Approximately 2 million people in the United States are living with limb loss, and this figure is expected to double by 2050. Lower-limb amputation accounts for the vast majority of all amputations, and diabetes—specifically, diabetic foot ulcers (DFUs)—is the leading cause of nontraumatic...
By Cheryl Carver, LPN, WCC, CWCA, CWCP, DAPWCA, FACCWS, CLTC – Wound Educator
With the millions of people living with chronic wounds, there are also millions of people living with cardiovascular disease. Every year, there are approximately 670,000 Americans diagnosed with heart disease. This equals more than one person diagnosed each minute! The skin may be the largest organ, but the heart is most vital in circulating oxygen and nutrient-rich blood throughout your body. A healthy heart is a leading factor in wound healing. Cardiovascular diseases that impede healing include peripheral arterial disease, coronary artery diseases, heart failure, and other heart and vessel issues that can inhibit blood, oxygen, and nutrition in wound healing.1,2
This issue of cardiovascular health recently hit home. I was diagnosed with left-sided heart failure on February 1, hospitalized the next day, and then topped it off with pneumonia. Ironically, it is American Heart Month. I guess it was my way of celebrating? I am known for being a bit of a workaholic. I can tell you I have learned my lesson the hard way and have no choice but to slow down and put myself first. While lying in my hospital bed, I started thinking about my patients with chronic wounds along with cardiovascular disease, and what we can do to not only support their wound closure, but also their heart health.
- Arterial ulcers are commonly caused by blocked arteries. They are often referred to as ischemic ulcers. Arteries are responsible for delivering nutrients and oxygen to different tissues. If the artery is clogged, then this prevents the nutrient-rich blood from flowing to the extremities, and an ulcer results. These usually involve the full thickness of skin, and occasionally cause pain that subsides when the legs are lowered below the heart level.
- LOCATION: Feet - often tips of toes, between the toes.
- SHAPE: Punched-out appearance.
- COLOR: Pale, gray, yellow, or black. Light exudate.3
- Venous ulcers are caused by poor blood circulation from venous insufficiency. The veins in the legs have one-way valves that keep the blood flowing to the heart. If the valves are damaged, the blood backs up and "pools" in the veins to cause a possible ulcer. These ulcers are superficial, shallow, and irregularly shaped, with pain and edema. These can sometimes be associated with infection or inflammation.
- LOCATION: One inch below the knee to just above the ankle (gaiter area). Ulcers may affect one or both legs.
- SHAPE: Irregular and can cause edema.3
- Diabetic neuropathic ulcers occur primarily in people with diabetes, although neuropathic ulcers can affect anyone who has an impaired sensation of the feet.
- LOCATION: Usually located at increased pressure points or related to trauma on the bottom of the feet.
- SHAPE: Variable, depending on the patient's circulation. Punched out, while the surrounding skin is often calloused or hyperkeratotic.3
- COLOR: May appear pink/red or brown/black.
Encouraging Patients to Adopt Healthy Heart Habits
- Eat a variety of colorful vegetables and fruits to boost their nutrition. This is the best way to get all the vitamins, minerals, and nutrients one needs to be healthy.4
- Manage stress, laugh, and smile as much as possible. Find that "even balance" or slow-down.4
- Engage in physical activity three times a week. This will help decrease the risk of heart attack and stroke.4
- Do not smoke, and limit alcohol.4
- Maintain a healthy weight.4
- Try to get 7 to 9 hours of sleep a night.4
- Schedule regular screening with your health care provider.4
Healthy Heart Education
February is Heart Month, but we need to remember that heart conditions can happen at any age and that education should always be at the forefront. Take steps now to help YOUR Heart or educate your patients. Half of all Americans have at least one of the three top risk factors: smoking, high blood pressure, and high cholesterol.5 The American Heart Association website provides a variety of free handouts for condition topics in a question-and-answer format. Please refer to the American Heart Association for additional education and resources for you and/or your patients.6
1. Duke L. Heart health important for wound healing. Wilson Times, February 6, 2019. http://www.wilsontimes.com/stories/heart-health-important-for-wound-heal.... Accessed February 19, 2019.
2. Gross T. Essential facts about heart failure. Chicago: Wound Care Solutions; 2017. https://www.woundcareinc.com/resources/essential-facts-you-need-to-know-.... Accessed February 19, 2019.
3. Cleveland Clinic. Leg and foot ulcer types. Cleveland, OH: Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17169-leg-and-foot-ulcers.... Accessed February 19, 2019.
4. Rome Memorial Hospital. Regional Center for Wound Care shares tips on heart health for American Heart Month. Rome, NY: Rome Memorial Hospital. http://www.romehospital.org/hearttips.aspx. Accessed February 19, 2019.
5. American Heart Association. What is cardiovascular disease? https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardi.... Dallas, TX: American Heart Association. Accessed February 19, 2019.
6. American Heart Association. General website. Dallas, TX: American Heart Association. https://www.heart.org/. Accessed February 19, 2019.
About the Author
Cheryl Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. She currently works as a Clinical Specialist for a leading independent provider of wound care solutions for long term care facilities in the United States, American Medical Technologies a d/b/a of Gordian Medical, Inc. Carver is not only known for her knowledge and expertise, but for enjoying her vocation as much as anyone possibly could. Her strong passion is driven from a life long list of personal experiences as a caregiver. Her mother passed away in in her arms at the young age of 47, due to complications from diabetes, amputation, and pressure ulcers. She now has dedicated her professional career to wound care education in hopes to bolster quality of care and strengthen pressure ulcer prevention. She has received many high reviews from her fellow physician and nurse students from across the country, including but not limited to: plastic surgeons, cardio-thoracic surgeons, general surgeons with wound care experience. Ms. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease specific educational video sessions accessible to employee providers and colleagues.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.