ASK THE CARDIOLOGIST

1. What is white coat hypertension?
White coat hypertension is the transient elevation in blood pressure that is observed in patients who may get nervous or anxious in a doctor’s office. In order to separate this from true hypertension, home blood pressure monitoring is often recommended. Even at home, blood pressure readings can vary by 20, 30, or 40 points in a given day so looking at one reading is not as important as the average over several days. In a recent study, taking 2 readings in the morning and 2 readings in the evening for 7 days and then averaging the results was sufficient for the assessment of hypertension. An additional important point is that before you check your pressure you should be seated and relaxed for at least 2 minutes. Remember, high blood pressure is a silent killer so don’t wait until you feel bad to check your blood pressure.

2. What are the symptoms of coronary artery disease (CAD)?
CAD is still the leading cause of death in the United States. Classically symptomatic CAD is associated with chest pain occurring with exertion and relieved with rest. The discomfort may take on many forms, but usually is described as pressure /tightness/ heaviness in the chest and may be associated with shortness of breath. The pain may also radiate to the neck, arm, or jaw. The typical duration is usually minutes, not just a few seconds. However, the symptoms may be just shortness of breath, or even more subtly, fatigue. Also, many patients mistake cardiac symptoms as being related to indigestion. Early diagnosis and treatment is the key to preventing the complications of CAD and if you are experiencing any of these symptoms, you should consult with your physician.

3. If my cholesterol reaches the treatment goal, can I stop my cholesterol lowering drugs?
A common misconception is that treating cholesterol is like treating a cold with a course of antibiotics. High cholesterol is not something that is treated for a brief period of time and is “cured.” On the contrary, it is a chronic medical condition which requires lifelong therapy to keep under control. Key to this understanding is that the majority of patients, in addition to having poor dietary habits, also have a genetic predisposition towards high cholesterol. So, before stopping your cholesterol medicines on your own, please consult with your doctor.

4. How soon after a coronary event can I travel out of the state or a long distance from home?
Although there are no hard and fast rules, we currently recommend individuals having stent placement or bypass surgery stay close to home for the first two to four weeks following the procedure. In the event of a complication or confusion regarding medications, the patient would receive prompt treatment and follow-up as needed.

5. What does the ejection fraction mean?
The ejection fraction is a measure of the heart’s function. It is the percentage of blood expelled during each contraction of the left ventricular chamber. In most healthy individuals, it is approximately sixty percent. This means that sixty percent of the blood that is in the heart prior to its beat is ejected from the heart with the contraction. As the heart function begins to deteriorate, the ejection fraction falls as well. The ejection fraction is important because it is directly related to prognosis and mortality; the lower the ejection fraction, the higher the risk of death from cardiac causes. The ejection fraction is measured by a variety of techniques including echocardiography, nuclear medicine scanning, heart catheterization, and others. The main goal in the treatment of individuals with a low ejection fraction is to raise it through a variety of measures including medications, various procedures, and pacemaker devices. As the ejection fraction improves, so does the individual’s overall prognosis.

6. What are the present goals in regards to blood pressure?
The present recommendation is to achieve the lowest possible blood pressure that an individual can tolerate. In the past, 140/80 was felt to be a reasonable goal, however, further studies have shown that lowering the blood pressure even more can result in even more benefit. This is particularly true in those individuals with previous strokes, diabetes, and heart attacks. Unfortunately, some individuals cannot tolerate a very low blood pressure; thus, our goal is to achieve the lowest blood pressure that one can reasonably tolerate on medications with the least side effects.

7. What is a BNP test?
BNP stands for “brain natriuretic peptide”. This is a hormone that is released when the chambers of the heart are stretched during congestive heart failure. It is a test that has become increasingly popular over the last several years, particularly when physicians are having a difficult time determining whether or not shortness of breath is due to the heart or the lungs. When results of this test are very elevated, it is quite specific for the heart. The BNP level directly correlates with outcomes in patients with congestive heart failure. Tracking the BNP has also been useful in monitoring therapy in patients with congestive heart failure.

8. How important is Plavix or Effient after stent placement?
Plavix or Effient is an essential drug following placement of both bare metal and the newer drug coated stents. It inhibits clotting of platelets and greatly lessens the likelihood of “stent thrombosis” or the clotting off of a stent that can lead to a heart attack or death. We usually treat our patients for a minimum of 9 months and in most cases, suggest even longer. If the drug is stopped too soon after a stent procedure, a catastrophic event like a heart attack or death may result.

9. What vitamins are recommended for the prevention of heart disease?
At present, there is no vitamin supplementation that has been proven beneficial in the prevention or treatment of heart disease. Theoretically, it makes sense that anti-oxidant vitamins would help thwart the progression of cardiovascular disease. The studies have been a disappointment and even suggest potential harm with beta-carotene and vitamin E. These vitamins may have to be obtained naturally through the foods we eat. Until recently fish oil was thought to be effective but is no longer felt to be beneficial.