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Low density lipoprotein or LDL is the bad cholesterol that adds to plaque development alongside triglycerides, which is another lipid. High density lipoprotein or HDL is the good cholesterol that diminishes plaque development. Plaque can hinder the blood supply to the heart, brain, legs or kidneys, leading to heart attacks, stroke or even death. To lower the cholesterol for a younger heart, you may follow the below steps:
- Reduced fats: Do without greasy meats such as bologna, salami, pepperoni and wieners; and greasy red meats such as ribs and prime cuts of hamburger, pork, veal or sheep. Likewise, you must abstain from skip skin on chicken or turkey. Stay away from full-fat dairy items including whole grain, cheese, cream, cream cheese and spread. These food items contain saturated fat and cholesterol. Both are connected with higher blood cholesterol and plaque development.
- Intake fiber: In particular, get used to food items which are high in dissolvable fiber. In the gut, dissolvable fiber can provide bulk to the bile and easily expel it from the body. Search for dissolvable fiber in oats, oat wheat, ground flaxseed, psyllium, grain, leafy vegetables, in addition to some whole grain oats.
- Go veggie: Pick no less than one meatless meal for every week. Substitute animal protein (meat, poultry, eggs, cheddar) for plant-based protein such as beans, lentils, tofu or quinoa. Consume these plant-based proteins with a plate of mixed greens, soup, panfry, or a burrito.
- Be aware of carbs: Following a low-carb eating routine can help you get in shape and decrease cardiovascular hazards. Pick high fiber sugars like oats, whole grain, starches, beans, lentils, and organic products, which will give you the energy you require, apart from keeping you feeling full.
- Lose some weight: In case you are overweight or stout, shed the additional pounds. Weight reduction brings down the LDL levels. Reducing even 10 to 20 pounds can have a positive effect.
- Move more: Do an hour and a half of cardiovascular exercise every day for an ideal heart wellbeing and weight reduction. Cardiovascular exercise implies any action that uses muscles in an efficient way and builds the heart rate. Strolling, cycling, paddling and swimming can be helpful. In case you discover an hour and a half overwhelming, begin with 30 minutes and work your way up a little at once. For a few people, 45 minutes to an hour of cardiovascular practice is sufficient.
- Pick the correct rhythm: Go for a direct level of work out. You will know you have achieved it when you can bear on a discussion when you work out, yet cannot sing. High intensity workout is better at raising HDL levels. However, it additionally expands your danger of wounds, making it difficult to keep working out.
A heart disease is definitely something, which is serious. In most cases, it is the result of a person’s lack of prudence when it comes to staying fit and moderating what food items feature in the diet. But is this always the case? Well, not at all. Genetic or hereditary heart diseases, such as hypertrophic cardiomyopathy, long QT syndrome, very high cholesterol levels running in the family and many others, provide enough reason as to why not.
This is because a person cannot be blamed for a hereditary heart disease as the reason why this occurs is on account of the genetic makeup. So, the best way for one to know, if there is a risk of this sort of disease is to take a look at the family history with respect to the disease.
- Keep a record: One of the ways by which a person can get to know if there is a risk of a hereditary heart disease is by finding out, if a condition known as arrhythmia is prevalent in the family. This is a condition in which the heart has an irregular heart beat and can be potentially lethal. Other things which are to be watched out for include, but are not limited to, a track record of members in the family who have faced a heart failure at a young age, especially prior to them reaching the age of 50.
- Watch out for signs: It is not always true that the signs of hereditary heart diseases pertain to the heart. If a person has fainted or has had seizures, and an effective treatment could not be performed by making use of the normal medicines, which would generally be used in these circumstances, it could be taken as a sign of presence of hereditary heart disease.
- Get tested: To know if there is a risk of a hereditary heart disease, it is important that a person gets genetically tested. This is to be done so that the gene analysis can provide details as to which hereditary heart diseases a person has, along with the other members of the family. There are various tests for things such as HCM, ARVD and Marfan syndrome.
Apart from this, undergoing genetic counselling is also considered important. This is to keep a check on the worries of having a sudden heart attack as well as the concerns one may have about passing the genes relating to the heart disease to one’s offspring. This is one of the most necessary, but underrated things when it comes to dealing with a hereditary heart disease.
Heart ablation or cardiac ablation is a procedure done to treat irregular heartbeats or arrhythmias. It is performed by an interventional cardiologist, a doctor who specialises in doing procedures for heart problems and it involves threading long wires called catheters through a blood vessel into your heart. The irregular heartbeats is treated by delivering an electrical pulse using electrodes to specific areas of your heart.
A normal heart beats at a steady rate, but sometimes, your heart may beat too quickly, too slowly, or unevenly. These heart rhythm problems are called arrhythmias and one of the treatments for this heart problem is cardiac ablation. Other treatment modalities are medications and changes in lifestyle. Heart ablation is prescribed when the other treatments fail. Arrhythmias mostly happen in older people and in people who suffer from other heart problems like cardiomyopathy.
Here are answers to most frequently asked questions related to ablation
Who will benefit from heart ablation?
The beneficiaries include people who
- Suffer from arrhythmias that don’t respond to medicines
- Suffer from side effects from arrhythmia medicines
- Suffer from a specific kind of arrhythmia that respond very well to cardiac ablation
- Are at a high risk for cardiac arrest or other complications which can be fatal
Cardiac ablation is very helpful for patients who have certain kinds of arrhythmias like atrial fibrillation and ventricular tachycardia, which cause fast heartbeats.
How to prepare for cardiac ablation?
You will have to undergo extensive tests to record your heart’s electrical activity and rhythm. Your doctor will ask and record whether you have any other disease like high BP and diabetes.
If you are a woman and pregnant, you must not get this procedure done as it involves radiation. You will not be allowed to eat or drink anything after midnight, the night before the procedure.
How is heart ablation done?
Heart ablations are done in a special room known as an electrophysiology laboratory. It usually takes three to six hours and is usually done under general anaesthesia or local anaesthesia with sedation.
The catheters are threaded either from your neck, groyne or arm into your heart. Your cardiologist also injects a special contrast dye to help him see areas of abnormal muscle in your heart. He then uses a catheter with an electrode at the tip to give radiofrequency energy to the weak heart muscle to correct your irregular heartbeat.
You may have to stay overnight after the procedure.
- Blood clots
- Damage to heart valves or arteries
- The build-up of fluid around your heart
- Heart attack
Inflammation of sac surrounding your heart or pericarditis You will have to be monitored regularly after ablation to check for problems in your heart beats. If you wish to discuss about any specific problem, you can consult a Cardiologist.
Blood pressure readings above 140/90 are classified as hypertension or high blood pressure. Hypertension causes straining of blood vessels and an interruption in the blood flow. There are no specific symptoms, but prolonged hypertension can lead to a heart stroke.
Listed below are a few ways to reduce high blood pressure:
- Limit your salt intake: The sodium content in salt disrupts the balance of fluids in your body, leading to high blood pressure. To avert hypertension, cut down on your daily salt intake to a maximum of one tablespoon.
- Indulge in physical exercise: If you are suffering from pre-hypertension (mild hypertension), it can be avoided or controlled by engaging in physical exercise such as brisk walk, swimming or playing a sport. Exercising regularly can lower blood pressure levels by 5 mmHg (millimetres of mercury).
- Bask in the sun: Exposure to sunlight alters the nitric oxide levels in your blood which leads to reduction in blood pressure. Thus, soaking up the sun can prove to be a great way to avoid a stroke in future.
- Add ginger and cardamom to your diet: The two spices, ginger and cardamom, provide required warmth to your body and help in stabilising the circulation of blood in your body and help in bringing down blood pressure levels.
- Add more green vegetables to your diet: Green vegetables, preferably the leafy ones, are rich in nutrients such as magnesium, iron and folate which help in maintaining the blood circulation that is essential for combating high blood pressure.
- Switch to decaf coffee: If you can’t give up coffee entirely, switch to decaf beverages as caffeine is responsible for tightening your blood vessels which leads to increased stress and blood pressure levels.
- Start drinking tea: Herbals teas such as chamomile, ginger, green tea and hibiscus tea contain herbal properties which soothe your blood vessels and nourish the blood flow. Herbal teas also help in hydration and rejuvenation of fluids in your body.
- Update your playlist: Music is proven to be therapeutic and updating your playlist with soothing Sufi, Celtic or Instrumental tunes can help you relax your mind and combat stress related blood pressure spikes. If you wish to discuss about any specific problem, you can consult a cardiologist.
Causes and symptoms of Cardiac Arrest, Heart Failure and Heart Attack
Aortic valve stenosis is a heart condition in which the valve to the biggest artery- the one which provides oxygen-rich blood to our body, called aorta, is narrowed. This prevents the valve from opening fully, obstructing the blood flow from your heart into your body.
When the aortic valve doesn’t open, your heart needs to work harder to pump blood to your body making the heart muscle weak. If left undiagnosed aortic stenosis is fatal.
These symptoms should spur you on to seek medical care right away:
Chest pain or tightness
Feeling faint with exertion
Fatigue after increased activity
Heart palpitations — rapid, fluttering heartbeat
The disorder doesn’t produce symptoms right away and is usually diagnosed during routine physical exams when your doctor listens to your heart with a stethoscope. He usually hears a heart murmur resulting from turbulent blood flow through the narrowed aortic valve.
There are other ways to diagnose aortic valve stenosis and gauge the severity of the problem, like:
Echocardiogram – This produces an image of your heart using sound. It is the primary test to diagnose a heart valve problem. Sound waves are directed at your heart here and these bounce off your heart and are processed electronically to provide images of your heart. This test helps your doctor check diagnose aortic valve stenosis and its severity plus chalk out a treatment plan.
Electrocardiogram (ECG) – In this test, patches with electrodes are attached to your chest to measure electrical impulses given out by your heart. These are then recorded as waves on a monitor and printed on paper. Though this can’t diagnose aortic stenosis directly, it can tell you that the left ventricle in your heart is thickened which normally happens due to aortic stenosis.
Chest X-ray – This allows the doctor to see the shape and size of your heart directly. If the left ventricle is thickened, it points to aortic stenosis. It also helps doctor check the lungs. Aortic stenosis leads to fluid and blood in the lungs, causing congestion.
Exercise Tests – Exercise is used to increase your heart rate and make your heart work harder. This test is done to see how your heart reacts to exertion.
Computerised Tomography (CT) Scan – This means a series of X-rays to create images of your heart and observes the heart valves. It is also used to measure the size of aorta and the aortic valve.
Magnetic Resonance Imaging (MRI) – This uses powerful magnets and radio waves to create images of your heart and valves.
Once aortic valve stenosis is confirmed, you may have to go in for monitoring or heart valve surgery according to your doctor’s advice.
Our heart is basically a muscle. So when this muscle weakens the heart is unable to do its function i.e., to pump blood throughout our body and keep us alive.
The heart muscle gets progressively weak due to a disease called cardiomyopathy.
There are different types of cardiomyopathy caused by different causes. Untreated cardiomyopathy can lead to heart failure or early death. Treatment can’t cure the condition but can give you extra healthy years of life and prevent serious complications.
Cardiomyopathy has 4 main types, they are:
Dilated Cardiomyopathy: This is the most common form and its principal cause is that your heart muscle becomes too weak to pump blood. The heart muscles stretch and become thinner in this case leading to the four chambers of the heart to expand causing a pathology called an enlarged heart.
Hypertrophic Cardiomyopathy: This happens due to genetics. It occurs when the walls of your heart thicken and prevent the flow of blood through this natural pump.
Arrhythmogenic Right Ventricular Dysplasia: This is a rare form of cardiomyopathy. It causes sudden deaths of athletes and is caused when fat and fibrous tissues replace muscle in the right ventricle of the heart.
Restrictive Cardiomyopathy: This is the least common form of the disease. The cause is the stiffening of the ventricles, the part of the blood which receives blood. When these stiffen, the heart doesn’t get enough blood to oxygenate. Scarring of the heart due to heart disease and a heart transplant operation can be a cause of this stiffening.
Ischemic Cardiomyopathy: Ischemic cardiomyopathy is caused due to coronary artery disease which causes blood vessels supplying blood to the heart to become narrow. The heart doesn’t get enough oxygen and a person can die due to a heart attack.
Other types of cardiomyopathy are grouped into this category and can include:
Left ventricular noncompaction happens when the left ventricle has trabeculations, projections of muscle inside the ventricle.
Peripartum cardiomyopathy, another form of the disease can occur during or after pregnancy. This is a form of dilated cardiomyopathy and can be fatal. There’s no documented cause.
Alcoholic cardiomyopathy is caused due to alcoholism causing an enlargement of the heart.
Takotsubo cardiomyopathy, or broken heart syndrome, happens when extreme stress leads to heart muscle failure. Though rare, this condition is more common in post-menopausal women.
Doctors will decide the treatment after finding out the extent of damage due to cardiomyopathy.
Few people will not require treatment till symptoms like chest pain, dizziness, shortness of breath and edema appear.
Others whose life is affected due to symptoms are treated with lifestyle changes and medicines. The bad news is that cardiomyopathy can’t be cured but can only be managed and controlled by doing the following:
Exercise is also crucial to keep the heart healthy and maintain a healthy weight through regular bouts of low-intensity exercise.
Medications for high blood pressure will be prescribed to prevent water retention, keep the heart beating normally, prevent blood clots and reduce inflammation.
Pacemakers and defibrillators can be implanted.
Surgery like heart transplant can be done as a last resort. If you wish to discuss about any specific problem, you can consult a homeopath.
The results of a study conducted by the Department of Medicine, University of Ulsan, Korea, show that multivessel coronary stenting can be performed with a high success rate along with an acceptable clinical outcome. Coronary stenting has proven itself to be an accepted means for treating of obstructed coronary arteries. The need for multivessel coronary stenting has been inflated because of the larger number of patients with unfavourable cardiac profiles. Conventionally, bypass surgery is regarded as a standard means for relieving angina in cardiac patients with multivessel coronary disease as it could lead to a downright revascularization. Further, it also allows a prolongation of lifespan in a specified subgroup of patients.
How are they performed: Despite the coming of modern generation of stents, patients with multiple stringent arteries in the heart receiving coronary after bypass have recovered better than those whose arteries were grafted with balloon angioplasty or stenting. This report is presented in the 64th Annual Scientific Session in the American College of Cardiology. This report echoes past studies which shows that patients afflicted with multiple narrowed arteries receive better results with coronary artery bypass grafting, which is also known as CABG or bypass heart surgery. In case of multivessel stenting, which is known as angioplasty or percutaneous coronary intervention or PCI, a stent is put within the arteries to hold it wide open and facilitate the flow of blood.
Which one is better: In a new study, it is reported that patients with new stents are susceptible to 47% higher risk of any of the outcomes like death or cardiac arrest as compared to patients who undergo bypass surgery. In CABG, a vein or artery from other parts of the body is grafted on the constricted coronary artery for allowing easy blood flow to and from heart. This study reinforces present regulations that recommend CABG to treat patients with substantial constrictions in various arteries, a condition often termed as multivessel coronary artery ailment.
Renowned cardiologist Seung Jung Park from Asan Medical Centre in Seoul, South Korea opines that CABG is still a much preferred option on the basis of their medical data. Another study known as Bypass Surgery Versus Everolimus - Eluting Stent Implantation for Multivessel Coronary Artery Disease or BEST trial deserves mention. It is one of the two randomly controlled trials for comparing bypass to angioplasty since the introduction of modernised stents that emits medication, which would prevent blood clot.
This study was implemented on 880 patients at 27 healthcare centres in four countries. Each patient had multivessel coronary artery disease and were determined to be equally eligible to go through either of the methods. Half of these patients were randomly chosen to be given angioplasty with everolimus-eluting stents, and the other half received bypass surgery.
All the patients were tracked for about five years and during this prolonged follow up, angioplasty was related to a considerable upsurge in the incidence of myocardial infarction, target vessel revascularization and often death. Because, it is a more invasive process, bypass surgery is normally recommended only for patients afflicted with higher-risk constrictions in more than one artery.
If you are one of these patients and this concern plagues you, it is recommended to talk to a cardiologist without much delay.
My mother is suffering with Large ASD (4.3 CMS) She is 55 years old. All the tests are done (Anjo, Cath study and TEE). Finally doctor is said need surgery. So pls kindly suggest which Surgery is best (Surgery or Device)
Hello sir good afternoon I wanna know about Dyspnea disease what is it? And is there any treatment of it? My friend is suffering from this problem. She is Gasping from doing a little thing .so please tell me sir this is serious problem or it may be solve from some treatment. Please suggest me sir. And also tell which type of diet we should follow for her. Thanks.
Hello.my mother has slight pain in her heels. .and some of the doctors said that this can be a reason for clotting. .which may lead to heart problems. Is there any real serious issues related to this? As she frequently suffers from this pain, or there might be some other reasons. Please reply as soon as possible. Thankyou.
I am a patient of high cholesterol since last 10 years ,which is the best diet to be healthier with less medication and average fitness routine.
You feel your heart begin to beat wildly in your chest as you break into a cold sweat and have trouble catching your breath; is this a heart attack or panic attack? Your first thought is that it's a heart attack since you have an impending feeling of doom which you may even have felt before your attack began. This makes your heart beat even faster and you become so overwhelmed that the feeling gets even worse until you begin to feel light-headed or maybe even pass out. This is a panic attack.
When you suffer from anxiety, the slightest thing can trigger a panic attack and some can be so intense that you can't imagine it being anything other than looming death. It's very common for those having an anxiety attack to mistake it for a heart attack and this fear is enough to just take over and really wreak havoc on your heart rate, but no matter how fast your heart beats or how panicked you feel; you are not having a heart attack and this episode will not kill you.
One thing that will prove helpful in dealing with this is learning the differences between the two:
Signs of a Heart Attack:
Pressure in the Chest (described as feeling like there is an elephant sitting on your chest).
Chest pain - note that this is not always present.
Pain in the right arm.
Pain in the back or shoulder blades for women.
Nausea or vomiting.
Panic attack symptoms include:
Increased heart rate.
Sharp or stabbing chest pain that lasts only 5 to 10 seconds.
Pain that is localized to one small area.
Pain that usually occurs at rest.
Pain that accompanies anxiety.
Pain that is relieved or worsened when you change positions.
Pain that can be reproduced or worsened by pressing over the area of pain.
The bottom line: Be vigilant and get checked out promptly.
Heart disease doesn't affect all women in the same way and neither does it have the same warning signs as heart diseases in men. For women, heart disease is a bigger threat than breast cancer. Cardiovascular diseases also kill more women than men as the disease progresses differently in men and women. Here are a few things you should know about heart diseases.
Women have more atypical symptoms of heart attacks: The classic symptoms of heart attacks are pain in the left arm, chest pain and heart palpitations. Though women may exhibit these symptoms, they are more likely to have atypical symptoms. These include nausea, stomach aches, pain in the shoulders and upper back and extreme fatigue.
Preeclampsia and gestational diabetes can increase risks of heart disease: Even though your blood pressure may go back to normal and conditions like preeclampsia or gestational diabetes may go away post pregnancy, their effects linger on. The risk of heart disease for a woman who suffered from preeclampsia doubles while gestational diabetes can cause glucose intolerance leading to obesity or other such conditions which are risk factors for heart diseases.
Hot flashes could be a sign of heart problems: Hot flashes are usually associated with menopause but may also be a symptom of underlying heart problems. Hot flashes that occur after a exerting a strenuous effort on something can be a sign of angina in women.
Men and women do not face equal risks: Traditional risks to heart diseases such as cholesterol, obesity and high blood pressure affect both men and women but some factors such as diabetes, stress, depression and smoking affect women more than they affect men. Since women tend to lead a more sedentary lifestyle than men, a lack of exercise also affects them more than it affects men. In addition, a low level of estrogen can also increase the risk of cardiovascular conditions. This is usually seen after menopause.
Metabolic syndrome increase your risk of getting a stroke:
There are five metabolic risk factors for heart disease. If you have 3 or more of them, it is termed as metabolic syndrome. These risk factors are:
- A waist circumference of more than 35". This is also called abdominal obesity
- A triglyceride level higher than 150 mg/dL
- A low level of good cholesterol i.e. HDL cholesterol that is less than 50mg/dL
- High blood pressure
- High blood sugar. This could also be a sign of diabetes.
While some factors like genetics are out of our control, most of these factors can be controlled by conscious lifestyle changes. Your doctor may also prescribe medication for the same. Heart disease can occur at any time so do not take your heart for granted.
Heart Blocks are a result of plaque buildup in your arteries, which blocks blood flow and circulation to the heart, causing heart muscle damage and heightens the risk for heart attack and stroke.
Arteries which have smooth and elastic walls become thick and restrict blood flow from the cholesterol deposits over the years. Blood clots can also block the arteries that supply oxygen rich blood to the heart. These can eventually lead to strokes and heart attacks.
Some warning signs that you may be at risk of heart blockage:
- Have you had a mild stroke: Plaque that accumulates in the carotid artery supplying oxygen rich blood to the brain can cause a stroke. People who have had strokes are more prone to heart attacks.
- Do you often feel fatigue and dizziness: Reduced oxygen from poor circulation and blood flow can result in fatigue and tiredness as well as dizziness.
- Experiencing shortness of breath: Poor blood flow can lead to shortness of breath from even mild forms of exercise or even from carrying out daily chores or walking.
- Sudden chest pain: Chest pain or angina result from reduced supply of blood to the heart. It can be felt as pressure, tightness in the chest, squeezing in the chest, numbness or burning.
- Unexplained lower back pain: This can result from pressure in the spine as a result of pinched nerves due to compressed vertebrae discs as a result of poor blood flow.
- Erectile dysfunction in men: If an erection becomes difficult or impossible, it could be a warning sign of clogged arteries. These arteries supply blood to the pelvis area and help achieve an erection.
- Calf pain: Blocked leg arteries can cause calf pain, especially in smokers . THis is an early sign of possible heart blocks.
- Painful, numb and cold hands and feet: Plaque build up in the arteries of the extremities can cause numbness and coldness in the hands and feet.
Remember early detection is the key to prevent or delay heart attacks.
The word acute coronary syndrome refers to a group of symptoms that are caused by blockage of the blood flow to the heart muscles. The most common result of this is myocardial infarction or heart attack as it is popularly called. Reduced blood flow leads to death of some portion of the heart muscle wall. While the word heart attack sounds almost fatal, it need not be the case. Knowing how to identify an attack and being aware of some simple measures can help save lives.
The tell tale signs of a heart attack are as follows:
- Chest pain and discomfort usually described as a tightness or burning in the chest region
- Pain along the left side of the shoulder and neck, going up into the jaw, down to the arm
- Nausea and vomiting
- Profuse sweating
- Difficulty breathing
- Dizzy or fuzzy feeling
- Tired, extreme fatigue
- Anxious, apprehensive feeling
However, be also aware that there are a lot of people who experience a silent heart attack. Women, obese, elderly, and diabetic patients can have silent attacks and depending on severity, either they go on with life as usual or can have a fatal attack.
Once you are doubtful of a heart attack, the next step is to reach the closest medical facility for a diagnosis. In addition to a detailed examination and history, the following two tests will be performed.
- Electrocardiogram (ECG): A 12-lead ECG will measure electrical activity of the heart and identify irregular electrical activity, which is indicative of a myocardial infarction.
- Blood tests: Presence of certain enzymes in the blood, CK-MB and troponin are indicative of a heart attack. A complete electrolyte profile also will be done, and increase or decrease of some electrolytes is helpful in diagnosing a heart attack.
- In addition to these two, chest radiography, cardiac angiography, echocardiogram, stress test, and computed coronary tomography may also be required to confirm the diagnosis.
Once diagnosed, the first step would be to relieve the symptoms, negate the effects of reduced blood flow, and restore cardiac function.
- Dissolve the clot: Using thrombolytics like clopidogrel
- Nitroglycerin: To dilate the blood vessels and improve blood flow, especially to the heart muscles
- Anticoagulant therapy: Blood thinners are usually used to avoid blood clot formation; aspirin and heparin are the most commonly used agents.
- Drug therapy: Blood pressure maintaining drugs like beta blockers and/or angiotensin-converting enzyme (ACE) inhibitors are also used
- Use of Statins: Statins are used to reduce the amount of cholesterol in the blood and stabilize plaque deposits.
In very severe cases, angioplasty and stenting or coronary bypass surgery may be required. Educating people on how to identify a heart attack and manage it is very useful and can help save lives.
The commonest refrain, when we advise a patient, about exercise is " lack of Time".
You do not have to spend lot of time for exercise. Instead if you just follow, the "Rule of Four", you can keep your heart healthy after a heart attack>
What is Rule of Four:
Four Times a Week: You must exercise atleast four days of week.
Forty min at a time: You must exercise atleast forty minutes in a session.
Four Kms distance: To be heart healthy, you must conver 4 kms in those forty minutes.
So, you need not complain about lack of time, for not doing the exercise. Even if you follow this simple "Rule of Four", you can keep your heart healthy.