Heart Conditions

Many factors can cause heart conditions that need medical or surgical attention.

Some of these are a result of structural disorders, such as birth defects. Some are the result of disorders of the electrical signals of the heart such as abnormal heart rhythms. Others are caused by muscular problems such as when a heart attack causes blood to stop flowing through the heart such as disorders of the valves of the heart or arteries that are blocked by plaque.

More detailed information is available on the following heart conditions:

Angina

Angina is chest pain or a sensation of pressure that occurs when the heart muscle is not getting enough oxygen. It tends to trouble women at a later age then men.

Symptoms: Angina usually first appears during physical activity or emotional distress, both of which make the heart need more oxygen. If the reduced blood flow is severe enough, angina can occur when a person is at rest. When angina usually lasts only a few moments and goes away with rest. Sometimes it is worse when a person is active after having eaten.


Aortic Valve Stenosis

Arotic Valve Stenosis is a narrowing of the opening of the aortic valve. It is due to abnormalities of the valve. About 5% of heart defects are due to aortic valve stenosis. However, there may be many cases that are not diagnosed. It is likely that this is the most common cardiac defect.

Symptoms: Severe blockage may cause chest pain or feeling a loss of consciousness with activity. Symptoms depend on what caused the blockage.


Arrhythmia

Arrhythmia is any variation from the normal rhythm of the heartbeat. The heart rate at rest is usually between 60 and 100 beats per minute. Lower rates may be normal in young adults, particularly those who are physically fit.

Symptoms: The most common symptoms are:
  • Palpitation (varying heart beat), shortness of breath, chest tightness
  • Person can feel dizzy, light-headed, lose consciousness.
  • Palpitations start and stop suddenly or gradually and can last seconds to hours.


Hypertension (High Blood Pressure)

High Blood Pressure is a condition in which the pressure of the blood pumping through the arteries is abnormally high. This increases the risk of stroke, aneurysm, heart failure, heart attack and kidney damage. More than 50 million Americans have high blood pressure, and a third are entirely unaware of it. The risk of complications occurs mostly when Hypertension persists for years without good control. Hypertension typically does not cause symptoms unless very severe. It usually remains silent until it leads to complications, usually arrhythmias, heart failure, heart attacks, strokes and kidney failure. Blood pressure is considered controlled when the average reading is 100-120 systolic and pre-hypertensive when the average reading is 120-135 systolic. It is considered elevated when the average reading is over 135 systolic. The diastolic should average less than 85. We recommend you get your own blood pressure monitor and keep a written record of your readings.

Coronary Risk Factors: There are many risk factors for heart disease, but these are most important:
  • High Cholesterol.
  • Diabetes.
  • High Blood Pressure.
  • Smoking Cigarettes.

These are true killers.

Do not forget the above. A family history of heart disease is usually included in the above. The 4 most important risk factors also often run in families.

Obesity is a factor but not as potent as the above. Obesity makes you more prone to the above risk factors.

Symptoms: Hypertension is often called the "silent killer" because symptoms do not appear for years until a vital organ is threatened. Signs of long-untreated high blood pressure (such as headache, fatigue, nausea) can be the result of damage to the brain, eyes, heart and kidneys.

Caution: The blood pressure varies considerably. High blood pressure for a few hours may not hurt you as long as you are under a treatment program with your doctor.


Heart Attack

Heart Attack is a medical emergency in which the supply of blood to the heart is suddenly and severely reduced or cut off, causing the muscle to die from lack of oxygen. More than 1.1 million people experience a heart attack each year, and for many of them, the attack is their first symptom of coronary artery disease. If a heart attack is suspected call 911 and don't drive to the hospital.

Symptoms: Common symptoms include:
  • Acute onset of chest pain. Diabetics may not get chest pain
  • Acute shortness of breath specifically in the older person or diabetics
  • Acute pain in the neck, jaw, left or right arm, stomach
  • Acute nausea, vomiting, dizziness in combination with above.


Heart Failure

Heart Failure occurs when the heart muscle fails to pump as much blood as the body needs. The faulty pumping means the body doesn't get the oxygen it needs, blood backs up in the veins and lungs.

Symptoms: Common symptoms include:
  • Shortness of breath with normal activities
  • Shortness of breath at night, worse when you lie down.
  • Cough at night


High Cholesterol

The body needs two kinds of fats in the bloodstream to operate well: They provide the body from cold and help avoid injury. Fats and protein from lipoproteins, which travel through the bloodstream, especially cholesterol moving in the blood can lead to heart attacks and stroke. The ideal cholesterol readings have been modified over the years as research has shown that the lower the cholesterol, the lower the incidence of heart attacks and strokes. High cholesterol is only one of the four major risk factors for heart disease (see under Coronary Risk Factors). The bad cholesterol is called LDL Cholesterol. The good cholesterol is called HDL Cholesterol.

Symptoms: There are no symptoms for high cholesterol unless the condition is severe. High cholesterol over a period of years leads to cholesterol/fat build-up inside the heart, neck, brain, leg arteries, leading to heart attack, stroke, angina, etc.

Bad Cholesterol: (LDL Cholesterol):
For most adults an ideal LDL Cholesterol is 100 or less. This is very hard (But not impossible) to achieve with diet alone. However, this is clearly the first stage (see Heart Healthy Diet section)

Unless you already have already a heart condition, you should put your effort on a healthy diet for 3-6 months before taking drugs (See Drug Therapy). When you check your cholesterol you should be fasting for at least 9 hours or 12 hours if possible.

If you have a heart condition or a diabetic or if you smoke, your LDL cholesterol should be 70 or less. Today this is frequently achievable with diet and drugs. I usually add drug therapy to diet when LDL cholesterol is over 130, and defiantly if over 160. These decisions however are made on an individual basis, since other factors have to be considered such as age, likelihood of pregnancy, liver disease, etc.

For sure, you should make every effort to keep your LDL Cholesterol "the lower the better"

Good Cholesterol: (HDL Cholesterol)
The higher the HDL Cholesterol the better. Males run lower HDL cholesterol then women but this benefit to women is mostly lost after the menopause.

We currently do not have good drugs to raise HDL Cholesterol although some promising drugs are in research, those won't be out for a few years.

What factors raise Good Cholesterol?
  • Exercise: Most important. Before you exercise aggressively and depending on your age make sure you check your heart status.
  • Maintaining Ideal Body Weight: lose weight if you are chubby or obese.
  • Alcohol: Small to no more than moderate amounts raises the good Cholesterol
  • Drugs: Niacin does the best job in raising HDL Cholesterol at this time. But Niacin can have side effects, can be expensive and is a "high maintenance" treatment that requires effort on the part of the patient and doctor to use it safely and effectively. Starters can have the modest beneficial effect.
  • Genes: Your genetic make up often determines upon HDL level. Low HDL Cholesterol often runs in families.


Your best bet with HDL Cholesterol is:
  • Exercise regularly.
  • Achieve or maintain ideal weight.
  • Be physically active, walk instead of drive, use bicycles etc.


Drug Therapy
Treatment for High LDL Cholesterol:
  • Diet remains the cornerstone of treatment (See Heart Healthy Diet section)
  • Drugs - Statins are the clear winners. These include Crestor, Lipitor, Vytorin, Zocor, Lescol, Simvastatin, Lovastatin, Menacor and Pravachol. The First Three are generally considered the "heavy hitters" Statins are proven to reduce chances of heart attacks, strokes, etc.

An important aspect of Statin Drugs is that they are not only (extremely) effective at lowering your bad cholesterol, but they have other benefits. These are called pleitropic effects. They include features such as anti-inflammatory effects on the blood vessels (cholesterol blockage of the heart is an inflammatory disease) and they reduce likelihood of clots forming n the vessels.

Statins are safe drugs to use. The chances of serious side effects are low, at less then 2%. Muscle aches are common but not considered serious. Usually one statin causes more side effects then others.
You ought to get the best deal you can on these drugs (look for insurance company coverage) but overall, statins are worth the investment. Another drug is Zetia. It works in the bowel by binding cholesterol. Used alone it is not as effective as when used with a Statin. Zetia is not drug of first choice for high cholesterol, statins are. Make sure you have tried all the statins before you move to Zetia only.
WelChol is another choice.
In several cases, combinations are necessary.
But remember, always follow your diet. Get used to eating healthy. It is a matter of habits.

Treatment for high cholesterol is life-long. We control high cholesterol we don't cure the disease. It is not likely taking an antibiotic for curing an infection. The disease, which is often in your genes, stays there unless controlled by diet and drugs.

Heart Healthy Diet:
Overall the most important ingredients to most healthy diets is to apply what we know to you daily life. Most of it is good habits, some discipline (you do not have to perfect all the time) and common sense.

Most healthy diet has things in common:
  • Avid cholesterol and fats:
    • White meats are far better than red meats and pork. However you can find reasonably good red meats like sirloin that is much better than rib eye or New York's. Eat more white meat than red meats. Some sensible people eat red meats three times a week. Avoid hamburger meat, bacon, etc.
    • Avoid cheeses, standard salad dressings (like ranch), butter.
    • Eat more fish, consider supplementing your diet with 3 capsules of fish oil (Omega 3) daily. Omega 3 oil helps prevent heart attacks and help prevent life threatening irregular heart beats.
  • Carbohydrates:
    • Avoid processed carbohydrates such as too much rice, flour , bread products, potatoes.
    • Use more unprocessed carbohydrates such as cereals, salads, vegetables.
  • Consume more olive oil and other health oils (vegetable, carola) and avoid unhealthy oils. Nuts are healthy. You do have to keep track of calories, some oils are rich in calories.
  • Be selective with daily products use 2% milk or skim milk. Avoid Cheeses.


I suggest you visit often Heart Healthy websites, such as the American Heart Association, etc.

In Summary,
  • Be Active
  • Eat smart
  • Get preventive check ups with you family doctor, who is up to date on preventive medicine.

In my practice, I like to work in conjunction with your primary care physician in effort to keep you healthy and live a full life.

High Blood Pressure: (HBP)
There are many effective treatments for HBP but the first point that needs to be made in that exercise, weight control and good diet (avoid high salt intake) are core issues. Fat and cholesterol does not effect your blood pressure, but people who consume high fat / high cholesterol diets also tend to consume high salt diets.

Drug therapy is almost always necessary of you have high blood pressure. Losing weight can take time and is often unsuccessful while, in the meantime, your blood pressure remains high. So I don't hesitate to start drug treatment, it can always be stopped if you lose a lot of weight.

Treatment of HBP is life long. We control HBP, we don't cure it.

Drug Treatment:
Each doctor has their favorite drugs for HBP. But there are drugs that not only help your blood pressure but they help protect your heart muscle and your kidneys. Not all drugs protect your heart muscles or kidneys.

Generally considered top choices for HBP control are:
  • ACE Inhibitors: such as Altace, Lisinopril, Zestril, Enalapril (Vasotec), Captopril, ACEon and Mavik. These can cause cough in a lot of people.
  • ARBs: they work somewhat similar to ACE Inhibitors. Examples include Cozaar, Diovan, Avapro, Atacand and Benicar.
    • Point # 1
      ARB's are more expensive but not proven better than ACE. If an ACE does the job well, an ARB shouldn't be necessary. I use ACE first, if cough occurs, then I switch to an ARB.
    • Point # 2
      ACE are usually available in generic, ARB's are not.
    • Point # 3
      Adding a small dose of water pills and boasts the effect of the drug. Most ACE and ARB drugs are also available with diuretic.
  • Beta Blockers: good for HBP control and also very helpful to prevent arrhythmias (which patients with HBP are prone to)and heart attacks.
  • Diuretics: Inexpensive and effective. Better to avoid high doses.
  • Calcium Channel Blockers: tend to be more expensive as a group but do not necessarily protect your heart as well as the above.


Smoking:
Cigarettes have several unhealthy effects. They cause heart attacks by thickening your blood and contracting the arteries in your heart. Also they are suspected of having other unknown bad effects.

They can cause lung, tongue, throat and bladder cancer. They lead to strokes.

Cigarettes lead to cholesterol plugging of the heart and brain vessels by causing damage to the lining of vessels. This leads to the cholesterol build-up and plugging.

What is the end result?
  • Cancer
  • Heart attacks
  • Sudden Death
  • Strokes


You will add good years to your life if you quit smoking.

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