Questions Needed
Glenn and I are doing an up-coming podcast on heart health with two professionals in cardiac care. We would like to know your areas of concern. If you have a question in the area of heart attacks, cardiac rhythm problems, diet, cholesterol etc. for our guests, please leave them below and I will pick some to ask on the show. Thanks so much for your help!
Update: This comment thread is closed.
Update: This comment thread is closed.
posted by Helen at 2:33 PM
65 Comments:
What frustrates me about health care in general, and cardiac health in particular, is the conflicting advice we continually receive as to what to eat. Some questions on that would be helpful.
anonymous,
I agree--for years we are told to eat low fat and then studies show that doing so makes no difference. Thanks for the question.
I'd like to know, once and for all, if you can die of a broken heart (or, less eptly put, what are the biological effects to health/heart-health of things like depression, OCP, and other psychological disorders or personality types).
Hum. As a lazy person, I'd like to know what the minimal amount and easiest types of (low-impact, low-effort) exercise that gives best bang-for-the-buck (the knee in the curve of greatest benefit to health versus time and effort put into it). Also, since I've got more self-control than time, is a more rigidly controlled diet and a little less exercise almost as good as a less rigidly controlled diet and more exercise, or is there a minimal amount of exercise one really needs?
Hum...and...what is the best way to avoid being scared into a heart attack? Aside from not going hunting with Dick Cheney...
Without a lot of work, I can keep my total dietary fat intake under 20%-25% of calories, and have no complaints from my wife or myself about taste. It does take paying attention (and I suspect that hers might be higher than mine, she is less able to resist cheese than I am.) I tried for about six months to keep to the Ornish 10% limit; it was hard to do, and I doubt that we were ever actually much under 15%. But I did learn a lot about low- and no-fat cooking, which makes the 20% target a lot easier.
Is it worth while to keep doing this? (Neither of us has any heart problems, although we're both overweight and trying to lose.)
I am concerned about the drive to reduce cholesterol levels to meet arbitrary targets. I've read reports in reputable sources (e.g., JAMA) that suggest the following ill effects from cholesterol reduction, especially from the use of statins: liver damage, cognitive loss, depression and irritability, muscle damage and pain, peripheral neuropathy, susceptibility to infection, among others. Some studies suggest that -- on balance -- cholesterol reduction has a neutral effect on health, and may even have a detrimental effect on the health of older persons.
I would like to know about ways to lower blood pressure without prescription medications.
Please ask about sleep apnea. My understanding is that it contributes strongly to heart disease, and is largely undiagnosed.
I have heard more and more about high iron content in the blood being a very bad thing. Is this true and if so how much is to much? Thanks.
The two cardiac questions I have are related:
1) how often inflammatory conditions such as myocarditis, pericarditis and endocarditis go undiagnosed or misdiagnosed as as a heart attack, or even something non-cardiac?;
and 2) what patients of those conditions above are now being prescribed in place of Vioxx (which in some cases I know of, caused problems just as bad as the condition they were treating).
Thank you,
M. in Boston.
My husband is an extraordinarily fit athlete (cat 4 racing cyclist, used to run marathons) who had undiagnosed hypertension for years. Now we have his "walking-around" bp under control with medication, but he still has exercise-induced hypertension, which is to say that during strenuous exercise, when his heart rate is elevated, his blood pressure shoots up to dangerous levels.
Is anyone doing research/studies/treatment of exercise-induced hypertension in athletes?
And thanks for the interesting podcasts!
There are company's,such as Heart Check America to name one, that advertise scans. I have read that they are good and I have read that they are a waste of time and money. Which is it?
I am an insulin dependent diabetic. I have Type 1.5 diabetes. Everyone keeps telling me I have to be careful -- it's imperative I keep watch. What am I watching out for -- specifically?
Jack Jacobson, Wash. DC
What actual evidence is there that all of the statins reduce 1st (or 2nd) heart attacks.
Are the recommendations for treating Hypertension changing? http://www.nhlbi.nih.gov/guidelines/hypertension/phycard.pdf
If so, what is the evidence that there is an actual reduction of end organ damage?
Is there evidence for using OTC preps like co-Q 10 or other antioxidants helps with cardiac pathology? What about the B vits and homocystine reuction? Omega 3's? Others?
Thanks
Several years ago I had a triple bypass when they found that one of my arteries was 95% blocked, but I was told that I didn't have a heart attack.
I have Rheumatoid Arthritis and take large doses of anti-inflammatory drugs. I've thought that this was the reason I didn't actually have an attack. I take half an aspirin, 1000 mg of naproxen and 4 mg of prednisone per day. I don't recommend it, but I do think they saved my life.
Ask about the role of inflammation in causing heart attacks and whether the aspirin is really helpful.
I've read that people who take certain heart medications should not eat grapefruit within an hour of taking their medicine. Are there other foods, vitamins, and supplements that cardiac, high cholesterol, and high BP patients should avoid?
I'm 56, female, and fairly fit. However, I have premature atrial contractions (PACs) and premature ventricular contractions (PVCs). My doctor doesn't seem particularly worried about this. Should I be?
I have lots of questions about what younger women (25-35) can do to protect their hearts and what, if anything, they should be doing to make sure that any potential problems are diagnosed and treated early.
The corollary to that is what kind of barriers can people expect in seeking preventative cardiac care and how to deal with or get those. (Example: Will doctors take your concerns seriously if you're a certain age or gender, would they be right not to be concerned based on gender and age, and what possible risk factors could trump that (like family history, or certain medications, etc.) that you should point out to your doctor)
I would like to know the relationship between the high intake of simple carbohydrates and elevated cholesterol levels, and the link beween good cholesterol and heart health.
Thanks Helen and Glenn for the podcasts!
When treating CHF, what is the difference in using an ACE inhibitor or beta blocker? Why one or the other, or both?
What are the latest CHF treatment innovations?
Helen, thanks for an interesting blog. The podcasts you are doing with Glenn are very informative.
Once you take (and pass) a stress test, where doctors find no blockages, how long are you good for? Is this something you should do annually? Every two years? Five years?
I too am dismayed at the conflicting blood lipid targets in the medical research and especially the mainstream press. I spoke with my cardiologist last year concerning the blood marker targets provided by the AHA. I asked about C-reactive protein as a more accurate marker for heart diease that LDL. His response was without a treatment for blood inflamation researchers cannot establish thresholds, is this true? (it sorta makes sense).
Now I read for every 1 unit (mg/dl) increase in ones HDL results in a 2 to 3 % reduction in risk of heart diease compared to a 1 % risk reduction when lowering LDL by 1 unit. Does that mean we have been chasing the wrong lipid holy grail for 30 years? Sure made the drug companies a lot of money along the way!
Has there been any long term studies on cognitive memory loss from taking statin drugs? They sure seem to have affected my short term memory. My family doctor's reply was asked about this was "statins have been shown to protect against alzheimer's. Is this true?
A financial question: I have to decide fairly soon how to take my retirement annuity. To make an intelligent choice, I need to have some idea of my life expectancy. My family doctor and my cardiologist insist that if I take care of myself I could make it to 85. I doubt it; I smoked for many years and hardly any of the men in my family lived that long. I'm pretty sure they're giving me the most optimistic prediction possible because they think this will be good for me. Maybe so, but it would also be good to get an honest estimate so I could plan intelligently for my family's financial security. Specifically, some realistic odds on 10-year survival would be nice. Any place to get this info?
Alan G.
If osteoarthritis in the neck causes tingling and sometimes numbness in the left arm/hand, how can you tell whether it's the neck or the heart causing the effect? Blood pressure normal and the effect only lasts two or three minutes a couple times a day.
Helen,
In 2004 I watched my mother (a very young 64) go through six heart catheterizations in eleven months. They also put in four stents, one of which ended up creating a greater blockage than already existed. Once my father reached his frustration point and took her to a third cardiologist, he immediately recommended bypass surgery and said that it should have been done long before.
I guess the question is, how do you know when it's time for a second (or fourth) opinion, when you can see a loved one deteriorating? Also, is there any sort of resouce online that rates heart specialists?
I'm 31. Should I be taking a baby asprin a day?
There are clearly risks in taking statins for cholesterol control. Probably there are risks with the other types of cholesterol meds (Niacin, zetia) as well. The Web is full of alarming reports/comments, quite a few from doctors, citing dangers of Lipitor (to pick a particular statin that I am using) and advocating non-statin approaches to cholesterol control. Vitamin C therapy is one option mentioned. What ARE the options for effective low risk cholesterol control? Which options are lowest risk and most effective?
Does reducing my chol really help?
How about assuming a family hist of high chol but no history of heart disease?
I would like to hear how cardiac health care is using phyto-pharmaceutical's clinical applications in their practice. Here's why I ask. My mother in-law was on heart medication, the doctor warned her... " if you stop taking your meds, you may die". After researching his diagnosis and the pharmacology of her meds, we gave her instead "Digitalis Purpurea". It's been five years now, she hasn't needed the meds and is still alive. She is 83, now.
My son was born severely premature at 24 weeks. I read research that children this premature have a 90% chance of an enlarged heart at age 10. What are the health implications longterm for these children? He recently had heart pain but the EKG and Chest X-Ray were normal. Should we have an Echo or Ultrasound done?
So much research on heart disease in men has been shown to have limited application to women, and some assumptions about good health for women (low fat diet) have recently been qualified. If I go for a check-up now, what tests should I request for heart health as a healthy 53 year old woman? What preventive measures still apply? And is the calcium I take for bone density good or bad for my heart?
Thanks Helen,
I'm interested in risk factors. How important are the genetic determinants if you are not showing the other risk factors. There is a clear genetic proclvity to heart attacks in my family. My father and grandfather both had massive heart attacks around age 51-2. I'm 47, but i don't smoke, my weight is good, BP is normal, Cholesterol is normal, I run regularly and am in good shape for my age. I know I'm reducing the risk, but how much do genes trump everything else in this area?
Years ago, I was told I have an "inverted aortic arch." My phyisician said this is unusual, but nothing to worry about. Nonetheless, I am concerned that it may be an indicator of another heart problem. So what's the latest thinking: problem or not?
What is the real risk of elevated cholesterol? Is a number around 100 the Holy Grail? Why do people with elevated (read above 200 with elevated triglycerides) cholesterol live a lifetime without effects?
I have a SVT-related tachycardia condition. About seven years ago I had a catheterisation, which because the current leakage was too close to the AV node had to be abandoned - they use a heated wire to ablate the conducting tissue in the heart, and if they do that to the AV node, it's pace-maker time (boy is it a weird feeling being shot up with adrenalin!).
Amazing technique, but I was wondering if it had been refined since those days.
My mother had a deformed left ventrical valve that the docs had to replace. The surgery was successful, and she is doing well. What are the chances that such a condition would be genetic? I'm 26 and stay in shape, but if I were to have a problem, how would it be diagnosed? Is it simply when the dr. listens to my heart and noticies an irregularity, or are there signs I should be on the lookout for?
Dear Mrs, Reynolds,
I have been told I have a "very slightly" leaking heart valve. What are the implications of this condition?
Thank you for all that you and Glenn do.... I read his instapundit blog at least twice a day, and decided to begin blogging after seeing his great interview with Brian Lamb.
Many Blessings !rkoyhai
What should younger people (i.e. under 30) be looking for? What kinds of screenings are you supposed to get? It seems like no doctors worry about heart issues for younger, apparently healthy people; most of my friends ignore pains and aches and assume it has to do with exercise strains and stuff a chiropractor can fix -- how are you supposed to tell the difference between something stupid and something life-threatening? Especially if you don't have health insurance and don't have lots of time and money to burn on random doctor's visits for what you figure will be nothing?
I'm not knowledgeable about the heart, but these sound like great questions and I look forward to your podcast and the experts' answers.
Why do we fill out family histories when our doctors never read them?
I have four brothers, all had heart events in their late 30's or early 40's. As the youngest child (female) of eight, I wondered aloud to my doctor why my heartbeat gets irregular when I lay on my right side. "nothing to worry about" was something I was told for years. It wasn't until I was in my 40s and started having distrubing dreams that my doctor noticed my family history and ordered a battery of tests, including nuclear scans. Short version: abnormal is normal for me.
Still, I worry, since heart disease has taken all of my uncles on my mother's side. However, my cholesterol is low, my bp is naturally a bit too low...I'm more given to fainting. Should I worry?
Is congestive heart failure reversible, and if so, how? Are there alternatives to a lifetime of drugs?
There has been a lot of news recently about cardiac pacemaker & defibrillator recalls. I would be curious to hear the cardiologist's perspective on:
- How much harm is generated by intense media buzz around devices that are extremely effective but have very low failure rates? Do patients that could benefit actually get scared away from life-saving therapy?
- To what degree is the litigious environment in the US actually slowing innovation & hampering the standard of care? Especially in the medical device and pharma industries.
How do I know the difference between a panic attack and a heart attack? Cold sweat, shaking, short of breath, sense of doom. With a family history of heart problems, though my numbers are good.
To Rebecca,
I am not a doctor but there are alternatives the congestive heart failure drug only therapy. Look into Cardiac Resynchronization Therapy. It's an advanced pacemaker that can help certain patients with CHF. It does not cure it but it can dramatically improve people's quality of life. Do some research and ask your cardiologist about it. Look into the COMPANION and MADIT studies for some of the clinical information. Good luck.
Did not read the 39 previous posts, but I doubt this one came up...
My question:
Does Beta Glucan 1.3 actually help in reducing cholesterol?
Sorry if this one came up already,
I read somewhere that cholesterol is something produced to protect our arteries from too acidic conditions and it will stick to where there is too much friction to protect our arteries, so my question:
If this is true, what is causing the over-acidic condition? ( food additives, chemicals, stress?... )
During extreme cardiovascular exercise, the HR increases for a time and then plateaus. Is it dangerous to exercise for long periods of time at or near this plateau? This occurs in bike racing and many trainers recommend this type of training.
My heart occasionally races for a few seconds, then usually everything returns to normal. After one episode I nearly blacked out, I had this checked out; EKG is fine, 24 hour holter monitor didn't find anything, same with stress test. I've never had a recurrence of the black out since, it's been four months.
Bottom line: Do I need to pursue it? Can these episodes cause damage? They don't really bother me....
Thanks so much Helen, I really enjoy your blog and appreciate your perspective on so many things.
Is there a substitute for baby aspirin as it is not good for your ears, I hear. And, if you have occasional, random transitory pain in the heart area but your stress test is OK is there any reason to be concerned? Is this common? Thank you for asking.
I would be interested in their take on the drug-eluting stents that have been available for a couple of years from two companies (and more on the way). Do they think this is helpful long-term in helping in-stent and end-stent restenosis?
And what do they see as the next helpful wave of minimally-invasive heart devices? What do they think (whether in devlopment or not) would most benefit an increasingly aging population?
One last question--there are three sizeable companies in the cardiac rhythm management market. One of these is in the process of being bought by another medical device company. Do they see this as a good, bad, or neutral event? And do they foresee consolidation and mergers as a major upcoming trend?
Hello Dr. Reynolds,
Further to Mr. Dauphin's comment above, do you foresee medical technology being able to minimize the effects of genetic inclinations towards heart disease in the future? My family also has a history of heart attacks, aneurysms, etc. and it has made me think twice about having kids of my own for fear of what I might be passing on to them. Thanks for taking our questions.
Patrick
I have just been diagnosed with statin induced neuropathy - I have been using various statins, starting with Mevacor, progressing to Zocor and have now been on Lipitor for about 6 years when this all started. (A total of over 10 years of statin usage) Since it seems that many having been having this problem, evan after years of usage, what is our alternative - I am afraid to go back on the statin drugs - I cannot stand the pain and weakness in my legs and extremities. I have developed anxiety due to this condition. My doctor put me on CO-enzyme Q-10 and he hopes I will return to normal, but with no assurances. He also said my cholesterol level will go right back up to where it was (around 300) after about four weeks.
I would just like a good discussion on this very important issue - thank you!
Kathy
Question: Does running damage the heart long term? I have in mind 6 miles per day average. Thanks
I'm recovering from anorexia and bulimia. I've heard much about how it's likely I've damaged my heart, and nothing about exactly what I've done to myself. If there's any information out there that gets into the specifics, I would appreciate hearing about it. Thanks - S.
I'd like to get an insurability question out there. Many years ago I had a brief dizzy/blurred vision episode. It passed after a few seconds. I discusse with friends the next day and they all urgently suggested I call my doctor. I did and my doctor took the "fail safe" response and told me to get someone to drive me to the nearest hospital. The hospital immediately admitted me as a stoke patient. Long story short they never found out what was wrong or what happended but it all went down in the records as a stroke and I became uninsureable. I'd like to hear from the experts about this. I suspect that the drill is the same for anyone having chest pains or discomfort and immediately goes to to an emergency room.
Jerry
My wife is 52, weighs 106 lbs., is in fabulous shape (she's a dancer), has HDL's higher than her LDL's, has low blood pressure (110/65 on average). Last Sept. she had a heart attack, albeit a mild one, caused by a single blockage in her left descending cardiac artery. It was stented and she is fully recovered and back to her normal activities (dancing, skiing, hiking, etc). Her mother had bypass surgery at 50. My question is this: how much of a person's heart health is determined by heredity? My wife certainly didn't fit the profile of someone who would have an early heart attack, and probably wouldn't have gone to the hospital at all had it not been for her knowledge of her mother's problems, nor would she have been admitted had she not told the ER doc (a young woman) about that fact (all the ER tests were negative and the heart attack itself wasn't diagnosed until the 6 and 12 hour blood enzyeme tests came back positive).
Mike Doughty
I have read that recent studies indicate the diastolic pressure can cause trouble. My pressure is usually 80s/150s or 160s. Should I be concerned? I am 66 and in good health.
When are heart palpitations abnormal? I have read where everyone's heart skips a beat now and then, but if it happens many times a day, is that normal? What if your heart speeds up for just a few seconds a couple of times a day? Is that normal?
My son had a congenital heart defect repaired surgically at age 3. A recent news story indicated (as I understood it) that once a patient outgrows the Pediatric Cardiologists, there is no real data on problems as an adult.
We are saving kids and infants today, that would not have made it jsut a few years ago. Are there procedures, studies or statistics on the long term success of these pediatric patients through adulthood?
i have atrial fibrillation. i'm 66 and don't want to be on warfarin the rest of my life. discuss ablation or any new procedures and their likelihood of success. i did not respond to cardioversion at age 63.
I would like a more detailed and technical, but not quite medical explaination about what exactly the types and levels of lipoproteins (LDL and HDL) and triglycerides actually DO in your blood.
Not how to control levels, but how do they interact, cause high blood pressure, heart disease and risk of heart attack. What other factors do we know about (besides the basics of weight, heredity, diet) and what don't we know yet?
(in English, not Latin please!)
I've heard that there is some evidence that heart problems and circulation problems are really inflammation problems, i.e. an inflammation of the artery causes them. What is the evidence, and how much do NSAIDs help
Some say that homocysteine is a more important factor than cholesterol
http://www.abbottdiagnostics.com/Your_Health/Heart_Disease/Homocysteine/homocysteine_vs_cholesterol.cfm
The Clinical Evidence Mounts
Numerous studies reported in the past 15 years provide impressive support for the homocysteine theory of arteriosclerosis. When nearly 15,000 male physicians were followed for 5 years, those with the highest homocysteine levels were three times more likely to suffer a heart attack, even when taking other risk factors into account.' In another prospective study, focusing on about 600 Norwegian patients with coronary artery disease, heart attacks, and deaths rose in straight-line relation to the plasma homocysteine level.(10) An international study of healthy middle-aged men from 11 countries convincingly shows that the risk of dying from ACVD increases with the average homocysteine level in a given nation (see "Homocysteine Levels and Cardiovascular Mortality"). Finally, a prospective study reported early this year shows that, for each 5-[Lmol/L increase in blood homocysteine content, the risk of middle-aged men dying of ischemic heart disease rises by one third.(12)
Will
B6,B12,folic acid,aspirin,flax,garlic and oatmeal help reduce the risks?
Is video imaging of the heart worthwhile? When will it be more widely used?
(I have my own opinion on the subject -- video imaging of my ex-husband's heart showed serious problems that his HMO had been trying to ignore; his HMO doctors initially refused to even look at the images, but finally then did and saw he was in a life-threatening position. I'm unsure why many doctors don't like VI, unless it's because they didn't prescribe it.)
My younger brother was diagnosed with WPW when he was 16. He was at home watching golf and his heart stopped. This was due to WPW. Our Cardiac Specialist said that WPW may be one of the causes of Sudden Infant Death Syndrome (SIDS). Is there any research that could help me to better understand this?
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