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Heart Month Q & A

Last Updated Thursday, March 14, 2013 1:03:59 PM


The numbers tell the story: Approximately 600,000 people die of some form of heart disease in the United States every year.

  • Heart disease causes one out of every four deaths in both sexes
  • In the United States, someone has a heart attack every 34 minutes; every 60 seconds, someone dies from a heart disease-related condition
  • 82 million Americans will develop some kind of cardiovascular illness 

The following events and lectures were presented to educate our community on the prevention and treatment options of heart disease and heart attack.

Women and Heart Disease – February 6, 2013
El Camino Hospital, Mountain View Campus

Nurse Barb Dehn and Dr. Catherine Collings presented a "talk show" format lecture on the prevention and treatment of heart disease, signs and symptoms of a heart attack, and ways to keep your heart healthy. The event was well attended by over 100 community members. Photos from the event are posted on the right side of the page.

Heart Forum – February 9, 2013
El Camino Hospital, Mountain View Campus

Over 100 community members attended our 4th annual Heart Forum event to hear from physician experts about risks, prevention, and treatment advancements in cardiovascular disease. If you missed the event or a lecture, we invite you to view the event videos online.

Peripheral Vascular Disease – February 13, 2013
El Camino Hospital, Los Gatos Campus

Dr. Hardeep Ahluwalia presented to 40 community members about prevention and treatments for leg pain and vein trouble including minimally invasive non-surgical procedures.

Many event attendees submitted questions for our physician speakers, however there were more questions than time. Dedicated to furthering the conversation and increasing awareness, the physicians took time to answer the remaining questions below.


Prevention/Diagnosis

Image of Dr. NouriDr. Bahma Nouri specializes in interventional cardiology, cardiovascular disease and cardiology. He is a member of the American Academy of Internal Medicine. Dr. Nouri was also a recent fellow at the Fogarty Institute for Innovation. 

Dr. Nouri provided the first lecture at the fourth annual Heart Forum. His topic was Tips for Reducing Your Risk of Cardiovascular Disease.



Q: My mother had cardiomyopathy – is that hereditary?

A: Sometimes cardiomyopathy can be hereditary though there are different kinds of cardiomyopathy, and many are acquired. The fact that your mom had this does not necessarily mean you will have it too. You should talk to your doctor and see which kind of cardiomyopathy your mom may have had.

Q: Once blood pressure is controlled with medication, is it possible to stop taking it? Or should one continue taking the medicine for life?

A: Often high blood pressure can require treatment with medication for a long time or even for life. If a person has mild hypertension, a combination of diet and weight loss can allow blood pressure to improve to the point that medication can eventually be stopped. Before stopping any heart medications, you should contact your doctor to see if this is a safe option for you.

Q: When is the best time to take baby aspirin – morning or night?

A: Aspirin works equally well in the morning as at night. There is no recommended time to take it. Sometime aspirin should be taken with food to minimize an upset stomach. Talk to your doctor about the best way to take this medication.

Q: How many aspirin are you supposed to take if you feel you're having a heart attack – does it make a difference to chew or swallow?

A: Most doctors would recommend on adult (325 mg aspirin) and would recommend you chew it rather than swallow as it can work faster. It is important to remember that if you feel you may have a heart attack you should contact your doctor or call 911 immediately as an aspirin alone is not sufficient to treat a heart attack.

Q: Having AFib and 1 ablation – will this keep the risk factor down?

A: There is no data yet that an ablation alone will reduce the risk of stroke for AFin entirely. Most patients still require Coumadin. If you have had an ablation you should contact your doctor to see if stopping medication is safe for you.

Q: What's the best way to increase HDL and lower LDL?

A: Diet, weight loss and exercise are the best ways. Most statin medications will decrease LDL, though have little effect on HDL. The vitamin Niacin can help increase HDL as well. It is important to talk to you doctor about which strategy works best for you.

Q: I have low blood pressure. Am I still at risk?

A: Low blood pressure renders a lower risk for heart disease. However, low blood pressure can be a risk factor for dizziness or fainting which can increase the risk for falls and injuries. Talk to your doctor if you have low blood pressure to see what your risk for complications might be.

Q: Does taking cod liver oil help with reducing cholesterol?

A: Cod liver oil and other omega 3 fatty acids can reduce triglycerides and lower the overall cholesterol in the body. Talk to your doctor about whether cod liver oil or other omega 3 fatty acids are right for you.

Q: If you have high cholesterol (mostly hereditary), can you reduce with diet and exercise without taking a statin?

A: Yes, diet and exercise are often the first steps in lowering cholesterol. Statins are a medication option. It is important to remember that the decision to start a statin or just stay with diet and exercise to control cholesterol is an individual one, and should be made in conjunction with your doctor.


Additional Prevention & Diagnosis

Image of Dr. Jane LombardDr. Jane Lombard is board certified in Internal Medicine with added certification in Cardiovascular Disease

She specializes in preventative cardiology, cardiovascular disease in women and women athletes. She is a member of the El Camino Hospital Chinese Health Initiative and is also a physician with the Palo Alto Medical Foundation.

 


Q: Does 30 minutes a day of exercise need to be done in one shot?

A: One should exercise for a cumulative time of 30 minutes a day to maintain health, and 60 minutes a day to lose weight. You do not need to perform high intensity exercise, but you should push yourself such that it is slightly difficult for you to hold a conversation and exercise at the same time.

Q: Cinnamon is supposed to help keep blood sugar and insulin levels lowered and "in check". Are there any heart medications or conditions that would not be a good idea to take cinnamon with? (side effects etc.)

A: Cinnamon does not interact with any medications. It can however, as one of the side effects, cause an increased heart rate.

Q: What type exercise do you suggest to prevent CAD?

A: The best kind of exercise is the one that you can enjoy for 30 minutes each day. Studies have shown that doing exercise socially helps maintain this good habit.

Q: What is considered good blood pressure? Is there a best time of day to take it?

A: The desired blood pressure is: Systolic 90-119 and Diastolic 60-79 An accurate reading requires that one not drink coffee, smoke cigarettes, or engage in strenuous exercise for 30 minutes before taking the reading.

Q: Besides the typical symptoms, how else can cardiovascular disease be diagnosed? After diagnosis, do you have it for the rest of your life?

A: Your physician may order the following tests to diagnose cardiovascular disease. The physician may order some or all of these tests. Each test will assist your physician in determining the need for further testing.

  • EKG
  • Chest X-ray
  • Stress Test
  • Echocardiogram
  • Cardiac Catheterization/Coronary Angiogram
  • Carotid Ultrasound
  • Vascular Ultrasound
  • CT Heart Scan

Once you have been diagnosed with cardiovascular disease you have it for the rest of your life. Cardiovascular disease is a chronic condition that needs to be managed such that one does not suffer bad outcomes such as stroke or heart attack.


Screening/Tests

Image of Dr. Deepu Nair

Answers to the screening and testing questions below are provided by Dr. Deepu Nair. Dr. Nair has interests in cardiac imaging modalities, including computed tomography, echocardiography and nuclear medicine.

He is the Medical Director of Echocardiology at El Camino Hospital and is board certified in Adult Echocardiography, Cardiovascular Computed Tomography, and Nuclear Medicine.

Dr. Nair also spoke at the fourth annual Heart Forum on the topic of The Heart of Imaging - Better Pictures Improve Results in Cardiovascular Care.

Q: For someone with no indications of heart disease, what is best test(s) for baseline info of heart health?

A: The best 'test' is a history and physical by your primary care physician, with focus on any possible cardiac risk factors such high blood sugar, high blood pressure, high cholesterol, overweight or lack of exercise.

Q: If you don't have any symptoms, is it a good idea to have a carotid artery test as a preventative measure?

A: This is a matter of opinion, but I would generally recommend against carotid ultrasound on a routine basis. It might be worth considering if you and your physician feel you have multiple risk factors for plaque buildup (e.g. smoking, hypertension, high cholesterol) or if you have evidence already of plaque buildup in other arteries (e.g. coronary artery disease, peripheral arterial disease).

Q: I had AFib last summer, was in the hospital for two days, and am now on a large dose of Aspirin as a blood thinner. I also take meds for blood pressure and cholesterol. I exercise regularly. Should I get a carotid artery check or some other vascular tests?

A: Not necessarily. You and your physician should discuss the targets for cholesterol and blood pressure which are appropriate given your history. Carotid artery testing or other vascular tests are best when used to evaluate symptoms.

Q: I have hereditary high cholesterol. My Father died from complications after open heart surgery. I'm having occasional chest tightness; do you recommend any preventative tests?

A: This is a potentially serious issue. If you are having chest tightness, you are no longer in the realm of prevention. You should discuss this with your primary care provider and get testing to evaluate your chest tightness, particularly given your family history and high cholesterol.

Q: If I had a heart attack at 57, do my children need to be on a statin?

A: Not necessarily. Your children should have a thorough physical examination by their physician and should have their risk factors for heart disease monitored (e.g. blood pressure, cholesterol, blood sugar, smoking status). If they have high cholesterol, they should work first on diet and exercise. If the high cholesterol persists despite this, they should discuss the situation with their primary care physician to see if medication is necessary.

Q: I have heard that an ejection rate of blood in the heart is a predictor of good heart function. What is it and what is considered optimal?

A: A normal ejection fraction is > 55%. This is a number calculated during an echocardiogram, most often, and indicates the Pumping function of the heart. However, it is just one of many possible measurements of heart function and needs to be interpreted in the context of your overall health. Not everyone needs an evaluation of ejection fraction.

Q: What tests are recommended to detect the early signs of heart disease?

A: Most importantly you should have a physical examination and lab work with your primary care physician. A baseline ECG is usually also reasonable. Beyond that, most tests are necessary only if you have symptoms or multiple risk factors for heart disease. Tests we discussed such as CT calcium scoring may have a role in a select group of higher risk patients.

Q: I have heart disease – how often should a cardiologist do an EKG? Echo?

A: This really depends on the type and extent of your heart disease. In some cases, an annual echo and ECG may be necessary, but in most people these tests can be done less frequently. This is something you should discuss with your cardiologist.

Q: Are the LifeLine screenings I receive flyers for in the mail something you recommend? How about a body scan?

A: I think screening is most useful if you have reason to think you are at risk for heart disease, but I think it best done after discussing the tests with your primary care physician. Unnecessary screening can lead to unnecessary treatments and increased risk in some cases.

Q: If both parents and my niece suffer from heart disease, should I pursue getting an EKF or EEG? How often?

A: If you have a strong family history of heart disease, you should discuss your own risk with your primary care physician. An ECG would be reasonable to get once. Other testing might be necessary if you are having symptoms or if you and your physician decide that you have a high risk for heart disease after reviewing your history.

Q: How accurate is an exercise stress echo in diagnosing or identifying the existence of CAD?

A: This depends on the populations studied, as all diagnostic tests perform differently when applied to high-risk vs. low-risk populations. In general, we think of stress echo as being about 80-90% sensitive for detecting CAD, but once again this does vary depending on the study population.


Treatment

Image of Dr. James Joye

Answers to questions about treatments are provided by Dr. James Joye. Dr. Joye is the Director of Research and Education at the Norma Melchor Heart & Vascular Institute at El Camino Hospital. He is the President of Vascular Interventional Advances (VIVA) Physicians. He holds numerous medical device patents and has been credited with the development of cryoplasty for infrainguinal arterial disease and percutaneous bypass of lower-extremity occlusive disease.

 


Q: If Lipoprotein (a) is a marker for CVS, would reducing its level help prevent cardiovascular disease? If that is true, how can I reduce Lp (a)?

A: Reduction of Lp(a) probably helps, but literature and trials are inconclusive to date. Traditional lipid lowering diets and meds (statins) are advised.

Q: If you have a 3 lead pace maker, what other precautions should you take?

A: The most important precaution you can take would be to be under the regular care of a cardiologist.

Q: What meds or treatments, in addition to exercise, can be done to help with high blood pressure?

A: There are innumerable treatments and medications that will help to reduce high blood pressure. Please talk to your primary care physician about what might be best for you.

Q: How do you treat a heart murmur?

A: Treatment will depend on the location and severity of the murmur. An echocardiogram is recommended to better define a course of treatment.

Q: What's the most noninvasive procedure to find a blood vascular clog?

A: An ultrasound is the most noninvasive procedure in this case.


Signs/Symptoms

Image of Dr. Catherine CollingsDr. Catherine Collings was our featured guest in the Community Wellness Lecture for Heart Month, Women and Heart Disease, hosted and emceed by Nurse Barb Dehn.

Dr. Collings is the founder and Medical Director of the Cardiovascular Pulmonary Wellness Center Norma Melchor Heart & Vascular Institute at El Camino Hospital. 

She has special interests in Women's Heart Health, preventative cardiology and cardiac rehabilitation. She board certified in Internal Medicine with added certification in Cardiovascular Disease and Nuclear Medicine.

Q: Can you explain about inflammation of the blood vessels and if the inflammation can spread to the heart? Can bacteria in the mouth migrate down to cause inflammation in the heart and the blood vessel?

A: Inflammation is thought to be an integral component of vascular disease. For example, patients with inflammatory conditions such as lupus and rheumatic arthritis are known to have an increased risk of vascular disease. Several studies have explored gum inflammation as a promoter of vascular inflammation, though the results are not definitive. Nevertheless, I suspect that dental health, particularly maintaining gum health to minimize gingivitis, is important for vascular and heart health.

Q: Could back pain be the only symptom/sign of a heart attack?

A: Lower back pain is unlikely to be a symptom of heart attack but mid back pain, in and around the scapular area, may be a symptom of heart attack.

Q: Occasionally, my heart may skip a beat, is that normal?

A: Occasional skipped beats can be a normal occurrence. It is important to differentiate between occasional skipped beats and palpitations with rapid heart rate radiating into the neck, or skipping beats with symptoms of dizziness. If you are experiencing rapid heartbeats or skipped beats associated with dizziness or lightheadedness, seeking medical attention would be the next step.

Q: Per a recent CT scan I have a nodule in my liver; can I be started on cholesterol medication? My cholesterol is 280.

A: If you have nodules in the liver, be sure to get a formal opinion from a liver specialist. Once this is done, attention to cholesterol, including taking a cholesterol medication, can still be undertaken.

Q: How important is a high C-reactive protein of 4-5 if blood pressure, blood sugar, and cholesterol are good?

A: You have raised an interesting question. While C-reactive protein is a marker of inflammation, it has a lot of limitations. For example, it is elevated in other inflammatory conditions--as simple as a recent infection or environmental allergies or a mild or indeterminate immunologic condition. If all CV risks are well within normal limits, including family history, I recommend rechecking the CRP at a 6 month interval and then reconsidering whether further treatment is needed.

Q: What causes a ruptured abdominal aneurism?

A: Aortic aneurysms are most frequently related to long standing HTN, high cholesterol levels, diabetes, and tobacco use, but are occasionally associated with the sole risk factor of family history. Rupture of the aneurysm has to do with its size. If there is a family history of aneurysm, screening is important and is accomplished with an abdominal ultrasound and sometimes a cardiac (heart) ultrasound, both simple tests. I also recommend a screening ultrasound in individuals with risks of HTN, high cholesterol, diabetes, and tobacco use.

Q: I am 61 years old, eat healthy, exercise, but a few months ago my family and I noticed I would slur common words. Not all the time, maybe a few times a week, at different times of day. Should I be concerned?

A: Yes, I would be concerned with slurred words. I recommend that you first see a neurologist and have further neurological testing. The neurologist, in turn, may recommend a cardiovascular evaluation.

Q: I occasionally experience a tightening of muscles in my left arm, above the elbow. It may last for 3 to 4 minutes. Is this something that needs to be checked out? If so, what type of diagnosis would be appropriate? I do lift weights twice a week.

A: Tightening in the upper arm can be a symptom of coronary disease and should be evaluated by a doctor. In preparation for the evaluation, it would be important to determine when the tightening occurs--during the weight lifting, during other physical or emotional stress, or as a random occurrence. These details will be important to the doctor to order the next best tests.


Peripheral Vascular Disease (PVD)

Image of Dr. Hardeep S AhluwaliaDr. Hardeep S. Ahluwalia is fellowship trained in vascular and endovascular surgery from Duke University and underwent additional fellowship training in the treatment of peripheral vascular disease at El Camino Hospital  in Mountain View.  He is also Board Certified in Vascular Surgery.

Dr. Ahluwalia was a guest speaker at our Community Wellness Lecture for Heart Month, Peripheral Vascular Disease: What you need to know. In this lecture he covered topics including prevention and treatments for leg pain and vein trouble, including minimally invasive non-surgical procedures.

Q: You spoke of leg pain – is there any significance in leg discoloration that comes and goes? What about hands turning blue?

A: Leg and hand discoloration is significant in the sense that it probably is associated with coldness of the extremities. Blue discoloration of the feet in particular can signal a vein problem in that they may not be functioning and "regurgitating" the blood down the legs causing them to turn blue and swollen. Hands that turn blue could also signal a problem in the circulation in the same way: the venous blood is having a hard time recirculating back to the heart. Raynaud's phenomenon must also be considered.

Q: Is venous insufficiency a marker for heart disease?When diagnosed, I was told that there was nothing I can do, just wear pressure stockings.

A: Venous insufficiency is not necessarily a marker of heart disease. It can absolutely be treated with exceptional results! We would be happy to treat that and improve your symptoms. There is absolutely more that can be done other than simply masking the symptoms with compression stockings.

Q: My hands and feet are always cold – even in warm weather. I have to sleep in socks. I also get a lot of feet and toe cramps at night. Sometimes these will wake me up. Is this an indication of vascular disease?

A: Cramps in your feet particularly at night could certainly signal peripheral vascular disease. Reason being, gravity is no longer helping you carry blood (oxygen and nutrients) to your feet when you are lying flat. That is called "rest pain". This is a significant finding and you should absolutely consult a vascular surgeon.

Q: Should occasional (3-4 times a week) leg pain when lying down be reported to a cardiologist if it goes away by elevating my leg?

A: Any leg pain should be reported to a vascular surgeon. Vascular surgeons are trained in dealing with arteries and veins. Cardiologists are trained on the heart.


Miscellaneous Questions

The following questions and answers were provided by various physicians, nurses and clinicians on the El Camino Hospital staff.

Q: Any relation between heart disease and menopause?

A: Million dollar question! There is no simple answer to this one. The incidence of heart disease certainly rises after menopause and occurs earlier in women with, for instance, early surgical menopause. Nevertheless, most of this increase, as it is for men, is felt to be related to advancing age AND to advancing cardiovascular risks-excess weight, inactivity, diabetes, hypertension, and so forth that often occur with advancing age. In decades past, heart disease in women was felt to be due simply to the decline in hormones after menopause and thus the strategy was to "reverse" menopause by maintaining women on hormonal replacement. Unfortunately, final results of such experiments indicated that hormonal replacement with both estrogen and progesterone increased heart and stroke risks. This strategy has since been abandoned. For the moment, until other research trial results are available, it is felt safe to use hormones for menopausal symptoms in the first few years of menopause without concern about promoting heart risks. However, 5 years or so after menopause, hormones should be discontinued or used at lower doses. Expect to hear more about results of other research trials in upcoming years which we help will clarify a gray zone of information.

Q: I have high blood pressure, are there potential problems with doing hot yoga?

A: An increase in blood pressure is physiologic (normal) with exercise stress, mental or pain stress, and heat stress. Exercise that is dynamic and aerobic such as walking or jogging or cycling increases blood pressure in a normal fashion as long as resting blood pressure is normal. Isometric exercise such as heavy weight lifting can result in excessive blood pressure elevations. This could be exacerbated by heat stress as well, particularly if you are not acclimated to the heat. If your hot yoga class requires you to perform heavier isometric exercise or causes a great deal of strain, it may be causing excessive blood pressure elevation. What is most important is to have good control of blood pressure before undertaking activities which are physically strenuous, be that exercise or heat stress.

Q: How should I distinguish between an ocular migraine and stroke risk with occasional transient vision problems?

A: One's age, history of migraine, and cardiovascular risks such as hypertension, high cholesterol, or cardiac arrhythmia would all factor into distinguishing ocular migraine from transient stroke-type visual symptoms. A neurologist is your best advisor to sort out the subtle differences between an ocular migraine and a stroke.

Q: How does menopause affect cholesterol levels?

A: Menopause can be associated with an elevation in cholesterol and triglyceride levels. It is uncertain whether this is strictly a hormonal effect or the consequences of increased age, inactivity, or increased weight associated with the aging years after menopause. Regardless, what is most important is to know your own cholesterol and triglyceride levels and set up a consultation if they are out of range.

Q: What role does mental stress play with heart health?

A: Mental stress plays a big role in heart health. Vessels everywhere in one's body, including the heart, are dynamic--they constrict (become more narrow) or dilate (expand) depending upon a variety of factors. We know that stress can be associated with constriction of the heart vessels and a lowering of blood flow to the heart. Just as exercise and dietary choices influence heart health, one's state of mind can also influence heart health.

Q: I have high cholesterol (290 to over 300) for more than 20 years. I really like to check with a heart doctor but the problem is the financial consideration. We are low income is there any medical aid available? How do I apply for help?

A: El Camino Hospital has a partnership with RotaCare Clinics, located throughout the Bay Area. Their mission is to offer medical care to low income and non-insured patients. For more information, please call 408-379-8000.

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2013 Heart Forum Videos

If you missed the event, or would like to revisit the information presented, please watch the video.

Community Wellness Lecture with Nurse Barb and Dr. Collings

These images were taken at our February 2013 Heart Month Community Lecture with Dr. Catherine Collings and Nurse Barb Dehn. Our topic of discussion was Women and Heart Disease.


Image of Women's Heart Health Lecture Nurse Barb and Dr. Collings

Image of Women's Heart Health Lecture participants

Image of Women's Heart Health Lecture patient story

Image of Women's Heart Health Lecture patient story