Q. "What are the criteria for a woman to have a stress test? Is there a specific age? In the absence of symptoms, when do you recommend screening?"   
Margaret, Morrisville

A. Cardiovascular disease remains the leading cause of death among women. However, symptoms can be somewhat atypical, such as shortness of breath, fatigue and vague chest tightness upon physical exertion. The chances that cardiovascular disease is present is increased if there are additional risk factors for cardiovascular disease, such as diabetes, high blood pressure, high cholesterol, strong family history of heart attacks or stroke and/or a women has gone through menopause. A stress test is one way to screen for the diagnosis of cardiovascular disease. Women are strongly encouraged to discuss their concerns with their primary care physician or with a specialist in cardiovascular diseases.     
Dr. William Hirsch

Q. "I have heard that if your blood pressure is higher in your legs than in your arm, you have heart disease. Is this true of false?"       
Joan, Morrisville

A. Blood pressure is fairly consistent in all arteries. Blood pressure is not the same as the pulse wave you feel in the arteries. The pulse wave is the shock wave sent out from the heart into the elastic arteries of the peripheral circulation. Like a wave on the ocean that gets bigger on its course to the shoreline, a pulse should be higher further away from the heart. Coarctation, or a stricture of the aorta, is suggested by diminished leg pulses, as well as reduced leg blood pressure.   
Dr. Philip Deibert

Q. "Can Atrial Fibrillation be a genetic disorder?"
Barbara, Newtown

A. Atrial Fibrillation refers to an irregular heart rhythm with disruption of normal aortic electrical activity. Although Atrial Fibrillation is not necessarily a genetic problem, it can be caused by some diseases that can be genetic, such as:

• 1) Thyroid disorders;
• 2) Valvular heart disease ;
• 3) Long standing hypertensive disease;
• 4) Coronary artery disease

Dr. Srimivas Atri

Q. "Should a person at 50 whose blood pressure is 141 over 81 go to the doctor?"
Rosemary, Fairless Hills, PA

A. Yes, a blood pressure of 140/80 or greater is now considered unhealthy. A physician evaluation will identify courses for hypertension, as well as evaluate other potential risk factors. Education into treatments, including lifestyle changes can be provided. There is much a person can do to reduce their risk of heart attack or stroke. One of the most important is to increase physical activity, with physician approval, through exercise programs such as those offered at the St. Mary Wellness Center.
Dr. Jonathan Gold

Q. "I have two sisters who have had silent heart attacks and one of them just died. How does a person know if their heart arteries are blocked? How do you find that out, or do you just wait until you have a heart attack?"
Linda, Washington Crossing, PA

A. Your question is excellent because within it are three important questions. The first question is: Can patients have heart attacks without any pain? The answer is ‘yes‘. Some individuals with serious blockages in the coronary arteries, the arteries that feed the heart muscle, never have chest pain. The reason that patients do not get chest pain often relates to either a very high tolerance to pain or conditions such as diabetes, which make an individual’s nerves less sensitive. Studies suggest that as many as 50% of patients with coronary artery disease never had "chest pain" prior to their heart attack. The second question is: Does family history play an important factor in heart attacks? The answer is ‘yes’.The third question is: Should you wait for something to happen? The answer is ‘no‘. First, see your family doctor and express your concerns. Your family doctor will want to determine your risk of heart disease and examine you for major risk factors, including high blood pressure, diabetes, family history, cigarette smoking, cholesterol levels, and obesity. In someone with risk factors as apparently strong as yours, Stress Testing would be the next step. St. Mary has invested a lot of resources in state-of-the-art diagnostic equipment to help us accurately diagnose coronary artery disease so it can be treated quickly and effectively with either medication, coronary angioplasty, or open heart surgery if needed. The first step is yours. Go see your doctor soon.
Dr. Richard T. Leshner

Q. "My husband has always had a slow pulse going back to high school days when it was noted on a physical. He is 53 years old and could not get his heart rate up during a stress test. Could that be a sign of blockage? What could it mean?"  
Mrs. D

A. On the average, a heart beats 60 to 100 times per minute. Some people will have resting heart rates that do not fall within this normal range. Athletes often have slower resting heart rates, due to a conditioning effect on the heart and involuntary nervous system.

A slow heart rate can sometimes indicate heart disease, and may necessitate treatment, if it is associated with a problem with electrical conduction in the heart, or if it is causing symptoms of dizziness, lightheadedness; or loss of consciousness. In these cases, a pacemaker is sometimes placed to trigger a faster heart beat.

In the case of someone who has had a slow heart rate since childhood and is asymptomatic, this is most likely a normal variation, not requiring treatment, although this should be assessed by a physician. An inadequate heart-rate response to exercise can also indicate heart disease, but there are many factors involved, including the amount of exercise achieved on the stress test, fatigue, other disease processes, etc. An inadequate heart rate response to exercise may not be indicative of any heart disease and may not necessitate any further testing, but his should be discussed with the cardiologist who performed the test.
Dr. Richard Kass

Q. "I want to find out about a test. It’s a 2DMY echocardiogram that my doctor ordered. I have some questions."
Marina, Bensalem

A. A 2-D echo is a simple noninvasive ultrasound test of the heart performed with a hand-held device pressed against the patient’s chest and back. It aids the heart specialist in evaluating the structures of the heart. An echo is useful in evaluating heart weakness or heart failure, coronary artery disease and heart-valve abnormalities.
Dr. Richard Hyman

Q. "In college, my husband was diagnosed with a heart murmur and advised to cut down on caffeine. He didn’t ask any questions at the time, and there is heart disease in his family. He tries to keep his caffeine level low, works out frequently, and keeps his weight at a healthy level. Is there anything else he should be doing to protect himself, and how serious is a heart murmur?"
Michele, Yardley

A. Although keeping caffeine intake to a modest level is in general a good idea, as caffeine can trigger certain heart-rhythm abnormalities, I am not aware of a specific interaction between caffeine and heart murmurs in general.

Heart murmurs can range from being completely benign to very serious. A complete cardiac exam by a qualified internist or cardiologist should be periodically performed to assess this murmur.

If the examination is more suspicious concerning the type of heart murmur, a noninvasive test called an echocardiogram should be performed.
Dr. Charles Paraboschi

Q. "I have read reports that aspirin is just as effective as Coumadin as a blood thinner, with less side effects. If that is so, why can’t people just be put on aspirin?"
Margaret, Levittown, PA

A. Both Coumadin and aspirin are blood thinners but they work in different ways. Aspirin is referred to as an antiplatelet agent. Platelets are one part of the body’s protective mechanism to help you stop bleeding if you get a cut. They however are also components of the clot that can form during a heart attack or stroke. Aspirin makes platelets less likely to clot and therefore you are less likely to have a heart attach or stroke. Coumadin works in a different way to make your blood thinner. Its most common use is to prevent stoke associated with an abnormal heart rhythm called Atrial Fibrillation. A large study was done comparing aspirin vs. Coumadin in patients with Atrial Fibrillation, and Coumadin was found to be much more effective with this particular problem. Both aspirin and Coumadin may have side effects of bleeding problems but are reasonably safe when used with caution. They are not interchangeable medications. Your doctor chooses which agent to use based on the problem you are trying to prevent or treat.
Dr. Deirdre Walsh

Q. "Recently my doctor prescribed Zocor 20mg, in order to lower my cholesterol. I have been taking Vitamin E (400 to 800) daily, but read an article that said that you should not take Vitamin E when on a cholesterol lowering medication. Should I avoid taking Vitamin E?"
Sarah, Churchville, PA

A. Thank you for your question regarding the use of vitamin E by patients on Zocor. There are no national recommendations regarding the use of vitamin E. There were older studies suggesting it was helpful for patients with heart disease, but more recently several large studies suggested there was no benefit. In fact there was one study which found that vitamin E blunted the benefits seen when patients were taking Niacin and Zocor together.; However this was only one study and with relatively small numbers. We are specifically recommending to avoid vitamin E in patients with a low HDL who are taking medications to raise their HDL.  The jury is still out on whether there is any benefit to patients with normal HDL levels.
Dr. Ronald H. Fields