way, Spees said. "It really prioritizes what Thanksgiving is about, versus the food."

So, take a walk around the block with grandma, or go play with the kids in the backyard, Spees suggested.

Or try dancing, Dunham said. "Our family had a 'Soul Train' line last year."

Remember what you're there for

Little choices do matter to health over time, Dunham said. And understanding carbohydrates, proteins and fats are all important for daily meals.

But holiday meals are more, she said. "I think joy is a great component to a plate, especially when it comes to Thanksgiving," Dunham said. And meals that serve up a side of joy "are going to be meals that are going to be filling and satisfying, regardless."

Spees also will be thinking beyond the kitchen.

"Enjoy the day," she said. "Focus on your relationships with people. Life is short. Enjoy the day."

These tips from experts will keep your holiday on the healthy side – and leave room for some indulgence.

11/16/2023

11/08/2023

What is a Heart Attack?

A heart attack is scary. If you’ve had one, or are close to someone who has, you’re not alone. Many people survive a heart attack and go on to enjoy productive lives.

As you work toward recovery, the frequently asked questions below can help you better understand what’s happened, and how your heart can heal. Knowledge is power. So use this information to live healthier and longer.

Your heart muscle needs oxygen to survive. A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely.

This happens when coronary arteries that supply the heart muscle with blood flow become narrowed from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis.

When plaque within a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the artery to the heart muscle.

Ischemia is a condition in which the blood flow (and thus oxygen) is restricted or reduced in a part of the body. Cardiac ischemia is decreased blood flow and oxygen to the heart muscle. When damage or death to part of the heart muscle occurs due to ischemia, it’s called a heart attack, or myocardial infarction (MI).

About every 40 seconds, someone in the United States has a heart attack.

Why didn’t I have any warning?
The process of atherosclerosis may have no symptoms in its early stages. But when an artery is narrowed by over 70%, muscle pain or cramps may occur when tissue needs more oxygen than it’s able to receive.

When a coronary artery narrows and constricts blood flow, other nearby blood vessels that serve the heart sometimes expand to compensate, which may explain why there may be no warning signs.

Such a network of expanded nearby blood vessels is called collateral circulation, and it helps protect some people from heart attacks by delivering needed blood to the heart. Collateral circulation can also develop after a heart attack to help the heart muscle recover.

Is my heart permanently damaged?
When a heart attack occurs, the heart muscle that has lost blood supply begins to suffer injury. The amount of damage to the heart muscle depends on the size of the area supplied by the blocked artery and the time between injury and treatment.

Heart muscle damaged by a heart attack heals by forming scar tissue. It usually takes several weeks for your heart muscle to heal. The length of time depends on the extent of your injury and your rate of healing.

The heart is a tough organ. Even though part of it may have been severely injured, the rest of the heart keeps working. But, because of the damage, your heart may be weakened, and unable to pump as much blood as usual.

With proper treatment and lifestyle changes after a heart attack, further damage can be limited or prevented.

How long will it take to recover from my heart attack?
Talk to your health care professional about your recovery time. Heart attacks can have longer or shorter recoveries and complications. It depends on the size and location of the damage and treatment of your heart attack.

In the damaged area, scar tissue may form and doesn’t contract or pump as well as healthy muscle tissue. As a result, the extent of damage to the heart muscle can affect how well the heart pumps blood throughout the body.

How much pumping function is lost depends on the size and location of the scar tissue. Most heart attack survivors have some degree of coronary artery disease (CAD) and will have to make important lifestyle changes and possibly take medication to prevent a future heart attack. Taking these steps can help you lead a full, productive life.

Is all chest pain a heart attack?
No. But if you have chest pain or discomfort, see a health care professional right away. One common type of chest pain is called angina. It’s a recurring discomfort that usually lasts only a few minutes. Angina occurs when your heart muscle doesn’t get the blood supply and oxygen that it needs and is a signal that you’re at higher risk of having a heart attack.

The difference between angina and a heart attack is that angina attacks don’t permanently damage the heart muscle.

Different types of angina include:
-Stable angina, or angina pectoris. It often occurs during exercise or emotional stress when your heart rate and blood pressure increase, and your heart muscle needs more oxygen. Learn more about stable angina.

-Unstable angina. One of several acute coronary syndromes, it occurs while you’re resting or sleeping, or with little physical exertion. It comes as a surprise. Unstable angina can lead to a heart attack and it should be treated as an emergency. Learn more about unstable angina.

What are different medical terms for a heart attack?
Acute coronary syndrome (ACS): The umbrella term is for situations in which the blood supplied to the heart muscle is suddenly blocked. Learn more about ACS.

STEMI: A common name for ST-elevation myocardial infarction, it's caused by a complete blockage in a coronary artery.

NSTEMI: A non-ST-elevation myocardial infarction is when an artery is partially blocked and severely reduces blood flow.

Myocardial infarction (MI): It occurs when an area of the heart muscle (myocardium) is damaged or dies after blood supply is blocked. It’s the classic medical term for a heart attack.

Coronary thrombosis: It occurs when a clot is formed in one of the arteries that supply blood to the heart muscle. It's also called coronary occlusion.

Coronary occlusion: An obstruction of a coronary artery that hinders blood flow to some part of the heart muscle and can cause a heart attack.

Are there other causes of heart attack besides blockage?
Sometimes a coronary artery temporarily contracts or goes into spasm. When this happens, the artery narrows and blood flow to part of the heart muscle decreases or stops.

A spasm can occur in normal-appearing blood vessels as well as in vessels partly blocked by atherosclerosis. A severe spasm can cause a heart attack.

Another rare cause of heart attack is spontaneous coronary artery dissection (SCAD), which is a spontaneous tearing of the coronary artery wall.

How is a heart attack different from cardiac arrest?
People often use these terms to mean the same thing, but they describe different events.

A heart attack is when blood flow to the heart is blocked. It’s a circulation problem.

With sudden cardiac arrest (SCA), the heart malfunctions and suddenly stops beating. Sudden cardiac arrest is an electrical problem caused by irregular heart rhythms called arrhythmias. A common and potentially deadly arrhythmia is ventricular fibrillation. This happens when the heart’s lower chambers suddenly start beating chaotically and don’t pump blood.

A heart attack can cause ventricular fibrillation, which in turn can cause sudden cardiac arrest. Death can occur within minutes after the heart stops.

Cardiac arrest may be reversed if CPR (cardiopulmonary resuscitation) is performed and a defibrillator is used within minutes to shock the heart and restore a normal heart rhythm.

What is a heart attack? The American Heart Association explains myocardial infarction, also called heart attack.

11/06/2023

Emergency Treatment of Cardiac Arrest:

Cardiac arrest can strike without warning:
Do you suspect someone is experiencing cardiac arrest? The signs are:

-Sudden loss of responsiveness – The person doesn’t respond, even if you tap them hard on the shoulders or ask loudly if they're OK. The person doesn’t move, speak, blink or otherwise react.

-No normal breathing – The person isn’t breathing or is only gasping for air.

What to do:
If you think the person may be suffering cardiac arrest and you're a trained lay rescuer:

-Ensure scene safety.

-Check for response.

-Shout for help. Tell someone nearby to call 911 or your emergency response number. Ask that person or another bystander to bring you an AED (automated external defibrillator), if there’s one on hand. Tell them to hurry – time is critical. If you’re alone with an adult who has signs of cardiac arrest, call 911 and get an AED (if one is available).

-Check for no breathing or only gasping. If the person isn’t breathing or is only gasping, begin CPR with compressions.

-Begin high quality CPR. Push down at least two inches in the center of the chest at a rate of 100 to 120 pushes a minute. Allow the chest to come back up to its normal position after each push.

-Use an AED. As soon as it arrives, turn it on and follow the prompts.

-Continue CPR. Administer it until the person starts to breathe or move, or until someone with more advanced training, such as an EMS team member, takes over.

Cardiac arrest strikes immediately and without warning. Here are the warning signs.

11/02/2023

How to Stay Active in Cold Weather:

When winter blows in, you can pull the blankets over your head and go back to sleep—or you can suit up and head out for an outdoor winter adventure! The American Heart Association offers these tips for working out in the cold of winter.

There’s no reason you need to take a break from physical activity when the temperature drops. In fact, exercising in cooler weather has some distinct advantages over working out in warmer weather.

Tips to Keep in Mind:

1. No heat and humidity to deal with. Winter’s chill might even make you feel awake and invigorated.

2. You may be able to work out longer in cold weather—which means you can burn even more calories.

3. It’s a great way to take in the sunlight (in small doses). Not only can light improve many people’s moods, it also helps you get some vitamin D.

4. Exercise boosts your immunity during cold and flu season. Just a few minutes a day can help prevent simple bacterial and viral infections, according to the Centers for Disease Control and Prevention.

Try these outdoor activities:
-Brisk walking or hiking
-Jogging or running
-Raking leaves
-Shoveling snow
-Ice skating
-Sledding
-Cross-country skiing
-Snowshoeing

Stay Warm, Stay Safe:
Staying warm and dry when heading out to exercise in cold weather is all about layers. A little preparation can keep you safe from cold weather hazards like hypothermia and frostbite.

Cold temperatures, strong winds and damp conditions (like rain and snow) steal your body heat. For example, according to the National Weather Service, a 30-degree day with 30-mile-an-hour wind feels like about 15 degrees. And if you get wet (from rain, snow or perspiration) that effect is only magnified. That’s why layers of clothing are so important. They help trap the heat and form a kind of insulation against the elements.

Resist your instinct to start layering with cotton. Once cotton becomes wet with sweat or snow, the moisture is trapped and will actually make you feel colder (and heavier). For your first layer, you want something that pulls moisture away from your skin, like the moisture-wicking fabrics used in high-performance sportswear. Next, add a layer of fleece; finally, top with a thin waterproof layer.

Know the Signs:
Hypothermia means the body temperature has fallen below 35 degrees Celsius or about 95 degrees Fahrenheit. It occurs when your body can't produce enough energy to keep the internal body temperature warm enough. It can kill you.

Symptoms can include:
-lack of coordination
-mental confusion
-slowed reactions
-slurred speech
-cold feet and hands
-shivering
-sleepiness

Children and the elderly may be at more risk because they may have limited ability to communicate or impaired mobility. Elderly people may also have lower subcutaneous fat and a diminished ability to sense temperature, so they can suffer hypothermia without knowing they're in danger.

Stay Hydrated:
Don’t forget to drink water when exercising in cooler weather. Thirst isn’t the best indicator that you need to drink.

Bye-Bye, Couch Potato!
If the winter weather prevents you from getting outside, don’t just reach for the remote. Make your time inside count. There are many ways to get physical activity indoors—no gym required. Hand weights or resistance bands are a great addition, but not necessary. You can also wear a heavy backpack to add intensity to your workout.

Try these indoor activities:
-Home workout circuit
-Dancing
-Active housework like vacuuming and sweeping
-Mall walking
-Bowling
-Roller skating
-Yoga or other fun group classes at your local gym, studio, or community center
-Stair climbing

What if I’m recovering from a cardiac event or stroke?
Some people are afraid to exercise after a heart attack. But regular physical activity can help reduce your chances of having another heart attack.

The AHA published a statement in 2014 that doctors should prescribe exercise to stroke patients since there is strong evidence that physical activity and exercise after stroke can improve cardiovascular fitness, walking ability and upper arm strength.

If you’ve had a heart attack or stroke, talk with your doctor before starting any exercise to be sure you’re following a safe, effective physical activity program.

When winter blows in, you can pull the blankets over your head and go back to sleep&mdash.