Why do I have heart palpitations? I am only 47.

Heart palpitations have many causes. The most common causes include stress, fever, anxiety, use of certain medications (thyroid pills, use of anti asthma medications), excess caffeine, mitral valve prolapse, heart disease, an over active thyroid, abnormal electrolyte levels (potassium or magnesium) and disorders in the heart conduction system.

In most young people, palpitations are transient and benign. However when heart palpitations are associated with symptoms like shortness of breath, chest pain, dizziness, sweating or fainting spells, then you definitely need to see a doctor.

If you have had only one episode of heart palpitations then you do not need to worry. However, if you have symptoms or if your palpitations are recurrent, you do need to see a doctor. The work up of palpations begins with an ECG. Some people are asked to wear a halter monitor which records the heart rhythm for a number of days. Your doctor may check your blood to look at the levels of potassium and magnesium.

The treatment depends on the cause. In most cases the treatment is drug therapy or some type of laser ablation of the abnormal electrical pathways in the heart.

My blood cholesterol is normal but my doctor insists I take a statin!

Well, you can always say NO. In truth, your doctor is not practicing evidence based medicine. 

There is absolutely no reason why someone with normal cholesterol levels should take a statin. Statins have to be taken for life, are prohibitively expensive and have many side effects. 

Statins are generally recommended for people who have high cholesterol and/or risk factors for heart disease. The current media hype about statins for everyone is total nonsense.  If your cholesterol levels are normal and you want to keep them normal, stop smoking, exercise regularly, eat healthy and keep away from doctors who give idiotic advice.

More on Calcium and the Heart

A recent report on a large randomized study from New Zealand evaluated extra calcium supplement use (at least 500 mg/ day) in more than12,000 patients over the age of 40. The findings were not entirely surprising. The pooled data revealed that excess calcium carries a significant risk for heart attack. More over there was also an increased risk for stroke and sudden death in patients who took calcium supplements.

How calcium causes the increase risk of heart disease is not fully understood but believed to be due to alteration in vessel compliance. This eventually leads to calcium build up in the blood vessel wall. These authors summarized the data were succinctly. For every 1000  people treated with calcium for 5 years, it leads to prevention of 26 fractures, but on the other hand, there were 14 additional heart attacks.

This is the second large study from New Zealand which directly points the finger on calcium.

So where does this live the patents who have osteoporosis and all the calcium fanatics?

Well, there is no increased risk when eating the daily-recommended levels of calcium. It is the excess level of calcium that is of concern. The eternal myth that bigger is better certainly does not hold up for calcium (or for any other foods). For people who want to prevent osteoporosis, eat natural foods and leafy green vegetables that contain calcium. Moreover, drink adequate milk and eat consume dairy products. And do not forget to walk. 

What is so difficult is why the American population is so fanatical about calcium pills. The majority of these health supplement pills and minerals are made in the Orient. There are countless reports about fakes and counterfeit products including dry wall and chalk material found in these pills- so why take a pill instead of fresh fruit?

If you do take calcium supplements, speak to your doctor about it first and do not go overboard. The daily recommend calcium intake for both men and women is about 1000 mg/day. Like everything else in life, too much of calcium may not be good for you- here is to a glass of milk.

Can vitamin D reverse my coronary disease?

First, the simple answer-NO. 

You can eat all the vitamin D you want, it will not do anything for your heart disease. There has been a lot written lately about vitamin D and how it benefits people with coronary artery disease. This is utter nonsense. 

The fact is that there are no clinical studies to document these statements. The people who advocate vitamin D are the ones who sell it. It should also be remembered that vitamin D pills are not a substitute for the conventional heart medications. 

If you want to reduce your risk of heart disease, maintain a healthy weight, eat more veggies than meat, do not smoke, exercise regularly and get a regular check up with your doctor. 

If you listen to the charlatans who recommend vitamin D for plaque reduction, you will end up dead sooner than you think.

Is there a finger test that can detect heart disease? Part 2

The endopat is widely available in the office of many doctors. So the question is, “does it work?”

Well, the test is new and it is marketed heavily because it makes a lot of money for the doctors. The test cannot image your heart and no one knows for sure if the changes in the finger are the same as those in your heart.

More important, the test is not covered by most insurance or Medicare plans. When a test is not covered by Medicare, you can usually assume that it has more to do with profits for doctors .  In short, this is just another bogus test which has no practical application. One can tell easily that you are at high risk for heart disease just based on the history. One does not need an expensive finger test to tell a person to start walking or stop smoking.

Common sense indicates that people who live healthy, usually do not develop medical problems.

Save your money by avoiding this BS test and learn to live healthy. If you have high blood pressure, diabetes or high cholesterol, change your lifestyle, stop smoking, start walking, and eat a healthy diet with low fat. This is one piece of advice which does not require an EndoPAT test.

Is there a finger test that can detect heart disease? Part 1

Yes, there is. It is called the EndoPAT and is not worth it. The test was designed by researchers at Mayo Clinic and it is also known as the endothelial peripheral arterial tomography test. The device is applied on the fingertip and it can painlessly measure the health status of your blood vessels. The device prints out a few numbers, which can predict your heart's outlook. The device has fine sensors that can monitor flow of blood in your arms and fingers.

In simple, the Endopat sensors are placed on both the right and left index fingers. Then a blood pressure cuff is applied on one of the arms. When the cuff is inflated, the blood flow to that arm is stopped and the sensor will show no flow. At the same, the sensor on the opposite index finger will display your normal blood flow. After a few minutes, the blood pressure cuff is released and allows blood flow back to the hand. If the finger sensor on the affected arm shows normal rush of flow, then the vessels are working fine. IF the flow is sluggish then your vessels are unhealthy.

The endopat works on the idea that the arteries in your heart also react to stress in the same way as your arms. If the flow to your finger is sluggish then the flow to your heart vessel is also sluggish. In addition, this leads to a diagnosis of atherosclerosis and one can take preventive measures.

The aim of the test is to identify people who have early atherosclerosis. This test may be applicable for diabetics, people who smoke or those who have high blood pressure. This finger test can tell when the vessels are getting stiff and one can adopt a healthy life style much early on.

Can I take a vitamin to prevent a heart attack or chest pain?

Unfortunately there is no evidence which shows that vitamins can either prevent or treat a heart attack. There are many alternative health care practitioners who recommend mega doses of vitamins for every medical disorder underneath the sun. However, there is not one scientific study which has shown that vitamins can cure or prevent a heart attack. Moreover, if you start mucking around with chest pain at home and treat it with vitamins, you may end up dead.

Vitamins may be taken as a health supplement for overall health but are not a substitute for traditional treatments for a heart attack. Laboratory studies have shown that vitamin C and E can lower bad cholesterol and reduce fat build up in blood vessels. However, no human study has shown that vitamins alone can prevent a heart attack. The risk factors for heart disease are obesity, high cholesterol, uncontrolled high blood pressure, smoking, diabetes, lack of exercise. No one has even shown that lack of any vitamin can cause a heart attack.

Why vitamins are recommended for treatment of heart attacks in the first place is a mystery. For all consumers, if you have no documented deficiency of vitamins than there is no need to take any supplements.

Even if you have a deficiency of a vitamin, which is preferable- decent juicy fresh fruits and vegetables or a cardboard pill made from the Orient which may be a fake or contain contaminants?

If you have chest pain, stop fooling around with vitamins- take whatever heart pill your doctor recommended.

What medications are used to treat high blood pressure?

The major types of medication used to control high blood pressure include:

Thiazide diuretics. These water pills act by removing the excess water and salt from the body. These drugs are the first line for treatment of high blood pressure; they are cheap, effective and have minimal side effects. In the majority of individuals are very effective and should be the first line drugs of choice.

Beta blockers. These medications act by decreasing the work of the heart and dilating (opening) up the blood vessels. They have been around for more than 50 years. Unfortunately, they are not very effective in African Americans but otherwise work in all ethnic groups. The side effects include decreased libido and glucose intolerance.

Angiotensin-converting enzyme (ACE) inhibitors. These drugs have today become the gold standard and are very effective in the treatment of high blood pressure. They also protect the heart and are useful in all groups of patients. They are useful in individuals with diabetes, heart failure or those who have angina (chest pain). They are readily available but some are expensive and do have a tendency to produce a persistent dry cough.

Angiotensin II receptor blockers. These latest medications open up the blood vessels and decrease the blood pressure. However they are very expensive and are not first line treatment. They are to be used in individuals who do not respond to the other drug treatments. Some clueless physicians routinely prescribe these drugs as first line therapy for hypertension.

Calcium channel blockers. These drugs have been around for many years and work well in African Americans. They are very effective in the treatment of blood pressure. They are reasonably priced but should not be used in patients with a weak heart. They do tend to cause swelling in the feet.

Renin inhibitors. These are the latest drugs available to treat blood pressure. They act by inhibiting a chemical (renin) which is known to cause high blood pressure. The new drug, Tekturna (aliskiren) is a renin inhibitor. The drug is very expensive and is not a first line drug. The drug is most effective when used in combination with other drugs.

Alpha blockers. These medications have been around for decades but are rarely used to treat high blood pressure because of their side effects

Central-acting agents. There are some medications which act in the brain to decrease the nerve impulses to the blood vessel. They are quite effective in decreasing blood pressure and widely used (e.g. clonidine, Aldomet)

Vasodilators. There are a variety of medications which can open up narrowed blood vessels and decrease blood pressure. These medications are often used intravenously in the ICU for emergent use in the treatment of hypertension.

Once your blood pressure is under control, your doctor may add aspirin and/or a medication to lower your cholesterol to your regimen to further decrease the risk of a heart attack.

Resistant hypertension

In some cases, high blood pressure may be resistant to a single drug and a combination of 2-3 drugs may be required. Many of these combination therapies are done on a trial and error basis. In some cases, the individual will be referred to a heart specialist who deals with blood pressure treatment.

FOR more on blood pressure monitoring devices, please visit www.medexsupply.com

How is high blood pressure treated? part 1

Once the diagnosis of high blood pressure is made, it is important to start treatment even if one has no symptoms. Because there are no symptoms, many individuals delay treatment and then it is too late to reverse any of the complications. The treatment is life long.

Blood pressure goals aren't the same for everyone. Although everyone should strive for blood pressure readings below 140/90, doctors recommend lower readings for people with certain conditions.

Blood pressure treatment goals

140/90- for the health adult

130/80- for those with chronic kidney disease, diabetes or heart disease

120/80- for those with a weak heart

Drug treatment

The treatment of hypertension is straightforward. Over the last three decades various guidelines have been established. There are also numerous types of drugs used to treat hypertension and which drug the physician selects is based on his/her experience. For most individuals, a single drug may suffice, and in others multiple drugs may be required to control the blood pressure.

How do i treat my high blood pressure? part 2

Avoid stress. For those with high stress, one should try and avoid or decrease the stress levels. Rest, relax and exercise.

Coping skills

There is no cure for high blood pressure and thus life long treatment is required. To help cope with the management of blood pressure, one should do the following:

Home blood pressure monitoring. This is useful tool for home use and one can monitor the treatment and see if the medications are working.

Take the medications regularly. Do not skip medications, sometimes rebound hypertension can occur.

See the doctor regularly. At least once a year, see your physician and get your blood pressure measured and make sure that it is well controlled.

Hypertension is not a fun disorder; it has no symptoms and yet requires life long treatment and there are a lot of Dos and Don’ts associated with this disorder. Many people question why they have to take drugs if they do not have any symptoms plus the medications can be expensive. But on the plus side, well controlled blood pressure will add years to your life. On the negative side, one may end up with one eye, have a weak heart, remain with one kidney and be demented- the choice is very simple- you better take the medications as prescribed and quit complaining.

for more on blood pressure devices, please visit www.medexsupply.com

How should I manage my high blood pressure? part 1

Compliance

The major problem with the treatment of hypertension is that because individual has no symptoms, he/she refuses to take the medications. Compliance with blood pressure medications is a difficult problem and it is important for the individual to understand the importance of treatment. One may skip a day, but routine skipping of blood pressure medications is only waiting for a disaster to happen.

Self-care

Changes in lifestyle are not only a key to improving blood pressure, but are important for general good health. In addition to losing weight, one should make efforts to control the blood sugar, stop smoking, live an active life style and eat well.

Eat healthy. One should eat healthy and change the diet from eating too much meat to a more vegetable oriented diet. Limiting salt may help some individuals in the control of blood pressure.

Maintain a healthy weight. Make efforts to lose weight. Obesity is associated with other problems besides hypertension also.

Exercise: “Couch potatoes” better move along. Inactivity leads to higher blood pressure and worsens obesity.

Don't smoke. This is the ultimate taboo for many medical disorders. One should try to stop smoking. There are no magical drugs to help one quit smoking- cold turkey is still the best treatment.

Risk factors for high blood pressure: part 2

Modifiable risk factors:

- Obesity: if there is one risk factor which worsens
hypertension, it is weight gain. The excess weight
means that the heart has to work much harder to pump
blood around the body. By decreasing weight, blood
pressure can be significantly decreased. Weight loss
is one key factor which can help reduce high blood pressure

- Non active lifestyle: Individuals who are not active
or couch potatoes generally tend to develop higher heart
rates and high blood pressure. Physical inactivity also
increase weight and is generally not a recommended life style
goal.

- Smoking is the universal factor for most health problems.
If people stopped smoking, more than 50% of the physicians
would be out of a job. Smoking is bad not only for the
blood vessels, but bad for health in general

- Sodium intake. For some individuals too much intake of salt
(sodium) may cause an increase in blood pressure. Salt
causes water retention which in turn causes an increase
in body fluids. Even though salt induced high blood pressure
is rare, one should avoid too much salt

- Stress is known to be associated with high blood pressure.
Most individuals have different levels of stress and should
try and avoid it.

- Medical conditions: Certain chronic conditions also may
increase your risk of high blood pressure, including high
cholesterol, diabetes, kidney disease and sleep apnea.

- Pregnancy: In some females the blood pressure may increase
during the later part of the pregnancy (eclampsia). This is
a serious condition which needs urgent treatment. The blood
pressure resolves after delivery of the infant

To lower blood pressure, one should make an attempt to lose weight. With weight loss one can also have a lowering of blood sugars and cholesterol. Finally, cessation of smoking is highly recommended. Besides saving you money, quitting smoking will give you a new lease on life.

for more on supplies for monitoring your blood pressure, please visit www.medexsupply.com

What are risk Factors for high blood pressure?

High blood pressure is common in our society. Some individuals have a number of risk factors that increase the risk of developing high blood pressure. The risk factors that may influence blood pressure are categorized into either modifiable or non modifiable.

Not Modifiable Risk Factors

- Age. Blood pressure will occur once all individuals
reach a certain age. Men tend to develop high blood
pressure much earlier than female, but by the 6/7th
decade of life, most elderly people have some degree
of hypertension.

- Race. High blood pressure is particularly more common
among blacks, and occurs at a much earlier age compared
to Caucasians. Serious complications, such as stroke
and heart attack, also are more common in blacks.

- Family history. High blood pressure is more common in
families with a history of hypertension.

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.