OHSU

Ask the Heart Experts

Every day, our experienced team of cardiologists, cardiothoracic surgeons and vascular surgeons answer heart health questions from people in the community. You can review a list of Frequently Asked Questions on the topics below, or contact our heart experts to submit your own question.

FAQ Topics

 

Arrhythmia

 

I have an irregular heartbeat. What’s the best way to treat it?

Another term for an irregular heartbeat is arrhythmia. The best treatment depends on the type of arrhythmia you have. For some types, you may not need any treatment. With other types, you may need medication. Serious arrhythmias may require an electrical device such as a pacemaker or defibrillator, or a procedure called catheter ablation. Catheter ablation treats small areas of heart tissue that cause an irregular heartbeat. This can eliminate the need for long-term drug treatments.

 

Sometimes my heart feels like it’s skipping a beat. Is this dangerous?

You could be experiencing palpitations, which can feel like a fluttering in the chest, or stronger or skipped heart beats. Palpitations are often nothing to worry about. Many healthy people experience short episodes of palpitations, sometimes made worse by too much caffeine or lack of sleep. However, palpitations could be a sign of underlying heart disease or potentially curable arrhythmias. Warning signs include sustained palpitations that start and stop abruptly or occur with other symptoms such as notable shortness of breath or dizziness. Your doctor can run tests to determine if your palpitations are linked to heart disease.

 

What is the difference between a pacemaker and a defibrillator?

A pacemaker treats a slow heart rhythm (if your heart is beating too slowly). Some heart conditions that a pacemaker can help with include heart block, fainting (syncope) and an irregular heartbeat (atrial fibrillation). A defibrillator treats a fast heart rhythm (if your heart is beating too quickly), and is used in heart failure or cardiac arrest situations. A defibrillator always has a pacemaker included. Both are implanted in the same spot: under your collarbone, usually on the left side.

Getting a pacemaker or defibrillator implanted is generally a simple surgery that usually requires only a single overnight stay in the hospital. Both are also common; more than a million people in the U.S. have a pacemaker or defibrillator. Pacemaker batteries typically last about eight to ten years, and defibrillators around five to seven years.

 

Are there medicines for atrial fibrillation (A-fib) that won't lower blood pressure? Mine runs in the 100/70 range.

While many medicines for atrial fibrillation do lower blood pressure, there are some that do not, including disopyramide and flecainide.

 

I take Warfarin, Metoprolol and Digoxin daily. I still experience atrial fibrillation, usually three times a week. Is ablation the answer to getting off all these medications?

Ablation is an option to treat atrial fibrillation when other treatments have failed or are not tolerated. If successful, ablation can allow patients to decrease the number of medications that they need to take and may improve your quality of life.

 

I had an episode of atrial fibrillation eight months ago and have been taking amiodarone. Now I am being forced to stop taking it. Is there anything else I can do to reduce the risks?

Amiodarone is a good medicine for atrial fibrillation, but it does have many side effects, and so we try to avoid having patients on it long-term. There are other medicines -- with fewer side effects -- that help with atrial fibrillation. Also, if you have only had one episode of atrial fibrillation, stopping amiodarone makes sense because you may not have any more atrial fibrillation for a long time.

 

Congenital Heart Problems

 

Why should people who have hypertrophic cardiomyopathy  (HCM) get genetic counseling?

HCM is primarily a hereditary/genetic condition that runs in families, affecting multiple generations; therefore, your family members (such as your parents, brothers, sisters and children) are likely at risk. Genetic testing may help identify the underlying cause of your HCM. It could help you better manage the disease and provide important information for your family members.  If family members are at risk, monitoring of the heart -- even without symptoms -- is recommended: Early detection and diagnosis may help prevent, delay or lessen some Hypertrophic Cardiomyopathy complications.

 

I was born with an abnormal heart. Are there things I need to be worried about now?

Every year, more and more children born with heart defects are successfully treated and become healthy adults. Having a congenital heart defect is a lifelong journey, and it is important that you know how to care properly for your heart for your entire life. Depending on the type of heart defect you have, there are a number of things that occur more commonly in adults as a consequence of their congenital heart disease.

A heart specialist can help you figure out what happened when you were a child, and more importantly, what you need to be aware of for the future. Specifically, you may have special needs during a pregnancy, be at risk for a fast heart rhythm or even an infection of the heart. Diagnostic tests may not be as straightforward in you as they would in someone without a heart condition, and should be interpreted with your specific defect in mind. You may need a pacemaker, or even more heart surgery. Whatever your needs, you’ll want a specialist who understands your unique heart.

 

I am 37 and had a Mustard procedure done. I have chest pain, but no symptoms. What would cause this and how long will it last?

Chest pain is not uncommon in someone who has had a Mustard procedure. It may sometimes be caused by some strain on the right ventricle (the chamber acting as the main pump that was designed only to pump blood to the lungs), or at times residual scar tissue in the chest wall from prior surgery. In either case, it can be difficult to treat. The good news is that most of the time chest pain does not seem to be a sign of serious trouble, although you should make sure your doctors evaluate you for arrhythmia or signs of heart failure.

 

I’ve been hearing a lot about kids suddenly dying while playing sports. Why does that happen?

What you might be hearing about is hypertrophic cardiomyopathy. It’s an abnormal thickening of the heart muscle; the condition is usually inherited. Other things that can cause sudden cardiac death include abnormalities in the coronary arteries or flaws in the heart’s electrical system. A good gauge is your family health history: If anyone in your family suddenly died below the age of 30, then talk to your doctor.

The American Heart Association (AHA) recommends that anyone who plays a sport in high school get a screening, which is usually a sports physical and completion of an AHA questionnaire. In a typical sports physical, a health care provider will take a thorough health history and listen to your child’s heart. If cardiac issues come up in a sports physical, your child will likely be referred to a pediatric cardiologist. Most conditions can be treated with lifestyle or exercise modification, or medication when necessary.

 

I was diagnosed with hypertrophic cardiomyopathy (HCM) four years ago. What advances have there been made in minimally invasive surgeries for my condition?

During the last 20 years, we have made several advances in treating the symptoms caused by HCM. Alcohol septal ablation was developed in the mid-1990s, but the technique initially had a high rate of complications. Currently, through studying thousands of people undergoing this procedure, we have greatly improved its success rate. Also, new medicines have become available in treating HCM, and often we can treat your symptoms without surgical procedures.

 

General Cardiology Questions

 

Can cancer treatments damage my heart?

While cancer treatments including radiation and chemotherapy can help fight cancer, they may have negative side effects on your heart. Although this is rare, treatment can weaken your heart muscle or affect your heart’s ability to pump blood. Before you begin a cancer treatment that might affect your heart, you will have basic tests like an electrocardiogram (ECG) or tests to measure your heart function such as a cardiac ultrasound (echocardiogram). By finding heart problems before starting treatment --and by monitoring them carefully -- we can help prevent heart issues. Make sure to talk to your oncologist if you have a pre-existing heart condition, or if heart disease runs in your family.

 

Can moving to a mile-high altitude (Denver) cause heart and/or vein problems?

It can lead to an increase in angina (chest pain or discomfort) or trouble breathing in people who have coronary disease or heart failure.

 

Are symptoms of heart disease different for women than men?

Heart disease remains the #1 killer of women in the U.S. Most people associate heart problems with chest pain that radiates to the jaw or arm. However, symptoms of heart disease in women may be different and can include extreme fatigue, shortness of breath, indigestion, nausea and pain in the jaw or upper back. If you experience these symptoms — especially if you have risk factors for coronary artery disease such as high blood pressure or diabetes — talk to your doctor. Although signs and symptoms of heart disease may differ in women, the basics of prevention are the same, regardless of gender: Eat healthy, don’t smoke, exercise regularly and consult with your doctor about your cholesterol.

 

What are the signs of heart failure?

Hearing "heart failure" can sound scary. But what it means is that your heart muscle is weak and cannot supply enough blood to your body. That results in symptoms such as shortness of breath, fatigue, bloating and swelling in your legs. If you have been diagnosed with heart failure, you will need to avoid consuming too much salt and fluids, and manage your care closely with your doctor. You may need to take medications including beta blockers, ACE inhibitors or diuretics. Heart failure is common, and it is manageable: If you have heart failure, you can live an active, healthy life. In fact, medical guidelines encourage just that: Medicare is now paying for cardiac rehabilitation and structured exercise programs to help heart failure patients get safe, moderate exercise.

 

Heart Attacks

 

I had a heart attack a while back and wonder if I still need to take aspirin every day. Can I stop?

Blood clots can cause heart attacks: Aspirin makes your blood cells less likely to clot. Taking aspirin daily is a proven treatment for heart attack and stroke survivors, and for patients with coronary artery stents or heart bypass surgery. Daily aspirin may also be used to reduce the risk of heart attacks and stroke for patients with diabetes or peripheral vascular disease. Talk to your doctor if you have conditions that increase your risk of bleeding. If gastrointestinal or other side effects concern you, don’t stop taking aspirin without first talking to your doctor: Suddenly stopping aspirin can increase your risk of heart attack.

 

Does a heart attack always feel like a sharp chest pain?

While a heart attack is often portrayed in TV and movies as someone clutching their chest and falling to the ground, there are actually many subtle symptoms that can indicate a heart attack. Some early heart attack symptoms might include chest discomfort, shortness of breath, shoulder or arm pain—but others you might not expect are nausea, a feeling of fullness, fatigue, back or jaw pain, anxiety and pain that travels down one or both arms. Early heart attack signs may occur hours or weeks before the actual heart attack.

It’s important to know these less obvious signs and know to act upon them: If you recognize these symptoms, call 911 immediately. 85 percent of heart damage occurs within the first two hours of a heart attack.

 

Does loud (high-decibel) noise increase the risk of heart attack, high blood pressure or stroke?

Studies on traffic-related noise have demonstrated an association with an increased risk of heart attacks.

 

Prevention

 

My father has diabetes but is in good health. His cholesterol is a little high. Should I be worried?

Diabetics suffer from heart disease and stroke at twice the rate of everyone else. Due to diabetic neuropathy (nerve damage), diabetics are less likely to feel the symptoms of heart disease, such as chest pain. That said, they can control their risk of heart disease by monitoring blood sugar and lipid levels (blood fats, including cholesterol). A cardiologist can also watch for high lipid levels and atherosclerosis, (hardening of the arteries), which are precursors to heart disease.

Like all diabetics, your father should also avoid smoking, engage in regular exercise, lose excess weight, and consume a diet high in fiber, fruits, vegetables, fatty fish and whole grains, and low in processed sugars for a lower risk of heart disease and increased quality of life.

 

What’s the link between type 2 diabetes and heart disease?

People who have type 2 diabetes are twice as likely to develop heart or vascular disease. Even people with pre-diabetes or metabolic syndrome have higher risk. Blood vessels of people with diabetes can become thicker and damaged, making it difficult for blood to flow. Some individuals with diabetes are also less likely to feel symptoms of heart disease, such as chest pain, because the process that affects blood vessels also affects nerves.

Fortunately, research shows early intervention and prevention measures help lower the risk of heart disease. These measures include a comprehensive medical and lifestyle management program that promotes exercise, weight reduction and targeted medical therapy. Since 15 percent of Americans have type 2 diabetes, and nearly one-third are at risk to develop it, a team approach is needed.

 

What’s the best exercise program for your heart?

The best exercise is the one you like to do! Like all things in life, if you enjoy what you’re doing, you are much more likely to make it part of your life. The goal for good health is to get regular aerobic exercise every day -- non-stop movement that makes you feel like you’re moving, lasting 20 minutes or more (the American Heart Association recommends at least 150 minutes a week). You might choose to spend those 20 minutes in an exercise class, riding a bike or swimming. Remember, a brisk walk is an excellent form of aerobic exercise, and it’s right outside your door. The benefits of exercise are many: it lowers blood pressure, improves blood sugar and blood fat levels, it may help you lose weight, and it is a natural anti-depressant. If you take medicines for high blood pressure, diabetes or cholesterol, exercise will help them all work better.

 

At what age should I start getting heart-related screening tests?

Starting at age 20, healthy adults should get checks of their blood pressure every two years, cholesterol every five years, body mass index (BMI) at every regular health care visit, and waist circumference as needed, according to the American Heart Association. Starting at age 45, blood glucose also should be checked every three years. If any of your results are abnormal, you may need to have them checked more frequently. More comprehensive screening may be needed for those with diabetes, high cholesterol, high blood pressure, a history of smoking and/or a family history of heart disease or stroke.

 

How can I tell if I have heart disease?

Blood pressure, blood sugar and cholesterol levels can help to determine a person’s risk of heart disease. However, 50 percent of people with heart disease experience a heart attack as their first symptom. To detect heart disease sooner, there are now more sophisticated ways to screen for it, such as the coronary artery calcium score, a non-invasive test that uses modern low-dose radiation CAT scanning to detect plaque (atherosclerosis) in the heart arteries—before symptoms develop. The scan may be considered for people with, diabetes, high cholesterol, high blood pressure, obesity, a family history of heart disease and past or present smokers.

 

Is it more important to raise good cholesterol or lower bad cholesterol?

First, cholesterol itself isn’t good or bad. It’s a natural substance that’s created by the body to keep us healthy. Cholesterol and other fats can’t dissolve in the blood; they are carried to the cells by carrier particles called lipoproteins, including low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Too much LDL can clog arteries, increasing your risk of heart attack and stroke; HDL may help to remove cholesterol deposits from the lining of your arteries. Your ideal LDL cholesterol level depends on many factors, including age, activity level, blood pressure, whether you smoke or have diabetes, and your family medical history. The best way to treat low HDL cholesterol is by making healthy lifestyle choices, such as partaking in regular cardiovascular exercise, eating a heart healthy diet, watching your weight and quitting smoking.

 

I haven’t exercised in years. How do I start a new exercise program?

Remember: Some exercise is better than none. If you haven’t been exercising in a while, start slow: Do just 10-15 minutes a day, three times a week. Gradually build up the number of days to ideally five days a week, and then as you feel stronger, try to increase your time in five-minute increments each week with a goal of 30 minutes, five days a week. The type of exercise you choose (such as walking, cycling or swimming) should be something that you enjoy and can sustain in the long term. To lose weight or improve fitness, you will need to exercise 60-90 minutes a day. The intensity of your exercise should be just enough to get you breathing a little harder, but still comfortable having a conversation.

 

I have been having some concerns about my heart health. Is my resting blood pressure a concern: 115/65, with a pulse of 47?

Your blood pressure is actually excellent. Your pulse is lower than normal, but that is not necessarily a problem if you are otherwise healthy and feel well. If you haven’t discussed your pulse with your primary care provider, I would recommend that you do so. He or she may want to perform an ECG (electrocardiogram).

 

Which is better for your heart? Margarine or butter?

Neither one is optimal for heart health for two important reasons:

Butter contains high levels of saturated fat and cholesterol, which increases blood cholesterol levels and the risk of heart disease.

Many margarines, while containing mainly vegetable oils, also contain trans fats (partially hydrogenated fats). Trans fats, along with saturated fats, increase blood cholesterol levels and your risk of heart disease.
More important is that you read the label of margarines and stay away from “partially hydrogenated” or “trans fats.” Look for products such as Smart Heart and Promise Activ, fortified with plant stanols and sterols that can actually help decrease cholesterol levels.

 

I have some arteries that have extremely high calcium scores on a CT (one is 700+) and others that are zero. Does that tell you anything? I have never had symptoms and I bike 10 miles a day.

The finding of a high calcium score in one of your coronary arteries is important. While you may not be having symptoms, this is a sign of significant coronary artery disease. You will need to work with your health care provider on lifestyle modifications as well as medical therapy to reduce your risk of having a heart problem in the future.  Additionally, a stress test can be considered in people with a calcium score above 400.

 

If stents do not help a heart problem, what is the next step? My husband has three stents and is ready for another.

I would look at factors which impact the progression of his coronary artery disease. Often, seeing a cardiologist with a focus on prevention might identify additional risk factors which might impact intensity of treatment via nutrition, exercise and medications.

 

Surgery and Procedures

 

I have a thoracic aortic aneurysm. What caused it and do I need surgery?

An aortic aneurysm is a weakened and bulging area in the aorta. Your aorta is a major vessel that carries blood from your heart to your entire body. Aneurysms in your upper aorta are called thoracic aortic aneurysms: They are associated with smoking, high blood pressure and atherosclerosis, and can be passed down through families.

Surgery is the best treatment if your aneurysm is large or fast-growing because it may rupture and cause internal bleeding. Surgery addresses the problem by replacing the damaged area in your aorta. There are also newer surgical techniques that can repair -- rather than replace -- an aortic valve affected by an aneurysm.

 

My husband has an aortic aneurysm that is a little larger this time than the last time they measured it, though it’s not large enough to operate. He is already on blood pressure medication. Is there anything else we should consider?

He should continue to control his blood pressure with medication as well as have his aneurysm size measured at least annually.

 

I have heart valve disease. Will I need surgery?

The heart has four valves that help it pump blood to the body efficiently. The four valves are called the aortic, mitral, pulmonary and tricuspid. Heart valves can wear out over time and become narrowed (stenosis) or leaky (regurgitant). Many heart valve conditions can be managed with medicine, without surgery. However, people with advanced heart valve disease may need surgery to either repair or replace the affected valves. If you have advanced heart valve disease, you might not need open heart surgery: Recently new techniques have become available that allow doctors to replace or repair the heart valves without opening the chest. Transcatheter aortic valve replacement (TAVR) allows us to place a new valve inside the narrowed aortic valve. The new valve is guided into position through a catheter in the groin or between the ribs.

 

Veins and Arteries

 

What is peripheral arterial disease, and am I at risk?

Peripheral arterial disease is a condition in which fatty deposits build up in the arteries outside the heart. These deposits often restrict blood circulation in the legs and cause leg pain during activity. Many people, however, have no symptoms. People with peripheral arterial disease have a four-to-five times greater risk of heart attack or stroke than those without the disease. You are at greater risk of peripheral artery disease if you:

  • Are over age 50
  • Smoke
  • Are overweight
  • Have diabetes, high blood pressure or high cholesterol

The good news is that early diagnosis and treatment can help improve symptoms and reduce the risk of heart attack and stroke.

 

Is there something I can do about varicose veins? I’ve heard insurance doesn’t cover treatment.

That’s a common myth. Varicose veins can be more than just unsightly bulges in your legs. They can be very painful and indicators of serious underlying health problems such as blood clots, skin ulcers or other cardiovascular diseases. That’s why it is so important to see a physician specially trained in the diagnosis and management of venous disease. Treatment for varicose veins can range from non-invasive to a minimally invasive procedure called catheter-radio frequency technology, which is performed under a local anesthetic. This new technique is covered by many insurance companies and offers significantly less pain and bruising than other treatments. It can usually be performed in under an hour in a doctor’s office, and has little to no downtime for patients.

 

My doctor told me I need to see a vascular surgeon. What do they do?

A vascular surgeon treats diseases of your arteries and veins that affect blood circulation. Conditions helped by vascular surgeons include narrowing of the carotid artery, aneurysms of the arteries of the chest, abdomen and extremities as well as diseases limiting blood flow to your legs and hands, intestines or kidneys. Patients with foot problems related to diabetes, tumors involving major blood vessels, and lymphatic disorders may also benefit from care by vascular surgeons. Many vascular problems can be addressed by a vascular surgeon, using minimally invasive treatments.

 

Are severe spider veins a sign of vascular disease?

Severe spider veins reflect genetic and hormonal influences; they run in families, and are far more common in women than men. They generally do not mean underlying vascular disease or a threat to your health. They may be associated with varicose veins, big veins on the surface of the leg, but may just as often appear in isolation. Spider and varicose veins can cause discomfort in the legs and can be treated for pain or cosmetic concerns.