EVERYTHING ABOUT

heart health

Every week I am posting about  everything you need to know about hormones. This weeks topic is about heart health.

Did you know …

  • The heart is the hardest working muscle in the body
  • The average heart is the size of an adult fist.
  • Your heart will beat about 115,000 times each day.
  • The beating sound your heart makes is caused by the opening and closing of its valves.
  • Each day, your heart pumps about 2,000 gallons of blood.
  • If you were to stretch out your blood vessel system, it would extend over 60,000 miles.
  • The human heart weighs less than 1 pound, but a man’s heart is typically 2 ounces heavier than a woman’s.
  • A woman’s heart beats slightly faster than a man’s.
  • An electrical system controls the rhythm of your heart. It’s called the cardiac conduction system and is measured on an ECG – electro cardio gram
  • The heart can continue beating even when it’s disconnected from the body.
  • The first open-heart surgery occurred in 1893, performed by Daniel Hale Williams, who was one of the few black cardiologists in the United States at the time.
  • The first implantable pacemaker was used in 1958. Arne Larsson, who received the pacemaker, lived longer than the surgeon who implanted it. Larsson died at 86 of a disease that was unrelated to his heart.
  • The youngest person to receive heart surgery was only a minute old.
  • The earliest known case of heart disease was identified in the remains of a 3,500-year-old Egyptian mummy.
  • The fairy fly, which is a kind of wasp, has the smallest heart of any living creature.
  • The American pygmy shrew, the smallest mammal, with the fastest heartbeat at 1,200 beats per minute.
  • Whales have the largest heart of any mammal.
  • The giraffe has a lopsided heart, with their left ventricle being thicker than the right, because the left side has to get blood up the giraffe’s long neck to reach their brain.
  • Most heart attacks happen on a Monday.
  • Christmas day is the most common day of the year for heart attacks to happen.
  • It’s possible to have a broken heart, it’s called broken heart syndrome and can have similar symptoms as a heart attack. The difference is that a heart attack is from heart disease and broken heart syndrome is caused by a rush of stress hormones from an emotional or physical stress event.
  • Death from a broken heart, or broken heart syndrome, is possible but extremely rare.
  • Heart cancer is extremely rare as heart cells stop dividing at a very early age
  • Yet heart disease is the No. 1 cause of death worldwide

Meet Sally and get to know all about heart health

Intro heart health

Risk factors for CVD

Heartbeats

Tips for a strong heart

Heart 101

  • Is the muscle that pumps blood throughout your body.
  • Every time your heart beats, it is pumping blood.
  • The heart muscle is divided into four compartments or chambers

– 2 on the left side

– 2 on the right side

  • the upper chamber on each side is called an atrium, which receives and collects blood
  • the lower chamber on each side is called a ventricle which pumps blood out.
  • the right ventricle pumps blood only to the lungs
  • the left ventricle pumps blood to all parts of the body except the lungs.
  • There are 4 valves that control the flow of blood inside the heart working like one-way doors keeping the blood moving in one direction.
  • When the heart beats, the valves close to keep the blood from flowing backward.
  • Oxygen-poor blood that returns from the body collects in the right atrium
  • It passes through the tricuspid valve into the right ventricle, which pumps it through the pulmonic valve into the lungs, where it picks up fresh oxygen.
  • Oxygen-rich blood coming from the lungs flows into the left atrium then through the mitral valve into the left ventricle to be pumped through the aortic valve into the aorta the main artery and from there to all the other arteries in the body.
  • The heart’s electrical system provides the power to keep your heart pumping.
  • Electrical impulses start in an area known as the heart’s natural pacemaker,
  • The natural pacemaker is a specialized group of cells in the wall of the right atrium called the sinoatrial node (SA node) spontaneously produce electrical impulses that travel through the heart’s conduction system to make it contract regularly.
  • The impulses trigger timed contractions, which coordinate the flow of blood between the four chambers.
  • If the heart’s electrical system gets out of sync, cardiac arrhythmia can occur, which feel like palpatations.
  • The electrical system can be measured and monitored via and ECG – electro cardio gram
  • The hearts own blood vessels called coronary arteries wrap around the outside of the heart muscle and keep it supplied with oxygen-rich blood.

Blood Vessels 101

  • Blood vessels are responsible for distributing nutrients, minerals and oxygen your body needs to function properly
  • There are five classes of blood vessels

– arteries and arterioles which form the arterial system

– veins and venules which form the venous system

– capillaries which are the smallest bloods vessels, linking arterioles and venules through networks within organs and tissues

  • Aside from capillaries, blood vessels are all made of 3 layers

– The adventitia or outer layer composed of connective tissue / collagen, which provides structural support and shape to the vessel

– The tunica media or a middle layer composed of elastic and muscular tissue which regulates the internal diameter of the vessel

– The tunic intima or an inner layer consisting of an endothelial lining, an exceedingly thin single sheet of endothelial cells, which provides a frictionless pathway for the movement of blood.

  • A 4th layer – Endothelial cells are covered with a protection layer. The Endothelial Glycocalyx – EGCX, a microscopically thin, negatively charged, gel‐like, sugar mesh coating that “blankets” the endothelium, providing a nonadherent shield of protection. Damage to endothelial cells first happens after the EGCX is damaged
  • The amounts of connective tissue and smooth muscle in the vessel wall vary according to the vessel’s diameter and function, but the endothelial lining is always present.
  • In the finest branches of the vascular tree, the capillaries their walls consist of nothing but endothelial cells
  • Endothelial cells line all blood vessels and regulates exchanges between the bloodstream and the surrounding tissues.
  • Signals from endothelial cells organize the growth and development of connective tissue cells that form the surrounding layers of the blood-vessel wall.
  • New blood vessels can develop from the walls of existing small vessels by the outgrowth of endothelial cells, which have the capacity to form hollow capillary tubes.
  • Which makes the endothelial cells very important

Diagnosing CVD

CVD can be due to various causes making testing essential

Various tests and markers

ECGs

  • An electrocardiogram (ECG) is one of the simplest and fastest tests used to evaluate heart health.
  • Natural electrical impulses coordinate contractions of the different parts of the heart to keep blood flowing the way it should.
  • An ECG records these impulses to show how fast the heart is beating, the rhythm of the heart beats (steady or irregular), and the strength and timing of the electrical impulses as they move through the different parts of the heart.
  • Changes in an ECG can be a sign of many heart-related conditions.

Cardiac stress tests

  • Measures the heart’s ability to respond to an external stress, such as exercise
  • Cardiac stress tests compare the coronary circulation while the patient is at rest with the circulation during maximum cardiac exertion
  • Showing any abnormal blood flow to the myocardium (heart muscle tissue).
  • The results can be interpreted as a reflection on the general physical condition of the test patient.
  • Can be used to diagnose CAD also known as ischemic heart disease and or assess patient prognosis after a myocardial infarction (heart attack).

Nuclear stress test / radionuclide tests

  • uses a small amount of radioactive material (tracer) and an imaging machine, such as a PET scanner to create pictures showing the blood flow to your heart.
  • The test measures blood flow while you are at rest and during activity, showing areas with poor blood flow or damage in your heart.
  • May be done after a regular exercise stress test to get more information about your heart, or it may be the first stress test used.

Coronary Angiogram

  • Is a procedure that uses X-ray imaging to see your heart’s blood vessels – the coronary arteries
  • Will show any restriction in blood flow going to the heart.
  • During a coronary angiogram, a type of dye that’s visible by an X-ray machine is injected into the blood vessels of your heart.
  • The X-ray machine rapidly takes a series of images (angiograms), offering a look at your blood vessels.
  • If necessary, your doctor can open clogged heart arteries (angioplasty) during your coronary angiogram.

Electrophysiology procedure EP

  • Also called invasive cardiac electrophysiology, is a series of tests that examine your heart’s electrical activity
  • The heart’s electrical system produces signals (impulses) that control the timing of your heartbeats.
  • During an EP study, doctors can create a very detailed map of how these signals move between each heartbeat.
  • An EP study can help determine the cause of heart rhythm problems (arrhythmias), such as bad electrical pathways.
  • Performed in a hospital by heart doctors (cardiologists) with special training in heart rhythm disorders (electrophysiologists).

Echocardiogram

  • Checks the structure of the heart and surrounding blood vessels, analysing how blood flows through them and assessing the pumping chambers of the heart.
  • Can help detect damage from a heart attack, heart failure,

congenital heart disease, problems with the heart valves, such as endocarditis (infection), cardiomyopathy thickening of the walls of the heart

Cardiac MRI

  • detect or monitor cardiac disease by evaluating the anatomy and function of the heart chambers, heart valves, size of and blood flow through major vessels, and the surrounding structures such as the pericardium (the sac that surrounds the heart)

Cardiac CT or CAC – Coronary Artery Calcium score

  • Used to find calcium deposits in coronary arteries.
  • An effective way to spot atherosclerosis before symptoms develop
  • The more coronary calcium you have, the more coronary atherosclerosis you have increasing risk of future cardiovascular problems.

Coronary CT Angiogram (CCTA)

  • A heart imaging test that gives a more detailed picture of the coronary arteries
  • Helps determine if plaque build-up has narrowed the coronary arteries
  • An iodine-containing contrast material is injected intravenously (IV) to ensure the best possible images of the heart blood vessels.

CIMT – Carotid Intima-Media Thickness test

  • Determines the extent of plaque build-up in the inner walls of the arteries supplying blood to the head.
  • Increased thickness in the inner layers of the carotid artery, may indicate risk for cardiovascular disease.

 

Blood tests

Lipid profile test

  • Also called cholesterol test as cholesterol is still believed to be the official culprit of CVD
  • Measures the levels of fats in your blood and can point out towards your risk of having a heart attack, stroke or other heart disease.
  • Total cholesterol = HDL cholesterol + LDL cholesterol + 20% of Triglycerides level
  • In general, your total cholesterol should be under 200 mg/dL or 5.2 mmol/L.
  • HDL – High-density lipoprotein cholesterol referred to as the “good” cholesterol, it is ‘presumed’ to keep arteries open and your blood to flow more freely.
  • LDL – Low-density lipoprotein cholesterol referred to as the “bad” cholesterol, where too much is ‘presumed’ to lead to plaque deposition in your blood vessels, and results in reduced blood flow.
  • Triglycerides: are fatty acids being transported in the blood, for storage in fat cells. High levels can raise your risk of CVD. Triglyceride level should be less than 150 mg/dL / 1.7 mmol/L
  • Lipids also contain the fat soluble vitamins A, D, E, and K

High-sensitivity C-reactive protein test (hs CRP test)

  • Measures inflammation
  • Is a protein produced by your liver as part of your body’s response to inflammation that may occur due to an injury or infection.
  • This blood test has a great significance in diagnosing heart conditions and can help determine your risk of heart disease before you have symptoms.
  • A raised hs-CRP test values indicate a higher risk of heart attack, stroke and cardiovascular disease.
  • An hs-CRP level above 2.0 mg/L is considered an indication of increased risk of heart disease.
  • BUT CRP levels can be temporarily increased by many other situations other than a heart disease, like a viral infection.
  • Important to do the test twice, two weeks apart.

Natriuretic peptides test

  • Natriuretic peptide is a protein that your heart and blood vessels make to help your body eliminate fluids, relax blood vessels and excrete sodium into your urine.
  • When your heart gets damaged, levels of BNP entering your blood increases.
  • Normal BNP levels vary depending on age, gender, and weight.

Troponin Test or Cardiac Troponin

  • Is a protein found in heart muscle used to identify heart injury or damage
  • Is only released into the blood when heart muscles become damaged.
  • Two types of cardiac troponin
  • T – cTnT
  • I – cTnI – more specific than cTnT
  • A high level of troponin in the blood may indicate you are having or recently had a heart attack.

GGT – Gamma-Glutamyltransferase

  • A liver enzyme
  • Increased GGT activity is a marker of inadequate antioxidant levels and increased oxidative stress.
  • Ample evidence suggests that elevated GGT activity is associated with increased risk of cardiovascular disease (CVD) such as coronary heart disease (CHD), stroke, arterial hypertension, heart failure, cardiac arrhythmias and CVD-related mortality

ESR – erythrocyte sedimentation rate – inflammation marker

IL-6 – interleukin-6 – inflammation marker

  • High levels of both have been associated with cardiovascular mortality and morbidity

Types of Heart Disease aka CVD

Heart disease describes a range of conditions that affect both your heart and blood vessels, therefore the correct terminology is Cardio (heart) Vascular (blood vessels) Disease – CVD

As the cause of the problem can originate from either or heart or blood vessel optimal treatment strategies relies on accurate identification which requires an specialist doctor called a cardiologist.

NB! – Many forms of cardio-vascular disease can be prevented and or treated with healthy lifestyle choices

 

  • Heart rhythm problems – arrhythmias, palpitations
  • Congenital heart defects – malfunction you’re born with
  • Heart valve disease – stenosis, insufficiency
  • Heart muscle disease – Cardiomyopathy makes it harder for your heart to pump blood to the rest of your body and can lead to heart failure.
  • Heart infection – occur when irritants such as bacteria, viruses and fungi infect your heart. The types of heart infections are endocarditis, myocarditis and pericarditis
  • Disease in blood vessels, such as inflammation and or narrowing of the coronary artery called CAD or arteries in the body, such femoral artery.

CVD Signs & Symptoms

  • Chest pain – angina
  • Chest tightness
  • Chest pressure
  • Chest discomfort
  • Arrhythmias / Palpitations caused by irregular heartbeats.
  • Fatigue
  • Dizziness
  • Low or high blood pressure, depending on which valve disease is present
  • Shortness of breath
  • Abdominal pain due to an enlarged liver – suggesting tricuspid valve malfunction
  • Leg swelling, numbness, coldness – suggesting blockage / narrowing in the femoral artery
  • Pain in neck, jaw, throat, upper back

Heartbeat

A beating heart squeezes (contracts) and relaxes in a continuous cycle.

Systolic – period of contraction

  • the ventricles squeeze tight, forcing blood into the blood vessels going to your lungs and body.

Diastolic – period of relaxation

  • the ventricles are filled with blood coming from the upper chambers the left and right atria.

Blood Pressure Levels

  • Measured in mg Hg – milligrams of mercury
  • Systolic the upper number
  • Diastolic the lower number
  • Normal – 120 / 80 and under
  • Elevated – 120-129 / 80
  • High blood pressure – Hypertension stage 1 – 130-39 / 80-89
  • High Blood Pressure – Hypertension Stage 2 – 140 or higher / 90 or higher
  • Hypertensive crisis (consult your doctor immediately) – higher than 180 / 120 or higher

 

Hypertension

Picture this

  • The heart squeezing blood through blood vessels is like squeezing on a tube of toothpaste
  • If the tube is tight or blocked, you have to squeeze very hard to get a little bit of toothpaste
  • The same thing happens if the blood vessels are tight, restricted, inflamed or blocked
  • The heart must work harder, beat harder to move blood through the body.

Medical Procedures for Heart Health

Coronary Angioplasty and Stent Implantation – improves blood flow to your heart.

A small balloon is inflated inside one or more of your coronary arteries to open up an area that has become very clogged and, therefore, narrow.

After this, a special expandable metal tube (a ‘stent’) is usually put into the artery, expanded, and left there to keep the artery open.

Coronary angioplasty is not a cure for CAD. It only treats the part of the coronary artery that has become very narrow

Thrombolytic therapy – medication through a drip to dissolve a blood clot that is narrowing or blocking a coronary artery.

Coronary Artery Bypass Graft surgery (CABG) – also called bypass surgery or ‘CABG’ (pronounced ‘cabbage’). A blood vessel is taken from the chest, leg or arm and attached (‘grafted’) to the coronary artery allowing blood to bypass the narrowing or blocked part of artery.

Artificial pacemaker surgery – a small device put under the skin of your chest, below your collar bone. One or two wires connect the pacemaker to the chambers of your heart, making small electrical currents that stimulate your heart muscle and help it pump regularly.

Defibrillation – helps to restore a normal heart rhythm when your heart stops beating properly during cardiac arrest. It may also be used to treat other heart rhythm problems (like if your heart beats too slowly or too fast).

Implantable cardiac defibrillator (ICD) – a small device is put into your chest and connected to your heart by one or more wire leads. It monitors your heart rhythm and corrects it if it beats too slowly, too fast or stops beating.

Heart valve surgery – fixes a damaged or faulty heart valve and helps your heart to pump blood properly.

Cardiac ablation – a procedure that scars tissue in your heart to block abnormal electrical signals, used to restore a normal heart rhythm.

 

Is Inflammation the Real Cause of CVD?

  • Inflammation is part of your body’s immune response to an illness or injury where if helps fight off germs and facilitates healing.
  • Short term inflammation is helpful even essential
  • Inflammation degrades and causes dysfunction of the endothelial and EGCX layers leading to leaky blood vessels
  • Sustained low levels of inflammation, promote the growth of plaques, loosen plaque in your arteries and trigger blood clots
  • Studies show that targeting inflammation without changing cholesterol levels have a significant impact on CVD
  • Important to work with the risk factors which create and increase inflammation

– Hypertension

– Stress and Cortisol production

– Hyperglycaemia and Insulin production

– Low Testosterone

– Low Estrogen

Risk Factors for Developing CVD

  • Age – Aging is associated with a chronic inflammatory state increasing the risk of damaged and narrowed arteries and a weakened or thickened heart muscle. Also the decline in sex hormones influence immune competence and disease susceptibility.
  • Sex – Men are generally at greater risk of heart disease. The risk for women increases after menopause.
  • Genetics – A family history of heart disease increases your risk of coronary artery disease, especially if a parent developed it at an early age (before age 55 for a male relative, such as your brother or father, and 65 for a female relative, such as your mother or sister).
  • Chronic ‘Silent’ Inflammation – inflammation is now considered the major cause of plaque build-up
  • Smoking – Nicotine tightens your blood vessels, and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. Heart attacks are more common in smokers than in non-smokers.
  • Stress – Unresolved stress and altered Cortisol production increases inflammatory cytokines involved in endothelial inflammation
  • Poor diet – A diet that’s high in omega 6 fatty acids, and or glucose increase inflammation and thereby contribute to the development of CVD.
  • Poor Gut Health – dysbiosis, leaky gut increase inflammation
  • Poor detoxification – increases inflammation
  • High blood pressure / Hypertension – Uncontrolled high blood pressure can result in hardening and thickening of your arteries, can cause them to narrow, rupture or leak and can also cause blood clots.
  • Low Testosterone and Estrogen – decrease endothelial health and function
  • Hyperglycaemia, Insulin Resistance & Diabetes – high levels of blood glucose increases endothelial inflammation, high levels of insulin increases your risk of CVD.
  • Obesity – Excess fat tissue increases the production of inflammatory cytokines and thereby the risk of endothelial inflammation.
  • Physical inactivity – Lack of exercise also is associated with many forms of CVD.
  • Poor dental health – If your teeth and gums aren’t healthy, germs can enter your bloodstream and travel to your heart, causing endocarditis. Brush and floss your teeth and gums often, and have regular dental check-ups
  • High blood cholesterol levels – may increase the risk of plaque formation and atherosclerosis, but studies show that targeting inflammation without changing cholesterol levels have a significant impact on CVD.

Tips for a Strong Heart

  • Heart disease is the No. 1 cause of death worldwide, but is mostly preventable.
  • Get moving – Your heart is a muscle and, as with any muscle, exercise is what strengthens it.
  • Quit smoking – Nothing good to say about smoking and yes it’s linked to heart disease. Each puff of nicotine from tobacco smoke temporarily increases heart rate and blood pressure
  • Maintain or Lose weight – Another predicter of heart disease is being overweight, especially excess tummy fat
  • Eat heart-healthy foods – Focus on anti-inflammatory foods, heart organs, oily fish, especially small, wild fish, such as mackerel, sardines, avocados, berries, remove all seeds and seed oils, limit glucose.
  • Don’t forget the chocolate – Well actually cocoa has powerful antioxidants increasing HDL cholesterol and decreasing LDL. Milk chocolate doesn’t hit the mark, chocolate must contain high cocoa, minimum 85%
  • Avoid overeating – This causes too much blood to shift from the heart to the digestive system
  • Avoid or limit alcohol – Max 1-2 units of alcohol per day, preferably not every day
  • Avoid or limit caffeine – Max 2 coffees / teas per day in am
  • Track daily fluid intake – If you have heart failure, it’s common for your body to retain fluid.
  • Don’t stress – Stress will amongst other things increase blood pressure and heart rate.
  • Monitor blood pressure – Max 120/80
  • Get adequate rest – Sleep ideally between 10pm and 6am. Power naps of max 20 minutes latest 2.30pm

Hormones and Heart Health

  • Hormones are inflammatory modulators, and hormone

deficiencies are associated with increased CV risk and adverse CV outcomes

Cortisol – strong predictor of CVD

  • Low CAR – Cortisol Awakening Response indicates high IL-6
  • Low waking Cortisol indicates high TNF-alpha
  • High free and metabolised Cortisol levels indicate high CV mortality
  • Flat CAR indicates high CV mortality
  • High evening Cortisol indicates high CV mortality

 

Insulin – insulin resistance is strong predictor of Hypertension and Hyperglycaemia

  • Thins and impairs EGCX function
  • Increases ROS, oxidative stress and inflammation
  • Optimal glucose regulation is key to EGCX and endothelial function

 

Testosterone – Low Testosterone levels in men increase their risk of developing

  • CAD
  • Metabolic syndrome
  • Type 2 diabetes
  • Increases endothelial dysfunction
  • Increases inflammation
  • Increase oxidative stress
  • Increases proinflammatory cytokines (IL‐6, IL‐1β, TNF‐Alpha)
  • Optimal blood levels – 500 – 800ng/dl

 

Estrogen – low Estrogen levels in women during and after menopause connected with a decline

  • endothelial function
  • CAD decreased by 54% with ERT
  • Even better protection when combined with T also for bone health

Optimal blood levels

  • Recent menopause – 40‐60pg/mL or dried‐urine levels of1.8 ‐
  • 2.0ng/mg
  • Postmenopausal – 20 to < 40pg/mL, or dried‐urine levels of 0.7 -1.3 to 1.5ng/mg

Anti-inflamatory Foods

Intake of the following foods is shown to reduce inflammation

Organ meats:

Liver, kidney, heart per gram weight have more anti-inflammatory nutrients than any other foods, try to eat them twice a week

Oily fish:

Wild salmon, sardines, herring, mackerel and anchovies. Farmed salmon may contain less omega 3 fatty acids and more omega 6 and heavy metals, plastic, etc.

Fatty fruits:

Avocado and olives

Healthy fats:

Olive oil, coconut oil, organic butter, beef tallow

Sulphur foods

Egg

Sea vegetables:

Kelp and seaweed

Freshly made Herbal teas:

Rosemary, Thyme, Sage

Deeply coloured fruits, berries, papaya, mango, etc smoothies are good

Be careful with excessive intake of the following foods as they contain many anti-nutrients, and Omega 6 fatty acids, which increase inflammation and oxidative stress and disrupt the gut.

Read this article for more information 

Veggies:

Broccoli, kale, Brussel sprouts, cabbage, cauliflower, etc., should be boiled before consuming to reduce the anti-nutrients

Nuts:

All nuts should be soaked before consuming to reduce the anti-nutrients

Grains:

Especially those with gluten, such as wheat, barley, and rye should be reduced to the minimum or avoided completely

Pulses:

Chick peas, soy beans and other beans, lentils, etc., must be soaked and boiled before consuming

 

Best Heart Health Supplements

  • Omega 3 fatty acids – Fish Oils – are major anti-inflammatory important for heart health and hormone balance.

My favourite is Pure Artic Oil from Ecology.

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  • Broccolox a supplement of broccoli sprouts containing a sulphur molecule called sulforaphane, which increases the production of glutathione one of the body’s most important anti-inflammatory molecules. When choosing sulforaphane as a supplement it is important the product contains whole raw broccoli sprouts as sulforaphane is first produced during digestion.
  • Dried Heart Organ capsules
  • Magnesium – Taurate or Orotate best for heart health.
  • Vitamin D
  • Coenzyme CoQ10 
  • Vit B 12 
  • Folate
  • Combining Folate & B12 
  • Grape seed extract – can lower systolic blood pressure.

Medication for Heart Health

  • Anticoagulants – Blood thinners
  • Antiplatelet Agents and Dual Antiplatelet Therapy – Blood thinners
  • ACE Inhibitors – for blood pressure
  • Angiotensin II Receptor Blockers -for blood pressure
  • Angiotensin Receptor-Neprilysin Inhibitors – for blood pressure
  • Beta Blockers – for blood pressure
  • Calcium Channel Blockers – for blood pressure
  • Statins – Cholesterol-lowering medications
  • Digitalis Preparations – for heart failure
  • Diuretics – for blood pressure
  • Vasodilators – for chest pain

Questions? Please don't hesitate to contact me

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