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Ask Dr. Lansky - Recent Answers

I'm a 42-year-old female. I have been experiencing hiccup-like shortness of breath with increasing frequency for about two months now, and other symptoms including tiredness, anxiety, nausea, and some light chest pains. I had a chest x-ray last week that came back normal, but after looking up heart symptoms, I'm quite concerned. I just went back on birth control pills and am wondering if this could be causing the symptoms?

Yes, the symptoms you describe could be caused by birth control pills (especially if you are a smoker.) You should talk to your doctor about switching to another method of birth control and seeing if that relieves some of your symptoms. It is important to note that while the symptoms you describe could be caused by the birth control pills, they could also be caused by heart disease. You should have your doctor conduct a thorough evaluation for heart disease to be sure.

I am a 52-year-old woman with a family history of heart disease and stroke. I sleep well at night but have pronounced daytime sleepiness when sitting still. I have had sleep studies done and wear a CPAP. Can excess sleepiness be a sign of heart disease?

Yes, excess sleepiness or fatigue can be a sign of heart disease. See our article on the signs and symptoms of heart disease. Heart problems are not the only possible cause, given your history of sleep apnea (which can prevent you from getting restful sleep), but it is a good idea to see your doctor and get your heart risks assessed to be certain.

I have been diagnosed with possible coronary microvascular syndrome after an abnormal stress test and an angiogram showing clear arteries. I continue to experience chest pain, sometimes with exertion, sometimes at rest, particularly when I first go to bed at night. Can this condition be treated with medication? Are there any further tests to confirm this diagnosis? When I experience this chest pain, can I just work through it since I know my major arteries are clear?

This could be microvascular disease, but you might want to make sure it is not something else—gastritis, ulcer, or another non-cardiac cause of the chest pain. Sometimes a stress test can produce a false positive (showing there is something wrong when everything is normal), and this is especially common in women. Talk to your doctor to see if any other functional test might be of value, such as a perfusion MRI or PET scan.

It is possible that your symptoms are caused by a coronary microvascular syndrome, also known as cardiac syndrome X. To learn more, see our article on cardiac syndrome X.

Syndrome X can often be treated with medications including nitrates, beta-blockers, and calcium channel blockers, alone or in combination, to improve blood flow. If none of these medications work, imipramine, an antidepressant, may be used; it has been shown to reduce the frequency of chest pains. The goal of treatment is to relieve your chest pain and improve your quality of life. Equally important is the need to control other risk factors for heart disease such as high blood pressure and high cholesterol, as well as to maintain a heart-healthy lifestyle that includes eating a heart-healthy diet, exercising regularly, and not smoking.

I have recently been experiencing bouts of rapid heartbeats. They only last for 30 to 60 seconds, and often wake me up at night. I have not been diagnosed with heart disease. Am I ok as long as there is no pain?

What you describe are called palpitations, and they have many possible causes. Most likely they are nothing serious, but they can sometimes be a symptom of underlying heart problems (especially if accompanied by sweating, faintness or dizziness, or chest pain). Even if there is no pain, any heart symptoms should be taken seriously until proven otherwise, so you should definitely schedule a full cardiac evaluation. Getting checked out will also go a long way towards putting your mind at ease in the likely case your symptoms are not serious.

Can you have a mild heart attack and not realize it?

Yes. Not all patients who suffer a heart attack have symptoms, and heart attack symptoms may be subtle and attributed to other causes. A minor heart attack might not affect the function of your heart a noticeable amount. The main problem is that a mild heart attack is a symptom of serious coronary artery disease. Without treatment, chances are that someone who has suffered a mild heart attack may be in line for another (potentially deadly) heart attack in the future.

If you are concerned about symptoms you have had in the past, see a doctor to have your heart risk evaluated: imaging and other tests can look at your arteries to see if they are blocked or narrowed, and look at your heart muscle for evidence that it has been damaged by a previous heart attack. If you are found to be at risk, you will have a chance to start a treatment plan to prevent future problems.

Are swollen ankles a sign of a heart problem?

They can be; swollen ankles can mean your body is retaining fluid, one of the signs of heart failure. They can also be caused by disease in the blood vessels of your legs called chronic venous insufficiency. However, swollen ankles can be caused by many other things, including too much salt intake, birth control pills, obesity, sitting too long, and more. See your doctor so she or he can determine the cause and prescribe appropriate treatment.

I am 56-my brother had a heart attack at my age now, my mother had a heart attack at 45. I have been experiencing intermittent prickling pain under my collarbone and shortness of breath after ascending stairs. I want to be checked out but don't know where to start. My general doctor says I don't need to worry because my BP has stayed consistently well below 130/90 over a series of office visits. I am willing to pursue and to take control of my health. What do you advise?

I advise that you find a good cardiologist as soon as possible for a full risk evaluation and very likely further tests. You have a strong family history of heart disease, and now you have symptoms; you need to take this very seriously. The fact that your blood pressure is normal has no bearing on whether or not you have heart disease: there are many different heart disease risk factors, any combination of which puts you at risk, even if the others are normal.

Results of a recent exercise test suggest microvascular disease. All the other cardiac tests I have had have been normal. My doctor is suggesting a heart catheterization prior to diagnosing microvascular disease. I am concerned about the risk associated with this test — is there a less invasive way of diagnosing this?

I would suggest a 64-slice CT angiogram, if you have not already had that done. You will still be exposed to radiation and to contrast dye, and the resolution is not as good as the traditional catheter angiogram, but it is an option if you want to avoid the more invasive test.

I am 52 and have been diagnosed with LPa disease, which has caused premature arteriosclerosis. My doctor says it is hereditary. I have never heard of it. Can you tell me more about it?

Lp(a) is short for lipoprotein(a), a modified form of low-density lipoprotein (LDL) cholesterol. LDL is the bad cholesterol that sticks to the lining of the artery walls, leading to fatty plaque buildup ( atherosclerosis or arteriosclerosis). The level of Lp(a) in your blood is mostly determined by your genes, which are inherited. Just as high levels of LDL cholesterol can run in families, so can high levels of Lp(a). A high level of Lp(a) increases your chances of developing atherosclerosis before the age of 60, also known as premature atherosclerosis.

The Women’s Health Study found that extremely high levels of Lp(a) (greater than or equal to 65.5 mg/dL) have been associated with a 66% increased risk of heart disease, particularly in women with high levels of LDL (bad) cholesterol.

High Lp(a) is difficult to treat and does not seem to respond to cholesterol-lowering statin medications, although it can be lowered in some patients with niacin or aspirin. However, there is no evidence that lowering Lp(a) levels reduces your risk of heart disease. Instead, in patients with high levels of Lp(a), doctors focus on treating other heart disease risk factors, which can modify the added risk associated with high Lp(a) levels. High cholesterol is aggressively lowered with statins or niacin, and high blood pressure is controlled. Modifying risk factors such as eating healthy, exercising regularly, and not smoking is also important to reduce the overall risk for heart disease.

Do you have any tips for healthier shopping that you recommend? I know I should start to eat healthier but when I get to the grocery store I tend to buy what I usually do because it is easier and faster.

Start with fruit and vegetables—you can’t go wrong; lean meats include skinless chicken or turkey; flank steak can satisfy steak lovers without overdoing fat, pork chops are lean and of course cold water fish are excellent. But remember: everything in moderation and small servings.

When it comes to starches, avoid the staple pasta and bleached rice and explore whole grains and legumes, which provide a rich source of fiber and B vitamins and can be delicious. These include whole rice, peas and beans, cracked wheat and many others. Explore recipes from different cultures, which can be very easy to prepare and rich in flavor and diversity. Some of my favorites are Persian, Mediterranean and Indian recipes. When you get to the dairy aisle, remember to select low- or no-fat options; these are rich in calcium, an especially important nutrient for women because of the risk of osteoporosis. Visit our Heart Healthy Diet article for more.

Is there any way to reverse the damage caused by an unhealthy lifestyle (not exercising, smoking, etc?) Or is the damage permanent once it is done?

With proper lifestyle changes (and medications if necessary) research shows that it is possible to reverse the process of atherosclerosis that causes heart disease and heart attacks. The two most important treatments are daily exercise and a healthy low fat and low calorie diet. It take decades to develop coronary artery disease and you can expect it to take just as long to reverse it…so just start today! Certainly you need to stop smoking (see Quitting Smoking and use the resources to seek help, you don't have to do it alone). Join a gym or a rehabilitation center, and visit a nutritionist if necessary. It is all about taking the initiative and willpower: YOU CAN DO IT! If you're concerned about the damage an unhealthy lifestyle has done to your heart, talk to your doctor: there ARE options to roll back your heart risk.

Your site says that women often delay getting help when they have the symptoms of a heart attack, but how can you tell the difference between ordinary indigestion, back pain etc. and a heart attack?

The short answer is that there is no way for you to tell for sure whether these symptoms are caused by heart disease or something less serious. Recognizing that something is just not right is the first step. Don’t write it off or wait for it to go away – get help immediately and let your doctor figure out whether it is your heart or not. Evaluating your risk factors and screening tests (when appropriate) to determine your heart risk do not take long, but go a long way towards putting your mind at peace if your risk is low. If there is something wrong or you end up needing to control your risk, getting checked out right away allows more time for the prevention or treatment steps necessary to reduce your risk of serious complications. See our Heart Disease Signs & Symptoms and How to Survive a Heart Attack articles for what to look for and what to do.

Are there any "superfoods" to prevent heart disease? I keep reading about the benefits of things like olive oil and chocolate, do they really work? Also, are there any supplements I should be taking?

This is a common item of interest among my patients. Although it is true that some foods have shown heart health benefits in studies, there is far more evidence recommending an overall healthy diet rather than any single food. There is a lot of consistent research showing that a diet rich in fruits, vegetables and whole grains lowers your risk of heart disease and stroke, but very little saying that one kind of fruit or vegetable is better than another. As an example of this, consider whole grains, the benefits of which are confirmed in many studies. Whether there is a single component in whole grains, like fiber or folate, that makes them healthy is difficult to determine—there appear to be benefits associated with many nutrients in whole grains and possibly their interaction with each other.

Regarding supplements —after looking at all the research on vitamin and mineral supplements, both the US Preventive Services Task Force and the American Heart Association concluded that they should not be taken for the purposes of preventing or treating heart disease. There is research showing that people who choose to take vitamin supplements (mostly vitamins A, C, E, and beta carotene) are less likely to develop heart disease. However, this is largely because men and women who take supplements tend to be leaner, wealthier, exercise more vigorously, eat healthier, and are less likely to smoke than nonusers. Multivitamins usually have much lower doses of individual vitamins than single supplements. Some studies show that people who choose to take multivitamins have a lower risk of heart disease, but others don’t. In a survey of more than 1 million US adults, taking multivitamins did not reduce the risk of heart disease or stroke and appeared to increase the risk of dying from cancer in men who smoked.

I am a 34 year old otherwise healthy woman. I had a heart attack 2 weeks ago when I was diagnosed with Prinzmetal’s angina, there typically are no major blockages in the coronary arteries—the chest pain comes from spasms of the arteries.

If you did have an angiogram and your coronaries are relatively normal, you should follow up with you doctor so he or she can adjust your medication to control your symptoms. The good news is that there are a number of medicines that are generally effective at controlling symptoms in your situation (usually nitrates or calcium channel blockers).

I’ve been hearing a lot about the Someone recently thought they had a heart attack at my place of employment. A few months ago I saw a medical show where they said to try and make yourself cough if you thought you were having one. Is that legit? They said it would try and make your heart get back to its regular beats.

This technique is called “cough CPR,� but it has nothing to do with a heart attack, and won’t do you any good if you’re having one. Do not try this at home! If you think you might be having a heart attack, call 911 immediately. Cough CPR is taught to patients with heart rhythm problems who are prone to having a specific kind of rapid heart rate called supraventricular tachycardia. In these patients, coughing or massaging the carotid artery in the neck can sometimes restore the heart to its normal rhythm. Cough CPR could also potentially restore a more life-threatening heart rhythm abnormality that can result from a heart attack—but the most important thing in this situation is getting the paramedics at your side as soon as possible. So if you start having chest pain, just call 911!

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