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Heart Disease

Our guest experts in February 2010 were Jennifer Price and Dr. Leonard Sternberg from the Women’s Cardiovascular Health Initiative at Women’s College Hospital in Toronto.

Jennifer Price is an advanced practice nurse, cardiology in the Women’s Cardiovascular Health Initiative at Women’s College Hospital in Toronto. She holds an MScN, an acute care nurse practitioner certificate from the University of Toronto, and she is a certified cardiovascular nurse with the Canadian Nurses Association. She is currently a PhD candidate in the faculty of nursing at the University of Toronto and has a doctoral nursing fellowship from the Heart and Stroke Foundation. Her research focus is in the area of women and heart disease and cardiac rehabilitation. She is interested in developing methods of care delivery that improve attendance at cardiac rehabilitation programs, and interventions that improve access to cardiac rehabilitation for women.

Dr. Leonard Sternberg is chief of cardiology at Women’s College Hospital and director of the Women’s Cardiovascular Health Initiative and cardiac rehabilitation program. He was responsible for the development of the Women’s Cardiovascular Health Initiative at Women’s College Hospital in 1996, North America’s first cardiac rehabilitation and prevention program designed specifically to meet the unique needs of women with heart disease. Dr. Sternberg has been heavily involved with cardiovascular health promotion and prevention of heart disease. His research interests cover the spectrum of ischemic heart disease, ranging from prevention to treatment and ambulatory care. He has been instrumental in bringing attention to women’s vulnerability to heart disease in Canada.

Here are their answers on Heart Disease.

Q: How would I know if I have heart disease?

A: Heart disease often has no symptoms. But there are some signs to watch for. Chest or arm pain or discomfort can be a symptom of heart disease and a warning sign of a heart attack. Shortness of breath (feeling like you can't get enough air), dizziness, nausea (feeling sick to your stomach), abnormal heartbeats, or feeling very tired are also signs. Talk with your doctor if you're having any of these symptoms. Tell your doctor that you are concerned about your heart. Your doctor will take a medical history, do a physical exam, and may order tests.


Q: What are the signs of a heart attack?

A: For both women and men, the most common sign of a heart attack is:

  • Pain or discomfort in the centre of the chest. The pain or discomfort can be mild or strong. It can last more than a few minutes, or it can go away and come back.

Other common signs of a heart attack include:

  • pain or discomfort in one or both arms, back, neck, jaw or stomach
  • shortness of breath (feeling like you can't get enough air), which often occurs before or in combination with the chest pain or discomfort
  • nausea (feeling sick to your stomach) or vomiting
  • feeling faint or woozy
  • breaking out in a cold sweat

Women are more likely than men to have these other common signs of a heart attack, particularly shortness of breath, nausea or vomiting, and pain in the back, neck or jaw. Women are also more likely to have less common signs of a heart attack, including:

  • heartburn
  • loss of appetite
  • feeling tired or weak
  • coughing
  • heart flutters

Sometimes the signs of a heart attack happen suddenly, but they can also develop slowly, over hours, days and even weeks before a heart attack occurs.

The more heart attack signs that you have, the more likely it is that you are having a heart attack. Also, if you've already had a heart attack, your symptoms may not be the same for another one. Even if you're not sure you're having a heart attack, you should still have it checked out.

If you think you, or someone else, may be having a heart attack, wait no more than a few minutes – five at most – before calling 911.


Q: Where do women who do not live near Toronto go to get all the benefits such as those offered at the Women’s Cardiovascular Health Initiative at Women’s College Hospital? Also, where can I get access to information from recent studies on what to do to improve heart health?

A: There are many excellent cardiac rehabilitation programs throughout Ontario. The Cardiac Health Foundation can help you locate a cardiac rehabilitation program close to you. 


Q: Are there any natural remedies for treating aortic stenosis?

A: Aortic valve stenosis – or aortic stenosis – occurs when the heart's aortic valve narrows. This narrowing prevents the valve from opening fully, which obstructs blood flow from your heart into your aorta and onward to the rest of your body.

When the aortic valve is obstructed, your heart needs to work harder to pump blood to your body. Eventually, this extra work weakens your heart and limits the amount of blood it can pump, leading to symptoms, such as fatigue and dizziness.

If you have severe aortic valve stenosis, you'll usually need surgery to replace the valve. Left untreated, aortic valve stenosis can lead to serious heart problems. To the best of our knowledge there is no natural remedy or cure for aortic stenosis.


Q: What is the difference between a cardiologist and a vascular surgeon?

A: The cardiologist looks after your heart, diagnosing disorders and diseases of the heart. Some cardiologists do angiograms (a diagnostic test looking at the coronary arteries) or angioplasties (an intervention to open up blocked coronary arteries). A vascular surgeon performs surgery on many different arteries and veins in the body – but not the coronary arteries. A cardiovascular surgeon operates on the heart and coronary arteries.


Q: I went for a pre-admission physical prior to shoulder surgery. My family doctor heard something unusual in my neck veins. I am female, 49, and do not have high blood pressure, high cholesterol or diabetes. I am five pounds overweight, physically active, with no family history of heart disease. I am scheduled for a Doppler later this month. I have been getting a tight feeling on the right side of my chest. I went for a stress test one year ago and it showed that I was very healthy. They put it off to something I may have done at the gym. What should I be asking my general practitioner?

A: Your family physician may be doing carotid Doppler studies to determine if there is any blockage in your carotid arteries. Be sure to ask your doctor what the results of the studies are and if you need to do anything else. Ask your doctor if you are healthy and ready for the shoulder surgery.


Q: I am a 63-year-old woman who takes medicine for high blood pressure and high cholesterol. Recently I had cardiac testing which included an echocardiogram and stress test. I was told that I had 'age-related' issues but otherwise my heart is a keeper. Unfortunately I forgot to ask what they meant by 'age-related' issues. Could you explain what it means? 

A: Unfortunately we cannot guess at what your physician meant. We do know that age is a risk factor for heart disease – the older we get, the more likely we are to develop heart disease and high blood pressure.


Q: What is the recurrence rate for atrial fibrillation that had been cardioversed and is in sinus rhythm? (Editor’s note: Cardioversion is a brief procedure where an electrical shock is delivered to the heart to convert an abnormal heart rhythm back to a normal rhythm.)

A: Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body and symptoms of heart palpitations, shortness of breath and weakness.

The recurrence rate can be 10 – 90 per cent depending on whether this is the first episode of atrial fibrillation or you have chronic atrial fibrillation. This will also depend on the use of medication to control atrial fibrillation, and on the underlying cause of the atrial fibrillation.


Q: Should people with a family history of heart disease take anti-cholesterol medications if their cholesterol and lipid blood levels are within the normal range?

A: Everyone is an individual and as such is treated differently. Your doctor looks at your risk factors for cardiac disease and what your cholesterol levels are now when determining whether or not to suggest taking a blood cholesterol-lowering agent. If your cholesterol levels are within normal range and family history is your only risk factor, taking cholesterol-lowering medication is not recommended. However, you should control your weight, follow Canada’s Food Guide and exercise routinely to maintain a healthy life.


Q: I have rheumatoid arthritis but I find that even though I am 62 my doctors don't mention preventive strategies for heart health as there is so much else to discuss at an appointment. Do you think low-dose Aspirin is effective for women? I have read that it is more effective for men. If I am taking NSAIDs (nonsteroidal anti-inflammatory drugs) already, would adding aspirin make sense?

A: Whether you need daily Aspirin therapy depends on your risk of heart disease and stroke. Risk factors for a heart attack or stroke include:

  • smoking tobacco
  • high blood pressure — a systolic pressure of 140 millimeters of mercury (mm Hg) or higher, or a diastolic pressure of 90 mm Hg or higher
  • total cholesterol level of 240 mg/dL (6.22 mmol/L) or higher
  • low-density lipoprotein (‘bad’) cholesterol level of 130 mg/dL (3.68 mmol/L) or higher
  • lack of exercise
  • diabetes
  • stress
  • having more than two alcoholic drinks per day for men, one drink per day for women
  • family history of stroke or heart attack

If you've had a heart attack or stroke, chances are your doctor has talked to you about taking Aspirin to prevent a second occurrence.

If you have strong risk factors, but have not had a heart attack or stroke, you may also benefit from taking an Aspirin every day. First, you'll want to discuss with your doctor whether you have any conditions that make taking Aspirin dangerous for you.

Some conditions that may prevent you from starting daily Aspirin therapy include:

  • a bleeding or clotting disorder (bleeding easily)
  • asthma
  • stomach ulcers
  • heart failure

It's also important to tell your doctor what other medications or supplements you might be taking, even if it's just ibuprofen. Taking Aspirin and ibuprofen together reduces the beneficial effects of the Aspirin. Taking Aspirin with other anticoagulants, such as warfarin (Coumadin), could greatly increase your chance of bleeding. There is a higher rate of peptic ulcer bleeding if you take NSAIDS and Aspirin together – which we do not recommend.


Q: Why do men and women present with different symptoms when they are having a heart attack?

A: We are not sure why men and women present with different symptoms of heart attack. Differences may be related to physiologic determinants such as hormones, or gendered perceptions of pain. 


Q: I’ve heard that all older people should take statins. I’m 70 and don’t have high cholesterol but I do take four different pills for high blood pressure. I’ve heard some doctors recommend that everyone should take statins to lower their cholesterol, but I don’t want to take any more pills and I worry about yet more side effects. What is your opinion? Is niacin an alternative or is it also a statin?

A: Everyone is an individual and as such is treated differently. Your doctor looks at your risk factors for cardiac disease and what your cholesterol levels are now when determining whether or not to suggest taking a blood cholesterol-lowering agent. Both niacin and statins lower blood cholesterol, but they work through different mechanisms.  Both have side-effects requiring ongoing monitoring of individuals taking these medications.


Q: I am in my late 60s. Everyone on my father’s side of the family had heart attacks and angina starting in their early 60s. I was assessed as being at high risk for heart disease, but after losing weight and increasing exercise, I am now considered at low risk. Still, I feel like a walking time bomb. Are there tests I should be getting to anticipate a heart attack or do I just have to wait until it happens?

A: The best thing to do is speak with your family physician. In consultation with you, he or she can assess your coronary risk factors and talk to you about any symptoms you may be having. At your age you should be having your waist circumference, blood pressure, blood sugar and cholesterol monitored yearly. Depending on the results of this assessment, further testing such as an exercise treadmill test or echocardiogram (ultrasound of the heart) may be suggested.

Q: What exactly is a stress test? Does it involve use of drugs? Who is in the room? How long does it take?

A: A stress test, also called an exercise test, helps your doctor find out how well your heart handles work. As your body works harder during exercise, so does your heart. The test can show if the blood supply to the heart muscle is reduced. The test also helps us know what type and how much exercise you should be doing.

Typically a stress test is done by having the person walk on a treadmill while monitoring their heart rate and rhythm and their blood pressure.  The test is usually supervised by a doctor who is assisted by a technician. The test itself takes about 10 to 15 minutes, but it also takes about 10 minutes to attach the heart monitor and check the blood pressure prior to the test – so count on 30 minutes in total.

Some types of stress tests may involve the use of a medication, but this would occur if you were unable to exercise. We would use the medication to provide the ‘stress’ to the heart instead of having you walk on a treadmill. A doctor would be present to give the medication.  This type of test may take longer. 

There is also a nuclear test or stress echo which may provide more information. A stress echo would take over an hour total, and a nuclear test is done in two stages and can take up to half a day total.


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