Constipation and heart attack risk. Is this me?

[John_Anon]

I am a white male, age 55.  I move my bowels daily, but I frequently must strain a bit to do so.  Can I be said to be constipated?  And, if so, is this the kind of constipation that increases the risk of a heart attack?  I have elevated blood pressure (~135/90) and am concerned that any straining increases my risk of a heart attack.  I have read various definitions of constipation; none of which appear to apply to me (I move my bowels daily, which is much more frequently than "less than 3 times a week" and I don't strain to the point that I cause any tearing or otherwise have any chronic conditions that affect my bowel movements, such as hemorrhoids).

Thanks

[ed34]

Hi John,  I think it might be worth starting with the real basics. There are a lot of websites which help with this. For example, if you put stool colour into google and run a search, it will show several sites which let you see if your stool colour gives any clues. This can also be done for the consistancy. I don't know if you have been on anti biotics but even those can cause problems because the friendly bacteria in your gut is severely reduced and we rely on their symbiotic relationship to help us to digest foods properly. Always eliminate the simple first and if you cannot find a solution then I would have a chat with your Doctor. As I said in my first post, the most common cause for constipation is lack of fluids. Your body desperately draws in every drop of moisture from your stools in the bowel and leaves the stool difficult to pass.

[erijon]

Sorry, I did not mean to put words in your mouth, I am familiar with both maneuvers, but a  valsalva maneuver is not associated with an increase in blood pressure or a decrease low enough to cause cardiac arrest. The physiology of the maneuver are as follows;

1.Initial pressure rise: On application of expiratory force, pressure rises inside the chest forcing blood out of the pulmonary circulation into the left atrium. This causes a mild rise in stroke volume.

2.Reduced venous return and compensation: Return of systemic blood to the heart is impeded by the pressure inside the chest. The output of the heart is reduced and stroke volume falls. This occurs from 5 to about 14 seconds in the illustration. The fall in stroke volume reflexively causes blood vessels to constrict with some rise in pressure (15 to 20 seconds). This compensation can be quite marked with pressure returning to near or even above normal, but the cardiac output and blood flow to the body remains low. During this time the pulse rate increases.

3.Pressure release: The pressure on the chest is released, allowing the pulmonary vessels and the aorta to re-expand causing a further initial slight fall in stroke volume (20 to 23 seconds) due to decreased left ventricular return and increased aortic volume, respectively. Venous blood can once more enter the chest and the heart, cardiac output begins to increase.

4.Return of cardiac output: Blood return to the heart is enhanced by the effect of entry of blood which had been dammed back, causing a rapid increase in cardiac output (24 seconds on). The stroke volume usually rises above normal before returning to a normal level. With return of blood pressure, the pulse rate returns towards normal.

At no time during this process does BP increase beyond an individuals normal levels. It does however cause a drop in systolic pressure which cause the sensation of passing out.

Whereas,  stimulation of the vagus causes slowing of the heart rate and, if sufficient, can cause fainting or even cardiac arrest. Usually, when this happens, the heart's ventricles start beating on their own despite continued vagal stimulation. It is this response that is associated with the risk of cardiac arrest upon straining and not merely passing out.

Anyways, my apologies.

Jon

[skydnsr]

With all due respect, I meant valsalva, but thanks for the info about vasovagal episode.  Two different phenomena, but your additonal input is valuable.

[kenkeith]

John_Anon.  The link worked for me I just tried it. Sorry for any inconvenience.

Thanks skymaster.  Better said than my response.  We agree on the risk for a heart patient in the same matter heavy lifting can cause Valsalva maneuver and a heart event risk.

For some insight: When a Valsalva maneuver occurs, the blood flow in these veins are actually diminished greatly. With exercise involving straining, blood return to heart is minimal and therefore oxygenated blood leaving the heart is also minimal, which causes a lack of oxygenated blood flow to the brain. This can produce dizziness, spots before the eyes, and even fainting. Blood pressure is also altered during the Valsalva maneuver. With the onset of a Valsalva maneuver, at the start of a lift, blood pressure rises abruptly as the chest cavity pressure increases. This can be dangerous for individuals who have been diagnosed with a heart illness or are being treated for high blood pressure

[erijon]

Actually, what I think skydnsr is referring to is a vasovagal episode or vasovagal response or vasovagal attack. This is the same response you get when you cough or laugh enough that it makes you almost pass out. In people with vasovagal episodes, the episodes are typically recurrent, usually happening when the person is exposed to a specific trigger. The initial episode often occurs when the person is a teenager, then recurs in clusters throughout his or her life. Prior to losing consciousness, the individual frequently experiences symptoms such as lightheadedness, nausea, sweating, ringing in the ears (tinnitus), uncomfortable feeling in the heart, weakness and visual disturbances such as lights seeming too bright, fuzzy or tunnel vision. These last for at least a few seconds before consciousness is lost (if it is lost), which typically happens when the person is sitting up or standing. When sufferers pass out, they fall down (unless this is impeded); and when in this position, effective blood flow to the brain is immediately restored, allowing the person to wake up. Abdominal pressure or bearing down on your abdominal muscle is a common trigger.

This sensation closely mimics a heart attack as it is causing the same basic response by the same nerve bundle that is affected by a heart attack.

The Valsalva maneuver or Valsalva manoeuvre is performed by forcible exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut. Variations of the maneuver can be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart, or to "clear" the ears and sinuses (that is, to equalize pressure between them) when ambient pressure changes, as in diving, hyperbaric oxygen therapy, or aviation.

Keep in mind that any activity that causes an increase in blood pressure is a risk for causing a vulnerable plaque to rupture due to the increase in force of the blood moving in your arteries.

I hope this helps,

Jon

[skydnsr]

In my opinion, and with all due respect, it's not whether your bowel habits meet some particular definition of constipation that is the issue.  It's whether you are straining at stool.  Look up Valsalva maneuver or Valsalva phenomenon.  It is the Valsalva that induces cardiovascular risk.  (Legend has it that this is what happened to Elvis.)  If you are unlucky enough to have a heart attack or stroke while straining on the toilet, it won't matter if you strain every day or just once in your lifetime.  But straining at stool and having a Valsalva won't make you suffer a catastrophic event in your heart or brain, unless your cardiovascular system is in bad shape from other problems such as plaque.  So what you want to do is keep healthy all around.  And if you are straining at stool on any kind of regular basis, then whether you meet formal criteria for constipation or not, and whether your cardiovascular system is healthy or not, you probably are not getting enough fiber in your diet.  Insufficient fiber leads to other problems such obesity and bowel disease, even if you never have a heart attack or a stroke.

[John_Anon]

Thanks for the response.  

I don't know what kenkeith's problem is.  He gives me two links, neither of which have ANYTHING to do with my questions and then points to archives as if I haven't already searched there.  Oh, well, this is the internet, after all.

My diet is fairly regular and I think I am getting plenty of roughage.  I really haven't explored avenues for curing my "constipation", because I'm still investigating whether it satisfies the definition at all, and even if it does, whether the type I have increases a risk, such as for a heart attack or a stroke.

[kenkeith]

Beyond the scope of the question.  Interesting, but this is the heart forum.  Are you constipated or something?  If you are there is a more appropriate forum.  You can search the archives for the information, you are looking for.

[ed34]

How is your diet? do you drink enough fluids and eat enough roughage? Exercise is also a major factor with bowel movement which is why it's such a huge problem with patients in hospitals. Laying in bed for days, patients soon become blocked and a sister told me that the most common drug prescribed in my local hospital is gentle laxative. Stress can also lead to bowel problems among other things, but I was just wondering what avenues you have explored already. Your blood pressure is on the borderline of becoming high (mild) so you should keep it monitored. Exercise again can help improve blood pressure.

[kenkeith]

Sorry they didn't get into the subject of your interest.  Constipation can be extremely dangerous for those who don't  know that they have high blood pressure. The problem to force stool out can prolong a strain that will naturally cause the blood pressure to shoot up which might trigger a stroke or heart attack.

For more detail, http://biolife.wordpress.com/2007/04/29/10-things-about-the-killer-constipation-that-ive-learned/

[John_Anon]

Thanks for the link, but it seems that particular discussion is about headaches brought on by bowel movements more than anything else.  I don't have or get a headache from or after my bowel movements.

I'm interested in knowing what the technical definition of "constipation" is when discussing the increased risk, if any, related to heart attacks.  

Thanks

[kenkeith]

I have given you a link to a thread that is comprehensive on the subject of interest.. ttp://www.medhelp.org/posts/Migraines--Headaches/intense-headache-with-bowel-movement/show/546656