Women’s heart health: your questions answered

Michelle Carlson, MD & Jill Jordan, PA-C, , MMS, RD

Think men and women are just the same?  No, I didn’t think so.  But when it comes to heart disease, much of what the medical community talks about is focused on men’s heart health.  So on the Healthy Matters radio broadcast last Sunday, we focused on women’s heart health.

I was joined in the WCCO studios by two women whose careers are focused on caring for hearts.  They are Dr. Michelle Carlson, a cardiologist, and Jill Jordan, a Certified Physician Assistant with clinical practice in Cardiology.  Not only are these two really knowledgeable about cardiology in general, they are particularly tuned into the health of women.  Not only that, they do cool work with cancer and heart disease.   And I can personally vouch that they are approachable providers with a good listening ear and wise advice for their patients.

Three things you can do to learn more:

  • Listen to the podcast of the Women’s Heart Health show by clicking the logo here. It is Healthy Mattes Show #482, April 8, 2018

  • Click Dr. Carlson and Jill Jordan’s pictures here for their bio and contact information, or go to the Heart Center at Hennepin Healthcare to learn more and including info on making appointments.
Michelle Carlson, MD
Jill Jordan, MMS, PA-C, RD

 

 

 

 

 

 

 

  • Read on for brief and informative answers to listener questions that we did not have time for on the radio broadcast.  Heart attack, jaw pain, ischemia, family history, varicose veins, valves, exercise, diet, yoga.  It’s all here!  The responses are directly from Dr. Carlson and Jill Jordan.  Don’t miss the last question (scroll down!) about heart disease and cancer.   Pictures and links, too!

Continue reading “Women’s heart health: your questions answered”

Facebooktwitterredditpinterestlinkedinmail

Surgeon and TV star Dr. DiBardino talks heart valves

Dr. Daniel DiBardino
Dr. Daniel DiBardino

Hello from warm and muggy Minneapolis!  Yup, it’s summer here in the upper Midwest in my hometown.  Hope you’re cool and comfortable where ever you are checking in from.

Today’s topic is loosely about heart surgery and I’ll highlight one of my new surgeon colleagues at HCMC, Dr. Daniel DiBardino.

To get us started I talked a bit about heart valves in the last post which you can check out here.  Since that post I had a fantastic guy on the Healthy Matters radio broadcast:  Dr. Daniel DiBardino is a cardiac surgeon on the staff of Hennepin County Medical Center.  This guy is not only a skilled cardiothoracic surgeon but he’s also a bit of a celebrity.  And as I found, he’s the kind of guy that you warm up to in the first minute that you meet.  That’s Dr. DiBardino in the picture and you can learn more about him here.

My first bit of advice is to listen to the podcast of the Healthy Matters show featuring Dr. “DiBar” – just click my face here:

HM logo newer

I think Daniel is my first radio show guest (in nearly 8 years of broadcasts) that is also a genuine TV star.  You may have heard about the TV series Boston Med which aired on ABC back in 2010.  Boston Med was a real-life documentary series in which camera crews followed the action at a few of the premier hospitals in the United States.  Dr. DiBardino was a surgeon at Brigham and Women’s Hospital in Boston at that time and he featured prominently in the very first episode.  Totally cracks me up that his nickname on the show was “Dr. DiBar” – when you meet him it totally fits that he’d have a catchy nickname.  Here is the entire first episode of Boston Med if you want to check it out:

 

 

What do heart valves do?

In my last post, which you can check out here, I talked about the basic physiology of the heart.  I thought about getting into some more detail here in this post, but as I started to write more about the heart and what can go wrong, I quickly realized why it takes a a dozen years or more to become a cardiac surgeon.  This is a huuuge topic so I abandoned that effort.  Rather, I will simply offer a number of links for you to read more as you wish.  As always, I try to provide links only to reliable sources, the Internet being a pretty tough place to separate the wheat from the chaff, so to speak.

Overview of valve disease

First, for a great and readable overview of heart valve disease, click on this page from National Heart, Lung, and Blood Institute (part of the US Government’s National Institutes of Health – or NIH – which is our country’s major route for funding quality research).

Here’s an echo (ultrasound) picture of the four chambers of the heart – you can even see the valve leaflets of the mitral valve on the right side of this picture (though in reality that is the left side of the heart  . . . medical images are usually looked at backward like this!)

iStock_000063540139_Large

Aortic stenosis

One of the more common valvular diseases is aortic stenosis.  The aortic valve sits between the left ventricle (the big, muscular pumping chamber) and the aorta (the biggest artery in your body and the major conduit for blood to your body).  When the valve gets stenotic (or narrowed), it fails to open all the way. The heart then has to beat harder and harder and harder to get blood out to your body.  This can lead to feelings of dizziness, chest pain, or shortness of breath.  If untreated, it can lead to heart failure.

One in ten people over age 75 will get aortic stenosis.  Yikes!  The treatment is surgery and I’m happy to say surgery really works, as scary as it may sound.  To understand more about aortic stenosis, watch this short video from the Alliance for Aging Research:

 

Aortic insufficiency and mitral insufficiency

Also known as aortic or mitral regurgitation, this is just about the opposite problem of stenosis.  Valvular insufficiency is the situation where the valve fails to close all the way hence it gets leaky.  As we learned elsewhere, a leaky valve means blood goes the wrong way.  For more info, I recommend checking out the information from the American Heart Association here.

Random trivia since I love trivia:  the mitral valve is so named because someone thought the valve looked like a bishop’s mitre (hat).  Never learned that in med school!

Bishop's_mitre,_Bishopsgate,_London

What about the other valves?

Most heart valve problems occur in the aortic and mitral valves which are located in the high-pressure left side of the heart.  There are two other valves on the lower-pressure right side. They are the tricuspid valve (so named for its three leaflets) and the pulmonic valve (which is located between the right ventricle and the pulmonary artery leading to the lungs).

These right-sided valves can also have problems and are sometimes implicated in congenital heart disease (which means problems present at birth) but they are far less likely to need replacement as adult.

Valve surgery

As we talked about with Dr. DiBardino on the radio broadcast, valve surgery can involve replacement either with a mechanical valve made from manufactured materials or a bioprosthetic (aka tissue) valve which uses tissue from animals.  Both are perfectly acceptable options.   A good explanation on these two types is in this video.  I invite you to pay particular attention to the explanation of the differences between these 2 types of valves which starts about one minute into the video.

 

Dr. DiBardino

In my job I encounter all sorts of characters, and I’m just talking about the doctors!  This past week was really fun hanging out with Dr. DiBardino, one of the terrific surgeons at my hospital.  If you need a heart surgeon, you ought to know about this guy who practices at Hennepin County Medical Center.  As always, to reach any doctor any HCMC, call 612-873-6963.  Or check out HCMC.ORG.  And learn more about Dr. DiBardino here.

Thanks for subscribing to MyHealthyMatters.org.  What?  You haven’t subscribed by e-mail?  Do it today right below on this page.  Don’t worry I won’t flood your inbox with too many e-mails and I will never get all commercial and try to sell you stuff.

Bye!

David

 

Facebooktwitterredditpinterestlinkedinmail

Quick tips: ABCs of cholesterol and other meaty topics

Hi from the mailbox!DRH Letterbox

Another great Healthy Matters show this week -thanks to the listeners who are up on a Sunday morning – getting dressed, eating breakfast, going to church, drinking their coffee – and tuning in to listen to me talk about fungus and pus.   So a heartfelt THANK YOU to Healthy Matters listeners and for your terrific questions by text and phone.  

If you have not heard the show yet, you can do so a few ways:

  • Live radio broadcast:  WCCO 8-3-0 AM dial  – Sundays 7:30 a.m. Central
  • Live streaming on your computer/mobile: WCCO.COM  – Sunday 7:30 a.m. Central
  • Podcasts for listening at your convenience – podcasts available here.

The whole shebang is sponsored by my organization, Hennepin County Medical Center (HCMC) in be-yoo-tee-ful downtown Minneapolis.

This week’s post features quick answers to questions I received on the show.  These are quick and incomplete, so make sure to talk to your own doctor to learn more.

I’ll also be doing some video posts where I can answer questions by talking rather than typing . . .  look for those soon.

From the Healthy Matters mailbag

iStock_000022745765_Large

Several questions this week about cholesterol numbers, like this one . . . 

“My doctor recommended coming back in 6 months for repeat of cholesterol numbers and tweaking my lifestyle.  Is there an alternative to statins?”

Short answer:    Dyslipidemia, which basically means your cholesterol is out of whack, is a risk factor for developing cardiovascular problems in the future.  Statins remain the medications with the most scientific evidence to prove that they work.  There are alternatives, but none with such strong proof to back them up.

Longer answer:

  • LDL = low-density lipoprotein.  LDL = bad.  You want this one low.
  • HDL = high-density lipoprotein.  HDL = good.  You want this one high.
  • Triglycerides = fats floating around your blood stream.  You want this low.
  • Total cholesterol = a combination of the above (but you can’t simply add up the 3 of them to get your total cholesterol – it is a more complicated formula).

Your body actually requires cholesterol for life since it is part of cell membranes and an important part of the normal steroid hormones that your body makes.  Most cholesterol is manufactured in your liver, with only a modest amount coming from your diet.

The trouble for many of us is that our cholesterol factories (aka your liver) don’toff switch have an “off” switch.  It simply makes too much.  Think of statin medications as the “off” switch.  Yes, they have side effects (the most common one is muscle problems) and as science progresses, we will undoubtedly learn more about these medications.  But for now, for the right people, if you have cholesterol problems statins are the best way to reduce your risk of heart disease.

Who are the right people for statins?  Here are the latest guidelines (new in 2015):

  • People who do not have known cardiovascular disease and are between 40 and 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.

      This is cool and you should do this –> to find out your 10-year risk of heart disease, click here.

  • People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.  (Basically if you have known cardiovascular disease).
  • People 21 and older who have a very high level of bad cholesterol (190 or higher).
  • People with Type 1 or Type 2 diabetes who are 40 to 75 years old.

There are a LOT of people who could be taking these medications and receiving the benefit of reduced risk of heart disease.  Click here for a nice discussion of the guidelines.

 


Read on for another related question . . . 

“I thought the higher the HDL cholesterol the better.  My HDL was 100, LDL was 128, triglycerides 27.   Doctor expressed concern that sometimes an HDL at either extreme can be a problem . . and ordered a VAP test.”

Here is an analogy that works for me.  Bear with me, I made this up . . . 

Cropped shot of rubbish that's been put out for garbage collection day

Think of LDL and triglycerides as “garbage” floating around your bloodstream and attaching itself to your blood vessel walls, like garbage accumulating on the curb.

 Too much garbage = a mess of badness.

Now think of HDL as the “garbage trucks” driving around, picking up the garbage from the curb (vessel walls), and delivering it back to your liver where it can be processed and removed.  

You want lots of garbage trucks.

So in general, you want an HDL that is high (preferably 50-60 or more).  But can it be too high, as this questions asks?  Well, yes, it is true that HDL that is not working properly is not only ineffective in its garbage truck duties, but may actually be harmful.  However, we really don’t know what to do with that information.

The VAP test is a series of advanced tests that can more accurately pinpoint your cholesterol situation.  As I mentioned on the radio, however, we still don’t know what to do with the information since  getting the test will usually not lead to any change in treatments.  After all, we don’t really have any additional proven treatments.  So you can get the VAP test if your doctor recommends it, but be prepared to hear the same advice when it is back:  eat healthy, exercise, don’t smoke, take a statin if indicated.

And choose your parents carefully.


On to a new topic from the mailbox . . .

iStock_000021022726_Large“Do acid control medications cause Alzheimer’s Disease?”

Short answer.  We don’t know.

Longer answer:  This one has been in the news as of late since a group of German researchers published the results of their study which showed an association between proton-pump inhibitor use (PPI) and the development of dementia.  The study was in people over 75 who did not have dementia at the outset, but who were taking one of the common acid-suppressing agents called PPIs.  Examples (among many others) of these drugs are omeprazole (Prilosec) and lansoprazole (Prevacid).

 The study showed that more people on these medications developed dementia than those not taking them.  Why this may be the case is not known.  But it is really important to note that the association between these medications and dementia is not proof of causation.  In other words, these medical studies do not prove that doing one thing (taking the acid-suppressing medications) actually causes the other thing (getting dementia).   Here’s a link to the actual study if you are super into medical journal articles with subtitles like “A Pharmacoepidemiological Claims Data Analysis” – I’m not joking, that is the actual subtitle of this real page-turner.

Bottom line:  this is not a reason to stop taking your acid-suppressing medications if you have a strong indication to do so (you have proven acid-reflux disease, for instance).   I should add that many people take acid-suppressing medications for shakier reasons and probably don’t need them in the first place.

 


One more for the good measure . . . 

“Paryonychia on thumb. Causes?”

OLYMPUS DIGITAL CAMERA

Paronychia is an inflammation around the finger- or toenails.  It is sometimes chronic (long-lasting) but often acute (comes on quickly and resolves).  It is usually due to a bacteria or fungus getting in the grooves around your nails.  It shows up as a sore, red, and swollen area around the nail.  The acute kind may be due to minor daily-living types of activities (dishwashing, trimming nails, minor trauma . . . ) and may not need any specific treatment other that putting warmth or topical anti-inflammatories on it.

If there is pus oozing out of it, you may need antibiotics or drainage by your doctor.  Chronic paronychia may be due to a fungal or allergic type of dermatitis, and may require topical treatments with anti-inflammatories or anti-fungals.


The rest of the mailbox

To give you a sense of the range of topics on a typical Healthy Matters Open Lines show – I’ll show you a partial and condensed list of the topics listeners raised this week but that I did not get to cover.  I’m struck by the range of questions – and also just how legitimate they all are!  Doing the radio show really makes me aware of the shared human condition – I bet most of us can relate to something on this list . . . !

  1. Febrile seizures in infants.
  2. What is neuropathy?
  3. Clostridium difficile infections.
  4. Atrial fibrillation.
  5. Cold sores in a young adult.
  6. Epilepsy in children.
  7. Ear infections.
  8. Testing for Diabetes type 2.
  9. What is pre-diabetes?
  10. Causes of dry tongue?
  11. Carpal tunnel syndrome.
  12. High calcium in blood tests.

Keep listening, keep checking out the blog . . . and if you have a preference for what I should cover in the future please leave me a comment and I’ll do my best!

 

Facebooktwitterredditpinterestlinkedinmail