Benico Barzilai, MD
Benico Barzilai, MD

Mouin Abdallah, MD
Mouin Abdallah, MD

Wednesday, February 20, 2017 | Noon


Cleveland Clinic is recognized as the world leader in the 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. Benico Barzilai, MD and Mouin Abdallah, MD answer your questions about cardiovascular disease.

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retired RN: Hello, What can I do to lessen a constant pounding heartbeat? At times very strong and feels like heart is going to jump out of my chest. Feels like my heart is in fight or flight mode all the time. Worse when lying down on left side. No sob. I am female, 65, retired (no anxiety), take sular, Lisinopril, metoprolol, synthroid, Lipitor. Avoid caffeine. Take magnesium citrate and coQ 10. All labs and EKG normal. Echo showed mild aortic insufficiency. My internist thinks that I am just very sensitive to my heart beating. First noticed 10 years ago. Is it possible my body making too much adrenaline? Thank you!!

Mouin Abdallah, MD: It is known that we are more attuned to our body in calm settings and recognize normal body function like breathing and heartbeat. However it is possible that you might be having an arrhythmia or inappropriate secretion of adrenaline (or like substances). So it important to speak with your cardiologist about doing a heart and BP monitor during those episodes. If indicated you might testing of 24 hour secretion of adrenaline.

cleclifan: A couple years ago, when tachycardia found with heart monitor during sleep, PFO found. Lost insurance and couldn't afford to follow up. Now pain/heavy pressure on chest is constant, occasional stabbing pain, extreme pressure on heart when get up in middle of the night (also constant night sweats - not flashes but long-lasting drench hair and clothes sweats) and I think I had a couple minor heart attacks (pain, sweating for no reason, shortness of breath, anxiety). I chew aspirin when in bad shape. Is the big one coming? And if can't afford all the tests, anything I can do to avoid the big one? The constant elephant on chest thing is bad. Thin 59-year-old female. Uncle died of heart attack at 49. Thanks.

Mouin Abdallah, MD: I think it is best if you counsel with cardiologist to evaluate your symptoms. Not every sensation of elephant on chest means a heart attack and only extensive evaluation would determine if the sensation if heart attack related or not. Check with your primary care doctors to see if you need evaluation but other specialists like gastrointestinal and motility experts to determine if your symptoms are caused by other non-cardiac etiologies.

Doglover70: I had R shoulder surgery on 06/24/16. On 11/11/16, I began Medrol Dose 4mg for 6 days. On 11/12, severe side effects started like elevated BP, tachycardia etc. On 11/14 Ortho told me to discontinue and all symptoms should cease in few days. Almost all did except tachycardia. EKG normal rhythm but resting HR 100-120 every day. Diagnosed with HBP early 2016 and was taking 40mg Lisinopril; started on 01/18/17 Metoprolol Succ ER 25mg. Now BP is not well controlled and only slight improvement in HR. On various meds for other conditions, most long term with no side effects prior. Never had tachycardia before. PCP and I have tried to rule out any of meds I was already taking but none seem to be the cause. Is it possible to literally develop tachycardia overnight for unknown reason? Could the Medrol have interacted with meds already taking and started a bizarre physiological change in me? Slightest activity causes HR to go up to upper 140s and SOB, etc. Have appointment with cardiologist 02/22. I'm 46 Female.

Mouin Abdallah, MD: It is not normal to have a heart rate in the 120’s and up to 140’s with minimal exertion. I agree that you should be evaluated by a cardiologist to see what’s going on and how to treat it.

jetmango: Here is my diagnosis from previous year echo: LV systolic function appears good, normal LV chamber size and wall thickness, EF visually assessed approximately >55%, normal LA, RA and RV. Ao. Valve appears structurally normal, there's mild eccentric jet of AI, AMVL appears thickened and to bow. There is mild MR, there is mild TR. IVC is WNL. Small anterior fat pad/pericardial effusion. Pericardial effusion at 0.9cm. ...I tend to feel stabbing/burning fixed moderate pain in my chest after mild weightlifting or more strenuous cycling. I cycle from last 1,5 year, 20km daily to and from work 5 days per week. This wasn't happening before, at least not as severely. I stopped cycling during winter, tried it yesterday and the pain came back. It usually lasts for 2-3 days and then ceases. Could this point towards pericarditis or the pain can be related to the valve issues and I should ignore it?

Benico Barzilai, MD: You should not ignore it. I think you need further evaluation with tests such as stress echo and possibly an MRI to better define the pericardial process.

Martine: Hello. I had a heart operation since 5/12/2014 now am experiencing chest wall pain. I would like to know if it's normal please. Thanks:Marie

Mouin Abdallah, MD: First of all, you need to make sure it's not due to blockage of your coronaries. If you do not have symptoms after the surgery, then it is less likely to be surgery related since it developed further down the road, more than two years since the surgery. However, any chest pain needs to be investigated.

jetmango: However, I am concerned about what is happening after I exercise. The pain is not extremely strong, but it is annoying for sure and it worries me a lot. GP doctors here told me I can exercise as much as I want but I am still waiting for cardiologist opinion. I don't believe this is the case. Can you help shed some light on my symptoms? I really love cycling and exercising. I hope my question isn’t too long, I really need your help.

Benico Barzilai, MD: As we mentioned before, you require more testing to evaluate your symptoms. Since your symptoms seem to occur with or immediately after exercise a stress test would be very helpful to find the cause of your chest pain.

Blood Pressure

searching?: I am having trouble with my blood pressure being higher than 120/80 since the fall. I take 320mg of Diovan in the morning with a Seregan (heart calming herbs) then I take 20 mg of Bystolic 12 hours later in the evening with a Seregan. I also take magnesium and omegas for my heart plus COQ10. Despite my efforts, I still wake up with high blood pressure in the morning like 157/87/67 no matter what I take. From my readings during the day, I think, the Diovan is no longer working for me. The Bystolic in the evening seems to be working in bringing my blood pressure down. Also very curious is when I sit and rest, my heart rate does not go down but up? Then when I get active my heart rate goes down? Doesn't this seem counter intuitive? What is wrong with my heart or blood pressure that it goes up when resting but goes down when I am active? I have put on about five pounds. My top number seems to be high during the day while my resting rate and pulse are ok numbers.

Mouin Abdallah, MD: Many things cause BP control to worsen over time. Untreated sleep apnea is one, weight gain is another reason, or it could be that due to aging your body needs more BP medications. I would not conclude that Diovan is not working any more, but would say that you might need more BP medications. Also caution when using herbs; it is impossible to know what is actually inside supplement pills irrespective of what the bottle label might say.

searching?: I am 67. My blood pressure goes up when I sit or relax? I have been having this trouble for years now. When I exercise, it will then come down after exercise? I can't live on a treadmill? None of my doctors have an explanation? Another question, I had a hysterectomy in 30s as ovary burst. I have been on hormones since then. I tried dropping them for a menopause in 50s-60s but totally felt awful so resumed them. Could the estrogen and hormone pellets that I have been having injected for a year that are making me feel great, be causing a rise in blood pressure without headache or blurred vision or chest pain? What do I do about this? Who should I see for hormone replacement therapy at Cleveland Clinic?

Mouin Abdallah, MD: It depends on how high your blood pressure. A 24 hour ambulatory BP monitor might be needed to determine how to manage your blood pressure. A specialized nephrologist is recommended in your case.

sinaihospital: I have hypertensive heart disease, hypertension, Type 2 diabetes, and heart valve disease. Can this raise a risk of a heart attack for me at my age doctors? Yes or no? How often must I have an stress echo, a stress test, an EKG and blood tests from my cardiologist? My appt. with him is next month. Thank you doctors.

Mouin Abdallah, MD: Hypertension and diabetes are major risk factors for heart attacks in addition to high cholesterol which is common among patients with diabetes. That's why optimal control of diabetes, blood pressure, cholesterol, and abstinence from smoking in addition to losing weight and good sleep habits are important for you. It is not recommended to proceed with a stress test if you are not having symptoms of heart problems.

Sleep Apnea

earl359: What percentage of obese patients do you believe, that come to Cleveland Clinic that are heart patients, may have undiagnosed obstructive sleep apnea and don't know it? Do you think there needs to be more done by cardiologists to help identify this condition during routine stress tests? I myself have severe sleep apnea and was only diagnosed as of recently only because my anesthesiologist during hernia surgery told me saying I was struggling attempting to breathe while during the op. I always wondered why I woke up with a soaked t-shirt and a sore throat from snoring for so many years and now know why. Since then after being diagnosed, I did the same with my parents and observed them during their sleep and found the same, they too have severe sleep apnea. My mom during her sleep test was told her oxygen was very low on the dangerous side. She would have never had the test done if it were not for me going with her to the doctor and sort of like begging the doctor to test her.

Mouin Abdallah, MD: I totally agree with you, and if you read my answers today to the other questions, you will see that I do recommend frequently being tested for sleep apnea. Its great news that you facilitated diagnosing and treating your parents.

Trykkergirl: I wrote earlier, (71-year-old female) and do have sleep apnea (treated by CPAP since age 53), am dieting, eat healthy, just too much. Watching simple carbs. Normal cholesterol, 167 nothing above average, glucose is 85 (blood work and Echo last month), been losing weight, was 250 now 230 in four months. Forgot to mention, two mild mitral insufficiency and aortic regurgitation, moderate left atrial enlargement, EF 60-65%. Trivial tricuspid regurgitation and pulmonic insufficiency. I know I need to lose another 50 lbs., trying. You still think with more weight loss given this additional info, blood pressure will not spike as much? Seems to do it when resting late afternoon.

Benico Barzilai, MD: Yes. I believe weight loss would help with your spiking blood pressure. It also would be helpful if you control your salt intake, exercise may also improve your blood pressure.

Heart and Vascular Risk Factors

SnakeOil: I recently did a Calcium test, score of 77. Can one improve (reduce calcium deposits with diet, exercise, and/or meds)?

Mouin Abdallah, MD: There is no way to improve calcium score, however a healthy lifestyle such as healthy diet, exercise and modification of risk factors can help reduce the rate of progression of calcification of the coronary arteries and reduce the risk of long-term adverse events. It depends on the age when your calcium score is 77. For example a calcium score of 77 at a young age is much worse than a calcium score of 77 at an older age of 80 for example.

ccheartafib: So much has been discussed about using statins to lower cholesterol to “prevent” coronary heart disease. The literature is also saying that it’s not the risk cholesterol poses but more the plaque buildup causing high blood pressure which can lead to strokes. I am a male Caucasian, age 74 (with Afib and taking Atenolol and Eliquis), and for years and years I’ve seen one doctor after another with some prescribing a statin and another saying I don’t need it. The AHA “Heart Risk Calculator” (in my opinion) is bias and can only deliver a recommendation of a statin to the older population. I have a hard time assessing the risks so I ignore all of it with exception of eating a healthy diet and exercise. What is your take as it applies to the older population? Thanks. Joe

Benico Barzilai, MD: In general based on your risk factors including age, I would probably recommend a statin. However, without knowing your exact lipid panel it is hard to give a definite recommendation. More and more data suggests that treatment with a statin in this age group is very beneficial.

madrecura: Should you take COQ-10 if you are taking 40mg of Atorvastatin daily? If so how much and when should they be taken? Thank You. Jerry

Mouin Abdallah, MD: CoQ10 is over the counter. I use it with patients who cannot tolerate statins and I think it is helpful in patients who cannot tolerate statins. If you can afford it - it cannot hurt if you take it with atorvastatin 40 mg which is what we call a high intensity statin.

zarbal: I have a slight AFIB, my heart rate is around 62, my latest Cholesterol test result is the following: 1) Is following cholesterol considered normal or in danger zone. LDL 129, HDL 67, Triglyceride 65, HDL ratio 3.1, total Cholesterol 209. What would be your advice? Thank you

Mouin Abdallah, MD: Cholesterol risk is not an ON/OFF switch, but rather a continuous risk with increasing LDL. Also increasing HDL would decrease your risk of having plaque buildup and heart problems or stroke. The risk is not entirely dependent on cholesterol levels but other risk factors affect it. SO you should have a discussion with a preventative cardiologist whether you would benefit from treatment with statin or not (after trying adequate exercise, diet and other lifestyle changes).

lb3214: I am a woman and 64. I live in Tulsa, Oklahoma. My lab result on 11/30/2016 for Lp(a) is 94 and Apolipoprotein B is 165. Total Cholesterol 194, LDL 111, HDL 49, Triglycerides 170. I cannot find a doctor in Tulsa that specialize/familiar with reducing Lp(a) and Apolipoprotein B. In Tulsa, you cannot even get Lp(a) and Apolipoprotein B tests done. I requested these tests and the doctor had to send to Cleveland Heart Lab to have these tests done. My cholesterol test on 9/1 were all normal, no Lp(a) and Apolipoprotein B tested. I reduced the pravastatin from 40 mg to 20 mg because I felt my memory is affected. In three months, the lab result all went to abnormal range. My diet is very healthy. What can I do to lower my Lp(a) and Apolipoprotein B? Will exercise alone be able to lower my Lp(a) and Apolipoprotein B? If I have to be back on pravastatin, should I take 40 mg or 20 mg? Thank you.

Mouin Abdallah, MD: We recommend being evaluated by our preventive cardiology colleagues to evaluate your total risk profile and decide treatment.

SnakeOil: Thank you for the previous response. I'm 64 years old with a calcium score of 77 - you mentioned, lifestyle, diet, and exercise and 'modification of risk factors' ... I do exercise vigorously 4-6 days/ week, good diet, low weight, non-smoker .... What are the 'risk factors' that should be modified? And p.s. a very successful ablation two years ago that eliminated somewhat infrequent afib occurrences.

Mouin Abdallah, MD: It looks like you are taking great care of your health. Cholesterol is another risk factor for coronary calcification. Unfortunately some of our risk for calcification and atherosclerosis is genetic and familial that is beyond our control. There is also some data suggesting that extreme exercise is harmful, I would recommend reading James O’Keefe writings or watching some of his videos about the potential harms of extreme exercise. I'm not sure how vigorous your vigorous exercise is and whether it is extreme or not.

earl359: What is Cleveland Clinic’s current opinion on the taking fish oil? I have always read the zone books where Dr. Sears recommends taking fish oil for the prevention of various health problems and have decided to follow his dietary guidelines, and fish oil recommendations. I currently take three fish oils, along with 100mg of coq10, and 1/4 of a baby aspirin all with my lunch time meal. Living in NE Ohio, I also take 5000mg of vitamin D a day because the sun never shines here in the buckeye state seven months out of year, and we are all deficient in vitamin D according to a lot of doctors. What are your thoughts on it as I have always believed that Dr. Barry Sears is a good source of information on how fish oil prevents certain health problems, as it helps to thin the blood some, and works well with about 1/4 of a baby aspirin a day.

Benico Barzilai, MD: The data on the beneficial effects of fish oil is quite confusing. Some studies suggest the benefit of supplementation and others studies have not shown any clear cut benefit. I personally am not recommending it for my patients unless they have high triglycerides. I do not believe there are any side effects from fish oil. However, I do believe in the benefit of eating fish such as salmon and tuna along with a Mediterranean diet. We are strong advocates of the Mediterranean diet at Cleveland Clinic.

sbdavisrn: I have read a statistic that says that a person will usually will die within five years of being diagnosed with heart failure. Is this still true?

Mouin Abdallah, MD: There are different types and severity of heart failure. Most patients do not die within five years of being diagnosed with heart failure. A lot of the risk factors for heart failure are also risk factors for other diseases like diabetes, blood pressure, CAD, kidney problems, and patients might die from those problems also. We have great treatment for patients with heart failure including medications, pace maker, defibrillator if needed, and up to transplant depending on the specific case.

Atrial Fibrillation and Flutter

SunnieG: My husband is 80 years of age diagnosed with AFIB, congestive heart failure and thickening of the heart walls. He has had two partial nephrectomies (left and right). Cancer was found in right kidney only, and appears stable at this time. My questions are:
01) What heart or AFIB medications should be used with impaired kidneys?
02) Are there any new procedures to stop AFIB besides Cardioversion?
03) How many Cardioversions can a patient have safely?

Mouin Abdallah, MD: 01) What heart or AFIB medications should be used with impaired kidneys? Depends on how much residual kidney function he has. Most medications can be used with kidney problems if the dosage is adjusted to the kidney function.
02) Are there any new procedures to stop AFIB besides Cardioversion? Ablation is a good option to treat Afib, also for select patient pacemaker might work.
03) How many Cardioversions can a patient have safely? As much as needed to treat the Afib. if Afib keep recurring then you might need to consider about controlling the heart rate only and not restoring the normal rhythm. If your husband feels much worse during Afib, then ablation should be considered.

kathyw: I would like current information on Atrial Flutter and Atrial Fib. I have recently had an ablation and would like to know if I could have another. I am not overweight, don't smoke - very active, exercise regularly and eat healthy. I have the Atrial F & F that comes occasionally - typically once a month and always associated with having a glass of chardonnay. I would like to confirm that alcohol could be a trigger. There are evenings that I have wine and don't have AFIB. What medication can I take as when the episode starts it lasts 45 minutes and keeps me awake and I lose a lot of sleep I have become an insomniac waiting for an episode to happen when I lay down. Only happens when I recline? Should I sleep sitting up? Thank you for your help. I am so anxious to hear your feed back.

Mouin Abdallah, MD: It appears that you have paroxysmal atrial fibrillation. I recommend you consult with your cardiologist since there are medications that you take every day and prevents Afib/flutter from recurring and there are medications that you take after an episode starts. Only a cardiologist who knows you complete medical history can make those recommendations. Also you can think about ablation as an alternative option for A fib/flutter. Irrespective of what you and your doctor decide, being insomniac and not sleeping well will increase your risk for health problem and you should have your Afib controlled.

Edrose: Dear Surgeon, Is it best to take both Eliquis® and Multaq after a pacemaker implant for Paroxysmal Afib. About two years ago, I had one severe episode of Afib and was hospitalized for several hours and had the implant. It has been 2-1/2 years since the implant with no serious Afib events. Edward

Mouin Abdallah, MD: You should always discuss with your cardiologist the risks and benefits of continued anticoagulation if you have paroxysmal Afib. You should check your recent of stroke based on your risk factors and your bleeding risk and then determine whether you need to continue treatment.

Nama4: 73-year-old male with persistent afib. Have 2-lead pacemaker to control bradycardia. Take 5 mg twice-daily Eliquis, 10 mg daily Ramipril, and 10 mg daily Atorvastatin. BP runs 130-135/70-75. Otherwise healthy. Used to be a powerlifter. Still work out hard 3x week. Have read that top BP number should be 120 or lower for optimum heart health. Please comment.

Mouin Abdallah, MD: I think your BP control is adequate. Though lowering BP to 120 from 130 might decrease the long term risk of having a stroke, it will also increase the risk of falling down and symptomatic hypotension which is especially important in your case since you are on blood thinners.

Trykkergirl: Age 71, female 230lb, 5'5" dieting, exercise daily. No coronary disease, had Normal LV systolic function. EF normal, Normal left ventricular diastolic function though that sometimes is grade 1 diastolic dysfunction. Mild mitral and aortic regurgitation. No stenosis. Moderate left atrial enlargement. Trivial pulmonic insufficiency Paroxysmal Afib. Take Eliquis 5mg, Flecainide 100 twice daily, Lisinopril 20mg AM and Metoprolol Tartrate 25mg nightly. Occasionally BP spikes, get a headache, go into Afib couple times a year, usually doubling Flecainide and Metoprolol takes me out of Afib in two hours. Wednesday night took 10 and an IV at Emer Room of Labetalol to get BP down and eventually into NSR. Do not want ablation, too often doesn’t work. Normally BP is normal, except sometimes diastolic is in high 80's, pulse is low 50's all the time except when go into Afib. Short of breath all the time. Do you know what I could do to keep BP from spiking occasionally? My EP didn't change my meds Thursday.

Mouin Abdallah, MD: The best thing you can do for your heart and fib is to lose as much weight as you can, up to 50 lbs. in your case, and you will be surprised how much of the Afib and BP would improve when you do that. Also consider getting checked for sleep apnea.

fairgo: Hi. I am a long time Afib sufferer and have had three ablations, none successful. After being on Metoprolol 47.5 and Diltiazem 120 I was doing ok, but in the last six months my pulse rate is continually low. I wake to 34 pulse then it seems to be lower than 55 all day long, my blood pressure has also risen over this time so I also take Candesartan 32mg, it still isn't normal. I also have mild pulmonary hypertension. Do any of these indicate a problem or solution as my cardiologist seems stuck as to what he should do next with me. Thank you for your time

Mouin Abdallah, MD: If you had three ablations that were all not successful then you need to think about being evaluated in a dedicated Afib center to discuss options and alternatives, including another ablation by a highly successful cardiologist. Also it appears that you are not taking antiarrhythmic medications, to help keep you in sinus rhythm. Consider an opinion from another electrophysiologist.

bonhag: I have sleep apnea, atrial fibrillation, and kidney disease (GFR of 50). I read the information about the Maze procedure. Should I undertake that procedure? My cardiologist has me on Xarelto and that enough? My cholesterol and blood pressure are controlled with medications. I exercise regularly...but when I exercise I sometime see the pulse rate really skyrocket to rate for my routine is supposed to be I must be having atrial fibrillations, right? So what started as a few episodes of Afib, now appears to be moving to more often, is that the normal progression...getting worse over time? I guess this is three questions: Afib progressing over time? Is Xarelto to protect for stroke enough? And when do you consider the Maze procedure? Thanks. Robert

Mouin Abdallah, MD: There are several options to treat Afib, medications, ablation and MAZE procedure. We rarely recommend having MAZE procedure if the patient is not undergoing heart procedure for another reason. It is normal for the heart rate to go up during exercise and you might need a Holter monitor to determine whether the exercise heart rate of 160 is Afib or not.

captb727: After a successful ablation in 2010 my afib has returned. At this point my afib is intermittent. Should I wait for another ablation? My cardiologist has put me on eliquist.

Mouin Abdallah, MD: The decision to proceed with another ablation is related to how much can your afib be controlled with medications, how much Afib affects your quality of life and how much you can tolerate the medications. Many patients undergo more than one ablation.

marielle49: Hello, I have recently been diagnosed with Afib w/ RVR (two weeks ago) during a routine doctor visit. During the exam, I felt my heart beating fast and asked that it be checked. An EKG confirmed Afib w/ 150 BPM heart rate, so I was sent to the ER. Since then I am also seeing a Cardiologist. I've been researching and my Afib seems to be Paroxysmal, Symptomatic & Adrenergic. I am now taking Xarelto 20mg & Toprol XL 25mg, each once a day. My echo cardio was normal, I am wearing a monitor for a week and will take stress test end of Feb. My blood pressure was running high before this and presently it's all over the place, plus I now get bad headaches almost every day and also have slight dizziness (vertigo was occasional problem before this as well). I hate taking meds (Afib now seems controlled) and I am interested in catheter ablation. I live in NJ but will travel to Cleveland for an appointment. How do I proceed with planning this procedure? Any recommendations? Thanks for your help.

Mouin Abdallah, MD: We can facilitate setting an appointment with our EP department who performs ablation procedures.

Marilynmm: Information on the Watchman procedure. Pros and cons! Does being 77 make a difference?

Mouin Abdallah, MD: Watchman procedure is recommended for patients who have increased risk of stroke from Afib and who have problems with anticoagulation or increased risk of bleeding. Though the procedure has been performed in the US for several years, it was approved by the FDA in 2015. Last year, we published our group experience with the procedure which is very successful with minimal complications. Being 77 does not preclude you from the procedure, on the contrary being 77 increase your potential benefit from the procedure since your risk of stroke is increased.

edrose: Is Multaq recommended after a pacemaker implant together with a blood thinner? Ed

Mouin Abdallah, MD: Multaq is recommended to treat afib, irrespective of the pacemaker implementation. It is one of several options available to prevent Afib recurrence.

Trykkergirl: 71-year-old female, 5'5", 230 lbs. See EP regularly, Afib once or twice yearly, borderline diastolic dysfunction (said so then next two Echo's said normal), clear arteries on heart Cath, borderline kidney function, exercise 2 hours daily at nice clip cycling, short of breath (for years), Venus insufficiency 20 years, watch sodium intake. No fast food. Blood pressure spikes from time to time, which leads to headache, which leads to Afib, and fast pulse. Normally I can double metoprolol 25 and Flecainide 100 after first trying to take more Lisinopril (20) to get blood pressure down and Afib won't stay but couple three hours. Last month, I had to go to hospital, BP was 198/127 (normally 115/68 and normally pulse in 50's). Sick sinus syndrome. Take Eliquis 5. What can be done to get BP not to spike like that? Anything?

Benico Barzilai, MD: I assume from your question that you do not have a pacemaker. With a history of SSS, the absence of a pacemaker would limit the dose of the drugs such as high dose beta blocker, certain calcium channel blockers. You MAY be a candidate for drugs such as amlodipine or nifedipine which would not lower your heart rate but would also not control your atrial fibrillation. You need to be further evaluated before making concrete suggestions.

fastguppy: Hi, this is my 2nd time chatting, thanks for taking my question! I'm a 44-year-old active female, normal BMI with exercise and alcohol induced paroxysmal afib. I haven't afibbed since I started my new pill combo (June 2015), 0.125 mg digoxin, and 2x 150mg Rythmol daily. Beta blockers and Ca channel blockers don't allow me to exercise vigorously enough. I'm monitored every 2 months with a 48hr holter. If I happen to have afib, then catheter ablation will be an option, as the meds will have "failed". My Q: Is it safe for me to stay on these meds indefinitely? If I wait too long for ablation, will my heart be too reliant on Rythmol /digoxin? Any other long term health concerns with these meds? Thank you!

Mouin Abdallah, MD: No medication is risk free, however in your case the risk of afib is higher than the risk of medication. We have several options for medical treatment of atrial fibrillation, and you can always discuss with your cardiologist to switch to alternative medications if needed. You will probably need to be on medications to prevent afib recurrence, however i would not label that as being reliant on medications. Afib ablation is always an option, however the success rate is not 100 percent either.

sbdavisrn: I have been taking Digoxin for years - however, the price has now skyrocketed - almost $1.00 per tablet - in my Aetna Medicare PPO program. I tried to stop it once - with my cardiologist's blessing but experienced palpitations that I couldn't tolerate and my heart rate went to the 80-90's. I have A-fib and hypertension (plus pulmonary hypertension) and chronic heart failure and also take Atenolol, Avapro and Imdur. Is there another cardiac med that acts the same as Digoxin that I could substitute?

Mouin Abdallah, MD: Unfortunately there are no alternatives to Digoxin, however I use an app (No marketing intended, I have no gains from this app) called GoodRX for medication shopping and it's shown me prices of ten dollars for a one month supply of Digoxin. I suggest you try it.

lalton1: I have at least a 15 month history of afib with a total of around 30 afib experiences, and five in the last month. Recently have had pauses of greater than three seconds in heartbeats toward the end of an atrial fibrillation after taking 25mg of atenolol. Can I continue to take afib drugs? Recent studies have shown healthy people with afib have low rates of blood clots. Is it necessary to take blood thinners if you are otherwise healthy at 82 years old? Do you recommend ablation rather than drugs for me?

Benico Barzilai, MD: I would strongly recommend that you be evaluated by an electrophysiologist since you have had five episode of afib last month. The electrophysiologist may recommend drugs first and if the drugs do not seem to be doing their job, you may be a candidate for an ablation. Based on your age and probably other risk factors, our risk calculator which we use for estimating stroke (CHADS-VASC) would probably be high enough to recommend anticoagulation.

Heart Valve Disease

l Kavy: Can you discuss pros and cons of tissue vs. mechanical aortic heart valves?

Benico Barzilai, MD: In general, we recommend tissue valves in patients over the age of 65 years. In younger patients the decision for a mechanical vs. tissue valve should be a shared decision between the patient and the surgeon. Some patients are afraid of the need for second operation in 10-15 years so these patients may need a mechanical valve. Other patients are terrified over the use of blood thinners and then the decision for tissue valve may be warranted.

ookingforinfo: 15-year-old diagnosed with trivial aortic regurgitation. Heart and aortic valve structurally normal. No murmur/syndrome/disease, nothing abnormal present. No restrictions and follow-up in two years. Can patient outgrow this problem? Can this be the patient's normal or physiological or pathological or will nothing further will develop? Can be seen in four views on echo. I'm finding this rare in children and if a child has it, it is never an isolated lesion. Is that true? No family history of heart disease/syndrome. Heart structural normal. No bicuspid valve. Patient's doctor thinks the AR may resolve spontaneously. Is that possible? Can this progress from trivial to worse, if heart structure is normal? Do you agree with spontaneous resolve? An athlete, high-level competition, works out with weights. The doctor said no disease is present and doesn't classify this as a disease. How can this happen? Is this rare to have without disease present and the heart is structurally normal.

Mouin Abdallah, MD: Trivial disease, does not signify a major disease of the heart or the valves. Having said that, it is impossible to predict the future and long term monitoring and follow up might be warranted to detect disease progression (if any). It is probable that this might not progress over time. Consultation with an Adult Congenital heart disease specialist is recommended to evaluate whether this regurgitation is natural or pathologic especially if the patient is competitive athlete and lifts weights.

bkvfuller: I am a 61-year-old woman. I have mild COPD and mitral valve insufficiency. I stay tired all the time and feel winded easily. My dr. said that I should not need surgery for a long time. Is there anything I should be more aware of with this?

Mouin Abdallah, MD: I am assuming that you have mild Mitral regurgitation. Usually that does not cause any symptoms and I recommend additional evaluation for why you feel so tired all the time.

Schmidty266: Yes, hello how are you? My question is I have mitral value insufficiency and low BP. I guess its mild right now but my symptoms and the meds I'm on just don't seem to help and all that's being done is I'm being watched but I'm dizzy so much heart seem to race even when laying down outta breathe easy. My doctor is at Cleveland Clinic, Dr Niebauer. I'm wondering if I need another opinion? I know I was told it get worse as I get older.

Mouin Abdallah, MD: Dr Niebauer is a great electrophysiologist and If you think you want another opinion, It is best if you contact his office directly and he will arrange for a referral to another electrophysiologist.

bgard: Had a mini-AVR Aug. 2016 and recovery has been easy. Over the last few weeks have developed minor discomfort in upper back at heart level. It comes and goes lasting no longer than 10 minutes each time. Any ideas?

Benico Barzilai, MD: It is hard to say based on the data you provided. If I was following you, I would probably order an echo if one has not been done recently to look at the valve, the pericardium and to make sure the function of the heart is normal. It may also be worthwhile to do a chest x-ray.

magilla: 1) On page 84 of your site surgical outcome booklet for Heart and Vascular Institute (2015) shows a number of outcomes where the Observed percentage rate exceeds the Expected rate. Of concern is the Morbidity. O rate exceeds E rate by 71.5%. As a casual observer this doesn’t look good. Other outliers are Cardiac Event, Ventilator, surgical site infection, Sepsis, Return to OR and Readmission. In these cases what is being done to reduce the Observed rates? As a perspective patient these outliers concern me in terms of successful outcome.
2) Recently I heard a thoracic surgeon reply to a question on longevity of heart valves. A statement was made that most times the valves outlast the patients. If that statement is true? Why?
3) How of often are transfusions required during one procedure to replace heart valves, repair Aorta, and ablate the pulmonary vein for Afib? How soon before surgery should one bank their blood?

Benico Barzilai, MD: 1) We take our statistics very seriously and are always trying to improve our outcomes for our patients. Cleveland Clinic has been a leader in releasing outcomes to the public and we are always trying to improve based on this data.
2) Most times the valves do outlast the patient particularly when the patients are over 70 years old. However, in patients under the age of 65 the chance of having a need for a second operation in 10 - 15 years is a real one and we do a fairly high number of redo operations here.
3) This question is very dependent on the patient and the exact procedure, however the rate of transfusions for all procedures has dropped dramatically over the last few years.

Coronary Artery Disease

Bille: I am 81 and had a heart attack in 1991, also two stints in 2000 and 2001. I am in excellent health, work out at a gym four days a week. I take 20 mg. of Simvastatin each day. What is the long term outlook for stints and the use of statins....any long term negatives.

Mouin Abdallah, MD: It appears that the medications you are taking in addition to your lifestyle are working for you since you go to the gym and have not had heart trouble since 2001. In your case I would not worry about the long term side effects of statins but focus on the positives that you have had for many years from the medications and the stents. If it was up to me, I would even change your statin to a stronger one and high dose since as we get older our risk of heart problems goes up, consider switching to “high intensity statin treatment”.

engedward: Good day, I am an undergraduate student, and we are developing a device that could determine if the user is in state of heart attack, and if it detects the user needs help it will automatically contact the emergency hotline. So my question is, can we analyze heart rate to determine is in the state of heart attack, what are other data we could analyze to determine heart attack?

Mouin Abdallah, MD: EKG is needed, specifically the ST and T segments of the EKH help us diagnose a heart attack. There are several devices that do this already so you need to consult with a cardiologist before you invest too much time and money into this project.

madrecura: Had CABG in July, left side of chest still a little sore. Is that normal? Thank You. Jerry

Mouin Abdallah, MD: It may be that you feel some discomfort from bypass as long as it is not limiting your daily activity or impairing quality of life. Mild discomfort is expected up to a year after surgery. If it is severe and you are unable to do daily activities, you should discuss with your cardiologist to evaluate why you still hurt so much.

jercleclin: Is there a "normal" time period that by-pass new arteries no longer function properly to distribute blood?

Benico Barzilai, MD: There is no "normal". Some patients go for 20 years without problems where as other patients start developing blocked bypasses within a short period of time after surgery. In general, I start looking for clogged bypasses about 10 years after surgery in the absence of any symptoms, however, if you develop recurrent symptoms then further investigation is warranted.

Manish: Sir, he had again feeling chest discomfort and yesterday CT angio reveals that his LAD - 50% to 60% blocked with stenosis, LCX 35-40%, LM - Normal, RCA - Normal. On September 21, 2016 his open heart surgery had done of LMCA and now it is normal but LAD and LCX are blocked mentioned as above. My question is: Can doctor do again open heart surgery within six months or stenting his required? His Medicines are:

a) Ecosprin 150/20 OD
b) Beta Blockers- 25mg BD
c) Sorbitrate 5mg TDS
d) Nitroglycerin 2.6 BD
e) Lostanten 25mg BD

Benico Barzilai, MD: Yes - it is possible to do stenting and or repeat bypass surgery if necessary. However, you would need a cardiac catheterization to definitively estimate the coronary lesions as CT angiography may not be sufficient in your case.

eatveggies: I'm a 71-year-old female, 5'4" 122 lbs, seven years post "widow maker" MI, when 2 bare metal stents were placed in LAD. After recovery, life-style changes resulted in 35 lb. weight loss, regular exercise, change to a very low-fat diet - no further cardiac events, EKGs, lipid profile and other lab tests have all been very good since then. Three years ago, angiogram showed only 10% blockages in all three coronary arteries (chest pain at the time was due to GERD.) Two years ago, had hemithyroidectomy done at Johns Hopkins due to a benign nodule. A parathyroidectomy was also done when an enlarged parathyroid gland was discovered during surgery. Last year I completed a nine-week Ornish program. The program lab work included an hs-CRP test, which was 0.3 (lowest measurable level). Daily Meds: Crestor 10 mg, Diovan 160 mg., Synthroid 50 mcg., aspirin 81 mg., carvedilol 3.125 mg. My question: why would the beta blocker still be advisable for me? (my cardiologist thinks it is?) THANK YOU!

Mouin Abdallah, MD: You are taking a low dose beta blocker, very low dose. We know that patients who had a heart attack do better over the long term if they take beta blockers. I am not sure why you want to stop it or what you think you will gain or achieve from stopping it.

Stewie: What options are there for an elderly person (75 years) with a chronic total occlusion in one artery? Angioplasty was attempted and unsuccessful. She is on a couple of heart meds already.

Mouin Abdallah, MD: Chronic total occlusion is a specific type of coronary artery disease that needs to be evaluated by doctors who manage this all the time. Opening a CTO is very closely related to the skill and experience of the interventional cardiologist. We have few interventional cardiologists with great success rates in treating CTO’s.

jercleclin: I had a heart attack in April, 2006 at the age of 73 and in Nov, 2006 a triple by-pass at Cleveland Clinic. The back area of my heart had some damage, but in the past 10 years I have felt very good and feel my overall health is also very good. I work out in a gym 3-4 times a week, eat a low fat and organic diet, and do the "right things" I have been told that once part of the heart dies, the remaining healthy heart has to work extra hard to overcome the non-working part, resulting in the heart wearing out prematurely. My ejection fraction the past 10 years has been 61% (normal I'm told). Is my heart wearing out before it's time?

Mouin Abdallah, MD: An ejection fraction of 61% is pretty good and normal. The heart damage that you sustained at the time of the heart attack is not bad enough to reduce your EF. More importantly, congratulation on surviving you heart attack and doing great 11 years after your bypass surgery. I think your heart is doing great and your healthy life style is paying off.

Microvascular Heart Disease

gatorfrog: Hello, I am a 59-year-old woman with Microvascular Disease and also a thickened heart and mitral valve prolapse. I try to eat right and exercise so that I don't end up dying from heart disease. When I have seen the cardiac doctor, they tend to minimize the Microvascular part and I don't understand that. I feel that it is a serious thing since my arteries squeeze shut and therefore no blood flow. I take a calcium channel blocker for it and it works pretty well. My question is, is it not something serious that I should worry about? Or is it? Thank you for any help.

Mouin Abdallah, MD: It is something serious to have microvascular disease and thickened heart. We recommend a healthy life style including weight loss, regular exercise and healthy sleep patterns. Worrying about your disease would not make it better however taking action and living a healthy lifestyle is what makes your life better.

Heart Failure

josephcsom: I was diagnosed with LBBB 30 months ago not knowing at the time I had HF. My ejection rate is in the 30/35% range from that time to now. I am on Lisinopril 40mg & Metoprolol 200mg with no appreciative change in my condition? I have no other problems related to my heart or other organs, no Afib, nor diabetes, no HB etc. I live life normally and although retired, age 73, continue to maintain my home and property etc .I would like to see some improvement in my ejection rate however my Cardiologist seems to be hooked on the above meds. Can you suggest what other meds might improve my condition? I once mentioned Entresto but he did not think it would be of any benefit. He originally suggested an ICD, however I said no as I feel it is completely unnecessary at this time. I'm not trying to play doctor but I know how I feel and want to see some progress, not passive treatment waiting for the other shoe to drop. Your thoughts are be greatly appreciated. Thank you, Joseph

Mouin Abdallah, MD: Mr Joseph, there are additional medications that might help your EF improve. Also in your case you might benefit from cardiac resynchronization therapy, i.e. we implant a pacemaker/defibrillator that improves that heart function. This is important in your case since you have LBBB. I recommend consultation with an EP specialist and CHF specialist.

Diva/Lexi: What are the best things people can do to improve heart failure?

Benico Barzilai, MD: 1) Make sure you are seeing a cardiologist with expertise in congestive heart failure.
2) Take your medicine as directed.
3) A low salt cardiac diet should be followed.
4) Exercise regularly. I recommend participation in a cardiac rehabilitation program if feasible. Patients who undergo cardiac rehab have a much better long term prognosis.

J@CC: Diagnosed in 2001 with HF. EF 30. Determined cardiomyopathy as catheterization normal arteries. EF got lower (28), pacemaker/defib implanted 2006. LVL came out. Surgery (lung deflated/placed directly on heart). A nightmare. PM turned on to shock me as paddles did not work to get my rhythm back. Two years ago LVL issues high impedance on LVL. Do not want the same operation to replace it. My electrophysiologist will attempt to go through veins again with new thinner wires. After surgery into veins what are limitations on exercise? I played tennis a couple of months after first surgery and LVL came out. With second battery getting low what should be the limitations on exercise and what types and how long? Is tennis out? Would swimming be restricted? Does CC recommend dietary/vitamins, herbs supplements for patients with HF (EF 28), thousands of PVCs? No symptoms of HF other than being 70 years old not the stamina/speed in my younger years.

Mouin Abdallah, MD: I think in your case the main focus should be on undergoing the procedure successfully, since it appears that you had complications before. I recommend you have the procedure performed by an experienced EP who has done a lot of this procedure before. You should resume your functional lifestyle afterwards and the limitations on tennis and swimming will be temporary.

Diastolic Dysfunction

duffer50: I have been diagnosed with diastolic distinction and on Lasix for the last six months to help with minor shortness of breath. I also had my mitral valve and tricuspid valve leaks repaired in 2014 and an echo showed a small fistula. In your opinion, if being on Lasix for a long period of time, (several years is possible here) May effect other organs, would surgery be an option?

Mouin Abdallah, MD: Lasix is a safe medication to use long term, as long as kidney function and electrolytes are monitored at least once a year, sometimes more. Surgery is never recommended to treat diastolic dysfunction, however in your case since you heart surgery and two valves repairs (unclear to me if the fistulae was detected before or after surgery) it is recommended to continue to monitor your cardiac situation especially if the fistulae was detected after the surgery and not repaired.

Hypertrophic Cardiomyopathy (HCM)

gd1822: What are survival and complication rates for myectomy (surgical treatment for HCM) at Cleveland Clinic? How do I research the procedure at your site? Thanks

Mouin Abdallah, MD: Our surgeons specialize in certain procedures, and as you can see on our website, we have the most experienced surgeons and the best success rates. We also have a HCM center where you will see a cardiologist and a cardiac surgeon who specializes in HCM diagnosis and treatment and will decide whether you will need surgery or not, and whether you are on the correct medications and also whether you need a defibrillator. We also offer percutaneous therapy for HCM.

gd1822: What does Norpace do, relative to treatment of HCM?

Benico Barzilai, MD: In general it reduces the contractile forces of the heart, which can reduce the obstruction of blood flow.

gd1822: I have been diagnosed with HCM with mitral valve obstruction. I am considering surgery - myectomy? - And would like to know about the risk factors, including any links with renal failure or strokes.

Benico Barzilai, MD: The outcomes are very dependent on the experience of the surgeon and team. In many centers in the United States the surgeon may only do a few myomectomies a year. I would clearly find an experienced center. The outcomes including stroke and renal failure are very dependent on the surgical team. See previous response from Dr. Abdallah.

gd1822: What is percutaneous therapy for HCM?

Benico Barzilai, MD: I assume you mean alcohol septal ablation. This is a technique where alcohol is directly injected into the blood vessel feeding the thickened septum. This is only done by a specialized cardiologist and usually it is reserved for patients who are not surgical candidates (myectomy). In appropriately selected patients it can be quite effective with reduction in the gradient and improvement in symptoms.

xdwl: Hello, doctor, I am a 58-year-old female with HCM, and had myectomy in 2012. My heart function NYHA II. I am on Metoprolol Succinate 71.25mg/day. My recent echo: mild-moderate (1+-2+) MR and (1+-2+) AR. LA ID 4.7 cm; LA Volume 38 ml/M2; LV ID (diastole) 5.4 cm; EF 65%. No LVOT obstruction. It is table, and no much change since the surgery. The only change happened recently is my NT-proBNP. It was maintained stable in past two years between 400-600pg/ml. However, it increased to 780pg/ml in last Nov. and 1080pg/ml in Jan. 2017. I still feel well. I started to drink wine since last Oct. but no other changes. My doctor cannot explain the reason. I would like to get your advice if NT-proBNP increasing can be a concerns? I have medical follow up every six months currently. Should I have more frequent medical review? Thank you very much!

Mouin Abdallah, MD: I think you should continue to monitor the NT-proBNP as you are doing now. A Dobutamine stress echo is needed to evaluate your HCM. If you are not having any symptoms and you're functional status is good, then continue medical management. You also have to monitor your valvular heart disease.

heto7660: I went under an operation (septal Myectomy and mitral valve repair) last September at University of Miami, no Cleveland clinic because insurance issues. After three painful weeks of recovery, I was really happy about the results, however it's being 20 weeks already and I started to feel that something is not right , I'm having shortness of breath and dizziness very frequently when I make the minimal physical effort such walking, climb stairs etc., my heart rate climb to around 140 bpm, I will see my cardiologist on March 1, but I'm concern what is this happening to me, would it be that the valve repair went wrong or another problem might appears? Male 52 years old.

Mouin Abdallah, MD: It is difficult to tell exactly why you feel this way. It is definitely not normal. I think you're on the right track to check with your cardiologist to investigate your symptoms. You might need a stress echo or a cardiac MRI. I think also going to a center with high experience and volume of patients with HCM is important in your case. Best.

gd1822: What are common problems with alcohol ablation for HCM?

Benico Barzilai, MD: You have to make sure a pacemaker is not necessary. Complete heart block sometimes occurs but the risk of this event is low in experienced centers. Like all procedures involving the heart there is a small risk of stroke.

Aorta Disease

ChrisC: A CT scan in 2015 revealed a dilation of the ascending aorta in the range of 1.2-1.4cm. A CT scan one year later in October 2016, revealed that it had not progressed. At what point can I assume that the current condition will remain the same and how far is it from normal for a 65-year-old male?

Benico Barzilai, MD: I assume that the size of the aorta was closer to 4 cm rather than 1.2 or 1.4 cm since a normal aorta is usually about 3 cm. If indeed there has not been progression, you probably don't need another scan for 3 - 5 years. However, I would treat the risk factors such as hypertension to try to retard any progression of the dilatation.

Kavy: I am 52 with bicuspid aneurysm syndrome, with moderate bordering severe stenosis. I was told that it is best to wait until symptoms develop before replacing the aortic valve, in order to delay as long as possible. Do you agree with this? Also, can you tell me at what point is it possible to repair a valve vs. replacing? Thank you.

Benico Barzilai, MD: I assume you mean a bicuspid aortic valve with ascending aortic aneurysm. I follow these patients very closely. In particular, I am interested in the size of the aorta (usually recommend surgery if over 5 cm) and I also monitor the extent of aortic stenosis. If the aortic valve decreases to less than 1 cm2 I start watching the patient even closer to make sure the heart is not decompensating from the aortic valve stenosis. (Serial echoes). It is possible to repair the aortic valve at the time of the replacement of the ascending aorta in specific patients or the anatomy favors this.

tjennings: I am 51-year-old female and have an aortic aneurysm at 4.5 but it has been slow growing for 4 yrs. now. Is it necessary to have surgery to have it removed?

Benico Barzilai, MD: Usually we do not recommend surgery at this size of aorta unless you have a specific connective tissue disease (Loeys-Dietz). It might be prudent to undergo genetic testing but it depends on your family history and other circumstances.

tjennings: I have an aortic aneurysm at 4.6cm, I also have aortic valve stenosis and osteoporosis in lower spine, my OB dr. wants me to take prolia and 50,000 units of vitamin D for 8 weeks. Is this safe for me? I have heard of this much vitamin D making peoples heart race and chest hurt. I am 51-year-old female. Thank you! Tammy

Mouin Abdallah, MD: Any medications prescribed has risks and benefits. You cannot know if your heart will race and your chest will hurt from the vitamin D unless you take it or try it first. The vast majority of patients take this without side effects. I don't think this will affect your aneurysm size or management.

Congenital Heart

mrclifton88: I recently had a stress echo after experiencing palpitations. I was a told aside from a very small PFO everything was normal. Later, my doctor told me to discuss my results with a cardiologist as I have an Aneurysmal Atrial Septum. I am a bit concerned about this as I was not told about this at my echo test, and my appointment with the cardiologist is not for another month. The Dr. requested I see a congenital cardiologist, so I assume he believes I have had this from birth. Is this something to be very concerned about, or can I continue my activities as normal until my appointment? Thanks

Benico Barzilai, MD: Atrial septal aneurysm and patent foramen ovale (PFO) is usually present since birth. It is somewhat controversial what treatment is necessary for the atrial septal aneurysm and PFO if you have never had a neurologic event such as a stroke. I totally agree with seeing a cardiologist experienced in congenital heart disease. Since this has probably been around since birth, I don't think there is any urgency to see a cardiologist unless you are having symptoms.

Connective Tissue Disorders

lightning#: Hello, I've been given the diagnosis of Ehlers-Danlos Syndrome/connective tissue disorder and have been having (not the first time) chest pain and palpitations with shortness of breath and fatigue. Lately I've been increasing the dose of thyroid (Cytomel/T3 from 10 to 30 mcg/dy) and feel the symptoms are related. Taking 25 mcg of Cytomel today. I have seen a cardiologist in the past who said I had no cardiovascular disease. Is it safe to assume these symptoms need no further attention if they don't get worse?

Mouin Abdallah, MD: It is important to consult with a cardiologist with experience in managing patients with connective tissue disorder. If you did not have cardiac manifestations before, does not mean that you will never develop them with time, especially since you are having symptoms.

Broken Heart Syndrome

wsb5245: Could you explain "broken heart syndrome" causes and treatment and even history of this disorder being identified. Any issues to pay specific attention to make sure person has recovered and/or so it does not happen again? Thank you.

Mouin Abdallah, MD: Broken heart syndrome, professionally known as Takotsubo, after a Japanese jar used to catch octopus, is a rare disease, affecting more women than men, that affects people after severe emotional stress. The exact reason why it happens is not totally understood however the theory is that severe adrenergic stress would impact the heart muscles. It results in severe heart failure and shock and sometimes death. If treated appropriately, the heart function in most cases recovers completely within weeks. There is no dedicated treatment for it and therapies are focused on the treatment of heart failure.

Peripheral Artery Disease

dorian32: My question relates to peripheral artery disease. I have deep venous insufficiency in my left and right legs with superficial venous insufficiency in the left leg only. I am not overweight, do not smoke and otherwise have an active healthy lifestyle. Does this condition in and of itself suggest PAD?

Mouin Abdallah, MD: It appears that you venous disease and not arterial disease, which is what doctors call PAD. Venous insufficiency does not predispose to PAD.

Diagnostic Tests

earl359: Is it true that noninvasive CT scans of the heart's vessels are far better at spotting clogged arteries that can trigger a heart attack than the commonly prescribed exercise stress that most patients with chest pain undergo?

Mouin Abdallah, MD: A recent big trial showed that stress testing is equivalent to CT scan in deciding treatment of CAD and also diagnosing it. However, certain patients do much better with a stress test than a CT scan. From a cardiology perspective, most cardiologists prefer the "functional testing" as in a stress test as compared to an "anatomic test“as in a CT scan. We have a lot more evidence supporting stress testing as compared to CT scan.

sinaihospital: I have heart valve disease, hypertensive heart disease; hypertension; and Type 2 Diabetes. Do I need an okay from my cardiologist before having an operation, an endoscopy, a colonoscopy, or any other major tests; Yes Or No? Thank you doctors.

Mouin Abdallah, MD: Whether you need to see a cardiologist for clearance prior to procedures, depends on the type of surgery and also your primary care physician evaluation. Some primary care physicians can perform a thorough cardiovascular evaluation and bypass the need for a cardiologist evaluation.

wmw: Can you have a stress test with a pacemaker.

Mouin Abdallah, MD: Yes it is possible and perform a stress test with pacemaker. We might or might not be able to interpret the EKG part of the stress test however it is preferred if you complete the treadmill portion of the test if you can. We also have medical stress test options and stress nuclear test and stress echo options.


aryanshah: Hello! I want to be a cardiologist what should i do?

Mouin Abdallah, MD: Study hard and work hard and be dedicated to caring for other people hearts. You need to go through medical school (4 years) and internal medicine training (3 years) and then cardiology training (3 years) and additional specialty training (1-2 years).

Reviewed: 03/17

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians.