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A. Even
if you do everything right, you can still develop cardiovascular
disease. That’s why it’s especially important to have your heart health
evaluated by a physician. Most experts agree that if you are healthy, you should get a
regular checkup at least
- Twice in your 20s (every 5 years)
- Three times in your 30s (every 3 to 4 years)
- Four times in your 40s (every 2 to 3 years)
- Five times in your 50s (every 2 years)
- Every year if you are 60 or older
During an exam, your doctor will want to know if you have any specific complaints (such
as chest pain), and get a medical history including information about all prior illnesses,
hospitalizations, accidents, operations and allergies. Your doctor will also inquire about
any medications you may be taking—so don’t forget to mention over-the-counter
drugs and dietary supplements such as vitamins. The doctor will also want information
about your lifestyle or living habits that may have an impact on heart disease, such as
smoking, alcohol use, drug use and stress at work. Your cardiovascular physical
examination will include measuring your blood pressure, heart rate and rhythm, checking
the pulses, inspecting the veins of your neck, determining whether there is swelling, and
listening to breathing and heart sounds. The doctor will check:
- Heart rate and rhythm.
- Pulses. Your doctor will also feel the pulses in your neck, groin and feet and listen
over the arteries in the neck. Weak or absent pulses, or a murmur in the neck, suggest an
obstruction to blood flow.
- Swelling. Doctors routinely look for excess fluid by examining the legs and ankles for
swelling. Swelling, or edema, may develop with heart or kidney failure, liver disease, or
if there’s a blockage in a vein carrying blood back to the heart. Your doctor will
press on the skin and watch how far it can be indented.
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A. When
a heart attack strikes minutes can mean the difference between life and death. Heart
attacks often present with a pressure like heavy feeling in the center of the chest. This
sensation can radiate of spread to the neck, shoulders or arms. You may also be short of
breath, have nausea and vomiting and sweating. Pain that lasts only a few seconds is
rarely ever from the heart and the pain of a heart attack will last for minutes. If these
symptoms occur it is important to seek immediate attention.
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A. The
chest pain of angina pectoris is often a heavy tightness occurring in the center of chest.
It often occurs with exertion and resolves with rest. Angina will typically last from five
to twenty minutes. Angina may not always occur at the same level of exertion. It is
sometimes very difficult to tell heartburn from a heart attack. If your doctor is
concerned about the possibility of a heart attack you may undergo a stress test or
observed in the emergency room or chest pain center.
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A. The
familial nature of coronary artery disease is clear. There are many factors that may
account for this. Cholesterol levels, tendency for diabetes, blood pressure may all be
related to familial risks. Dietary habits may also be learned from parents and affect
cardiac risks.
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Q.
What is the importance of my cholesterol level?
A. The
blood levels of cholesterol and triglycerides are also important risk factors for coronary
artery disease. The level of cholesterol is directly related to the risk of coronary
artery disease. Cholesterol is measured as LDL or ‘bad cholesterol’ and as HDL
or ‘good cholesterol’. The level of cholesterol that your doctor will consider
"good" for you will depend on many factors. Levels of total cholesterol are
often best kept below 220. We can lower the level of our cholesterol by eating a diet low
in fats and cholesterol. Avoiding fried and fatty foods can be an important part of
controlling blood cholesterol.
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Q.
What is hypertension?
A.
High blood pressure or hypertension is one of the most common risk factors
for heart disease and stroke. Hypertension can be a silent killer, for until the disease
is very advanced, there are no symptoms of high blood pressure. It is important to have
your blood pressure checked regularly and to follow-up with your doctor is high readings
are seen. Normal blood pressure is less than or equal to 120 over 80 (120/80). High blood
pressure is greater than 140/90. The top number is the systolic blood pressure and the
bottom number is the diastolic. Blood pressure can often be lowered, when it is high, by
exercise, weight reduction and a low salt diet. These measures should be undertaken only
under the supervision of your doctor. There are a number of excellent medications to treat
high blood pressure and when successful, lower the risk of heart attack and stroke.
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A. When
the heart beats the doctor can hear heart sounds or tones. These are sounds the heart
valves make as they close. The flow of blood through the valves is usually very quiet or
silent. When this flow of blood makes sound a murmur is heard. Most heart murmurs are
benign or not serious medical problems. Some murmurs are serious and require special
evaluation by a cardiologist. The cardiologist may order a cardiac echo to evaluate the
heart muscle and valves. Some murmurs will lead your doctor to recommend that antibiotics
be taken before dental and other procedures to prevent infection or endocarditis.
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A. The
term "artificial pacemaker" is used for a small, battery-operated device that
helps your heart beat in a regular rhythm. Some are permanent (internal) and some are
temporary (external). It can help compensate for a defective natural pacemaker or blocked
electrical pathways in the heart. A pacemaker uses batteries to send electrical impulses
to your heart to help it pump properly. An electrode is placed next to your heart wall and
small electrical charges travel through the wire to your heart. Modern pacemakers can
sense the heart beat and inhibit itself when your heartrate is above a certain rate. The
pacemaker will pace when your heartbeat is too slow. These are called demand pacemakers.
If you have an artificial pacemaker, be aware of your surroundings and the devices that
may interfere with pulse generators:
Home appliances
CB radios, electric drills, electric blankets, electric shavers, ham radios, heating
pads, metal detectors, microwave ovens, TV transmitters and remote control TV changers, in
general, have been shown not to damage pacemaker pulse generators.
Several of these devices have a remote potential to cause interference by occasionally
inhibiting a single beat. However, most patients can continue to use these household
devices without significant worry about damage or interference with their pacemakers.
Power-generating equipment, arc welding equipment, and powerful magnets -- as in
medical devices (MRI), heavy equipment or motors—are capable of inhibiting pulse
generators. Patients who work closely with or near such equipment should be aware of the
risk that their pacemakers may not work properly in those conditions.
Cellular telephones
The cellular phones available in the United States (less than 3 watts) do not appear to
damage pulse generators nor affect how the pacemaker works. Technology is rapidly changing
as the Federal Communications Commission (F.C.C.) is making new frequencies available.
Newer cellular phones using these new frequencies might interfere with pacemakers.
Medical equipment
Carry a wallet I.D. card with you. Equipment used by doctors and dentists can affect
your pacemaker, so tell them you have one. Magnetic resonance imaging (M.R.I.) is a
noninvasive diagnostic tool that uses a powerful magnet to produce images of internal
organs and functions. Metal objects are attracted to the magnet and are normally not
allowed near MRI machines. The magnet can interrupt the pacing and inhibit the output of
pacemakers. Discuss with your doctor the possible risks and benefits before you undergo
MRI scanning. Extracorporeal shock-wave lithotripsy (E.S.W.L.) is a noninvasive treatment
that uses hydraulic shocks to dissolve kidney stones. This procedure may be done safely in
most pacemaker patients, with some reprogramming of the pacing. You will need careful
follow-up after the procedure and for several months to be sure the unit is working
properly. ESWL should be avoided in patients with certain kinds of pacemakers implanted in
the abdomen. Discuss your specific case with your doctor before and after the treatment.
Transcutaneous electrical nerve stimulation (TENS) is used to relieve acute or chronic
pain. Several electrodes are placed on the skin and connected to a pulse generator. Most
studies have shown that TENS rarely inhibits bipolar pacemakers. It may sometimes briefly
inhibit unipolar pacemakers. Diagnostic radiation (such as screening x-ray) appears to
have no effect on pacemaker pulse generators. However, therapeutic radiation (such as for
treating cancerous tumors) may damage the circuits of the pacemaker. The degree of damage
is unpredictable and may vary with different systems. The AHA recommends that the
pacemaker be shielded as much as possible, and moved if it lies directly in the radiation
field. If you depend on your pacemaker for normal heart pacing, the electrocardiogram
(E.C.G.) should be monitored during the treatment, and your pulse generator should be
tested often after and between radiation sessions. Dental equipment does not appear to
affect pacemakers adversely. Some patients may feel in increase in pacing rates during
dental drilling Electroconvulsive therapy (such as for certain mental disorders) appears
to be safely used in patients with pacemakers.
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