A cardiology technician at Naval Hospital Pensacola reviews an echocardiogram during a patient’s visit to NHP’s Cardiology Clinic Feb. 13. The hospital’s cardiology clinic evaluates patients with chest pain to rule out or confirm heart disease (Photo by: Navy Petty Officer 1st Class James Stenberg).

A Moderate Diet is Key

A balanced diet of moderation works best, noted Davenport. Weight management is a part of life, and caloric control with portion control should be a daily habit.

“Simply ensure you are not eating more than your metabolic needs – for most this is 1,500 to 2,000 calories a day”.

The American Heart Association recommends aiming for a diet that does not exceed 5% to 6% of calories from saturated fat. For example, if you need about 2,000 calories a day, no more than 120 of them should come from saturated fat, which is about 13 grams per day.

And although not every aspect of achieving a healthy heart is in our control, experts estimate that about 70% of clinical outcomes come from lifestyle choices and about 30% from genetics, Symons noted.

“Eating a healthy diet, getting enough exercise, getting enough sleep, maintaining a healthy weight, and avoiding tobacco use are the biggest variables service members have in their control,” he added. “Additional variables that the health care system can help with include controlling blood pressure, blood sugar, and lipid levels with medications if needed if lifestyle choices alone are insufficient.”

Heart disease in service members

Compared to the general population, military service members tend to be in better physical shape, said Symons. “The stress associated with active duty and combat in particular is speculated to possibly put military service members at higher risk over time of developing hypertension, and out of that becoming more at risk of cardiovascular disease, but the linkage is uncertain.”

However, working to achieve and maintain a healthy heart is particularly relevant to pilots since certain heart conditions that don’t get noticed on land can become symptomatic in the air due to pressure from high mental and physical demands pilots face when performing high-risk maneuvers, said Davenport.

“Aviators in particular are held to a higher standard of fitness and readiness as the complex mission sets they are expected to perform with are felt to require a higher level of fitness and readiness than the average service member,” said Symons.

In high-performance flight, for example, pilots must also be able to sustain sudden changes in pressure and altitude at speeds approaching or exceeding the speed of sound and gravitational forces up to nine times the normal pull (9Gs), said Davenport. “Modern military aircraft and now space flight push the limits of human physiology so much that any decrease in normal physiology could be detrimental.”

As a result, performing duties in flight involves paying attention to multiple complex cognitive inputs simultaneously, said Symons. “We want our aviators concentrating on their specific tasks.”

There are certain cardiac conditions such as arrhythmia – irregular heartbeat – or heart failure that do not lead to sudden incapacitation but may still lead to a decrease in performance of aircrew duties, thus decreasing safety of flight, said Davenport.

Atrial fibrillation, a type of arrhythmia, occurs when the two upper chambers of your heart experience chaotic electrical signals, said Symons. “It tends to cause palpitations, which can be distracting, and in rare cases, disabling.”

Symons, who is also chief of the Cardiac Electrophysiology Laboratory at WRNMMC, explained atrial fibrillation tends to originate in the pulmonary veins, which plug into the back of the left atrium of the heart. “Atrial fibrillation ablation [AFIB] involves creating a line of electrical block around where the veins plug into the back of the left atrium to discourage the pulmonary vein triggers from being able to escape into the left atrium and encourage atrial fibrillation.”

A balanced diet of moderation that doesn’t exceed 5% to 6% of calories from saturated fats works best to keep a healthy heart (Photo by: Army Capt. Jessica George, Fort Drum Garrison Public Affairs).

The procedure helps aviators by “walling off the common triggers in the pulmonary vein sleeves, modifying ganglionic plexi (nerves), which live in fat pads on the outside of the heart, and reducing the available surface area for wavelets of re-entry to organize and persist,” said Symons. In short, it disrupts the faulty electrical signals that cause the arrhythmia in the first place.

For pilots and aviators, “these lifestyle changes not only prevent sudden death but optimize our ability to fly, fight, and win,” said Davenport. “Before we can be the strongest Air Force, we must be the healthiest.”

Recognizing the signs

Though heart disease may present with obvious symptoms, such as chest pain or pressure, it can be more subtle, noted Symons. Shortness of breath with or without exertion, leg swelling, palpitations, lightheadedness, passing out, are also common signs of possible heart disease, Symons added.

Service members should pay attention to obvious symptoms such as chest pain and/or pressure and shortness of breath with exertion as well as be cognizant of getting tired easily or a sudden decrease in energy, said Davenport. For example, he said, some aircrew experienced symptoms while exercising, or after they completed a physical training test, marathon, or triathlon.

Some were discovered to have a major blockage in an artery. However, because they took action to take care of themselves, they were able to correct their high blood pressure or high cholesterol levels to continue their careers, he said. “In fact, over 90% are asymptomatic and were allowed to fly again.”

Personnel with a genetic history of heart disease do not escape their genetics, however, by making lifestyle choices to hinder heart disease they do not die or become disabled from it, like their family members might have.

Additionally, life stressors can negatively impact heart health by contributing to high blood pressure. So, focusing on a holistic health approach that includes joy, integrity, and social interaction will result in decreased inflammation and a longer life expectancy, ensuring a higher-quality life.

“Our three core values in the Air Force are integrity, service before self, and excellence in all we do,” said Davenport. “Just living out our core values is a great way to stay heart healthy.”