Do I need a pacemaker?

The world of pacemakers is quiet complex. Some people develop abnormal heart rhythms- the heart may suddenly go fast or too slow. When the heart rate is fast, one can take medications. However, when the heart rate is too slow, there are no medications that can be used on a daily basis at home. Slow heart rate can be treated in a hospital setting with intravenous drugs. There is no pill that can effectively increase heart rate.

So now, we have pacemakers. There are many types of pacemakers and they can cost anywhere from $8,000-$30,000. The type of pacemaker you need is determined after studies on your heart. Pacemakers are life saving. The procedure to insert a pacemaker is very simple and rarely takes more than 30-45 minutes (unless your doctor is incompetent). The procedure can be done under local anesthesia and is not painful at all. It involves placing a small thin wire (electrode) in one of the chambers of your heart. The procedure is always done using x rays to ensure that the electrode is inserted into the correct anatomical position. Then a miniature pacemaker (about the size of a credit card) is inserted beneath the skin in the chest. The electrode is then connected to the pacemaker. The pacemaker is programmed and you are all set. Today, pacemakers have saved countless lives and work well for 7-12 years. Only the battery needs to be changed every 5-10 years.

Pacemakers can be inserted at any age and the risks are minimal. In the past, there have been a few doctors who allegedly have inserted pacemakers for trivial reasons (like making more money). Today, there are strict Medicare rules on who can receive a pacemaker. If you have been told by your physician you need a pacemaker, discuss the issues with a cardiologist (heart doctor). After a pacemaker, you will definitely notice a difference in your overall health.

Is dark chocolate good for the heart?

For lovers of chocolates there is good news. Yes, dark chocolates are good for you in small amounts. There have been several small studies showing that eating dark chocolates may actually have benefits for the body. It is believed that dark chocolates made from cocoa are known to contain flavnoids- which are potent anti oxidants. In these studies, individuals were who given a very small piece of dark chocolate everyday developed a persistent drop in blood pressure.

So should consumers start to consume dark chocolates? Well, there have only been a few such studies and the numbers of individuals followed have been minuscule. The field of medicine is known for its ability to hype up news about everything positive- negative news is always hidden.

One should always be aware that eating too many chocolates can lead to excess sugars, weight gain and an increase in blood pressure. Further, dark chocolates have been consumed in some European countries for decades and citizens in these nations still develop high blood pressure and serious heart disease. Individuals who have high blood pressure should not chuck their blood pressure medications yet. No chocolate has been found to be a replacement for the conventional blood pressure medications.

If you really want to control your blood pressure better, try walking and reduce your weight. Eat a healthy diet and avoid too much of everything. This approach is safe, cheap, and free of side effects.

I was told to take antibiotics before my dental cleaning, Why? part 2

Now the American Heart Association has come up with new guidelines and recommend a short-term course of antibiotics only for individuals who are at a high risk for developing a bacterial infection of the valves. These include people with:

- A mechanical prosthetic heart valve
- Natural prosthetic heart valves obtained from animals
or cadavers
- Valve repair using prosthetic material
- A prior history of infective endocarditis
- Most congenital (from birth) heart abnormalities,
even if the abnormality has been repaired

Individuals who are at low risk and do not require antibiotics include the following?

- Those with innocent heart murmurs
- Mitral valve prolapse without regurgitation
or valvular leaflet thickening
- Mild tricuspid regurgitation
- Individuals with Coronary artery disease or
those who have undergone bypass surgery
- Simple atrial septal defect (hole in the heart)
- Individuals who undergo angioplasty or ballooning
of their coronary vessels
- Those with prior history of rheumatic fever but
normal valves
- Those who have pacemakers or other similar devices

In the low risk group, it is now believed that antibiotics are unnecessary and may cause more health problems such as allergies.

Individuals who are at risk of developing infective endocarditis should maintain good oral and dental hygiene. This may include a visit to the dentist for a check up, regular tooth brushing and use of dental floss. These preventive measures can prevent plaque-forming bacteria from sticking to your gums and teeth

I was told to take antibiotics when I go for dental cleaning, WHY?

Bacteria thrive in the oral cavity. During dental cleaning, these bacteria are often released and can easily enter the blood stream. This is a common occurrence. In normal people, this is of no consequence. However, there are some individuals who have a deformed heart valve, a congenital heart problem, a hole in the heart or some type of heart defects- for reasons not understood, bacteria, which are released from the mouth, can move, and attach themselves to heart valves.

The valves are like a magnet and attract these bacteria. Once the bacteria stick to valves, they set about an inflammatory process and gradually destroy the valve. This is known as infective endocarditis. Therefore, all individuals who have heart valve defects are advised to take antibiotics prior to any procedure that will release bacteria into the blood stream.

However, there have been many studies of showing that antibiotics do not always prevent infective endocarditis. Other studies reveal that antibiotics may not be required for all individuals with heart problems.

Can I double up my dose of statin when I miss a dose?

Most people forget to take their medications at some point in their lives. In most cases, nothing really happens. Statin are drugs used to lower your cholesterol and have to be taken for many years, perhaps lifelong. Therefore, it is understandable if a dose is missed occasionally.

However, if a medication is missed for any reason, doubling up is not a great idea. Statins are generally very safe drugs and most individuals are prescribed low doses. Therefore, if you miss a dose of statin on a single day, it will not do you any harm. Statins do not work immediately and their benefits are derived over many months. In any case, to be on the safe side, do not double up the dose if you miss a pill. Nothing will happen and rest assured you will not get clogged up vessels by missing a single pill.

There are many drugs that can cause serious side effects if the dose is doubled up.

Overall statins are very safe and one can even miss a couple of days with no harm. However, that does not mean that you should continue with this erratic drug compliance. For best benefit of statins, one should take the pill everyday. If you routinely miss taking your statin, then use a calendar, a visual reminder, an automatic pill dispenser or get someone in the family to remind you. If you do not want to take the drug, talk to your health care provider and get your cholesterol levels rechecked. One of the best ways to reduce cholesterol levels is by changes in diet and exercise- and this is where you should have started in the first place.