February 2014

My philosophy in treating cardiac patients is that lifestyle plays a pivotal role in our present and future health.  Making small changes in exercise and dietary patterns can translate into large health benefits, not only for our hearts but for our general well-being.  It is never too late to start!

 

April 15, 2014

Q:

I’m a woman who will be 40 years old in September and heard that women can experience different heart attack symptoms from men, and can include back pain. How can women differentiate certain types of back pain from heart-attack type back pain?

A:

You are absolutely correct that women often develop atypical heart disease symptoms.
Most people know that coronary artery disease is associated with classic squeezing or crushing in the middle or left side of the chest with the feeling spreading to the neck or arms, shortness of breath and sweating. Women may have these symptoms but more often than not they can have symptoms of nausea, lightheadedness, fatigue and abdominal and back pain.
These symptoms are often difficult to differentiate from a stomach problem or back problem.
Some important points to remember are that any new symptoms or those that are recurring should be evaluated by your doctor. In addition, many times only further testing with an EKG or stress test can help sort out the source of the pain. Please never hesitate to see your doctor. It is much safer to err on the side of caution then to make potentially harmful assumptions, especially regarding your heart.

February 25, 2014

Q:

Why is it when I do go to a heart specialist, first they say I have mitral valve prolapse and then when I go to another doctor for a second opinion there is no sign of it? I’m tired of my heart beating so fast.

A:

Mitral valve prolapse occurs when the mitral valve closes and buckles into the upper part of the heart chamber.  It can be associated with chest pain, shortness of breath and rapid heartbeats.  The diagnosis is made from a good physical exam and/or an echocardiogram (a sound-wave test of your heart).  Beta blockers are a class of drugs typically used to treat the palpitations from MVP.  A holter monitor that records your heart rate and rhythm may be helpful to define exactly what is causing your rapid heartbeat.

February 25, 2014

Q:

I have been diagnosed with sinus tachycardia. Yesterday my primary doctor sent me to the ER because my heart rate was 155 b.p.m. I was given three doses of adenosine (12 mg each) to slow down my heart. The medication worked for about two seconds and then my heart rate went back up to 155. I was released and told to continue my Amiodarone (60 mg, two times a day) because there’s nothing else they can do. Help.

A:

There are many different types of tachycardia.  If it really is sinus tachycardia then we usually look for an underlying reason for why your heart would beat so fast.  For instance under severe stress, infection, anemia, hyperthyroidism or fever, the heart will increase its rate. Your heart rate is fairly fast and I suggest a visit to a cardiologist to make sure that the rhythm is really sinus tachycardia.  Amiodarone is a potent drug not typically used to treat sinus tachycardia. In addition, 60 mg is not a standard dose for this drug. I would get a second opinion to sort out these inconsistencies.

February 19, 2014

Q:

How often and what tests are needed to monitor a mitral valve along with an aortic valve leak? I’m a 56-year-old woman, who otherwise is healthy and not on any medications.

A:

The fact that you are healthy and have no symptoms is a good sign.  I don t know how severe your valve problems are, but your doctor may decide to send you to a cardiologist who will take a history and listen to your heart and perform some cardiac tests like an EKG and  echocardiogram ( a sound-wave test) of your heart. The fact that this has been  detected prior to any symptoms is very helpful.  This way you can be monitored for any changes before serious valve disease develops.

February 19, 2014

Q:

When I eat my stomach bloats and I get short of breath. I have written down what I eat and I can’t pinpoint what is causing this to happen. I only eat two small meals a day because I always feel full, but I am overweight. Sometimes I even get pinching-type pain in my stomach. Any clue what can be causing this or what type of doctor I should see?

A:

This may be a symptom of a few things, including a stomach problem. The pain and bloating are not normal and you need to see a general practitioner first, such as an internist or family doctor. This doctor will perform some tests and then direct you to a specialist, if that is necessary.  Don’t wait too long. These symptoms should be checked.

February 19, 2014

Q:

Once the aortic valve is replaced, would you agree that I can lead a normal life or would I have any restrictions? I am a male in my 50s. What can cause this valve to fail?

A:

There are many reasons why a valve would not function well.  You may have been born with an abnormal valve that doesn’t open or close normally. Other reasons could be valve infections and degenerative changes in the valve.  Valve surgery is a major operation and is performed to replace the abnormal valve with a tissue or mechanical valve.  Yes, most people live normal lives with artificial valves. It is important to remember that you will need at least four to six weeks to recover.  Routine follow-up with your cardiologist will be necessary.  Good Luck!

February 19, 2014

Q:

I am a 63-year-old woman and I suffer from hot flashes constantly. I was talking to some ladies and they said that this can be a sign of blocked arteries in your heart. I realize that I can’t be going through menopause. I had my cervix and uterus removed in May 1979. Can you please give me an answer and also I am going to have an echocardiogram very soon.

A:

Women tend to have different symptoms than men with regards to blockages in the heart vessels or coronary artery disease.  The classic complaints of a tightness or squeezing pain in the chest may not occur in women. More typically women may complain of vague symptoms such as feeling fatigue, nausea, sweaty or lightheaded.  We don’t know why women have these more generalized complaints.  Your symptoms deserve an evaluation by your doctor.  An EKG or electrocardiogram may be performed in the office, but even people with coronary artery disease may have normal results with this test.  A stress test is a much more sensitive test for diagnosing heart disease. You are absolutely doing the right thing by seeing your doctor and having some cardiac tests performed.

February 17, 2014

Q:

Is there a test one can ask for? A Heart Disease Test?

A:

There are many tests that can be done to determine if one has heart disease. Simple blood tests such as a cholesterol level can determine your risk. Make sure you fast a good 12 hours prior to having blood drawn. In addition a stress test may be able to determine if there are significant blockages in one or more heart vessels and determine your heart rate and blood pressure response to exercise.  There is also noninvasive test that measures the amount of calcium in the arteries and this correlates well with blockages in the heart vessels.  It is called a calcium score.  You can ask your doctor, who will know your medical history and whether any of these tests are appropriate for you.

February 17, 2014

Q:

I have high blood pressure and some blockages but no stents yet. I’m almost 65 and have a twin sister who had a massive heart attack. What are my odds of getting stents or heart attack? I have low sodium and potassium levels.

A:

We know that certain factors contribute to a higher chance of developing heart disease.  These include high blood pressure, high cholesterol, diabetes, tobacco use and family history.  Also, increasing age will only increase the risk of heart disease. I can’t predict what your odds are of having  a heart attack on the information you provided, but it is very clear that maintaining a normal weight, eating a diet high in fresh fruits and vegetables, not smoking and exercise can significantly reduce your risk of heart disease no matter what age you start.  It is very important to know your numbers and take an active role in your health care.  Discuss with your doctor whether a stress test may be helpful to identify heart blockages.  But remember it is never too late to start a regular exercise program  and eating a healthy diet.

February 17, 2014

Q:

I have a high stress job. My health is fine other than the way my body reacts to stress (feeling panicky, loss of appetite). How do I know how much this stress is affecting my heart?

A:

There is no way to really measure stress.  It is much easier to measure the effects of stress, which would include something like high blood pressure.  Stress that causes physical symptoms can also produce a rise in cortisol and even contribute to weight gain.  Chronic stress may also accelerate atherosclerosis or hardening of the arteries.  Exercise, meditation, yoga and a good night’s sleep can help to manage stress. If despite these lifestyle measures the symptoms of stress are still present, you may consider talking to your doctor about anti-anxiety medication.

February 17, 2014

Q:

I am diabetic and my blood pressure has been running high in the morning. Is this normal?

A:

Many individuals with diabetes also have high blood pressure.  Morning blood pressure may be elevated in those with sleep apnea. In addition, if you are taking any medication for your blood pressure sometimes by the morning the effect of the medication has worn off.  Spacing out blood pressure medication can help with this time of fluctuation.  Keep a journal of your blood pressures and show this information to your doctor at your next visit.  High blood pressure should be treated to reduce the risk of heart disease and stroke.

February 17, 2014

Q:

I have been taking 420 mg of Diltiazem (a pill and a half) for more than six years for blood pressure. My prescribing doctor retired and my new one put me on only 240 mg of Diltiazem. Since I’ve started this dosage, I get periods of rapid heartbeat, like palpitations. Could this be the cause? Why would she lower it when it was working so well. What would you recommend?

A:

I have no way to know exactly why your doctor would change your medication. Diltiazem is a calcium channel blocker that is used to treat high blood pressure and can also control rapid heart rhythms so your palpitations may be related to lowering the dosage.  It would be helpful to identify these rapid rhythms so they can be adequately treated.  Many times a holster monitor is ordered to identify the specific heart rhythm abnormality.  I would call your doctor and let him/her know your symptoms before changing your medication.  Caffeinated beverages, alcohol and some cold medications can cause the heart to beat too fast and it might be helpful to avoid these drinks.

February 11, 2014

Q:

Is SVT serious?

A:

SVT, which is better known as supraventricular tachycardia, is a rapid heartbeat originating from the top part of the heart. It is not considered life-threatening.  It can cause palpitations or pounding in the chest, shortness of breath and even lightheadedness or passing out.  It is mainly caused by an abnormal electrical firing from the heart’s conduction system. SVT can be diagnosed with an EKG if the symptoms occur while in a hospital or doctor’s office. Otherwise a continuous ambulatory monitoring device may be worn to record any abnormal rhythm disturbances. Blood tests, an EKG, chest X-rays, an echocardiogram and a stress test also may be performed to determine a cause for the abnormal rhythm disturbance.

Your doctor may put you on medication to control the rapid heartbeat or recommend an  invasive procedure called an ablation that interrupts the electrical circuit responsible for the SVT. Usually this procedure can eliminate the abnormal pathway and potentially prevent the need for drug therapy.

Stay clear of any stimulants that might trigger SVT, such as alcohol, caffeine, decongestants and energy drinks.  Illegal drugs like cocaine, Ecstasy or methamphetamines can also induce an attack.

SVT can cause annoying and disabling symptoms, but treatments are highly effective and this disorder will not limit life expectancy.

February 11, 2014

Q:

Every time I yell it feels like my heart hurts, and it will hurt for at least 45 minutes. Does that mean I have heart disease?

A:

This does not necessarily mean you have heart disease, but as cardiologists we take every episode of chest pain very seriously.  It appears that stress triggers your pain. Managing stress is never easy, but the less stress in our lives the lower the likelihood of cardiac disease. Take some deep breaths, count to 10 or remove yourself from the situation if necessary.  Stress can raise blood pressure and cause an increase in catecholamines, which can put unnecessary pressure on the heart.

Classic angina or cardiac pain is generally described as a squeezing sensation in the middle of the chest that can radiate to the shoulders, back, neck or arms.  It is frequently accompanied by shortness of breath, sweating, nausea or a feeling of impending doom. But not all cardiac pain needs to be so typical.  The only sure way to really evaluate for cardiac disease is with an EKG and stress test and possibly an angiogram to identify any blockage in the heart vessels.

My best advice to you is to never ignore any chest pain.  You didn’t tell me your gender, but it is important to note that women tend to have more atypical symptoms then men. Get checked by your doctor.  It’s the safe thing to do!

February 11, 2014

Q:

I had rheumatic fever as a pre-teen. I will be 53 years old this year. Should I be concerned about heart valve failure?

A:

Rheumatic fever is an inflammatory disease that can develop as a complication of strep throat caused by the bacteria Group A streptococcus. It is most common in children ages 5-15, although it also can develop in adults.

Rheumatic fever can cause damage to the heart, including abnormal heart valve function and heart failure. The damage may include valve stenosis (narrowing of the valve) or valve regurgitation, which is a leaky valve. These may also cause irregular rhythms of the heart, especially atrial fibrillation.

Just because you had rheumatic fever does not necessarily mean you will develop  cardiac disease. A good physical examination, an EKG and an echocardiogram (a sonogram of the heart) can easily and safely be performed as an outpatient to obtain an overview of your heart valves and function.  I recommend given your history that you speak with your doctor about possibly having these tests.

The signs of rheumatic fever include fever, painful joints, skin rash or jerky uncontrolled body movements better known as St. Vitus’ dance. The only known way to prevent rheumatic fever is to treat strep throat infection promptly with a course of appropriate antibiotics.

February 11, 2014

Q:

I’m a student who wants to know how the cardiovascular system works. What can you tell me?

A:

The cardiovascular system is very complex.  It is made up of the heart and blood vessels, which continuously circulate blood containing oxygen and nutrients to the body.  The heart is one of the strongest and hardest-working organs in the body.  It pumps about 100,000 times a day. The heart is made of many structures, including the heart muscle (myocardium), heart valves and heart vessels.  All of these structures can become diseased and cause conditions such as heart failure, leaky or stenotic (tight) valves or develop blockages that can cause chest pain (angina) or even a heart attack.

Remember heart disease is the No.1 killer for both men and women.

Taking good care of your heart by eating a healthy diet full of fresh fruits and vegetables, fish and lean meats, healthy plant fats like nuts,  avocado, and olive and safflower oil. This will go a long way in preventing heart disease.

The American Heart Association has an excellent website for further information.

Good luck in your studies!

February 11, 2014

Q:

I’ve been clean from cocaine usage for three years. And after that I started getting pokes on the left side of my chest. Could this be a heart problem?

A:

Congratulations on your accomplishment!  Cocaine can cause many serious heart conditions, one of them is called coronary artery vasospasm.  This is an abrupt narrowing of a heart vessel that prevents blood flow to the heart muscle and may cause heart damage.  Since you have not used cocaine for three years, this would be unlikely.

It is difficult to determine without further testing what is causing your chest “pokes.”  It is always safest to see your doctor so he/she can determine whether these pains are serious or not.  An electrocardiogram (EKG) and/or a stress test can provide a great deal of information regarding your heart.  Certainly, individuals with high blood pressure, high cholesterol, diabetes and/or smokers are at higher risk for developing heart disease.  Treating these risk factors, maintaining a normal weight, regular exercise and seeing your doctor regularly has been shown to help prevent cardiac problems.

February 11, 2014

Q:

What medications and treatments are used in treating A-fib? Is using the paddles to shock the heart back into proper rhythm safe?

A:

Atrial fibrillation is an irregular and often rapid heart rate that occurs when the upper chambers of the heart beat chaotically and irregularly. There are different ways to reset your heart rhythm to normal.  The treatments do include cardioversion, which shocks the heart back to a normal rhythm.  This procedure is performed during sedation so you shouldn’t feel the electric shock.

Atrial fibrillation can also be treated with medications called anti-arrhythmics.  Depending on your heart condition, your doctor may recommend trying IV or oral medication to return your heartbeat to normal.  This may be done in the hospital with continuous monitoring of your heart rate. Some of the commonly used medications include amiodarone, propafenone (Rhytmol), flecainide (Tambocor) or sotolol (Betapace).

After careful review of your history, a physical and cardiac testing, your doctor will determine the treatment options for you.

February 6, 2014

Q:

Could a continued high dosage of Lasix (diuretic) cause a nutritional imbalance that could cause anemia or diastolic dysfunction (ventricle incompletely filling due to stiffening of tissue)?

A:

Lasix is a diuretic and is used to remove excess fluid from the body.  In addition to eliminating fluid it will also cause a loss of  electrolytes, such as potassium and magnesium.  These can easily be checked with a simple blood test and replaced by taking oral supplements.

Lasix does not cause blood loss or anemia and may be prescribed to decrease the diastolic filling pressure of the heart.  Anyone taking Lasix should also have periodic blood tests to check their kidney function. Usually patients on a diuretic like Lasix should adhere to a reduced sodium diet (2,500 mg daily). Talk to your doctor about your medications, especially if you have been taking them for a long time.

February 6, 2014

Q:

I feel strange movements in my heart and I literally feel pain in the organ. I don’t feel pain in my chest or my arm. What could this be?

A:

Pain in the chest or any sensation can indicate a number of different conditions.

Classic cardiac pain is described as a squeezing sensation in the middle of the chest that may radiate to the arms, neck or back. Frequently it is accompanied by sweating, nausea or shortness of breath.

But not all heart pain is typical. Chest pain should never be ignored and it is safest to make an appointment and let your doctor know your symptoms.

February 4, 2014

Q:

What is atherosclerosis?

A:

Atherosclerosis is the hardening and narrowing of the arteries. This slow and silent process may progress to block arteries putting blood flow to vital organs at risk. Atherosclerosis is the usual cause of heart attacks, strokes and peripheral vascular disease.

February 3, 2014

Q:

What are the risk factors for coronary artery disease?

A:

Most risk factors can be treated and include high blood pressure (hypertension), diabetes, high cholesterol and smoking. Those that cannot be controlled would be a family history of early heart disease and increasing age.

February 2, 2014

Q:

What is the link between smoking and heart disease?

A:

Smoking is one of the most potent risk factors for heart disease.  Cigarette smoke has numerous toxins and harmful chemicals that float in the bloodstream and accelerate hardening of the arteries. Secondhand smoke has the same effect so it’s important to avoid smoke-filled places and prolonged household exposure of smoke, especially for children.

February 1, 2014

Q:

What dietary changes can I make to reduce my risk of heart disease?

A:

The Mediterranean diet has been shown in numerous studies to reduce the risk of heart disease in those who already have had heart problems and even in those who want to prevent disease.

This diet is rich in fresh fruits and vegetables, fresh fish and beans, high in fiber and moderately high in mono-unsaturated fats like olive oil.  It’s also best to limit processed foods and red meat, which can raise the levels of cholesterol and problematic fats.  Recent studies have shown the benefit of a small handful of walnuts, almonds and Brazilian nuts to be cardio-protective.