Life After Heart Disease -- Dearing Johns, MD -- 02/19/03

Last Editorial Review: 10/23/2003

WebMD Live Events Transcript

When your heart takes a hit, from a heart attack or the diagnosis of heart disease or heart failure, a complete change of lifestyle and stress management is in store. What are the top tips on how to move from your old life to your new one? Dearing Johns, MD, was our guest as we discussed a new start for your heart.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live, Dr. Johns. Let's get right to our waiting questions:

Member: I have a blocked artery (50 year old female) due to heart attack 8 1/2 years ago due to homocystine. I am always fatigued. How do I get energy back?

Johns: That is a difficult question. I suspect it relates to cardiovascular fitness. The easiest way to rebuild your energy after a heart attack is regular progressive increase in exercise and it is far easier to regain your energy with regular programs, and it is easier to do it with professional guidance than to do it on your own. Other features that can cause lack of energy are levels of medications, level of your blood pressure, and how well you sleep at night. So it is a complicated question, or rather a question with a complicated answer.

Member: Over a year ago my doctor did an EKG and 24-hour Holter monitor and said I was shooting extra PVCs. Is this serious? It still happens. Should I have more tests?

Johns: The presence of PVCs, in itself, is not a bad or dangerous sign. Your doctor clearly knows a great deal more about you, but in general, you need mostly to be wary of PVCs provoked by exercise. Otherwise, know that most people have PVCs and are unaware that they have them. Most PVCs are asymptomatic. There are medicines that can block or prevent PVCs, but of the many studies that have looked at that problem, not one has shown that abolishing or reducing PVCs improves or makes a safer outcome. You should also know that there are triggers that cause PVCs such as caffeine, nicotine, and alcohol.

Member: I am a healthy 60-year-old female but every time a medical professional attempts to take my BP/pulse they advise my heart is so quiet they cannot hear it. When I ask what this means the response is, "Oh nothing." Is this something I should be concerned about?

Johns: The soft or difficult to hear korotkoff sounds when taking a blood pressure is not a bad or dangerous sound (korotkoff sound is the name given to the noise heard when taking a blood pressure). As long as your doctor can hear the sounds, he or she is getting an accurate blood pressure. The softness or intensity of the sound does not relate to your cardiovascular health. More important is the actual level of your blood pressure. It is important to know that number. A blood pressure of 140 over 90 is what we all should have.

Member: I am 49, had a surprise CABG last week. No heart damage. I was training for a triathlon. May I continue to do so, and yes, I am cutting my fat intake to 10%, probably from 25% before.

Member: What is a CABG?

Johns: CABG stands for coronary artery bypass graft. That is the term applied to the surgical procedure that bypasses blocked coronary arteries in order to re-establish blood flow.

Johns: You are very fortunate to have avoided actual heart damage. Once you have had a CABG, presumably the blood supply to your heart is as good as before you had blockages. It will take some time to recover from the actual surgery, but once you have recovered from the surgery, you should be able to continue your exercise. Triathlon training is a high degree of exercise and I would suggest you wait a few weeks until your doctor gives permission to restart this high-level exercise training.

You are doing the right thing about fat in your diet. The next best advice is to look to the stress in your life and develop ways to respond to stress in balanced fashion. So, there is no prohibition on exercise, it is just important to do it slowly, progressively, and regularly.

Member: Could severe dizziness with negative tests for stroke be an indicator of undetected heart disease? This was brought up my doctor but never fully addressed.

Johns: Severe dizziness can be an indicator of heart disease when there is an arrhythmia or very low blood pressure. Very low blood pressure can be detected by physical exam and blood pressure should be taken lying down, sitting, or standing. Arrhythmia is often difficult to detect by symptoms but when a very rapid or irregular rhythm occurs, it can reduce the amount of blood pumped out of the heart and lead to dizziness. The way to make this correlation is to use a recording device that will record your heart rhythm when you feel dizzy. It is usually or often called an event monitor.

Member: After having a heart attack and triple bypass, what type of checkups do you recommend?

Johns: Checkups following heart attack and bypass surgery are, generally, every three to four months for the first year after surgery. Following that time, if all is stable and appropriate goals or risk factors attained, often annual physicals suffice.

The cholesterol goals for a person who has had a heart attack are:

  • An LDL cholesterol (bad cholesterol) of less than 100.
  • Triglycerides should be less than 150.
  • The HDL goal for men is 40; l for women, 50.
  • Blood pressure should be less than 140 over 90 in clinic.

These are the important goals.

Member: What does it mean if you always have low blood pressure? I know that it doesn't mean it's good all the time. My father had the same, and passed away from heart disease.

Johns: Usually, a low blood pressure does not signify a danger unless the person feels severe fatigue, difficulty thinking, light-headed, or dizziness. The healthiest person is said to be the woman with a blood pressure of 110 over 70, well into her 80s. This blood pressure goal is less often seen in men, but would also be a healthy sign if the man or woman felt well.

Concerning your father, it is difficult without knowing more to give a specific answer, but sometimes, severe heart attack can itself cause low blood pressure. It is quite possible to have silent heart attacks and possibly your father's low blood pressure could have reflected unknown or silent heart attacks. Not knowing your father, or course, I cannot say more. Know only that if you feel well, your low blood pressure is a good sign.

Member: Is a CABG a safe procedure for a woman who has heart disease or has suffered a heart attack?

Johns: CABG long-term outcome is as safe in women as it is in men. It is true that early studies show a high morbidity and mortality (bad outcome) in women compared with men. However, the risk and benefits must be weighed and if you have blockages that impair blood flow to your heart, having bypass surgery, when appropriately recommended, is safer than not having bypass surgery.

Member: I have had three catheters; one implanted, two stents and the last one used brachy therapy. Two cardiologists say my arteries are clear, yet I have chest pain. What could be causing this continuing pain? The chest pain occurs only with exertion yet my arteries are supposed to be clear.

Johns: This is a difficult question and I might have to refer you to your doctor, who knows more features about you than do I, but you should also know that abnormality or inflammation in any of the structures close to the heart can mimic heart pain. That means inflammation of the cartilage connecting the rib to the breast bone, abnormalities of the lung or lining of the lung, even abnormalities of the esophagus or feeding tube, stomach or intestine, gall bladder or liver can mimic heart pain. Exercise can promote the reflux of acid from stomach to esophagus. So if you have excellent blood flow to your heart, it is possible that one of these other abnormalities could be cause of exertional chest pain. Remember, your doctor knows you better than I.

Member: My daughter had a heart attack at age 39 -- several areas blocked -- with CABG. Cholesterol was 156 with excellent lab workup. She has been on supervised Dean Ornish diet but has not lost weight. She is very concerned. What can be done to reduce her weight safely and reverse the heart damage?

Johns: This is really several questions in one. Reversing heart damage is primarily accomplished by all the healthy lifestyle changes and efforts to reduce risk factors that I am sure her doctor has discussed with her. Weight loss is another difficult and complex question. It is easiest accomplished by increasing exercise and decreasing calories. A reduction of 25% of total calories will usually promote slow, steady weight loss. For some, weight loss is easier by changing the dietary content. By this, I mean reducing carbohydrates by 25%-30%. In my opinion, for the long-term, it is important not to increase fat when decreasing carbs. Most people who restrict carbohydrates tend to maintain the same total daily calories by increasing dietary fat. So, not knowing what your daughter's usual diet is, my general recommendation is for her to avoid all breads and pastas (flour-containing carbs) and unprocessed sugars, and add 15 to 30 minutes of aerobic exercise, daily.

Member: I have the sensation of a big butterfly in my chest and wonder if I should tell my heart doctor about this, as I have valve problems.

Johns: I completely agree with you. Your intuition to tell your doctor is the right thing to do. Butterflies in your chest can signify irregular heart rhythm. Any change in the state of your heart, particularly if you have heart-valve disease, should be reported to your doctor.

Member: I found out last January I have a heart murmur. Should I have it looked at again?

Johns: If the physician who told you had a heart murmur was focusing on your heart murmur, it probably does not need further evaluation as long as you feel well (have no chest pain, dizziness, unexpected sweats, nausea, or faintness). It is important to know that you have a heart murmur so that in the future if you should need hospitalization your physician can know that this is a long-standing and, therefore, benign heart murmur. It is always a good idea to ask your regular physician the specific question, "Should I worry about this heart murmur?"

The danger during acute hospitalization of heart murmur is that it could sometimes signify heart infection. So if you were to develop fever and require hospitalization, your doctor would always want to exclude your heart as a source of infection. If he/she knows that the murmur has been there for sometime, it will be known that the heart is not the cause of the fever or infection.

Member: How harmful is smoking nicotine-free cigarettes after by pass surgery?

Johns: It has been shown that even nicotine-free cigarettes impair the function of the blood vessels. So any type of smoke in the lungs is bad for the blood vessels and so, therefore, the heart.

Member: If inflammation of chest cartilage is suspected as causing chest pain what is recommended for the problem, for example, medication, etc.?

Johns: Again, it is always best to follow your own physician's advice. But, generally, non-steroidal anti-inflammatory drugs (NSAIDs) markedly reduce the pain. Aspirin and ibuprofen are two anti-inflammatory drugs. One must always be cautious when taking prolonged, high-dose anti-inflammatory drugs because of the possible risk of stomach ulceration or negative effect on the kidneys. But with your doctor's knowledge and approval, these drugs are safe and effective for chest cartilage.

Moderator: We are almost out of time. Before we wrap up for today, do you have any final comments for us, Dr. Johns?

Johns: My best advice to those who have had heart injury is to focus on yourself. This is the time to take time for yourself. Change you life to healthier habits. Know your risk factors and work toward the ideal goal.

Moderator: Unfortunately, we are out of time. Thanks for joining us, members, and thanks to Dearing Johns, MD, for being our guest.

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