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Ask the Heart Doctor (Dr. Rimmerman 12/1/10)

Wednesday, December 1, 2010 - Noon

Curtis Rimmerman, MD
Staff cardiologist
in the Section of Clinical Cardiology, the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, at the Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic.

Description

Heart disease is the No. 1 killer in United States. It is therefore important for you to stay informed about heart health and what you can do to prevent or treat the disease. There are many types of heart disease, each having their own diagnosis and treatment options. Some forms can be prevented by making lifestyle changes including diet and exercise. Learn more about heart disease during this online chat with Dr. Curtis Rimmerman, Cleveland Clinic cardiologist.

More Information

Cleveland_Clinic_Host: Welcome to our "Ask the Heart Doctor" online health chat with Curtis Rimmerman, MD. He will be answering a variety of questions on the topic. We are very excited to have him here today!

Cleveland_Clinic_Host: Thank you for joining us Dr. Rimmerman, let's begin with the questions.

Dr__Rimmerman: Thank you for having me. I will try to get to as many questions as we can.


High Blood Pressure

son13: What could be the cause of high blood pressure that develops relatively early (20's) and is unresponsive to diet and exercise?

Dr__Rimmerman: First of all that is highly abnormal and needs to be investigated. One could be a blockage or narrowing in the arteries going to the kidneys which can be congenital. Another could be chronic kidney insufficiency. Last, may be an endocrine disorder, such as thyroid or the adrenal gland which sits on top of the kidney. Consider seeing a hypertension specialist especially if your blood pressure is exceedingly high and not responding to medication. The specialist can evaluate you for these possibilities.


Coronary Artery Disease and Treatments

Joel: I had an angiogram about 9 months ago. It showed blockages in 3 different arteries. I had a stent placed in my LAD. I was put on aggressive blood pressure meds, plavix, and increased Lipitor to 40 mg. and baby aspirin. 6 months later repeat angiogram due to chest pain. When I asked the doctor why he said that when you do angiograms it can cause the vessels to become inflamed and cause more plaque build up. How could I have gotten blockages in such a short period of time, especially where they did not exist before? The doctor is recommending triple bypass surgery. What's to say that since they now have performed a second angiogram, won't my arteries get blocked again, even though I have bypass? Maybe they will block up again beyond where they are bypassed?

Dr__Rimmerman: Coronary artery disease unfortunately can be very aggressive in its progression and we do not understand fully why this is the case. Certainly stenting can cause local vessel trauma and accelerate atherosclerosis and smooth muscle proliferation, this can cause increased scar formation within the vessel. By the sound of it you did not react well to the stent and bypass surgery may be your best option.

KathyG: I had a Taxus2 Express DES placed in my diagonal three years ago this month. I understand this particular stent is not performing as well as any other stent. My cardiologist just told me to discontinue Plavix now and stay on 81mgs of aspirin plus my other meds. She said I had good blood flow, the rest of my heart arteries were clean and the indication was 12 months of Plavix for single artery disease. I am nervous with the performance of this stent and the possibility of late stent thrombosis. Of course a bleed is of concern, also. What is your opinion of the track record of this stent. Is their long term data? Thank you.

Dr__Rimmerman: The track record of the stent is still quite good and compares favorably to balloon angioplasty. The fact that you made it 3 years without clinical re-blockage is extremely encouraging. I agree 12 months of Plavix is the mainstream recommendation at the present time.


Coronary Artery Disease and Regression, Stabilization and Prevention

PattyL: What are the probabilities of reversing plaque buildup in a person 80 or older who has calcium buildup in their arteries? Is reversal more likely in a younger person? If reversal is possible, please provide guidelines on what to do to aggressively try to reverse plaque buildup. Thank you

Dr__Rimmerman: Intravascular ultrasound imaging has shown only modest plaque volume reduction. More importantly plaque stabilization and reducing incidence of heart attack is most important. Make sure your LDL cholesterol is less than 70 mg/dl, and your US CRP is less than 1. Consider the Esselstyn diet, which is exceedingly low fat.

Mayflower: Hi Dr. Rimmerman, I am 41 and have strong family history (mother had stroke at 65 due to Atrial Fibrillation and father has coronary heart disease). My LP(a) is elevated at 102 (normal less than 70). LDL, HDL, Echo and Stress echo all in normal range. Is my risk of heart disease high? Anything I should do about my LP(a)? Which one is better for me, Fish Oil or Flaxseed Oil? I heard the new alternative medication, Pradax , for Warfarin. It is better? Is it good for every patient currently taking Warfarin?

Dr__Rimmerman: Genetics is very important and make sure you are optimizing your lifestyle as it pertains to heart disease. You might also consider niacin and you can discuss this with your local physician as it is the most effective medication at reducing LP(a). Please also have your US CRP checked and if abnormal, read the JUPITER trial for recommendations.

Ellen: What are treatment options if any, for 21 yr old male with total cholesterol 220, LDL 129, HDL 54 and ratio of 5.1? He is 6;2",weighs 170. Both parents have high cholesterol and are on statins. Family history includes a father who had heart attack (angioplasty and 3 stents) at 48 and grandfather who died of heart attack at 48. I am interested in how young adults are treated and who the experts are studying this age group. 2) My son had even higher levels of total cholesterol (255) and LDL (180) about 3 months ago. The past 3 months he reduced red meat, fried foods and also increased exercise level. The results were the improvement of about 20% in bloodwork noted in Q1 above. I'd like to know... if he maintains the same level of diet and exercise that generated the improvement, will the levels improve even further after 6 months? 12 months? OR is an even larger effort on diet and exercise required to improve beyond this level? Pleased to provide more info if needed.

Dr__Rimmerman: We have a preventive cardiology section at the Cleveland Clinic that provides evaluation and recommendations on dietary advice, cholesterol, exercise and risk factor modification efforts. This is physician led and your son would be an excellent candidate for an evaluation. See my.clevelandclinic.org/heart/prevention/pcrp.aspx for more information.

Charles: I am a 56 year old male with a family history of coronary artery disease later in life - my dad had bypass surgery in his 70s. I have been having some little twinges in my chest and would like to get a full cardiac exam. If I come to the Cleveland Clinic, what is included in a cardiac exam?

Dr__Rimmerman: That would vary depending on the physician you see but it would most likely include a cardiac imaging stress test, comprehensive blood work and possibly a cardiac CT - the latter test requiring discussion with your consulting physician. A visit in preventive cardiology would also be an excellent idea.

lmgaiso_1: I have very low LDL (45). My HDL is low as well (~35). It seems like HDL has a critical cut off of >40. How do you view the HDL number? Do you say 35 is < 40 and so that is bad? Or do you say that this guy has LDL to HDL ratio of 1.3:1 and that is great? Does the concept of having HDL > 40 go out the window for me because my LDL is so low? When LDL is < 50, how much less important is it to achieve HDL > 40? I can raise my HDL by eating more fat, but my LDL will increase proportionately. Should I raise HDL at the expense of also raising LDL? Should LDL Pattern B be treated?

Dr__Rimmerman: You are correct - focus on your LDL being so low, that is an outstanding number. I presume your total cholesterol is approx 100 and if so, your TC/HDL ratio must be very favorable.

denalidon: If one has significant plaque buildup in the major arteries of the heart, can it be reversed by any means other than bypass or balloon/stent procedures (eg exercise, medication, diet)? Thanks in advance for your answers!

Dr__Rimmerman: Typically the reversal is modest but stabilizing plaque to prevent future heart attacks can be done. Additionally consider a plant based diet, such as the Ornish or Esselstyn diet programs.

Mayflower: Hi Dr. Rimmerman, I heard that taking calcium make increase the risk of heart attack by 30%. Is it true? My CRP are normal (less than 1). Should I take Aspirin of 81mm?

Dr__Rimmerman: I would suggest you review your entire risk factor profile including family history and if all your risk factors are exceedingly low, then there is no reason for daily aspirin. Calcium and the heart remains debatable and if you have a low bone density I would favor calcium supplementation.

Peppy: You mentioned an US CRP of less than one. I had a 1 on whatever test was used by my doctor and he said that was normal. But it should be less than 1?

Dr__Rimmerman: 1 or less than 1 is considered low risk category.

curious28627: I am a white female, age 54, hypertension since age 40, high cholesterol and triglycerides despite medication. My father had first heart attack at age 46. Hypertension controlled with generic Lotrel. Do I need a cardiologist??

Dr__Rimmerman: You might be a patient where we would consider a surveillance stress test. If you have one I would suggest either echo or nuclear imaging along with the EKG. A preventive cardiology program would be extremely suitable for you. Check our website for a representative program such as this.

lmgaiso_1: If HDL is 35 and LDL 45, should the HDL be raised by increasing fat intake or reducing statin even if it means LDL will increase proportionately

Dr__Rimmerman: No - focus on your LDL for goals.

lmgaiso_1: Do you believe that a diet that has less than 10% fat calories can regress CAD? For me, such a diet increases my FBS although still <100. Does the increase in the FSB offset any benefits of the ultra low fat intake?

Dr__Rimmerman: No one knows this for sure. Although as long as your blood sugar remains normal, it suggests that on balance you are doing something good.

EW: Who is focused on studying and treating hyperlipidemia among young adults? I wonder whether a cardiologist who sees patients primarily in their 50's-90"s is the right person to go to-- or are pediatric cardiologist s following patients into their 20's these days?

Dr__Rimmerman: These specialists are best termed lipidologists and can be found in major medical centers both in pediatric and adult cardiology and endocrinology sections.

EW: What , if any, are risks associated with someone with CHD (no current blockages, all stable now) visiting places with high altitudes such as 12000' above sea level? Does that lack of oxygen challenge the heart muscles in a risky way?

Dr__Rimmerman: Presuming you have had a recent stress test which was normal and you are exercising currently without cardiac symptoms, your journey should be uneventful.


Heart Attack

vikram: I AM AN ASIAN-INDIAN MALE OF 45 .I HAD A HEART ATTACK IN INDIA IN MAY 2003, AND ANGEOPLASTY AND STENTING WAS DONE.MY LVEF CAME DOWN TO 32%.AFTER THIS FIVE YEARS PASSED WITHOUT A SINGLE PROBLEM, THOUGH I WAS TAKING THE RECOMMENDED MEDICINES.IN NOV 2008, I HAD A CARDIAC ARREST WITHOUT ANY WARNING AND WAS LUCKY TO BE REVIVED BY THE AMBULANCE TEAM.IN THIS PROCESS I GOT BRAIN INJURY ALSO.AFTER ONE MONTH I WAS DISCHARGED FROM THE HOSPITAL WITH ICD FITTED TO ME.MY LVEF HAS COME DOWN TO 21%.MY QUERRIES ARE--WHY DID THIS CARDIAC ARREST HAPPEN.-HOW DID THE LVEF GO DOWN FROM 32% TO 21% OVER FIVE YEARS DESPITE TAKING REGULAR MEDICATION.-IS ICD ENOUGH SAFE GUARD FOR THE FUTURE-WHAT DOES LIFE HOLD FOR ME REGARDING THE PROGRESS OF MY HEART CONDITION. WHAT NEW PROBLEMS WILL/CAN COME, ARE THESE AVOIDABLE.-IS STEM CELL TREATMENT RIGHT FOR ME.IF YES HOW TO GO ABOUT IT AT WHAT COST.WHAT HAPPENS TO THE HEART MUSCLES AFTER THEY HAVE BEEN DAMAGED IN HEART ATTACK-HOW IT AFFECTS THE BODY OVER TIME.

Dr__Rimmerman: This is not a complete surprise and could well represent abnormal heart geometry and adverse muscle remodeling after the heart attack. In addition the cardiac arrest could cause further heart damage - the ICD greatly increases your chances of further survival and continuing on your medications is essential. The heart muscle that has been damaged has been converted to heart scar and has resulted in reduced heart output.

Stem cell therapy is a possibility for you and you should investigate. See my.clevelandclinic.org/heart/disorders/heartfailure/stemcells.aspx and http://www.clinicaltrials.gov/ for information and studies.

Derek: I’m diagnosed with Acute anterior wall myocardial infraction, with stent placement three previous times. At this time the Cleveland Clinic is conducting Stem Cell Tests. Are these tests providing any results as of this period in time that, And if so is Stem Cell therapy that would help with regeneration of the Heart Muscle

Dr__Rimmerman: We are conducting stem cell studies at Cleveland Clinic. Dr. Ellis is the primary investigator. Please go to my.clevelandclinic.org/heart/disorders/heartfailure/stemcells.aspx and http://www.clinicaltrials.gov/ for information and studies.

lmgaiso_1: Can sleep deprivation increase the risk of MI?

Dr__Rimmerman: This touches upon the issue of stress and the heart. While these two are definitely connected it is difficult to measure. Longevity is thought to be related to proper sleep, reduced stress, good diet and regular exercise. All of these also benefit the heart.

vikram: WHAT HAPPENS TO THE HEART MUSCLES AFTER THEY HAVE BEEN DAMAGED IN HEART ATTACK-HOW IT AFFECTS THE BODY OVER TIME.

Dr__Rimmerman: A heart attack results in heart scar and reduced heart pumping function. If mild, the impact can be negligible, if the heart pump is severely damaged, less oxygen delivered to your muscles and organs coupled with congestive heart failure can develop.


Closure Devices

marijuani: In 2007 I had a TIA, they discover a FOP and was closed with a cardioseal the same year, do I still have to take large amounts of antibiotics every time I have a dental clean up? do I have to take them for any procedure that will involve bleeding? is my titanium cardioseal sensitive to magnets? Thanks.

Dr__Rimmerman: Antibiotics should continue for the first 6 months of the procedure and thereafter the device should be sealed over. Magnets should not be a problem.

Galjundi: I had an ASD operation on 5 October 2010, can I play now football? can the device move or slide away from the whole it covers? what are the possible reasons which might cause its move? what are the symptoms which result if it moves? Thanks

Dr__Rimmerman: Probably best to avoid contact sports for the first 6 months and as long as the device is felt to be stable in well into place ok to resume thereafter. The device is very unlikely to move and the only reason for it to move would be improper placement in the first place.

Galjundi: Dr do you think any hit on the chest might move the ASD device? for example hit by the ball or by a player, and does that have to last till the end of my life?

Dr__Rimmerman: It is unlikely to dislodge the ASD device but I would recommend not taking a chance for the first 6 months after placement.


Heart Valve Disease

garysoutpost: I have been diagnosed with moderate mitral regurgitation. Mitral valve prolapse. Moderate tricuspid regurgitation. Dilated aortic root (42MM). Diastolic left ventricular dysfunction. Tricuspid valve prolapse. Pulmonary hypertension (45mmHg). Severe bi-atrail enlargement (left more than right). Myxomatous mitral valve disease. Transesophageal ecg recommended. Should I pursue minimally invasive surgery to repair valve? Will the surgery correct atrial fibrillation?

Dr__Rimmerman: Surgery may be indicated depending on your TEE result. Need to document severity of mitral and tricuspid valve leak and confirm pulmonary hypertension before definitively recommending surgery. AFib surgery is highly successful and can be done at the same time.

flrp: I recently had my Mitral valve repaired using da Vinci robotic surgery and am I now more likely to have some other heart anomalies in the near future because of the Mitral valve repair surgery, for example heart arrhythmia's -- premature ventricular complexes --PVCs? Can you give us an update on performing bypass surgery without the need to stop the heart?

Dr__Rimmerman: PVCs and PACs are typically benign. Future heart rhythm abnormalities may occur particularly atrial fibrillation and atrial flutter while not a certainty. If they do occur they can be addressed successfully by most cardiologists.

Off pump surgery is an option for patients with anatomically suitable disease, particularly on the front of the heart. It is technically more challenging but may offer reduced neurological side effects.

wishbone: If Tricuspid valve repair was done once and if second repair can not be done, how risky is replacement of Tricuspid valve?

Dr__Rimmerman: Tough question - it depends on your underlying heart condition and pulmonary (lung ) pressures - this needs to be an in-person discussion.

vanjeda: I am a 24 y/o female, with an anterior MVP with severe regurgitation. I also suffer from anti-phospholipid syndrome and SLE, with a complex medical history that includes a PE and DVT. So far I am not experiencing any major symptoms as a result of the MVP, so my cardiologist says I can wait before doing a possible repair. My question is, how long do patients usually last for before requiring surgery, and is it not better to fix the problem before significant damage is done to the heart? He also said that an open heart surgery would be better as compared to a minimally invasive one. I was wondering how much more risk is there involved for a minimally invasive surgery with my other medical conditions, and if it's still possible to be done? Thank you.

Dr__Rimmerman: It is difficult to say when you will need surgery as it varies from patient to patient. I do recommend every 6 months echo imaging and if you are able combine this with treadmill exercise to obtain a functional assessment of your heart function and to assess your lung pressures.

treasuerhunter2: I have 2 bleeding heart valves, plus copd what about surgery. Mary

Dr__Rimmerman: I assume you mean leaking heart valves and the COPD does not preclude open heart surgery unless very severe.

akatemoore: when do you expect the Percutaneous procedure to be approved for aortic valve replacement

Dr__Rimmerman: We have a prior web chat transcript and video regarding this topic - I would suggest you look at the transcripts. my.clevelandclinic.org/heart/webchat/valve-disease.aspx

wishbone: How rapidly stenosis and regurgitation problem progress to Rheumatic Heart Disease patients?

Dr__Rimmerman: Typically they progress over a period of decades. Later in life, when the valvular heart disease is more severe, the progression is much more rapid.

wishbone: My wife is 61 years old. She suffers from RHD. She had Mitral valve replacement surgery done once. This followed with Redo Mitral, Aortic repair and Tricuspid repair with De Vega ring. Now her Aortic and Tricuspid valves are having Stenosis and Regurgitation. My doctor has advised a third surgery. Currently she does not have symptoms related to Aortic Stenosis and regurgitation. But she has symptoms related to Tricuspid. What is the risk for and against surgery?

Dr__Rimmerman: The risk for surgery is a third time operation, the risk against progressive elevation of lung pressures, irreversible heart muscle weakening and intractable CHF. A highly experienced heart institute is recommended.

CLSTAR: Is surgery on the tricuspid valve more difficult than other valves?

Dr__Rimmerman: In an experienced center, that has not been the case.

mike714: mike-my 90 year old mother has a very narrow aorta valve and is not a candidate for open heart surgery ,are there any other choices?

Dr__Rimmerman: Sure - we offer catheter based solutions for otherwise not surgical candidates.


Symptoms and Diagnostic Tests

davidB: recently had a checkup with health fair from winter park Florida and the EKG says left anterior fascicular block. Abnormal left axis deviation. "Q" what does this mean? Should I see a heart Dr., or is this a normal finding with no serious consequences?

Dr__Rimmerman: As long as you have a normal exercise capacity and no cardiac symptoms this is typically of no concern. Obtaining prior EKGs for comparison if you had them performed may be helpful.

BarbaraK: I am trying to find out information about the results of an echocardiogram. I was told I have a leaky valve. When I got my test results it had numbers for each of the following but no explanation - can you tell me what each is, what is normal and what is the significance? (1) IVSd (2) LVIDd (3) LVIDs (4)LVPWd (5)IVS/LVPW (6) Ao root diam (7)LA dimension

Dr__Rimmerman: The parameters you have provided are actually wall thickness and sizes of heart chambers and structures. Please discuss these details with your physician.

Linebarger: I am a 76 year old white male. First EKG was in 1956 (AF Physical) Resting heart rate 56. All EKG's since have shown 56 as heart rate. I take no medication. Last physical (Jan. 2010) BP was 136/84. On 10/31/2010, I was awakened at 8am with ache across chest. The area was from where the ribs come together in the middle upward about 8 inches and across chest. I would classify pain less than moderately severe. I went to ER. BP was 212/88, heart rate 42, oxygen at 100%. Pain persisted for2 hours. Over that time Heart rate gradually increased to 50, BP dropped to 130/70 and pain stopped. ER Doc said premature atrial causes. Resting heart rate has stayed at 50, BP now runs 153/68. What tests should be done to identify cause of this incident?

Dr__Rimmerman: By the sound of it, this could represent cardiac chest discomfort and a stress test should strongly be considered. If the stress test is normal, consulting with a GI specialist would be your next option.

curious28627: Is it serious to have 2 heart murmurs?

Dr__Rimmerman: Heart murmurs can be normal - So called functional murmur - it should be evaluated and the best test is a cardiac echo

mike714: mike how safe are the catheters? I heard strokes are very common from the procedure

Dr__Rimmerman: In an experienced center, a heart catheterization is a very safe procedure.

lmgaiso: my father's EF estimated by echo is 45%, estimated during a thallium stress test at 43% and a MUGA scan at 73%. Which do you believe?

Dr__Rimmerman: difficult question without having the raw data in front of me. I would trust the echo and the thallium and the MUGA seems way out of line.

CLSTAR: I've heard you can get a heart chat going thru an artery in the wrist. Does the Clinic do it this way?

Dr__Rimmerman: Yes - we do heart catheterizations through the wrist - it is done via the radial artery - in appropriately selected patients.

Mayflower: Is EF = 75% consider normal for my mom who is 66. Is EF the higher the better? She has Afib and moderate heart valve leakage and stroke 1.5 years ago. Can she take 20 hours flight to come to the U.S. for treatment?

Dr__Rimmerman: The higher the EF, typically the better but there are situations where too high EF can impair the output from the heart.

Peppy: I understand their is now a known link between migraine with aura and heart disease?

Dr__Rimmerman: There may be a correlation between coronary artery vasospasm and migraines.


Abnormal Heart Beats: Atrial Fibrillation, skipped beats and more

mlwingert: I am 73 years old and have had Atrial Fibrillation for more than ten years. It is considered as chronic because I am in a-fib 100% of the time. I have been taking atenolol, digoxin, and 325 mg of Rhythmol (twice a day) and nothing has helped to reduced the a-fib at all. I contacted Dr Marc Gillinov at the Cleveland Clinic a year ago and was told I am not a candidate for any surgical intervention. I want very much to get my quality of life back and would like to know if any other drugs are out there that would have a more positive effect on my condition, or if there is something else that can be done.

Dr__Rimmerman: First I would suggest a senior electrophysiology appointment - we can offer that at the Cleveland Clinic. IF you are in permanent afib - the rhythmol is of no benefit and should be stopped under the guidance of your treating physician. Please also discuss the use of coumadin since you are greater than age 65 years. Other medications do exist and could be attempted before surgery is offered.

skopelos: I know a few people who have hd cardioversions. The best result for any of them was a return to normal sinus rhythm for about 18 mos. Subsequent cardioversions for this person were not successful (a week or 2 at most). Is there any chance that a cardioversion will last for several years, say 4 to 5 at least? What is the probability for this? What are the critical factors for success? My afib began near the end of July this year, and I was diagnosed on Aug 20. Catheter ablation appears to be a longer lasting solution (return to normal sinus rhythm) than cardioversion. Should I skip cardioversion, and go straight to ablation? I am 69, and in very good health except for afib. When cardioversion ultimately fails, after hopefully one or two years of normal sinus rhythm, does the passage of time or anything else reduce the chances of a successful catheter ablation? How soon after catheter ablation can a person fly, say from Cleveland to San Francisco?

Dr__Rimmerman: Cardioversion duration success is extremely variable from patient to patient depending on the underlying cause of the afib. and also the duration of the afib Each case must be individualized. If cardioversion is not successful, it will also be successful a second time should certain medications be utilized.

MAL: I was diagnosed with AFib approx 2 years ago. I'm 53 years old, 5'7" and 128 lbs. I've tracked my symptoms and have them once or twice a month lasting anywhere from a few seconds to 45min. What are the guidelines for determining the need for ablation? I'm asking because my symptoms appear at incovenient times (often stress related). Thanks!

Dr__Rimmerman: Either medications or ablation are appropriately applied when your heart arrhythmia interferes with your quality of life. I would investigate further. We have a Center for Atrial Fibrillation at the Cleveland Clinic who can evaluate your symptoms and rhythm history.

skopelos: I was diagnosed with afib on Aug 20, 2010 (it actually began in late July). I have been taking warfarin since late Sep. but have still not been therapeutic for 4 weeks (I hit 3 weeks yesterday), so I have a blood draw every week. I plan to travel to a Greek island in March, and am not certain that I can have blood draws and analysis on the island. I may have to travel 4 hours by boat to the nearest clinic, and 4 hours return home to the island, and this would also entail and overnight stay; so all-in-all, a 24 hour effort for the blood draw. Would I be a candidate for dabigatran (the recently approved blood thinner)? Would percentage of your patients have been switched from warfarin to dabigatran? Thanks.

Dr__Rimmerman: WE have had limited experience with this medication but which we anticipate to grow overtime. Please consider consulting with a vascular medicine or hematology specialist prior to your trip.

clong232: How "normal" are PVC's and PAC's? I have a "normal" heart but I can feel my heart skipping and doing strange things throughout the day (probably around 20 times. I have been cleared by the cardio there is nothing wrong but I hate these skips. He says I am over turned in to them? Does everyone get these every single day like myself?

Dr__Rimmerman: We all have premature heart beats and some patients are more cardiac aware. You probably are one of these patients.

morecurious: Is there any relationship between A-Fib and Reflux?

Dr__Rimmerman: None definitively has been established

anette45: I'm after mvalve replacement and maze procedure my left atrium is 5.4 and I take multaq for persistent atrial fibrillation .I have also a double chamber pacemaker ;it not helps. IF multaq become unsuccessful there isn't another drug(antiarrhytmic)that I can try. I HATE TO THINK about AV NODE ablation as the last choice. Could you recommend something else? Anne.

Dr__Rimmerman: There are other heart rhythm medications. Please discuss this with an electrophysiologist.

morecurious: When I have a reflux attack why do I feel like my heart is in A-Fib?

Dr__Rimmerman: It may or may not be in afib and instead may be racing due to the stress of the reflux on your body.

skopelos: How soon after a catheter ablation procedure is it safe to fly?

Dr__Rimmerman: Typically we discharge our patients within 1 - 2 days of the procedure and many of our patients travel far distances to return home via plane.

Mayflower: My mother had a stroke at 65 and was told due to afib. At that time her heart size was normal. Now 1.5 year later, Echo shows she has enlarged Left Atrium and possibly two other heart. In addition, she has medium heart valve leakages in 3 of her heart. She was very healthy with the exception of High blood pressure. What's the root cause of her problem. afib caused here enlarged heart and valve leakage OR the other way around? what's the cause and effect among them?

Dr__Rimmerman: Not certain - would predict that high blood pressure played a role but clearly after a period of afib, the heart can remodel adversely and enlarge in size, particularly the left atrium.


Medications

Peppy: I understand Plavix can have a rebound effect when discontinued. Is there a way to prevent this? One doc said take it every other day until gone and another told me to double up on my 81mgs. of aspirin. What to do?

Dr__Rimmerman: I am not aware of this rebound effect and typically we recommend stopping it without additional modification to your medications.

EW: Do you recommend baby aspirin and/or statins for twenty-year olds with elevated cholesterol and family history? Are there studies that address long term effects of this (assume it is a lifelong regimen).

Dr__Rimmerman: Aspirin - no. Statins - yes in select instances particularly with familial patterns of hyperlipidemia. I suggest a meticulous diet and a visit to an experienced Preventive cardiology program. Check our website for more information about the program at the Cleveland Clinic.

morecurious: I have heard that a new medication to replace Coumadin is currently being tested. Have you any information on this medication or when we might expect it to be available for patients?

Dr__Rimmerman: While I do not have inside information, I am predicting within the year.


Weightlifting and Heart Disease

lmgaiso_1: What is the likelihood of weightlifting causing aortic dissection? Can weightlifting be done in a manner that is entirely safe for the circulatory system, aortic, valves etc?

Dr__Rimmerman: As a cardiologist, I do not advocate extremely heavy weight lifting – instead, lower weight and higher repetitions appear to be safer. In those patients with a known aortic abnormality heavy weight lifting is dangerous.


Cardiomyopathy

CLSTAR: when you have cardiomyopathy is there anything that can reverse or at least improve this condition?

Dr__Rimmerman: It depends what it is due to. If due to a virus it can often times improve over time. If due to alcohol, can improve with abstinence, please discuss with your physician


Printzmetal Angina (coronary artery spasm)

Gatorfrog: I have microvascular disease and Prinzmetals angina. Currently, it is under control with medication. What causes someone to have this? Are they born with it or do they get it after having a virus? The reason I ask is because I contracted the Epstein Barr Virus and shortly after that, I started having problems and was eventually diagnosed with both of those issues.

Dr__Rimmerman: No one knows for sure the cause of vasospastic angina, which is what you are describing. I do not believe it is linked to your prior illnesses. I am pleased to hear you are feeling better.

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Rimmerman is now over. Thank you again Dr. Rimmerman for taking the time to answer our questions about heart disease.

Dr__Rimmerman: Thank you for having me today.

Reviewed: 12/10


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