Ask the Cardiologist (Drs Nissen&Hubbard 9 24 12)
Monday, February 4, 2013 - Noon
Cleveland Clinic is recognized as the world leader in diagnosis and treatment of cardiovascular disease and has been ranked No. 1 in the nation for cardiac care by U.S. News & World Report every year since 1995. Dr. Steven Nissen and Dr. Mark Angel answer your questions about heart disease – from diagnostic testing to treatments.
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jeevan: hello doctor. I have some problem with my chest pain. so I want some suggestion what I have to do. please help me.
Dr__Nissen: If you have chest pain it is very important that you see your doctor as soon as possible. He or she will take a careful medical history and probably run some laboratory tests. Depending on that visit, a variety of other tests may be needed to diagnose your problem.
sinaihospital: I have hypertensive heart disease and also have aortic valve stenosis since 2004. It makes me tired with chest pains. Also I have type 2 diabetes will that give an increased risk of a heart attack? I am 47 years old also I have blood cholesterol & high blood pressure, what I can do to lower my risk factors for it.
Dr__Nissen: It is important for these conditions to be managed by a cardiologist since aortic valve stenosis can worsen over time. If you have type two diabetes, good control of your blood sugar and weight loss can be important in preventing worsening of the diabetes and heart disease.
For your high cholesterol and high blood pressure, medications are often indicated, particularly in patients with diabetes. If you need a physician, we would be happy to see you for a same day appointment in the department of Cardiovascular Medicine at Cleveland Clinic – 216.444.6697.
cz8kxq: What would be the expected symptoms of having a small cardiac vessel blocked, such as on the back of the heart. I have had a nuclear stress test, echocardiogram, numerous EKGs, multiple Holter studies and a heart catheterization that did not explain things and still have some symptoms, such as pressure in my chest and some PVCs. If I have these symptoms during exercise they go away if I continue. Thanks.
Dr__Angel: With a small blockage in one of the cardiac vessels the most likely symptoms you may experience would be exercise or anxiety related chest pressure or discomfort. The fact that these symptoms may improve with exercise suggest that you may not have significant blockage.
neptune: Does an ultrasound of the carotid artery which shows no evidence of plaque indicate that the other vessels in the heart and body are also free or relatively free of plaque?
Dr__Angel: Unfortunately the absence of plaque in the carotid artery does not necessarily mean that the other vessels such as coronary, peripheral or kidneys are free of plaque as well.
bas46: I have heard of surface 12-lead ECGs. What other types of ECGs are there and can an ECG be invasive?
Dr__Nissen: Almost all EKGs are surface EKGs but for specialized purposes we sometimes obtain electrical tracings from inside the heart during procedures performed by electrophysiologists.
KennethH: How can my wife go from a heart check test on October 5, 2010 of saying that she has a normal heart to dying of enlarged heart 18 mos later?
Dr__Angel: Unfortunately - yes.
Gatorfrog5: I have Prinzmetals Angina/Microvascular Disease and am on several medications, Digoxin, Verapamil, Potassium and Lasix. I recently had some blood work done and I had a high CRP reading. It previously was .92 and it rose to 4.95. Should I be concerned that this is an indication of heart trouble? Thank you in advance!
Dr__Angel: The elevated CRP does have some relationship for the potential development of heart problems. But it does not necessarily imply that this will be the case. Unfortunately there is no specific treatment for an elevated CRP but in many cases, we would recommend the use of a statin and baby aspirin. Occasionally, we see a high CRP because of a recent upper respiratory infection so re-checking would be important.
Cardiovascular Disease Treatments
Petermos: If after 35 EECP therapy treatments there has been significant improvement, would you recommend additional treatment and for how long?
Dr__Angel: If there has been a significant symptomatic improvement, I am a strong advocate of EECP treatments.
Petermos: Three years ago after being told I had severe coronary artery disease that was too risky for stenting, I was advised to have quadruple bypass surgery, I could die at any moment, medication was not an option, and there were no other viable options. After due consideration I declined the surgery. Over the past 18 months I have had 225 EECP treatments. There is much less angina. My stamina has improved. Is surgery still considered my best and only option?
Dr__Angel: Obviously, after three years without bypass surgery and the fact that you appear to be doing well with EECP, it would suggest that bypass surgery was not the only option.
However, I would suggest discussions with your physician regarding the location of your blockages and your overall heart muscle function as there are some situations where surgery may still be the best option.
liesel: On 2/2004 I had two bare metal stents back to back in the LAD. In April of 2004 I received intra vascular brachytherapy into the two bare metal stents due to restenosis. In December of 2009 heart cath showed a 50% blockage in one of the bare metal stents. I was told if and when the blockage gets higher, cardiologist would insert a DES inside the blocked bare metal stent. My question: Are there any other procedures you might do for removing the blockage inside a stent: maybe just cleaning it out through balloon angioplasty – or might there be a new procedure out there??? I am rather nervous about putting a DES inside a bare metal stent that previously had radiation therapy. I am also worried about blood clot problems with DES. I am 73 years old and in excellent condition.. Very healthy diet, exercise 5 times a week.
Dr__Angel: Your concern regarding the potential insertion of a DES inside a previously narrowed metal stent after brachytherapy is an appropriate concern. Studies would suggest that placing a DES in this situation would definitely require lifelong anti-platelet therapy with aspirin and Clopidogrel (plavix). One other option should this occur - would be consideration of internal mammary artery coronary artery bypass surgery.
Cardiovascular Disease Prevention
RayMC: What are the latest research developments in slowing/reversing plaque buildup in the coronary and carotid arteries? Is there anything more that can be done other than diet and lifestyle modification to offset genetic predisposition?
Dr__Nissen: Solid information that statins (drugs like lipitor, zocor and crestor) slow and in some cases reverse plaque build up in carotid and coronary arteries. Interestingly, the data on diet and lifestyle modification is not as solid but most people think that the combination of cholesterol lowering drugs and a heart healthy lifestyle is the best approach. We strongly recommend avoiding fad diets like the Esselstyn low fat diet.
gap: I am following a strict vegan diet including no oil except from nuts and avocados. Will statins help me in any way. I have mild high BP.
Dr__Nissen: We do not recommend a no-oil diet. There is not any evidence of a heart benefit. If you have high cholesterol and other risk factors you may benefit from drug treatment. If you have high blood pressure you may benefit from the DASH diet (you can look this up on our website or in more detail at NHLBI ) or from medications.
neptune: My wife has a high cholesterol 250 but on lab test is in the normal range of homocysteine and CRP. Is that strange?
Dr__Nissen: This is not strange at all. You can have high cholesterol with a normal homocysteine and CRP . We no longer check homocysteine in heart disease patients because studies have shown that treatment of high homocysteine shows no benefit.
neptune: As an advocate of the use of statins would the use of Red Yeast Rice be an acceptable substitute for a synthetic statin.
Dr__Nissen: Red yeast rice is dangerous and should not be taken by anyone. It contains a statin but not in controlled amounts and can lead to toxicity. If you have any of this - throw it out.
Petermos: What if any relationship is here between uric acid levels, gout and coronary artery disease?
Dr__Nissen: There is a weak relationship between uric acid levels and coronary artery disease but there is not good evidence that lowering uric acid levels protects against CAD.
gap: Drs. Ornish, Esselstyn, Campbell (China Study) all seem to believe in total avoidance of oil. However, it has been traditional to advocate Olive Oil or even Coconut oil and to suggest it would help heart patients suffering form atherosclerosis. Who is right - what do we know?
Dr__Nissen: We strongly disagree with Dr. Esselstyn - oil is not bad for your health. In fact, doctor Ornish does not agree with eliminating oil from the diet. there is no scientific evidence improves heart health. In fact as you point out, olive oil can be a healthy component of your diet. In general, we strongly advise patients to avoid these types of fad diets. Instead, we recommend the Mediterranean diet which is described in Heart 411.
aramaco: Two Questions: No. 1. After heart attack almost five years ago followed by a triple CABG I have tried several statins and they all start to affect my muscles after a few weeks. Crestor was the worse. I now have various muscle pains, mostly arms that are quite severe at times. Is there any evidence of long term muscle issues from statins and if so, how can they be treated? Question 2: Is there anything on the horizon that will replace statins, hopefully without muscle side effects. I have read about KYNAMRO. However, that doesn't seem to be a general cholesterol reducing agent. Thank you.
Dr__Nissen: First of all your problem of muscle pain with statins is common and can be difficult to treat. I have never heard of KYNAMRO. It is probably a fraudulent treatment. There is a new class of drugs that will be coming to market in the next several years known as PCSK9 inhibitors. We are studying these drugs at Cleveland Clinic. You may be a candidate for one of the trials. Suggest you contact our Prevention Clinic.
clara: Dear Dr. Nissen - I had asked you about symptoms I was having on the last chat. You advised me to seek help. I took your advice, and the next day they put a stent in the left anterior descending artery. I want to thank you for possibly saving my life. That was my 8th stent and none of my stents have failed. The told me I had very aggressive heart disease that was probably due to genes. All my stents are in the major arteries. I seem to be needing stents every year. I am thin, exercise, no blood pressure problems - I am not sure how to stop the progression. Again - thank you!
Dr__Nissen: I am glad that we were able to help you last time. You need the most sophisticated prevention treatment available. I am not certain where you live, but if we can see you at our prevention clinic here, we would be pleased to try to help. After eight stents the most important priority is trying to find a way to prevent further obstructions.
cr: During calcium scoring I learned accidently that I have a 4.5 ascending aortic aneurysm. This knowledge has forced me to consider a regular beta blocker to keep my heart rate in the fifties lowering the chances of growing larger threatening eventually rupture. Unfortunately the metoprolol prescribed, even 12.5mg once a day is causing havoc with my blood sugar metabolism and am trying to find the right time of day and conditions to take it, or even a different beta-blocker? that could be equally therapeutic but less impacting on sugar metabolism.
Dr__Nissen: blood pressure control is an important treatment for an ascending aneurysm. There are other drugs that can be used that may have fewer side effects. Please discuss with your doctor of if you would like we would be pleased to see you here.
Helping: During a recent MRI for my husband’s herniated disc, an aortic aneurysm was discovered. It is 3.6cm in size. This is new to us and we have appreciated the on line information from Cleveland Clinic. I have several concerns: The first is while we are in the “observation” stage are there things that would or could provoke it (like certain exercises, is it ok to continue his exercise routine and weights, are we still ok with sex, certain foods, etc.). Or on the other hand are there things we can do to improve the odds of being able to avoid surgery? My husband is 65 years old, and I look forward to a LONG life in our “golden” years. Any advice you can give us to help reach that goal is very much appreciated.
Dr__Nissen: An aneurysm of 3.6cm is not an immediate cause for concern but should be watched by your doctor annual visit. Exercise and sex will not make this problem worse and we encourage both types of activity. We recommend lower weight, high repetition exercise as opposed to high weight activities such as bench pressing. Most of these aneurysms are due to atherosclerosis so it is important to have cholesterol and BP checked and have both disorders treated if you have them.
asgalian: I am a 51 year old female with aortic dilation and on 50 mg 2x/day of metoprolol and 50 mg losartan. Is there a max heart rate or BP I should not go above during exercise?
Dr__Nissen: You may benefit from genetic testing to determine why you have aortic dilitation. It is relatively uncommon in a young (51 yo) woman. There is no reason to limit heart rate during exercise but it is very important that you be evaluated to determine the cause of aortic dilitation.
asgalian: Does an MRI give a clear enough picture to track an aortic dilation or is exposure to radiation in a CT scan the best option to view any change over time?
Dr__Nissen: You ask a very good question! We do worry about repeated CT scans. In some but not all patients, MRI can give an adequate picture. However, this is best discussed with your doctor.
healthyheart: I have an ascending aorta aneurysm 4.9 and am in A Fib. What is the relationship of these conditions? Thank you.
Dr__Angel: There may not be a specific relationship between the two conditions but both are most likely related to atherosclerotic disease of the blood vessels. This should be evaluated and treated independently.
msjt: I was diagnosed with a small pericardial effusion 3 years ago. It has been followed with repeat Echos and remains unchanged. In your experience is it normal procedure to just watch it and do nothing?
Dr__Angel: This is a fairly normal approach. Repeating echos on a regular basis is a fairly conventional way of managing this condition.
oldblueeyes1: Hope this isn’t a duplicate of a question I asked earlier but really would like to know how far we have come in using stem cell research to provide repairs to a damaged heart. I have congestive heart failure and been advised I need a heart and/or lung transplant.
Dr__Angel: Unfortunately over the last decade stem cell research although presented initially with extreme enthusiasm, to date is still investigation and not available for general use. I suspect that over the next 5 to 10 years we will make significant strides in this area.
Svetlana: My husband was diagnosed with cardiomyopathy 12 years ago, at the age of 39. At the time of diagnosis, his ejection fraction was 27. He was briefly hospitalized, but with medication was able to resume work and other activities. After several years his ejection fraction was 45. Four years ago, he started a regular exercise routine, including cardio and weights. Yet his ejection fraction has decreased to 35. According to his doctor, this is due to age and that he should continue doing the same thing he has been doing for the past 12 years. His medication routine hasn’t changed. Should we be considering a second opinion? Have there been any advances in treating cardiomyopathy during the last 12 years?
Dr__Angel: It seems unlikely that your husband’s heart function has decreased on the basis of age only. I would recommend a second opinion as there may be other medications that are available to improve his overall status. In addition, if his heart function is that low, he may be a candidate for an electrical device such as a defibrillator.
High Blood Pressure
CHERJU: I have high blood pressure that is being controlled with medication and other life style interventions. As I have gotten older I am now having an issue with my potassium being too low. At this point I have not been able to get it within normal range. I am concerned because my mother had a real issue with it and died of congestive heart failure. Do cardiologist address this problem or it there another specialist I need to see. My primary care physician is presently addressing this issue.
Dr__Angel: The low potassium most likely did not cause your mother's heart failure. It is usually a result/side effect of the medications we use for controlling high blood pressure. I am sure that your primary care physician is doing an excellent job, however it would not be unreasonable to get a cardiology opinion regarding your problem.
adourian: Does the study recently reported on in the Journal of American College of Cardiology" regarding the likely role of COP cells in aortic valve calcification offer any near term hope in slowing down aortic stenosis? Should I be having myself tested for osteopenia or be taking some sort of nutritional supplement as a precaution?
Dr__Nissen: The research on circulating osteogenic precursor (COP) cells is very preliminary and there are no immediate therapies directed at this target. We strongly recommend avoiding all nutritional supplements since these are not regulated by the FDA and can occasionally be dangerous.
sinaihospital: I have aortic valve stenosis left ventricular hypertrophy hypertensive heart disease it makes me tired it gives chest pains also I have type 2 diabetes I just a stress echo a stress test also I have high cholesterol and high blood pressure never got the test results back from my cardiologist still having the problems now I must call the cardiologist office to get the test results & if any more tests if are needed for me.
Dr__Angel: I am sorry to hear that you are having problems receiving your results from your physician. Seems as though you may be having significant problems. We would be happy to see you for a second opinion if travel is not difficult from Detroit to Cleveland.
Abnormal Heart Rhythms
rreverte: Hello there, I would like to know how the Pulmonary Vein Ablation procedure can affect the functioning of the heart. Does the capability to contract of the heart muscle is diminished or weakened?
Dr__Nissen: Pulmonary vein ablation does not weaken the ability of the heart muscle to contract in fact in some patients who have fast heart rates from atrial fibrillation, heart function can improve from a pulmonary vein ablation.
Complications: On 10-19-12 I had open heart surgery to repair the mitral valve because all four valves were actually leaking. From the surgery I had a small blood clot in my right eye, which caused some blindness for a few seconds. It is all well now. I also had A-Fib, heart rate very high in 90's & up, fluid in my lungs & had 600cc removed from right lung. The doctor put me on Xarelto & Metoprolol since 10-30-12 when I had to go back into hospital from these complications. Now the doctor is saying I may need to stay on Xarelto for the rest of my life. I am terrified of this medicine, but just as scared of what he said could happen if nor taken. May I have your honest opinion on all of this? I sometimes wish I had not chosen to do the surgery. Thanks in advance, Lavina.
Dr__Angel: Xarelto is a new type of blood thinner. Recent data released by the FDA indicates that it has a similar safety profile to the more conventional blood thinner warfarin (coumadin). The benefit of xarelto although potentially scary, may outweigh the risk of stroke, which can be catastrophic.
neptune: After a heart ablation for atrial fib. are there studies on how long the successful ablation might last? e.g. the pulmonary vessels reconnect and cause atrial fib to return.
Dr__Nissen: There are patients who have a return of atrial fibrillation in the months to years after an ablation - but there are also patients who never have another problem for many years. The procedure is relatively new so very long follow up (more than 10 years) is not available in the scientific literature.
bas46: If you see Brugada pattern type 1 on a 12-lead ECG on someone who is febrile what is the best way - gold standard - to determine if the person actually has Brugada Syndrome?
Dr__Nissen: The diagnosis of brugada syndrome is very complex and beyond the scope of this discussion. If you have concerns you should see a cardiac electrophysiologist who can advise you. We would be happy to see you.
bearly: I have been suffering with symptoms due to AFIB. I was cardioverted with help of Sotalol about 3 weeks ago. I do not feel any better although I am in sinus. I have to talk myself into staying calm during the episodes of shortness of breath and chest heaviness. I thought all of that would go away with the cardioversion. What else can I do?
Dr__Angel: If you are indeed remaining in sinus rhythm, unfortunately your symptoms may not only be related to the presence of atrial fib and other causes should be sought out. I would suggest discussing this with your electrophysiologist.
Marie1: I have tachycardia - told it may be an autonomic dysfunction as blood pressure goes low and heart raises when stand etc. Trying to take salt supplement 1000 mg. daily. after 2 days started with diarrhea. Any suggestions? I am allergic to lots of meds.
Dr__Nissen: It sounds like you have POTS (postural orthostatic tachycardia syndrome) - this is a disorder that requires specialized care. We have a group of physicians in the syncope section here - I recommend you see one of them.
Ruthonline: Is there a relationship between being diagnosed with low thyroid and 6 months later being diagnosed with A-Fib?
Dr__Angel: In general, patients with an over active thyroid may have associated atrial fibrillation. The presence of low thyroid and afib are most likely not related in this case; however there may be other types of heart conditions related to a low thyroid.
woofy: I have had three open heart operations, two bypass and one valve replacement. The valve was done by placing a cow valve on a conduit. But I am still left with a very bad Atrial Fibrillation problem. Is their any thing I can do to help with this problem?
Dr__Angel: The atrial fibrillation may or may not be related to your previous heart operations. Fortunately in this day and age there are many drugs and even potential catheter based interventional procedures which may help with your atrial fibrillation problem. I would suggest discussing this with your physician however we have a very distinguished atrial fibrillation treatment group at Cleveland Clinic who deal with difficult cases and it may be worth getting a second opinion from them.
BEBOPPER: I have been diagnosed with atrial fibrillation. My primary doctor has tried diltiazam to which I responded with chest pains. Next we tried metoprolol and my ankles were swelling. Then we tried lanoxin, it did not give the expected results. I do have high blood pressure under control with medication. I am scheduled to see a cardiologist this week. what may I expect and what questions might I bring to ask? I just read below that my questions probably won't be considered. So much for this "chat". John Deans.
Dr__Nissen: There are alternative approaches to managing your atrial fibrillation that include a procedure to ablate the conduction system of the heart but these are highly specialized procedures generally performed by certain cardiology specialists. It you truly have difficult to manage atrial fib, you may need to see an electrophysiology specialist.
camuetzel: Are there any precautions a patient should take after being diagnosed with the condition of left anterior fascicular block?
acordeon: Hi! I'm 42yo male, recent dx of intermittent but frequent Mobitz type 2 heart block on event monitor. In my 20's was dx w/ wenkebach heart block. Main symptoms now are chronic fatigue, occasional palps, some "funny feelings" in head, like head rushes. None of this seemed especially well correlated to the mobitz episodes during the event monitor. My cardio thinks I'll need a pacemaker eventually, but left it up to me as to now or later. Decided to wait, but now am wondering if I should go ahead. Since I started w/ wenke and progressed, am I more likely to progress at some point to 3rd degree block? If so, is there any reason to wait until I start having worse symptoms or passing out? What if I'm driving when I start having syncope? And can't 3rd degree block sometimes be fatal? Is the only reason to wait if I'm hoping it'll never get that bad? Thanks!
Dr__Angel: The fact that your symptoms do not necessarily correlate with the findings on your holster monitor may suggest another cause as well. However, based on the history you have provided, it does seem likely that at some point you will need a permanent pacemaker. I think your concerns are valid particularly about driving and passing out and I would discuss this with the physician in detail who proposes putting in your pacemaker.
xdwl: Hello, doctor. I am a 55 year old female with Hypertrophic cardiomyopathy (HCM) for 10 years. I received myectomy in later Sep. 2012. I suffered a few paroxysmal of AF (3 short episodes within 5 days) post-operation in ICU (no history of AF before the operation). I took Amiodarone for 3.5 months and developed shortness of breath. The pulmonologist can not confirm whether I got Amiodarone induced pulmonary toxicity. I stopped Amiodarone since the 4th Jan. 2013 and I am not on any antiarrhythmia medication since then. My recent holter: sinus rhythm, average HR 63/min, 5 PVC and 30 PAC in total. intraventricular block, and intermittent AVB (degree I). And my recent echo shows LV outflow tract obstruction eliminated, LA APD 37mm.I would like to know what is the likelihood of AF recurrence in post-surgery AF? Should I continue taking any antiarrhythmia medication for preventing my AF recurrence (post-surgery AF)? If yes, what would be appropriate medication for me? Thanks a lot!
Dr__Nissen: Atrial fibrillation is common after heart surgery. If you have not had any more episodes since Sept 2012, it is likely that you will not have a recurrence in the near future. It sounds like you had a great result from surgery.
Mary606: How far along is the Monoclonal antibody antidote for Pradaxa?
Dr__Nissen: There is no antidote on Pradaxa. However, recent data released by the FDA indicates that this drug is relatively safe.
cr: Beta-blocker Causing Havoc with Glucose Metabolism, Feel Worse.
Dr__Nissen: Beta blockers do slightly worsen blood sugar and can make some patients feel tired. However, if the beta blocker is being administered for the right reasons it can be a very good drug. Suggest discussing with your doctor.
Highpointer42: I had four heart caths in 2012 at the Clinic and started Ranexa 500mg twice a day in Nov. I was also taking 90 mg Isosorbide, but as of last week, down to 30 mgs.. I have struggled with episodic shortness-of-breath since X-mas. Any advice for an active 75 yo -138 lbs. with much CAD ? What chapter in Heart 411 should I focus on?
Dr__Angel: From your provided history, it would appear that you have significant coronary artery disease and the prescribed drugs appear to be appropriate and most likely beneficial. In some cases with persistent symptoms the option of catheter based intervention may be available and if not suggested previously enhanced external counterpuslation may be considered (EECP).
Walla: Sorry, I pushed the return button after greeting you. I sent in a question yesterday but not sure if I sent it to the right place. Will try again here. My question is regarding Multaq and your opinion about its safety and if it should be used long term. Should it be on the market at all with all of the cautionary statements made with its use. What alternative medicine is better in your opinion? Thank you.
Dr__Nissen: If it were my decision, Multaq would be taken off the market. There are alternatives but this would need to be reviewed carefully by our electrophysiologists to choose the right medications.
Mayflower: Hi! What’s your opinion on each of the new anticoagulant drugs (dabigatran, rivaroxaban and apixaban) comparing to warfarin? How do you decide if to switch someone (69 years old) who has been on warfarin for the past 4 years and relatively stable to the new anticoagulant drugs? And which new anticoagulant drug is better? Thanks!
Dr__Nissen: The new anticoagulant drugs are safe and effective. I have been slow to switch patients if they are well maintained on warfarin. Warfarin is a drug that has been around for more than 50 years and we know how to use it. It is very effective. I only switch patients if they have difficulty managing their warfarin. If you are stable on warfarin, you are probably fine to stay on the drug.
asgalian: What are the long term affects of taking both a B-blocker and ARB starting in one's early 50s?
Dr__Angel: Beta blockers have been on the market for close to 50 years and Angiotensin II receptor blockers (ARBs) for the last 20 years and to date we have no evidence of specific long term adverse effects.
healthyheart: please evaluate xarelto.... what is your opinion and experience with this drug? Thank you.
Dr__Nissen: Although expensive, xarelto is an acceptable alternative to warfarin for patients with atrial fibrillation. I have not used this drug because of its relatively short duration of action. In the small number of patients that I have switched from warfarin, I have used dabigatran which works in a similar fashion.
garchinh: I have been diagnosed with a sluggish/enlarged right ventricle. What is the treatment for this? I've been tested for sleep apnea and the sleep study indicated that I did not have sleep apnea. My symptoms include shortness of breath and HBP/erratic pulse which has been controlled with a beta blocker. I had a single bypass in 2009.
Dr__Nissen: Sleep apnea is a common problem that can lead to an enlarged right ventricle. It would be important for you to see a physician with experience in sleep apnea and heart disease. We would be pleased to see you at Cleveland Clinic if you like.
Migraines and Heart Disease
Peppy: There is some reporting in the media about the link between migraine with aura and heart disease. I had a non-stemi in the midst of a three week migraine. I have aura. Started with anesthesia for a dental procedure and just wouldn't stop. I had many meds to try and stop it. What is the connection and how should a patient be treated when they are post menopause and have these pop up aura's with migraine. They used to be linked to my menstrual cycle but now they just pop up unexpected.
Dr__Nissen: There have been reports of a relationship between migraine headaches and coronary artery disease but this relationship is not well defined. Patients with migraine can have unexpected dilation or constriction of blood vessels in the brain and some people think this may occur in the heart as well. In addition some of the meds used to treat migraine may have an effect on the blood vessels of the heart. It is best to consult an expert in these disorders. We would be happy to see you at Cleveland Clinic if you feel it would help.
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