What is atrial fibrillation (aFib)?

Devender N. Akula, MD

So the heart normally beats with a regular rate and rhythm. In atrial fibrillation, the top chambers of the heart beat irregularly. It’s something that we are seeing more commonly now and as people get older, it seems to happen more frequently. For example the prevalence is less than 2% in people who are less than 65 years old and above 65 the prevalence increases to about 9-10%.


This content originally appeared on Sharecare.com

What is aortic valve replacement surgery?

Steven J. Kernis, MD 

The term surgery is not quite as easily defined today as it was many years ago. By definition, surgery implies a procedure involving an incision, so the traditional surgery for valve replacement was called sternotomy, which is similar to bypass or open-heart surgery and is obviously risky and has a long recovery. During a sternotomy, the surgeon opens up the heart, removes the old valve and sews in a new valve. With the advent of the transcatheter aortic valve replacement (TAVR) technology, you can get a new valve without requiring any incision at all. The TAVR valve is delivered inside a stent, where it is collapsed like an umbrella. The physician pushes the stent through a catheter, which is like a long straw, and it travels into one of the arteries and into the heart. Once inside the heart, the stent opens up, again, like an umbrella, and compresses the old valve against the wall of the heart. The new valve works immediately.

A person with an aortic valve that is severely diseased or dysfunctional, meaning the valves can fail, is a candidate for aortic valve replacement. In fact, the basis of consideration of getting a valve replacement is determined on if the valve is severely dysfunctional and doesn’t open and/or close properly. Valves function like a doorway, and all the aortic valve does is open up and close so that the blood goes in where it should and in the direction that it should. The aortic valve is the last doorway before the blood leaves the left side of the heart. It’s sort of a big, main pumping chamber for the entire body other than the lungs. If the valve isn’t opening correctly, you can imagine what a problem that would cause for people. If the valve doesn’t close normally, then when the blood gets ejected out of the heart, a lot of it can regurgitate or leak backwards. Another thing to consider during valve replacement is whether the dysfunctional valve is causing somebody symptoms or a problem that disrupt everyday activities, such as not feeling well or difficulty breathing. The other thing that can happen is the body can fill up with fluid, causing heart failure. 



How does TAVR differ from traditional aortic valve replacement surgery?

Steven J. Kernis, MD 

Transcatheter aortic valve replacement (TAVR) differs from traditional surgical aortic valve replacement in that TAVR does not require opening up the chest and heart, or general anesthesia.

The standard surgical aortic valve replacement, which has been around for a long time, involves traditional or conventional sternotomy — opening up the breast bone. The person is under general anesthesia on a bypass machine. The heart is stopped and cooled down. The surgeons open up the chest and the heart to get to the old valve where they can see it. They actually cut it out and then take either a tissue or mechanical valve and sew it into place in the heart. The surgeons have other surgical options that don’t necessarily require opening up the breast bone, but in any way that they do it, it involves some type of chest incision, going on a bypass machine, stopping the heart and all of the risks that go along with that.

Transcatheter aortic valve replacement (TAVR) on the other hand allows surgeons to give someone a new heart valve through the groin, with no incision.  Most people do not require general anesthesia, just simple sedation, and they are up walking around later in the day with nothing but a little needle stick in the groin. This can be mildly uncomfortable, but certainly nothing like opening up the breast bone.


This content originally appeared on Sharecare.com.

How often should I have my blood pressure checked?

Hafeza Shaikh, DO on behalf of Lourdes Health System

How often you should have your blood pressure checked depends on a couple of factors. If you ordinarily don’t have any other medical issues, then your blood pressure ideally should be checked at least once a year or every time that you see your primary care doctor. This is really the first spot where doctors are able to screen and pick up cases of high blood pressure. If, in fact, your blood pressure is high in that first screen, it does need to be confirmed through either subsequent visits to the same doctor or via confirmatory readings at home.

If you haven’t seen a primary care doctor, then, certainly, you can go ahead and have your first check done at the local pharmacy or wherever you are able to get a blood pressure machine from.

Otherwise, if you’re not feeling well, that’s also a good time to get your blood pressure checked. For example, if you’re getting headaches chronically, maybe around the same time every day, or going on for more than a couple days in a row without any other explanation. You may even have blurry vision or more progressive issues like shortness of breath when you’re exerting yourself. All of those can also be signs of the blood pressure being high and that’s a really good time to check the blood pressure. Of course, if you can check it right at that time, then that’s fantastic as opposed to checking it several hours later when you’re home because it could have already recovered by then.


What factors affect blood pressure?

Hafeza Shaikh, DO on behalf of Lourdes Health System

One factor that affects blood pressure is age. With age, sometimes the resistance and the amount of stiffness that the blood vessels and arteries have can change. This can lead to hypertension, or high blood pressure, over time. Other reasons that people get high blood pressure include a couple of rare diseases that may be inherited, or a person may be born with.

Some factors that affect blood pressure are important because they are potentially reversible and can change with just simple modifications. For example, salt — sodium intake — in the diet. Unfortunately, the typical American diet is composed of take-out and prepared foods, which are consistently high in sodium. Blood pressure can also change just from acute issues such as stress levels and lack of sleep. Even sleep apnea can cause changes in blood pressure.


What is blood pressure?

Hafeza Shaikh, DO on behalf of Lourdes Health System

Blood pressure is the pressure in the blood vessels when the heart beats, and then when the heart is resting between the beats. Blood pressure is usually defined by two numbers: the systolic number and the diastolic number. A lot of times people refer to this as either the “top number” or the “bottom number.”

Blood pressure is super important. It reflects how the heart is able to circulate blood around the body to different organs. The reason we care so much is because blood pressure is implicated in so many important diseases, including heart disease and stroke, and often these are very life-altering diseases.


What numbers are considered high blood pressure?

Hafeza Shaikh, DO on behalf of Lourdes Health System

A top systolic blood pressure number in the range of 140 to 150 is the first stage of high blood pressure that doctors need to be aware of. One’s blood pressure numbers change over time, but typically, the top number — the systolic blood pressure — should be anywhere between 120 and 139. One exception in that situation has to do with age. If you’re above the age of 65, that top number can be in the 140s, meaning under 150, and still be considered within normal limits.

For the bottom number, anything above 90 when you’re over the age of 65 would be considered hypertensive; but otherwise, between 85 and 90 is considered the first stage of hypertension, so ideally, you want that bottom number under 85.


What lifestyle changes can help lower blood pressure?

Hafeza Shaikh, DO on behalf of Lourdes Health System

Lifestyle changes that can help lower blood pressure include the following:

• Exercise. It’s a hard-proven fact that a few minutes a day of cardiovascular exercise can really help drop the blood pressure a couple points and that can be critical, especially for someone running a borderline blood pressure that’s just a couple points higher than what it needs to be.

• Diet. If a high sodium diet is the underlying cause of hypertension, then that needs to be corrected. A lot of foods have so much hidden sodium, including foods that are take-out or foods cooked at home, such as frozen or canned products. It’s important for people to look at labels. For instance, the vegetable soup that seems healthy and benign may contain more than half of a day’s worth of sodium. It’s really important to become a label reader from that aspect. Take a look at the sodium and the percentages listed. Excess amounts of caffeine can also raise blood pressure.

• Sleep apnea. Treating sleep apnea, which is often an underdiagnosed condition, can also sometimes bring blood pressure down to a normal zone. People should ask their doctor if that’s something that they should be screened for.

• Stress. Excess amounts of emotional or physical stresses can also raise blood pressure, so that’s something to be watchful of as well.


What treatment options are available for high blood pressure?

Hafeza Shaikh, DO

Treatment options for high blood pressure (hypertension) include one of three medications — diuretics, calcium channel blockers or angiotensin-converting enzyme (ACE) inhibitors. This is usually the first-line medication for treating high blood pressure. In terms of diuretics, those are commonly things like hydrochlorothiazide or furosemide. In terms of calcium channel blockers, these are things like amlodipine, nifedipine or nicardipine. In terms of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), these are medicines like lisinopril, losartan and ramipril. The important thing is you want a medicine that’s going to treat not just your blood pressure, but any other issues that could be going on with your health such as diabetes, kidney problems, a history of a stroke or a history of heart disease. That really helps to guide therapy. If you don’t have any secondary conditions, then often, your doctor can choose from any of the three medications as their first choice.

However, communication with your doctor is important to make sure that you understand the potential side effects of these medicines, that you understand why your doctor chose one over the other, and that the proper effects are seen in the medication that were intended when they were first prescribed for you.


How does high blood pressure affect the heart?

Troy L. Randle, DO 

High blood pressure (or hypertension) affects the heart similar to the way weights affect muscles. When we lift weights, our muscles tend to get big and strong and thick. However, the heart is a muscle. Blood pressure is a weight that the heart has to pump against. The problem with the heart pumping against the elevated blood pressure is, the heart then starts to get thick and, unlike our outside muscles which gives us strength, when the heart gets thick it becomes stiff. It then leads to things such as heart failure. We can have stroke. We can have a high risk of heart disease and heart attacks as well. Over time, it can also affect vision and kidney function. So, it’s very important to get high blood pressure under control. 


How can young people’s blood pressure predict their health as they age?

Troy L. Randle, DO 

A young person’s diastolic blood pressure can be an indicator of heart health with age. If diastolic blood pressure is elevated and not controlled when a person is younger, this can indicate two things. One, the heart and arterial vessels are not relaxing as well, which is going to lead to stiffness and can be a precursor towards having heart failure or other heart problems later in life. The other is it may be a precursor to elevated systolic blood pressure later in life.


How often should I check my blood pressure at home?

Troy L. Randle, DO 

You should check your blood pressure at home at least once a day, three to five times a week. Two to three measurements a day would be ideal, but at least one, at different times of the day, is okay.

The morning blood pressure may be different than the afternoon blood pressure, which may be different than the evening blood pressure. Your doctor will want to see exactly what your blood pressure is and the time of day it is. You may be asked to keep a diary of that and bring it to the office visits so your doctor can keep track of your trends.


How does exercise affect blood pressure?

Troy L. Randle, DO 

As you exercise, your blood pressure is going to increase. The top number in a blood pressure measurement — the systolic — is the blood pressure as the heart is pumping the blood out. The bottom number — the diastolic — is the blood pressure when the heart relaxes. As you exercise, your systolic is going to increase. That’s a natural phenomenon. The diastolic may increase slightly but it’s not going to increase as much as that systolic will. If your diastolic increases by a few points — two to five points — that’s okay. But, it shouldn’t increase as much as, say, 10 points.


What are the risk factors for high blood pressure that I cannot change?

Troy L. Randle, DO

The risk factors for high blood pressure (or hypertension) that you can’t change are the following:

• Genes. The biggest risk factor for high blood pressure that you can’t change is genes. When you have a family history, you want to keep it in mind. Unfortunately, the genes that your parents passed on to you are what you have.

• Age. You can’t control your age. As people get older, there is a higher incidence of heart disease and high blood pressure.

• Gender. We can do things to make ourselves look a different gender, but our gender make-up that we were born with can’t change.


How bad are the side effects from blood pressure medications? 

Troy L. Randle, DO

Different blood pressure medications have different side effects. Calcium channel blockers are used to lower blood pressure, and the biggest side effect is having some edema or swelling. There are medications that may affect the kidneys. There are medications that slow the heart rate down and may make you a little bit tired or fatigued.

However, without medication, the biggest side effect of hypertension is a stroke. Other negative effects of high blood pressure include heart failure, heart attack and kidney failure.

How can I reduce high blood pressure?

Troy L. Randle, DO

To reduce high blood pressure, the biggest thing you can do is to change your lifestyle, mainly your diet and activity level. The following are some actions you can take:

• Increase your activity level and exercise more.
• Cut back on salt and monitor your sodium intake.
• Cut back on cholesterol, fats and red meats.
• Cut back on alcohol.
• Eat more fruits and vegetables.
• Lose weight. If you lose about 20 pounds you can drop your blood pressure 10 to 20 points.
• Stop smoking.

When should I start taking medication for high blood pressure?

Troy L. Randle, DO on behalf of Lourdes Health System

When people should start taking medication for high blood pressure is somewhat controversial in terms of what is a target goal. The consensus is to shoot for a blood pressure goal of 120 over 80, with treatment often beginning when blood pressure is around 140 over 90. A lot of people are resistant to medications and want to try lifestyle modifications. But if you can’t modify things, once you get over 140 over 90, it’s time to start talking about medication.


Why does my doctor need to see my blood pressure measurement kit?

Troy L. Randle, DO 

Your doctor may want to see your home blood pressure measurement kit to make sure your blood pressure reading at home correlates with your reading in his or her office. In other words, if the reading on your doctor’s monitor is higher than your monitor, your doctor will want to calibrate your home measurement with your measurement in the office visit.


How often should I check my blood pressure if I have hypertension?

Hafeza Shaikh, DO

If you have hypertension (high blood pressure), you should have your blood pressure checked in a doctor’s office every few months. Your blood pressure can be checked with a primary care doctor or with a specialist. If your numbers are stable, then your blood pressure can just be checked once or twice a year. This is assuming that no changes have been made to your medicines. Certainly, any time there’s been a change to the medicines that are treating high blood pressure, then you want to have your blood pressure checked at least a few weeks after that change has been made, just to make sure that things are stable.


This content originally appeared on Sharecare.com. 

How often should I check my blood pressure if I have hypertension?

Hafeza Shaikh, DO 

If you have hypertension (high blood pressure) you should have your blood pressure checked in a doctor’s office every few months. Your blood pressure can be checked with a primary care doctor or with a specialist. If your numbers are stable, then your blood pressure can just be checked once or twice a year. This is assuming that no changes have been made to your medicines. Certainly, any time there’s been a change to the medicines that are treating high blood pressure, then you want to have your blood pressure checked at least a few weeks after that change has been made, just to make sure that things are stable.


What are the main classes of hypertension treatments?

Hafeza Shaikh, DO 

The main classes of hypertension treatments include:

• Diuretics, which are also called water pills
• Calcium channel blockers
• Beta-blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)

There are over 200 different choices for blood pressure treatment, and they range from medicines that have been around for decades to medicines that are up-and-coming and being invented every day. Even outside of that, there are a whole other slew of medicines that are more of the miscellaneous or more advanced therapies for hypertension.


This content originally appeared on Sharecare.com. 

What are the risks of transcatheter aortic valve replacement (TAVR)?

Steven J. Kernis, MD 

Fortunately now in 2016, the risks that may occur during transcatheter aortic valve replacement (TAVR) are the same or even less than the risks that may occur during surgical valve replacement. That wasn’t necessarily the case five years ago when the device was in its early generation. The device is a lot safer now and can easily be put into people’s hearts with fewer complications. Still risks of TAVR include death, stroke, damage to the artery used for inserting the valve, valve leakage and major bleeding.


What should I expect after transcatheter aortic valve replacement (TAVR)?

 Steven J. Kernis, MD 

The patient that has bad symptoms due to the valve problems should expect to feel an almost immediate relief from symptoms after a transcatheter aortic valve replacement (TAVR). And, if all goes well, your lifespan increases after TAVR. We know that if you have a bad valve, especially if you’re having symptoms, your lifespan is reduced. If you get a new valve, you’ll live longer. That is very clear.


What is transcatheter aortic valve replacement (TAVR)?

Steven J. Kernis, MD

Transcatheter aortic valve replacement (TAVR) is an advanced minimally invasive procedure currently recommended for individuals who are considered too sick to undergo a surgical aortic valve replacement. In Europe it’s called “TAVI,” but it is the same procedure. It’s basically a way of giving someone a new valve without having to do an open heart surgery.

In TAVR, the aortic valve is replaced. The old one is not taken out. A new valve inside a stent is snaked up to the heart through a catheter, which is like a long straw. It is snaked up from the groin or sometimes from other areas, and advanced inside the old valve that isn’t working well in the heart. A balloon is inflated, opening the stent. The balloon deflates and is taken out, and what’s left behind is the opened stent with a new tissue valve inside. Hence, you immediately have a new fully functioning valve.


How long does a transcatheter aortic valve replacement (TAVR) valve last?

Steven J. Kernis, MD

No one knows for sure how long the transcatheter aortic valve replacement (TAVR) will last because the TAVR experience is still relatively young. The TAVR procedure was first done in 2002. There have been about one million of these put in worldwide. The surgical counterparts, the tissue valves, tend to last 10 to 15 years. The TAVR valve is probably going to be the same, if not better. It is a very, very durable valve.


How long does it take to recover from TAVR surgery?

Steven J. Kernis, MD 

Patients who might benefit from transcatheter aortic valve replacement (TAVR) are those with a severely dysfunctional valve (a condition known as aortic stenosis) that is causing them symptoms. Testing is done to see if the person is physically and anatomically appropriate.

The on-label indicated commercially available TAVR valves — valves in use outside of research trials — are for “high” or “excessively high risk” people. That’s been the case for a few years now. But, soon that indication is probably going to come down to include intermediate risk people as well. In fact, this valve may very well replace, entirely, the surgical valve. It’s much less invasive. People are out of the hospital in a day or two.


Which patients might benefit from transcatheter aortic valve replacement (TAVR)?

Troy L. Randle, DO 

High blood pressure (or hypertension) affects the heart similar to the way weights affect muscles. When we lift weights, our muscles tend to get big and strong and thick. However, the heart is a muscle. Blood pressure is a weight that the heart has to pump against. The problem with the heart pumping against the elevated blood pressure is, the heart then starts to get thick and, unlike our outside muscles which gives us strength, when the heart gets thick it becomes stiff. It then leads to things such as heart failure. We can have stroke. We can have a high risk of heart disease and heart attacks as well. Over time, it can also affect vision and kidney function. So, it’s very important to get high blood pressure under control.


How does TAVR differ from traditional aortic valve replacement surgery?

Steven J. Kernis, MD

Transcatheter aortic valve replacement (TAVR) differs from traditional surgical aortic valve replacement in that TAVR does not require opening up the chest and heart, or general anesthesia.

The standard surgical aortic valve replacement, which has been around for a long time, involves traditional or conventional sternotomy — opening up the breast bone. The person is under general anesthesia on a bypass machine. The heart is stopped and cooled down. The surgeons open up the chest and the heart to get to the old valve where they can see it. They actually cut it out and then take either a tissue or mechanical valve and sew it into place in the heart. The surgeons have other surgical options that don’t necessarily require opening up the breast bone, but in any way that they do it, it involves some type of chest incision, going on a bypass machine, stopping the heart and all of the risks that go along with that.

Transcatheter aortic valve replacement (TAVR) on the other hand allows surgeons to give someone a new heart valve through the groin, with no incision.  Most people do not require general anesthesia, just simple sedation, and they are up walking around later in the day with nothing but a little needle stick in the groin. This can be mildly uncomfortable, but certainly nothing like opening up the breast bone.


This content originally appeared on Sharecare.com.

How is a heart attack diagnosed?

Rozy Dunham, MD 

A heart attack is diagnosed at the very basic level with electrocardiography (EKG). A primary care doctor can do that in their office and, obviously, cardiologists do that in their offices, as well. An EKG in the midst of symptoms can instantly tell if someone is having a heart attack or if he or she is at risk for a heart attack.

Beyond just a plain EKG, a person might get referred to a cardiologist who would then perform a stress test. Stress testing basically uncovers blockages in the arteries. The person goes on a treadmill and exercises, sometimes coupled with imaging of the heart. Doctors may also do an echocardiogram, which is an ultrasound of the heart that shows how the heart is pumping, how the valves are working and how the heart is functioning, in general. So, doctors definitely have a lot of tests in their arsenal, but at the very basic level, an EKG should be done if a person is complaining of the symptoms.


Why do young people have heart attacks?

Vivek Sailam, MD 

About 700,000 Americans have a heart attack every year. While most people who have a heart attack are middle-aged adults or older, people in their 20s and 30s can experience them, too. In recent times, I’ve noticed in clinical practice that the age of those having a heart attack (or myocardial infarction) has become younger — specifically, less than 50 years old. The main reason for this is that more people have diabetes and high blood pressure (hypertension) at a younger age. There’s a significant increase in obesity as well. This trend is followed by an increased use of tobacco use in certain populations. The result is an increased number of heart attacks. I’ve seen several people in their early 40s who have had a heart attack. 

While sedentary lifestyles and poor habits play a big role in your risk for heart attack, your genes also have something to do with your chances of having premature coronary disease.


How are young people screened for heart disease?

Vivek Sailam, MD 

There are clinics where cardiologists screen young adults and athletes for heart disease. The American College of Cardiology (ACC) and other organizations provide doctors with specific guidelines for screening young people for heart disease. Today we know so much more about this problem than we did in the past. With screening, we hope the rate of sudden cardiac death among our younger population will decrease.

Screening tests may include:

• physical exam
• electrocardiogram (EKG)
• genetic testing
• imaging tests to check for birth defects and heart structure problems

If a doctor thinks a young person has a high risk for heart disease after performing a physical exam, it very important for that person to have a more thorough evaluation and appropriate tests. 


This content originally appeared on Sharecare.com.

What supplements help prevent varicose veins?

Nasser A. Chaudhry, MD 

Before discussing supplements and varicose veins, it’s important to remember that supplements are not regulated by the U.S. Food and Drug Administration (FDA). Therefore, the contents of supplements sold over the counter cannot be easily verified, and studies on supplements are difficult to evaluate. Supplements that have been advocated (but not proven) to help with the symptoms of varicose veins include horse chestnut, bilberry, sweet clover, butcher’s broom and hesperidin.


What type of doctor will treat my varicose veins?

Nasser A. Chaudhry, MD 

Doctors who practice phlebology are the specialists who treat varicose veins. These specialists may include family practitioners, internists, dermatologists, radiologists, cardiologists and general and vascular surgeons. Cardiologists are uniquely qualified to treat varicose veins, as cardiologists are uniquely qualified to do catheter-based procedures. Many of the treatments for venous insufficiency involve catheter-based techniques.


What is the difference between spider veins and varicose veins?

Nasser A. Chaudhry, MD 

The difference between spider veins and varicose veins begins with size — spider veins are usually less than 3 millimeters (mm) in size, while varicose veins are more than 3 mm in size. Simply put, there are two venous systems in the body: a superficial venous system (which causes most of the symptoms people have when they have vein problems and can usually be treated) and a deep venous system (where blood clots that could be dangerous often form). Spider veins and varicose veins are usually branches of superficial veins. Although spider veins are usually a cosmetic problem, both spider veins and varicose veins can be signs of more serious venous problems. The spider veins and varicose veins are usually twisty elongated branches that do not consistently work properly.


How do varicose veins affect my body?

Nasser A. Chaudhry, MD

Varicose veins can be a cosmetic problem, but they can also, and often, be a sign of more serious venous problems, including chronic venous insufficiency (CVI). We can define CVI with the help of ultrasound testing. In an upright position, we assess the competency of the valves in the veins. There can be leaking of the valves (blood flows towards the heart, but when the valves leak, the blood flows away from the heart) for up to 0.5 sec (normal). When the valves leak longer the patient is classified as having venous insufficiency. Symptoms of venous insufficiency include skin discoloration, itchiness, cramping, swelling, achiness, restless legs and pain (most venous pain occurs at rest). Conservative measures and simple office-based procedures can help with the effects of venous abnormalities on the body. 


This content originally appeared on Sharecare.com.

Do women have unique risk factors for heart disease? 

Rozy Dunham, MD

One risk factor for heart disease that is unique to women is the use of hormone replacement therapy. There are a lot of women who use hormones post-menopausally to reduce the symptoms of menopause. There is equivocal data on how hormones affect heart disease, but there has been some data to support that women who use hormone replacement therapy can be at increased risk for blood clots and heart disease.
Other risk factors can go all the way back to the pregnancy years. Women who have pregnancy-induced hypertension, gestational diabetes, eclampsia or pre-eclampsia are at higher risk later in life for cardiovascular disease as well.

The major risk factors for heart disease are the same in women as in men. Things like diabetes, smoking, hypertension, obesity — those are risk factors that are common across gender. But certain risk factors are actually more potent in women than in men. Tobacco smoking or cigarette smoking is a much stronger risk factor in young women than it is in men. So, if you are a woman who smokes, you are at higher risk than an equivalent male of the same age who smokes. Diabetes and hypertension are more potent risk factors in young women. So, though they’re common across gender, those risk factors tend to be stronger in women in terms of predicting heart disease.


Does heart disease differ between men and women?

Rozy Dunham, MD 

Heart disease warning signs for women aren’t the same as in men. Women are not at increased risk for heart disease compared to men, but they are at increased risk for worse outcomes. Women tend to die or have a higher mortality after their event than men do, so, although the prevalence of heart disease and the risk for heart disease is the same among men and women, more women tend to have worse outcomes from their heart attack than do men.


How can women reduce their risk of heart disease?

Rozy Dunham, MD

For women to reduce their risk of heart disease, diet and exercise are very important. But in terms of the classic risk factors, definitely quit smoking. Smoking is the most detrimental thing you can do to your health. So, quitting smoking is number one.

Then, it’s a matter of managing what they call your “numbers.” Know your blood pressure; make sure you have a healthy blood pressure. Know your blood sugar; make sure you’re not in the diabetic or pre-diabetic range. Your weight or body mass index (BMI) is important. Make sure you maintain a healthy weight or BMI and that’s mainly done through diet and exercise.

For women, the general recommendation is to maintain cardiovascular health and to maintain your current weight. If you’re at a healthy weight, you should be doing about 30 minutes of cardiovascular exercise most days of the week. That means doing brisk walking or light jogging or biking or swimming — something that gets the heart rate up — four to five days out of the week. If you’re looking to lose weight, that time would increase to about 40 minutes to an hour most days of the week in order to lose weight or maintain a healthy weight.

We all know about eating a heart-healthy diet. What that means is plenty of fruits and vegetables, whole grains and lean proteins. Avoid high-fat, high-cholesterol meats like beef. Avoid processed carbohydrates and try to load your plate up with fruits and vegetables as the main portion on your plate.


Why does heart disease differ in men and women?

Rozy Dunham, MD 

The differences in heart disease between men and women are multi-factorial. The mechanism of heart disease in women is different and under-recognized in women. There’s a delay in treatment as a result of that. Women themselves often don’t recognize the symptoms of heart disease and present for evaluation and treatment much later than men do. There’s often a delay of over six hours before they even think to call 911 when they begin to have symptoms.

Still, despite all the education that’s being done in women with heart disease, there’s still a lack of recognition amongst women when they are having symptoms and a tendency to be in denial when they’re having symptoms because they’re just too busy taking care of others rather than themselves.


What are some signs of heart disease in women?

Rozy Dunham, MD 

Women often have more atypical signs of heart disease which can be:

  • • unusual amounts of fatigue
  • • shortness of breath
  • • flu-like symptoms
  • • dizziness
  • • indigestion
  • • palpitations
  • • a feeling of anxiety or what they call a sense of dread

All of these things can be signs of heart disease, and women should have a low threshold for getting checked out. Women tend to have a higher threshold. Women tend to wait longer and blow things off when, in fact, they should have a lower threshold and present to their doctors quicker.

Women often chalk up symptoms of heart disease to anxiety and stress or fatigue, and they don’t present for evaluation soon enough. If they feel that something is not right, something is not typical, in terms of how they typically feel, they should contact their primary care doctor and let him or her decide if that thing needs further work up.


What is the Framingham risk score?

Hafeza Shaikh, DO

The Framingham risk score tries to take together the classical risk factors for heart disease and put together a predictive index for cardiac events in the future, which is individualized for each patient. It’s gender-specific and estimates your 10-year risk of cardiac events. It includes total cholesterol levels, HDL cholesterol levels, age, gender, tobacco use and systolic blood pressure. 


Why aren’t women equally represented in heart disease research?

Hafeza Shaikh, DO 

I think it may have been multifactorial. Some research studies done a long time ago focused on veteran and military populations and women are underrepresented. And in general, heart disease in women was not given enough attention decades ago.


How much fiber should I eat to reduce my risk of heart disease?

Hafeza Shaikh, DO 

You should eat 20 to 35 grams of fiber a day. Fiber lowers cholesterol, reduces the risk of diabetes and stroke, and it also helps with weight loss.


How can I help prevent heart disease?

Vivek Sailam, MD

My best overall advice to prevent heart disease is to be very, very knowledgeable about your own health. I tell people this every day. Don’t ignore signs and symptoms. Don’t ignore your health, because your health is extremely important.

I always tell people that your lifestyle is the key. Medicines are there to help you when you need them, but much of what doctors see today can be prevented through lifestyle changes, whether it’s with a better diet, better exercise program or a combination of both. Be active in your life. Don’t be sedentary. Limit stress. This is very important in terms of managing symptoms and also preventing heart attacks in some individuals.


Why are women more likely to be misdiagnosed when they have heart disease?

Vivek Sailam, MD 

It can be difficult to diagnose heart disease in women. The symptoms of heart attack in some men are similar to the symptoms you see on TV shows or movies. In women, the symptoms are very difficult to distinguish because they are not always typical. They don’t have the classic chest pain when coming into the emergency room with a heart attack. I think we all have to be very vigilant when women come in to the ER describing chest pain symptoms.

Women usually come in with symptoms as simple as fatigue. They may say, “You know, I’ve been feeling very tired over the past few weeks and I can’t do what I was normally doing. I may be having some shortness of breath when I’m going up the stairs.” These are all very, very atypical symptoms that we’ve been seeing. When we examine the woman more closely, or if she comes to the ER, it sometimes turns out that she is having a heart attack. Again, the symptoms need to be monitored very closely.


This content originally appeared on Sharecare.com.

Why is peripheral artery disease difficult to diagnose?

Anthony G. Smeglin, MD

Peripheral artery disease can be difficult to diagnose and is underdiagnosed because people don’t know what to look for, and doctors often don’t focus on it.

The majority of people with peripheral artery disease either don’t experience symptoms or they attribute their symptoms to other causes.

Typically, peripheral artery disease can lead to symptoms such as pain in the legs with walking (known as claudication), achiness and heaviness. Sometimes, if it progresses, it can lead to ulcers or gangrene.

Some four out of five people experience atypical symptoms. That can be that when they are walking they may just get a cramp and continue walking. They may have some numbness or some heaviness. These are the sort of symptoms that people will often just attribute to their other ailments. It can often be confused for spine issues, arthritis issues, and neuropathic issues. One of the most common causes of these types of symptoms is venous disease. That’s one of the things that needs to be teased out.


How do peripheral arterial and peripheral vascular disease differ?

Anthony G. Smeglin, MD 

Peripheral arterial disease and peripheral vascular disease are not the same thing. Peripheral arterial disease, or peripheral artery disease, is a process that affects the arterial blood vessels in the body. Peripheral vascular disease encompasses peripheral artery disease but also includes other things like venous disease or disease processes that affect the organs. Peripheral artery disease refers to arteries that lead to all areas of the body.


How is peripheral artery disease (PAD) treated?

Anthony G. Smeglin, MD 

Peripheral artery disease (PAD) is usually treated with lifestyle modifications to modifying risk factors.

Exercise is one of the most important treatment modalities for people with PAD. Too often people complain of pain when they walk and as a result they walk less or exercise less. People should walk more and exercise more. What that does is help the body develop and grow ‘collaterals’ or small blood vessels to help feed the muscle with more blood supply.

Other lifestyle modifications for PAD include:

• eating healthy
• quitting smoking
• controlling blood pressure
• controlling cholesterol


How is peripheral artery disease (PAD) diagnosed? 

Anthony G. Smeglin, MD

Peripheral artery disease (PAD) may be diagnosed through the following:

• A thorough medical history is taken and discussed. This will help delineate whether the symptom is coming from a blockage in the arteries or that it’s more likely due to a nerve, musculoskeletal or spine problem.

• A diagnostic procedure called an ankle-brachial index (ABI) will be done. This is recommended for all people over 65 with risk factors, and anyone over 50 who has a history of smoking or diabetes. The ABI is very sensitive and specific when done properly for picking up or screening for peripheral artery disease. If the ABI alone is not enough, the person would exercise (walk slowly) on a treadmill while an ABI is performed.

• More advanced tests called pulse volume recording or an ultrasound of the legs may be performed.


What are the potential complications of peripheral arterial disease (PAD)?

Anthony G. Smeglin, MD

Potential complications of peripheral arterial disease (PAD) include an increased risk of cardiovascular morbidity and mortality. What that translates into is that once someone has the diagnosis of peripheral arterial disease, they have a five year elevated risk of a cardiovascular problem. As such, risk factors and therapies are directed not only at peripheral arterial disease but also at the cardiovascular system in general.


How common is peripheral artery disease (PAD)?

Anthony G. Smeglin, MD

Peripheral artery disease affects anywhere from 15 to 20 percent of the population. It’s often underrecognized. If people feel like they have symptoms that may be concerning for peripheral artery disease, they should talk to their doctor.


Do people with peripheral artery disease need a monitored exercise program? 

Anthony G. Smeglin, MD 

People with peripheral artery disease (PAD) don’t have to have a monitored exercise program, but they may prefer it, and it works better. Most insurance companies will approve at least a 12-week or so monitored exercise therapy program.

People can exercise on their own if they prefer. They can go outside and walk around the block, ride a bicycle or swim. In the winter, they can walk around a mall. There are a whole host of exercises that can help get that heart rate up and circulation improved.