April 1st, 2011 by John Mandrola, M.D. in Health Tips, True Stories
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My neighbor Ed was a thin man all his life. He maintained an ideal body weight by combining regular physical activity with a modest intake of calories. He was a “young” seventy year-old who looked the picture of heart health.
Ed regularly read the newspaper while walking on his treadmill, he hit a golf ball straighter and longer than his peers, and he wore the same size jeans now than he did in college 50 years ago. What’s more, he bragged about his low blood pressure, normal cholesterol level and perfect blood chemistries. He took no pills. I think he went to his primary care doctor each year just to show off his health.
The morning he woke with crushing chest pressure and shortness of air stunned him. “This couldn’t be a heart attack?” he thought. An hour later, minutes after his urgent heart catheterization showed severe blockages in all three of the main coronary arteries, a sternal saw provided a heart surgeon access to his dying heart.
Ed did well. The story had a happy ending. He still looks the picture of health, but now there’s a scar on his chest and a few pill bottles in his medicine cabinet.
How can a human who exudes heart health go to bed well and wake up with severe heart disease? What’s missing? What could Ed have done differently? Could his doctors have measured anything—over and above the traditional risk measures—that might have suggested his obviously higher cardiac risk? Read more »
*This blog post was originally published at Dr John M*
March 23rd, 2011 by John Mandrola, M.D. in Health Policy, Humor
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In Washington, even exercise gets political.
This morning, the WSJ reported that a small group of Congressmen, primarily Republicans, have embraced the adrenaline-infused exercise regimen that is P90X. They jump, stretch and flex to the tune of Tony Horton, a man who clearly checked the right box on career day. The 90-day results-intensive program celebrates its “I couldn’t move the next day” sensations.
On the other side of the ideological spectrum resides the pragmatic approach of the White House. Last month, the NY Times described the regimented, non-boot-campish routine espoused by Mr and Mrs Obama. Our current executive branch favors a personal trainer who likes working people hard, but…”as politely as possible.” The president adheres to a common sense program of regular morning exercises that balances cardio and strength training. Calm, measured and balanced.
Both approaches to exercise appeal to me. Read more »
*This blog post was originally published at Dr John M*
March 18th, 2011 by John Mandrola, M.D. in Health Tips
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In the better-late-than-never category comes my shout out for World Kidney Day, which was March 10th.
I love their slogan: “Protect your Kidneys, Save your Heart.”
As an organ, the kidneys are a lot like offensive lineman in football; they do all the hard work but remain mostly anonymous. They sit motionless in the back of the body,quietly and humbly filtering salt, water and toxins from our bodies. Though some may think that pee smells bad, or is gross, not having “healthy” pee is a real problem. No one ever thinks of their kidneys until they malfunction.
Though the inner workings of the kidney–with all its convoluted loops, capsules and ion exchangers–are more complicated to understand than the heart, keeping your kidneys healthy is simple: just make heart-healthy choices. Read more »
*This blog post was originally published at Dr John M*
March 11th, 2011 by John Mandrola, M.D. in News, Opinion
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It’s heart wrenching when young athletes die of sudden cardiac death (SCD). Last week the death of Wes Leonard, a Michigan high school star athlete, was especially poignant since he collapsed right after making the game-winning shot. This sort of tragedy occurs about one hundred times each year in America. That’s a lot of sadness. The obvious question is: Could these deaths be prevented? Let’s start with what actually happens.
Most cases of sudden death in young people occur as a result of either hypertrophic cardiomyopathy (HCM), an abnormal thickening of heart muscle, or long QT syndrome (LQTS), a mostly inherited disease of the heart’s electrical system. Both HCM and LQTS predispose the heart to ventricular fibrillation — electrical chaos of the pumping chamber of the heart. The adrenaline surges of athletic competition increase the odds of this chaos. Unfortunately, like heart disease often does, both these ailments can strike without warning.
Sudden death is sad enough by itself, but what makes it even worse is that both these ailments are mostly detectable with two simple painless tests: The ECG and echocardiogram (heart ultrasound). Let’s get these kids ECGs and echos then. “Git ‘er dun,” you might say.
On the surface the solution seems simple: Implement universal cardiac screening of all young athletes. And you wouldn’t be alone in thinking this way. You could even boast the support of Dr. Manny Alvarez of Fox News and the entire country of Italy, where all athletes get ECGs and echos before competing. But America isn’t Italy, and things aren’t as simple as Fox News likes to suggest. Read more »
*This blog post was originally published at Dr John M*
March 5th, 2011 by John Mandrola, M.D. in Opinion, Research
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It’s hard to believe that turbulence could be a good thing for the heart. Consider how the word turbulent is defined: “Characterized by conflict, disorder, or confusion; not controlled or calm.” Those traits don’t sound very heart-healthy. But when it comes to heart rhythm, it turns out that a turbulent response — to a premature beat — is better than a blunted one. The more turbulent the better.
No, you haven’t missed anything, and turbulence isn’t another of my typos. Until [recently], heart rate turbulence was an obscure phenomenon buried in the bowels of heart rhythm journals.
What Is Heart Rate Turbulence (HRT)?
When you listen to the heart of a young physically-fit patient, you are struck not just by the slowness of the heartbeat, but also by the variability of the rhythm. It isn’t perfectly regular, nor is it chaotic like atrial fibrillation (AF). Doctors describe this — in typical medical speak — as regularly irregular: The heart rate increases as the patient inhales and slows as he or she exhales. This variability occurs as a result of the heart’s responsiveness to its environment. The more robustly and quickly the heart responds, the healthier it is.
HRT seeks to measure how quickly and vigorously the heart rate reacts in response to a single premature beat from the ventricle — a premature ventricular contraction (PVC). Normally after a PVC, the heart rate speeds for a few beats, and then slows back to baseline over the next 10 beats. The healthy heart responds with a more intense rise in heart rate and a quicker return to baseline. Using simple measurements of heart rate from a standard 24-hour electrocardiogram (ECG) monitor, a propriety software program averages many of these responses and comes up with a measurement of turbulence onset and turbulence slope. Read more »
*This blog post was originally published at Dr John M*
