We had plenty of questions last night from viewers of "The Cutting Edge: Attacking Heart Disease." Dr. Sahil Parikh and Dr. Arie Blitz from University Hospitals Case Medical Center in Cleveland were answering viewers' questions throughout the broadcasts.
Dr. Parikh specializes in cardiovascular medicine and attended medical school at Johns Hopkins in Baltimore. He later worked at Brigham & Women's Hospital and Massachusetts General Hospital before coming to Cleveland's University Hospitals.
Dr. Arie Blitz is the director of the Heart Transplantation and Mechanical Circulatory Assistance at University Hospitals Case Medical Center. He attended the Albert Einstein College of Medicine in New York. Dr. Blitz implanted the first Jarvik Heart Pump used at University Hospitals and has also researched children's cardiac surgery.
Q: Is coffee bad for the heart?
A: The short answer is no. Some people feel palpitations when they have caffeine but there is no evidence to suggest greater risk of major heart problems because of coffee consumption.
Q: Will anxiety cause palpitations?
A: Yes, anxiety can cause palpitations. It's not uncommon to feel an extra beat or two, but not significant arrhythmias.
Q: Will the inferior vena cava shrink with age?
A: The VC usually gets bigger with age, so no, it does not shrink.
Q: If I were to quit smoking now after smoking for 35 years, how long will it take for me to see the benefit? I have PAD, CAD, HB AND HIGH CHOLESTEROL.
A: We see the most benefit to patients with COPD. In all other cases, stopping smoking will slow down the progression of the disease. The overall health benefits are immediate.
Q: What percentage of blockage in an artery is need to worry?
A: The percentage depends on where the artery is located. If it is a coronary artery, 50% is concerning and 75% is severe.
Q: Is the da Vinci system more reliable than manual operations?
A: Da Vinci is not more reliable. Manual or robotic - it still all depends on a human. A person still has to operate the da Vinci.
Q: Is pain in the right side of the neck possibly heart related?
A: Pain in the neck can be heart related, but generally if it is, the pain is dull and pressure-like.
Q: Where can I get information about heart healthy foods?
A: Here are some heart-healthy foods:
• Oily fish. Mackerel, sardines, tuna and salmon contain omega-3 fatty acids, which make the blood less likely to clot and block blood flow.
• Tea. Some evidence suggests that the antioxidants in tea can help cut the build-up of fatty deposits in the arteries and fight blood clots.
• SOME Alcohol. Some kinds of alcohol (such as red wine) may help clear cholesterol from the body
• Foods containing vitamin E. Avocados and dark green vegetables are among those that can clear the body of bad harmful cholesterol.
• Garlic. It will lower blood cholesterol.
Q: Will taking daily Niacin pills and fish oil help raise HDL levels?
A: Absolutely. See this link. http://my.clevelandclinic.org/heart/prevention/nutrition/omega3.aspx
Q: How low should your cholesterol be?
A: It depends on the patient and what the target cholesterol is... Overall it should be less than 200, but more important is the breakdown. HDL should be over 40. LDL target depends on your risk level.
Q: What besides 80mg lipitor, lovaza and tricor can I do to help with my hyperlipidema? I am now counting carbs. I'm not diabetic or overweight. Does the new blood cleaning treatment work?
A: Without knowing your lipid profile it is hard to give you specifics, but there are a number of ways to help. Lifestyle changes - exercise, diet, quit smoking if you do. Medications (like the ones you mentioned) and others, but you should speak directly to your doctor about those options. And also supplements like fish oil and omega 3 fatty acids. I am not sure what blood cleaning method you are referring to, but I would guess it is experimental at best.
Q: Where can I find additional research on cardiac ablations for NSVT? I am a competitive athlete, my heart is not enlarged, but I do have a low/normal ejection fraction. I am looking at what is out there for athletes and NSVT and ablations.
A: Search online for peer-reviewed journal articles and other academic/expert content, but if you are concerned you should definitely talk to your doctor or consult a cardiologist.
Q: I have fluttering in my chest and into my neck at times. Saw doctor two days ago and he doesn't seem concerned, should I be?
A: You absolutely should get a second opinion and consult a cardiologist about your flutters and neck pain.
Q: I am 50, my brother is 51. He just had 5 bypass surgery. Both my parents had bypass surgery and strokes. My mom's sister died of stroke. My gp doc says so far so good. Should I be seeing a cardiologist for preventative care?
A: Not if you have a good primary care doctor that is doing the ongoing screenings for you.
Q: What is the future of the Continuous Flow Total Artificial Heart if the FDA allows for further operations of this type?
A: There is no FDA-approved continuous flow artificial heart.
Q: Just a quick question. I am 54 years old, 160 lbs, 5'7" and have been actively working out 3-4 days a week for years. I have had palpitations most of my life off and on maybe 4-5 times a year. In the last 6-8 months when I am running and my heart rate gets to 140 the palpitations start every 3-4 minutes. I do not have chest pain or shortness of breath. I am reluctant to see a doctor because of the rate hike to insurance by having this on my record but should this be checked out?
A: Yes! Always get cardiac problems checked out and evaluated by a cardiologist. Anything that is not normal for you is cause for concern.
Q: How can I get into a study for myocardial stem cell program?
A: Keep searching http://clinicaltrials.gov/. That's the location of all clinical trials on all topics.
Q: What is more important -- total cholesterol or the ratio?
A: Calculating your cholesterol ratio can provide useful information about your heart disease risk, but it isn't useful for deciding what treatment you should have to reduce your heart disease risk. Your total cholesterol and low-density lipoprotein (LDL, or "bad") cholesterol levels are more useful in guiding treatment decisions than is your cholesterol ratio. You can read more here. http://www.mayoclinic.com/health/cholesterol-ratio/AN01761
Q: What is the name of the blood test that can help detect the level of plaque or the high potential for heart attack if you have a family history of heart disease?
A: There are several blood tests. The one you seem to be talking about is the C-reactive protein test. But you should also read about these tests. http://www.mayoclinic.com/health/heart-disease/HB00016
Q: What is microvascular heart? Will I die from this problem?
A: Here's something from the NIH: "Coronary microvascular disease (MVD) is heart disease that affects the heart's smallest coronary arteries. Coronary MVD occurs in the heart's tiny arteries if the walls of the arteries are damaged or diseased."
Q: I had a heart attack at the age of 37. In 1999 they put a stent in. In 2006 the stent collapsed and they put another one in. I have had chest pains ever since the first one. The pain is getting worse with shortness of breath, dizziness and light headedness. I have had all the tests done including stress test with dye, echo. I am on metoprolol, isosorbide, metforman, aspirin, nexium, pravastatin, effexor. Everything comes back very good. I'm scared one of these days it is going to be serious and I will just ignore it. Please any suggestions?
A: You need to talk to your cardiologist to decide if there is anything else causing your chest pain. There are more meds you could be taking if the cause is definitely cardiac-related.
Q: When we use the Continuous Flow Total Artificial Heart, what are the advantages of CFTAH over other hearts?
A: The benefits are the size and durability of the device.
Q: I was diagnosed with Cardiomyopathy. The cardiologist stated that not enough oxygen is getting to my heart. I'd like to know to assist me with getting better care what questions should I ask him; if I should request a certain test on a regular basis. I've had a cardiac cath in 09.
A: You need regular evaluations with echocardiography, blood tests for all your risk factors (cholesterol, blood sugar, etc.). Some questions to ask your cardiologist: Is your cardiomyopathy reversible? What is the cause of it? What is the long-term prognosis? What treatments and medications are appropriate?
Q: The aortic valve is being replaced without surgery. When will they start doing the tricuspid valve replacement without surgery?
A: The tricuspid is more difficult to treat. There is a higher risk of clotting. There is ongoing investigation and research in this area, but it is a less common problem than the aortic valve.
Q: What signs of heart disease should a 30 year old active woman with low blood pressure look for? What can I do to lower my risk?
A: Coronary artery disease is something everyone should worry about. You should talk to your doctor and make sure your risk factors are regularly checked - your cholesterol level, blood sugar, etc. While your blood pressure may be low now, it is important to monitor it regularly. It tends to go up with age.
Q: Is it true constant shoulder pains can be an early sign of heart disease?
A: Most of the time the pain will be between your shoulder blades. Also, read these details from Mayo Clinic: http://www.mayoclinic.com/health/shoulder-pain/MY00189
Q: Can mild heart failure be halted or is it always progressive?
A: It depends on the cause, but yes in some cases it can be halted with proper treatment.
Q: Should one also let a heart pain go? I have had a few lately but not really any chest or arm pain. Like a needle in the heart. Then it goes away.
A: There are all kinds of chest pain with a diverse range of causes. You should definitely have it checked out.
Q: What about 50% blockage in the carotid arteries in the neck?
A: That is an increased risk for stroke. Standard practice is treatment for blockages 70% or greater, but all patients with blockage are at risk for atherosclerosis. You should follow treatments to reduce your risk (aspirin) and make sure you are getting regular risk factor screenings.
Q: Will foods that lower bad cholesterol also lower the good cholesterol? Like garlic and fish oil?
Q: What heart disease screening is available for women without insurance, especially those with a family history?
A: It depends on what type of screening you are looking for. You can have your risk factors evaluated really inexpensively (blood tests), and even in some cases for free. Consult your local hospital for reduced price screening programs.
Q: I have had my aortic valve replaced about 5 yrs. ago with a pig valve because I was born with a birth defect, bicuspid aortic stenosis. Will I be able to have the non-invasive procedure done to replace it in about 8 years?
A: The non-invasive procedure is still experimental and it is hard to predict what technology will be available in 8 years. They are doing things with catheters in Europe, but it is still experimental in the United States.
Q: Can diet medications such as adipex weaken your heart?
A: Adipex can increase your risk for pulmonary hypertension when combined with certain other medications and it is ONLY safe if you are taking it under the supervision of a doctor.
Q: I am a relatively healthy, 62 year old woman. I have a history of heart disease in my parents and grandparents. I am 40 pounds overweight. I go to the gym 5 times a week and try to eat well. I have had any number of the symptoms of a heart attack. Once about 3 years ago, I was convinced to go to the ER. It was nothing, cost me 2 days off work and thousands of dollars. Now I am out of work and have a high deductible insurance. I can't go to the doc or the hospital every time I am short of breath or feel tightness in my chest. Any suggestions?
A: You need an outpatient evaluation. Tests that are inexpensive but can determine whether the causes of your shortness of breath are cardiac-related.
Q: If someone continues to fail stress tests but nothing is found with a cath test what would be the next step? Would a heart murmur cause an abnormal stress test?
A: Not usually. You should be treated with meds and close follow-up.
Q: I heard a conference over the weekend that said arrhythmias are hereditary.
A: Read this article: http://www.netwellness.org/healthtopics/heart/heart_rhythm.cfm
"With certain genetic conditions that are inherited in a dominant fashion, a 50-50, flip-of-a-coin chance exists that each child of an affected individual will inherit the disease-causing gene change."
Q: My husband gets sharp pain on his chest once or twice a week for the last 4 years. The doctors did different tests to check if it is related to his heart, but the test result was negative for heart disease. What other disease would cause severe chest pain on the right side?
A: There are a number of possibilities. Can be related to lungs, esophagus, gallbladder or any other organ in the chest cavity. Need to continue conversations with your doctor.
Q: It seems that DRs are prescribing high cholesterol medicine to everyone. Is it really necessary? What are the risks of not taking this medicine?
A: Cholesterol medications work very well for patients at increased risk for heart attack. Medications reduce risk and prevent mortality. The number of patients at risk is always increasing which is why more people are on these medications.
Q: Do you know of any new treatments for very low HDL (24)?
A: Yes. There are many experimental new treatments and clinical trials going on for new medications. Talk to your doctor about available protocols.
Q: I have a heart murmur and a leaky heart valve. I need to have surgery to have a fistula. My cardiologist wants to do another nuclear stress test to see how the heart has progressed. Last stress test was in May. Is the stress test the best test to find out if I have any further damage to my heart or would an echo or another test give the same answers or results?
A: Not necessarily. A stress test, no matter how it's done, serves the same function. The other tests are only necessary if they find blockages. Your first line of diagnostics should be the stress test.
Q: How serious is sick sinus syndrome? I've had numerous monitors, stress tests, echocardiogram, carotid artery sonogram. All show nothing except low pulse (50-52) and premature beat. I get no answers.
A: Sick sinus syndrome is often treated with a pacemaker, but only when there are symptoms (fainting and dizziness). It is important that you continue the monitoring and tests.
Q: I have had 4 cardiac caths 4 to 5 months apart, with 5 stents placed. I still have symptoms chest pain/shoulder pain/very tired/ my doctor doesn't seem to take this serious. Is there something I need to be doing or watching for? I'm a 50 yr old female.
A: Your symptoms may not be heart-related. You should bring them up with your primary care doctor as well as the cardiologist.
Q: Can high triglycerides be caused by oral HRT being metabolized by the liver and if so, would switching to a patch avoid the elevation in triglycerides?
A: No. There are different hormonal effects on your lipids but the formulation of the hormones doesn't change the effect.
Q: I had two seemingly-healthy friends die at 54 from undetected heart disease. I turn 54 in a few months, and I have high cholesterol. I cannot take the meds to lower cholesterol. Should I get an MRI on my heart / arteries and veins to see if I have heart disease?
A: You should focus on controlling all of your risk factors and continue to have screenings to continually assess your risk. You should have an exercise test, and after consulting a doctor, obtain a coronary artery calcium score.
Q: Do elevated enzyme levels mean you have "had" a heart attack?
A: A heart attack diagnosis is made with 2 of 3 criteria. 1. Typical symptoms (chest pain, etc.) 2. EKG findings 3. Blood test findings. So with just the blood work doesn't confirm a diagnosis.
Q: Had an episode of Afib last year and afraid for it to happen again. What are the best ways to prevent skipped or extra beats or Afib if I have hypertropic cardiomyopathy?
A: There are definitely things that stimulate Afib. You should avoid alcohol and other stimulants. You should ensure you are getting proper treatment for your cardiomyopathy and confer with your cardiologist.
Q: I am taking norvasc for blood pressure. My heart rate is running in the 40's. Is this normal?
A: Heart rate and blood pressure can be related. Norvasc typically does not slow down your heart rate, but you should consult your doctor.
Q: What is the life expectancy of a pig valve?
A: 10 - 15 years
Q: I have tachycardia. My cardiologist sees me yearly. I've had an echo and numerous holters and he says my heart is healthy but just beats fast. He says it's nothing to worry about, but I can't help but worry it will damage my heart over time. I take metoprolol 100 mg 2/day and it still gets up to 104-106 with light activity and anxiety. Is there anything else I should be doing? Can this damage my heart over time?
A: It is not known if asymptomatic tachycardia is harmful long-term. Most of the time it's not harmful, but if it's very rapid (much higher than what you indicated) for a long period of time, you can develop cardiomyopathy. You should check with your cardiologist.
Q: I'm 32 with LDL of 82 and HDL of 84 - are those good numbers? or bad? Heart disease runs in my family, but I'm fairly active and take fish oil every day, but I do eat too many processed foods.
A: That is a good profile. Your HDL is excellent and is protective of heart disease.
Q: My current HDL level is at about 25. Should I be overly concerned? I am trying everything I can do naturally to raise it.
A: Your HDL level is only one of the many risk factors for heart disease. You shouldn't be overly concerned; However diet, exercise and certain medications can increase your HDL level. You should talk to your doctor. There are experimental treatments also available.
Q: My dad has been told he's high risk for receiving a stent and that bypass is not an option. His heart is extremely weak. What can be done to strengthen his heart so a stent can be done?
A: Patients who are not considered surgical candidates are definitely not candidates for a reason. It is hard to get specific without knowing the other risks involved. That said, he can always make lifestyle changes to reduce his risk and improve his heart health. He should also discuss medication adjustments with his doctor. Again, hard to get specific without more history.
Q: I have a pericardial effusion which has been present for over a year now and is located behind my heart in a very risky position. And irregular heartbeat, and slow. I have had about 8 ECG's that all state abnormal. What could be the underlying cause of this pericardial effusion and should my doctor be concerned as to whether or not to drain the fluid off my heart? I also have alpha one antitrypsin deficiency disease. Phenotype MZ diagnosed in 2000.
A: Causes can be a wide range of things - infection, kidney failure, autoimmune disease. There is no hard indication for draining the fluid. You need to continue searching for a diagnosis via blood tests and sometimes we'll consider a diagnostic aspiration of the fluid; However the yield of the aspiration is low and often doesn't outweigh the risks. Keep working with your doctors.