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Our Clinical Nurse Specialist is in to answer your health-related questions regarding heart failure self-care management.
Unfortunately, due to the large number of questions we receive, we may not be able to respond to all questions. We will, however, try to answer those
questions that we feel offer the broadest interest. Please check back periodically to see if your question - or a related question - has been answered. And remember, these responses are for educational purposes only - they should not be substituted for advice by your doctor. If you have an immediate medical concern, you should consult your doctor. If you have a heart-related home health care need, please e-mail or call us at 1-888-VNS-1-CALL (1-888-867-1225).
Disclaimer: All information is for educational purposes only and should not be substitued for advice by your doctor.
Question:
What is the difference between systolic and diastolic blood pressure? Why does blood pressure sometimes vary between the left and right arms?
Answer:
Systolic Blood pressure is the pressure in the aorta and large arteries due to the volume and velocity of left ventricle ejection of blood, the peripheral arterial resistance, the distensibility of the arterial wall, and the viscosity of blood. In short this means the volume and viscosity (thickness) of blood how much the arteries can accommodate increased blood flow and the ability of the left ventricle (the left side of the heart that pumps to the body) to pump blood into the system. Diastolic blood pressure is basically the pressure in the arteries when the heart is in it's refilling stage and is also effected by blood viscosity, arterial distensibilty, and peripheral resistance.
Blood pressure can vary depending upon the structure of the arteries, the amount of arteriosclerotic deposits i.e. calcium deposits and atherosclerotic deposits i.e. fatty deposits. The blood pressure which is highest should be taken as the true blood pressure.
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Question:
I have always been very healthy and my cholesterol level has always been around 160 – 190. At my last checkup, my cholesterol was 248. I am turning 46 this year, I run 12-18 miles a week, do not smoke, and drink plenty of red wine. Why isn't my running sufficient enough to keep me healthy? Should I change my diet?
Answer:
In order to keep your cholesterol low, avoid high cholesterol foods such as meat and dairy products, as well as food high in saturated fat. Saturated fat is in cake, cookies, ice cream, popular snacks, fast foods, etc. It raises cholesterol twice as much as high cholesterol foods. Healthy food choices are fish, grains, beans and legumes, fruit, and vegetables. There are many factors that influence cholesterol level, including family history. If your parents had high cholesterol, it is less surprising that you do. Your LDL level is high, and that probably accounts for the high cholesterol. You are exercising, and that has great benefit on the HDL, which is at a good level. Exercise raises HDL (the "good" cholesterol) and lowers LDL the "bad" cholesterol. Your running is probably helping you stay healthy, and it also has other benefits including weight control and coping with stress. As for changing your diet, eating out may make it more difficult to eat a heart-healthy diet. Choose entrees according to the above suggestions, and limit or avoid sauces. It is difficult to recommend a dietary change without knowledge of what you eat. Keep a food diary. Write down everything you eat, and decide where you can limit or avoid high-fat and high-cholesterol foods. There are books out about heart-healthy or low-fat cooking. The American Heart Association is another resource for information. The fact that you do not smoke is wise. You should find out what your blood pressure is. It would be good to repeat your cholesterol in about six months, and make sure it is done after you have fasted for 12 or more hours. Ask your doctor what your cholesterol ratio is. That determines coronary risk and is calculated by your total cholesterol and HDL level. It may be within normal range. Wine raises HDL, but its benefits are limited to one or two glasses per day.
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Question:
I am looking for a support group for survivors of heart attack in New York City. Can you help?
Answer:
Contact the American Heart Association New York City Affiliate. (212) 661-5335. You may also benefit from enrolling in a cardiac rehabilitation program.
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Question:
I was diagnosed with variant angina three years ago. The doctor was convinced that I had a massive blockage, rushed me to the hospital and performed a cardiac catheterization that showed no blockage. I take Norvasc daily and haven't had any problems. The doctor said I will probably have to take this medication for the rest of my life. Is this so?
Answer:
Variant angina is caused by arterial spasm rather than arterial blockage, and it is treated with calcium channel blockers, of which Norvasc is one. It has a protective benefit of guarding against recurrent coronary artery spasm.
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Question:
I'm a 26-year-old male who is having problem with palpitations of the heart and also dizziness. I have never had this happen before and I work out three times a week. I have been to the doctor and have had several tests done on my blood and body, but still don’t know the cause.
Answer:
You should see a cardiologist. He will give you a special test that records the rhythm of your heart for 24 hours, and you keep a record of your activity during that time period. The test may determine the cause of the palpitations. Palpitations may relate to stress or intake of caffeine as well.
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Question:
I am a retired B.S.N and need advice about purchasing a blood pressure monitor for myself and my husband. I’d like one with an automatic arm. I realize that there's nothing that beats the good old stethoscope and sphygmomanometer but I need convenience and ease in self-monitoring.
Answer:
The digital read-out with cuff manufactured by Sunbeam is considered reliable. Avoid purchasing any that read blood pressure via an attachment to a finger, since a cuff reading improves accuracy.
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Question:
I have a Sunbeam sphygmomanometer "Certified 960515". I haven't used it in a few years. Do you know how I can have it checked for accuracy?
Answer:
There should be no problem with accuracy with non-use. Sunbeam is considered reputable in terms of at-home sphygmomanometers. If you want to compare it with another reading, take it with you the next time you see your doctor. It is probably run on batteries, so make sure you put new ones in the apparatus.
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Question:
What is the correct treatment for a patient with cardiac heart failure?
Answer:
The medication regimen for heart failure is determined by your primary care physician and/or cardiologist. Standard treatment includes an ACE inhibitor, a diuretic or "water pill", Aldactone, and a beta blocker. Norvasc is a calcium channel blocker that treats high blood pressure and/or coronary artery disease, but is not specific for heart failure. Lasix is a diuretic or "water pill" that prevents fluid build-up that can happen in heart failure. Aldactone is also a diuretic, but it is used because it improves heart failure. ACE inhibitors relax the blood vessels so that the heart empties better to deliver blood and nourishment to the cells. Beta blockers improve heart failure, but are not beneficial if you have any pulmonary illness.
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Question:
My 26-year-daughter tried to donate blood today. Her iron test was borderline. They had to stop the donation after about 15 minutes because her blood wasn't flowing fast enough. Her blood pressure was good. Any insights you can provide would be appreciated.
Answer:
I would suggest getting more specific information from the center where the attempted blood donation was made. I would ask what the hemoglobin and hematocrit readings are. I would also ask for clarification of the reason the donation was terminated, and whether there is any potential need for medical follow-up. I cannot comment intelligently on the reason for the slow blood flow, nor is it clear how much blood was obtained in the 15-minute time frame. It may be related to something as basic as the drainage system used to obtain the blood.
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Question:
I am 32 years old, weigh 195 lbs. and am 5'9." Recently, I have been feeling dizzy and I checked my blood pressure which is 132/89. I just moved to a high-altitude climate and I just feel out of sorts. I have been living here for three weeks. What could be making me dizzy?
Answer:
The most likely answer is that your symptoms are related to the high altitude. However, I would suggest that you seek the advice of a medical doctor about these symptoms, especially if they persist. I would also advise you to have your blood pressure checked again.
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Question:
My husband had open-heart surgery in 1984 for a myxoma on the aortic valve. He was 19 at the time. The surgery was successful and he has not had problems since. He does have an enlarged heart and I fear that this myxoma could return. I would appreciate all information regarding myxoma and the possibility and signs of a possible return. He also snores a lot and at times his breathing stops for short intervals and then he gasps in his sleep and continues to snore. I would realy appreciate some assistance in this matter.
Answer:
Your questions show concern for your husband, but most of them relate to medical issues. It seems that you understand the need for medical evaluation, but your husband must see the need for him to take any action.
The best source of assessment is a cardiologist, since myxoma is a tumor in the heart. I spoke to a cardiologist before I responded, who said an echocardiogram is the simplest non-invasive method of detecting a myxoma.
A cardiology text indicates that myxoma can recur, but recurrence is low or rare. Signs and symptoms can be bizarre and confusing, but include shortness of breath, chest pain, fainting, and cough. There may be some edema (fluid retention in legs and/or lungs) and sometimes, fever or rapid pulse rate.
It sounds as if your husband would benefit from assessment for sleep apnea, given the snoring and breathing pattern you describe.
If you have doubts about the physician who assessed him, I suggest a second opinion, and/or another doctor. As I previously noted, a cardiologist is an ideal choice. Ask a physician you trust for a referral, if your husband is willing to be seen. Other good sources of referrals are family, friends, and nurses.
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Question:
Three months ago I switched to a pill with more estrogen than my previous pill and my skin has been breaking out. Could the break-outs be a result of more estrogen? Should I change pills to help my skin?
Answer:
The safest approach is to speak to the doctor who prescribed your estrogen. If the skin problem persists, I recommend that you see a dermatologist, since these are medical issues.
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Question:
After my 80-year-old grandfather came home from the hospital he was having jaw pain. He was taken to the ER, admitted and given a stress test, which he passed. But he is still having the jaw pain. He says that he does not have any chest pain. Seven years ago he had this same pain and they did a heart catheterization and found he had three arteries that were blocked. He then had an angioplasty. The doctors from the hospital feel that his jaw pain is not related to his heart problem but to his stomach. Can you help?
Answer:
It is very difficult to comment on one symptom. The fact that your grandfather passed the stress test suggests that the problem is not related to his heart, but is not as absolute as a coronary angiogram (cardiac catheterization). The fact that this is the same symptom he felt seven years ago when angioplasty was done merits a full assessment. If you are still concerned, it might help to get a second opinion from another cardiologist, and a GI specialist. It might be valuable to ask about a thallium stress test, if that has not been done. It is more definitive than an ordinary stress test. Another possible cause of jaw pain is TMJ, which I think is diagnosed by a dentist, since it is a problem with the temporal mandibular joint in the jaw area.
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Question:
I am taking a drug called Norco (Hydrocodone APAP 10/325) two times daily for my headaches caused from a concussion. I have been taking this medication for a year now, but now it is starting not to work as well as it should. Do you think I’m building a resistance to the drug? Was it wise for the doctor to prescribe me a narcotic for such a long period of time?
Answer:
A concussion is an acute event, and any related headaches should disappear. I suggest that you consult with a headache specialist and a pain specialist. At the very least, I recommend a consult with another primary care physician as soon as possible. A year is a very long time for symptoms to persist, and you need medical (doctor) assessment and intervention.
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Question:
My son is nine years old and has been asthmatic since he’s two months old. During the winter he has a constant dry cough even though he doesn’t wheeze. What can be done for his cough?
Answer:
A constant cough is often a specific type of asthma called "cough variant." Many children with asthma never wheeze, but rather cough and never seem really comfortable. This type of asthma can be worse at night, and can sometimes get worse with exercise or exposure to allergens. If your child is coughing persistently more than twice a week, or wakes with a cough more than twice a month, he may need to have changes made to his treatments.
Many children need to be on controller medications daily to prevent symptoms like coughing and wheezing. If the child is not on a daily medication for prevention of this persistent coughing, he should see your medical provider to discuss the possibility of starting one.
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