Question: Before I started a strenuous exercise program, my doctor ordered an exercise stress test to check my heart, even though I have no symptoms of coronary heart disease. That test was inconclusive, so I had a thallium stress test, which indicated some coronary disease. To confirm that finding, I underwent angiography, which found no sign of disease. Which test should I believe?
Answer: Angiography. That procedure, in which the coronary arteries are injected with dye and examined by X-ray, is the most accurate test for blocked coronary arteries. The two stress tests are safer and less expensive than angiography, which is why they’re generally done first. However, it is possible for those stress tests to turn up positive when there’s actually nothing wrong.
ASPIRIN, TIA, AND ULCERS
Question: Several years ago, I experienced a transient ischemic attack (TIA), which my physician said indicates a risk of stroke. As a precaution, he recommended aspirin therapy to reduce the chance of blood clots. After an episode of stomach bleeding, attributed to aspirin’s effect on a possible ulcer condition, I turned to Ecotrin, a coated aspirin. Should I stop using any kind of aspirin?
Answer: Probably not. Aspirin coated with an acid-resistant shell (Ecotrin and generic versions) should dissolve after leaving the stomach and thus cause less irritation than uncoated aspirin. However, some recent evidence disputes this. At best, it does offer the anticlotting benefits of aspirin, with less gastrointestinal risk. Those benefits are important after a TIA, in which blood flow to the brain is temporarily interrupted.
But considering your history of gastrointestinal bleeding from aspirin, you should have blood counts every couple of months. You can also visually check your stool for signs of internal bleeding (which turns the stool black). If bleeding does occur, your doctor might consider prescribing clopido-grel (Plavix), which doesn’t irritate the stomach.
For ordinary pain relief, people with a history of ulcers are usually better off taking acetaminophen.
Question: I’ve read that angina, the type of chest pain that sig-nals coronary heart disease, is usually brought on by exercise and relieved by rest. I sometimes experience chest discomfort while I’m resting but never while I’m exercising. Could that discomfort still be angina?
Answer: It’s unlikely. But an uncommon form of coronary disease can cause angina when you’re resting or asleep—due to arterial spasm, not blockage. To rule out that possibility, your physician could have you wear a heart monitor for 24 hours. You should also have a treadmill exercise test, even though you haven’t noticed the pain while exercising.
If those tests find no sign of coronary disease, your physician will investigate other possible causes of your discomfort. Ifs most likely to be a temporary problem, such as heartburn or spasms of the esophagus. Occasionally, however the discomfort reflects a chronic disorder, such as a hiatal hernia or gallbladder disease.
BLOCKED BUNDLE BRANCH
Question: I’m a 50-year-old male with a “right bundle branch block.” Is that cause for concern?
Answer: Not necessarily. The bundle branches are fibers within the heart muscle that transmit nerve impulses, causing the right and left ventricles to contract and pump blood into the arteries. Occasionally, transmission in one of the bundles becomes blocked, probably due to a clot in a tiny blood vessel feeding the bundle. The affected ventricle then contracts later than the other ventricle; this shows up as a characteristic pattern on an electrocardiogram. There are usually no symptoms, and there’s no treatment.
A blocked bundle branch, particularly on the left, does increase the risk of subsequent heart attack somewhat. That risk is compounded by the presence of other risk factors for coronary heart disease: high blood-cholesterol levels, hypertension, male gender, diabetes, age, smoking, and a family history of coronary heart disease before age 50.
Question: I’m 62 and have had Heart palpitations for years. vat can you tell me about theme?
Answer: “Palpitations” is a nonmedical term for any heart rhythm that feels abnormal. That can include extra beats, dropped beats, forceful beats, rapid beats, or irregular beats. For proper diagnosis, the abnormality must first be “captured” on an electrocardiogram or on a 24-hour heartbeat recording. Palpitations can be caused by emotional stress, an overactive thyroid, certain medications, or diseases of the coronary arteries, heart muscle, or heart valves. Sometimes there’s no detectable cause.
At some point soon, you probably should have your palpitations checked, but first try eliminating a few things on your own—caffeine (coffee, tea, cocoa, chocolate, soda), nasal decongestants, appetite suppressants—and see if it makes a difference.
MAGNESIUM AND THE HEART
Question: What does a low level of magnesium have to do with abnormal heartbeats?
Answer: Too little magnesium in the blood, an uncommon condition that is sometimes caused by chronic diarrhea or excessive alcohol intake, can lead to a type of abnormal heart rhythm known as ventricular tachycardia, a life-threatening event. Supplemental magnesium can correct the problem. However, since too much magnesium can also adversely affect the heart, magnesium blood levels must be monitored closely.
MITRAL VALVE PROLAPSE
Question: I am in my mid-thirties. A few years ago 1 was diagnosed as having a heart condition called mitral valve prolapse. What exactly is it, and does it make jogging or other exercise risky?
Answer: Mitral valve prolapse (MVP) involves a ballooning of the heart’s mitral valve leaflets or flaps, which control blood flow between the two left chambers of the heart. Recent improvements in taking and interpreting echocardiograms, or ultrasound images of the heart, have dramatically changed how doctors view MVP. They now know that MVP is far less common and risky than previously believed.
Individuals who’ve been told that they have MVP, particular more than two years ago, should ask their doctors to review the diagnosis. Those with true prolapse need to take special precautions—regular check-ups with a cardiologist and antibiotics before routine dental procedures—only if the echocardiogram shows that the mitral valve leaks (regurgitates) or that the flaps on the valve are unusually thick. As for exercise, most people with MVP can follow a sensible program. Ask your doctor for guidance.
WARMING COLD HANDS
Question: What causes cold hands, and what can I do about it?
Answer: The most common cause, other than cold weather, is simple nervousness. When you’re nervous, the surface capil-laries in the hands and feet constrict, causing a feeling of cold’ ness usually accompanied by localized sweating.
Less commonly, cold hands can reflect Raynaud’s syndrome. When exposed to cold, the fingers or toes actually turn white. This change is caused by spasm of the arteries that supply them (without sweating). Drugs such as nifedipine (Procardia) and prazosin (Minipress), available by prescription, can help. Occasionally, biofeedback techniques are useful.
WALK AWAY FROM LEG PAIN
Question: I suffer from leg pain because of poor circulation. Consumer Reports on Health mentioned that ifs possible to relieve the condition by exercising. What type of exercise do you suggest?
Answer: Simply walking, typically for a total of a half hour to an hour per day. The most effective regimen involves walking to the point of pain, stopping and waiting for the pain to subside, and then starting up again. But check with your physician first to make sure that would be safe for you.
Question: How can you tell chest pain caused by angina from that caused by a spasm of the esophagus?
Answer: It’s not always easy. Both types of pain are typically felt behind the breastbone. And the pain caused by an esophageal spasm often responds to nitroglycerin, the heart medication used to treat angina. However, there are three characteristics that do tend to set esophageal pain apart:
(1) Unlike angina, it’s more likely to occur when you’re at rest.
(2) it’s often related to eating; and (3) it may be accompanied by difficulty in swallowing.
Since it can be difficult to tell the two disorders apart by symptoms alone, your physician may need to do some specific testing. Angina is usually evaluated by an exercise test (usually a nuclear stress test); esophageal spasm can be determined by a manometric test, in which you swallow a tube that measures esophageal muscle tension.
Health handbook introducing you to read the article: Safe With Normal Blood Pressure?
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