Ask the Heart Doctor, Dr. Kalahasti

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Live Web Chat Transcript:
Ask the Heart Doctor- February 20, 2008

Dr. Vidyasagar Kalahasti
Cleveland Clinic Heart and Vascular Institute
Staff Cardiologist

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Cleveland_Clinic_Host: Welcome Dr. Kalahasti and thank you for being with us today. Let's begin!

Speaker_-_Dr__Kalahasti: Hello. It is good to be here.

Coronary Artery Disease

zzrider_2: If you have slight elevated heart enzymes at .4 and pass a nuclear stress test is it better to get a angiogram/ i had a angiogram 2 yrs ago and one artery was 50% it was the so called widow maker. Just got out of the hospital and had some chest pain but stress test was good?

Speaker_-_Dr__Kalahasti: If stress test was good and did not show any areas of decreased blood supply then you should continue with risk factor modification (i.e. BP, cholesterol control, regular exercise and low fat diet) to prevent progression of CAD.

carol: What medications should a patient be on routinely after a heart attack?

Speaker_-_Dr__Kalahasti: Aspirin, Clopidogrel,beta blocker medications such as metoprolol, atenolol, ACE inhibitors like captopril, lisinopril, Statins like atorvastation, simvastation. The important information is whether you had angioplasty or stents put in after heart attack, were you medically managed or did you CABG surgery. Do you have additional medical problems like HTN, DM, Hyperlipidemia etc.

betty: My husband has had 6 stents placed. Is there a time when nothing more can be done? He is still having angina. Should I ask a surgeon instead or go back to the doctor who put in his stents?

Speaker_-_Dr__Kalahasti: I would recommend a second opinion with an experienced heart surgeon.

marybeth: Can you speak to the recently proposed Screening for Heart Attack prevention and Education (SHAPE) guidelines?

Speaker_-_Dr__Kalahasti: SHAPE guidelines are based on noninvasive screening with imaging and these have not been validated that they actually improve morbidity and mortality. Imaging asymptomatic people may be very expensive.

slb60: Are there any medications that take away plaque?

Speaker_-_Dr__Kalahasti: Some of the statin medications have shown to regress plaque in limited studies. But, none of these are approved by the FDA for that specific reason in the coronary arteries.

1234mbhm: Can a previous bypass graft be stented?

Speaker_-_Dr__Kalahasti: Yes at experienced centers with skilled operators.

ya: What are collateral arteries? If you have them but have blockage do you need to have surgery? Or are collaterals enough?

Speaker_-_Dr__Kalahasti: Collateral arteries are natural bypasses that the heart develops if the blockage were to occur over a long period of time.

Speaker_-_Dr__Kalahasti: Collaterals may not be sufficient to help your circulation and may need surgery in some situations. Hence, you would need an evaluation to determine this.

Valve Disease

carolinasun: I have a mechanical heart valve and the doctor said I need to have surgery again - there is a leak around the valve - do I need to have a mechanical valve again - or can they replace it with a biologic valve to prevent Coumadin

Speaker_-_Dr__Kalahasti: Yes they can replace with biologic valve so you do not have to use coumadin. There are exceptions and technical issues which may need to be looked into before the decision is made.

bzgirl21: Is it possible to repair (versus replace) a mitral valve that has bileaflet MVP? If so, is this repair less successful than repairing just one leaflet and what is the percentage of success for this type of repair?

Speaker_-_Dr__Kalahasti: Repair of bileaflet prolapse is possible. I do not believe that this is any less successful than single valve leaflet prolapse in our institution. Usually one leaflet is more prolapsing than the other even in bileaflet prolapse and this determines the surgical approach. I do not know the exact percentage of success but should be able to obtain from out heart surgery website.

marybeth: I had 2 mechanical valves placed 7 years ago. I do not like being on the coumadin, nor do I like the click of the valves. Do they remove and replace valves for these reasons.

Speaker_-_Dr__Kalahasti: Yes they do remove them but a second time heart surgery has its own risks and so you have to make the decision about the discomfort with coumadin versus second time surgery.

mb08: I have Mitral Stenosis, My doctor told me that if I had a valvotomy, I would need to be on coumadin the rest of my life. Is this true?

Speaker_-_Dr__Kalahasti: If you have atrial fibrillation along with mitral stenosis then you do need anticoagulation with coumadin whether you have valvotomy or not.

queenb: What is mitral valve prolapse – can you have it your whole life and not get any worse?

Speaker_-_Dr__Kalahasti: Yes. Mitral valve prolapse is caused by sponginess of the mitral valve. You can go through your whole life without getting ill effects.

moira: If I had a mechanical heart valve placed, can I have an MRI - I need one for another medical problem

Speaker_-_Dr__Kalahasti: Sometimes it depends on the type of MRI equipment and sometimes it is related to length of time after heart surgery. It is best to speak to your doctor and the MRI lab that will be doing your testing.

geoswife43: Can untreated mitral valve prolapse lead to death? Can untreated mitral valve prolapse lead to Atrial Fibrillation?

Speaker_-_Dr__Kalahasti: Untreated mitral valve prolapse can lead to congestive heart failure symptoms and atrial fibrillation. You would need an evaluation to determine the severity of the mitral valve prolapse and mitral regurgitation (leaky valve).

Abnormal Heart Beats (arrhythmias, fast heart rates)

Angie4406: I started having palpitations a few years ago after a cortisone injection in my shoulder. I saw a cardiologist who performed an EKG, stress echocardiography, and a 24 hr. holter monitor. I did not have the symptoms during any of the tests but he felt the palpitations would disappear over time as the cortisone disappeared from my system. The palpitations did get significantly better with time but I find that they still occur occasionally during times of stress or when lying down. Should I be concerned or would the tests I had done have uncovered anything significant?

Speaker_-_Dr__Kalahasti: As the palpitations have become infrequent and you already had extensive testing, I do not believe you need additional testing.

bl50: I have fluttering in my chest and my heart races. The doctor said that is normal and told me I don’t need treatment. Now I am scared that my heart could be beating too fast. I am also tired all the time. What should I do.

Speaker_-_Dr__Kalahasti: I would recommend seeing a cardiologist for additional evaluation.

johnp: What is left axis deviation and what causes it? My dad has it – they told him not to worry but keep an EKG with him in case he has a problem so people knows he has it

Speaker_-_Dr__Kalahasti: Left axis deviation is a benign condition that is diagnosed on EKG. You may have it without having any problems. Most common reasons include high blood pressure.

Pericardial Disease

SouthernRose: I have pericardial constriction and diastolic heart failure. The constriction is supposedly mild. I'm having increasing symptoms of shortness of breath, chest pain, and increased episodes of heart failure manageable with medications that I have. I had a CT of the chest which was the best test to show both problems last year and it was repeated this year and was unchanged. ( I had a heart cath where they measured pressures last year . It showed constriction. Echo last year just showed the constriction last year. ) If things are unchanged why am I worse symptom wise. They don't seem to know why I'm having these symptoms. I know my body and something is not right. They say the CT shows that its unchanged but I get very short of breath and chest pain with exertion or walking up and sort of incline. What do you think is going on. By the way I had only mild blockages in my coronary arteries in Dec. of 2006.

Speaker_-_Dr__Kalahasti: You would need clinical evaluation here at our institution and would recommend seeing one of our experts on pericardial disease Dr. Allan Klein.

marybeth: I friend of mine had valve surgery and did just fine. However, shortly afterwards, she developed a pericarditis. Is this comment? How is this treated?

Speaker_-_Dr__Kalahasti: Pericarditis is fairly frequent after heart surgery. in most cases, it is self limiting without long-term sequelea. Most times it is treated with non-steroidal anti-inflammatory medications such as ibuprofen, naproxen, etc.

SouthernRose: What causes pericardial constriction and Diastolic heart failure?

Speaker_-_Dr__Kalahasti: There are multiple causes for pericardial constriction. It would be best answered when you see a physician.

Speaker_-_Dr__Kalahasti: Diastolic heart failure also has many causes and different treatments. Best discussed with a cardiologist.

Heart Failure

Cleveland_Clinic_Host: Dr. Kalahasti- we have received several questions about diastolic heart failure, can you give us brief overview

Speaker_-_Dr__Kalahasti: Diastolic heart failure can be caused by many different conditions. Uncontrolled high blood pressure and coronary artery disease are the most common causes. The treatment is similar to systolic heart failure along with control of blood pressure.

Cardiac Exam and Diagnostic Tests

smitty: What should be part of a physical exam? I am having a physical exam – I am a 45 year old male. I wanted a stress test – but that is not part of my appointment.

Speaker_-_Dr__Kalahasti: Physical exam is usually yearly and the main goal is to determine if there is physical abnormalities. If there are symptoms at the time of the exam, that will dictate additional testing.

rallymom: I have chest pain during the day. It is not related to anything specifically. I had a normal stress test – but I am worried it still could be my heart. Are there other tests I should have? What about an MRI or CT scan?

Speaker_-_Dr__Kalahasti: It is a very difficult question to answer. There have been patients who are diagnosed with heart disease despite having a negative stress test. Hence, I recommend close follow-up with a cardiologist. Cardiac CT scans can sometimes be helpful but they do involve radiation.

timg: I am 27 years old and my father died of a heart attack last year. I wonder if I should get checked. What tests should I have?

Speaker_-_Dr__Kalahasti: At the minimum a cholesterol check. You should also maintain a healthy lifestyle with regular exercise. Genetics can not be altered, but the effects of the disease can be minimized by lifestyle.

tomcat: What is the significance of a calcium score. I had one and it was 600 – not sure what that means.

Speaker_-_Dr__Kalahasti: You would need additional evaluation by a cardiologist. We do not know if you are having symptoms.

Symptoms of Heart and Vascular Disease

suzie: Is weakness, tiredness and lack of stamina with no other symptoms or discomfort in a 67 year old woman enough to warrant a heart work up? Blood numbers, weight, diet and exercise patterns are all good.

Speaker_-_Dr__Kalahasti: I do not believe that these symptoms by themselves warrant additional cardiac testing. Your primary care provider (PCP) should be able to determine if you need such work up.

dennis: What can cause the heart to be enlarged? Is that a bad thing? I was told my heart is big.

Speaker_-_Dr__Kalahasti: There are multiple reasons for an enlarged heart. If you have been told your heart is big, we recommend an evaluation by a cardiologist.

tomcat: Is it normal to be able to see your pulse in your neck?

Speaker_-_Dr__Kalahasti: Yes, it is normal. But, it may also may be seen in some severe disease. Therefore, you should see your doctor.

rgs52: If they take your veins from your legs for bypass surgery – can you have discomfort in your legs some time after the surgery. I had surgery last year but I feel my legs ache even now. What should I do?

Speaker_-_Dr__Kalahasti: Discomfort one year after surgery would be uncommon and hence, would need an evaluation to rule out a blood clot or infection.

Blood Pressure

jane: I am a 40 year old female with high blood pressure. I am on a medication to control my blood pressure. I just learned that I have a thyroid condition. Would this affect my blood pressure? If I get that under control can I stop my blood pressure medications?

Speaker_-_Dr__Kalahasti: Thyroid conditions do effect blood pressure. Hence, treatment of your thyroid condition would be important.

patsy: What blood pressure is good. I went to the emergency room for numbness and tingling in my hands. My blood pressure was 210/130 but after a time it went down to 150/90 and they said that was good and I could go home. Should I follow up with my doctor?

Speaker_-_Dr__Kalahasti: Yes and you will need treatment for high blood pressure for that value. We do not know your age or your medical history. In general, blood pressure is considered normal if it is less than 130 systolic and 80 or less diastolic.