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Heart Health Organization
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Author: Dr. Gautam Kedia
Question: Why Should I Worry About My Blood Pressure?
Answer: Hypertension is defined as high blood pressure. In the United States, around 30 percent of people suffer from hypertension that can be controlled, even reversed. Adults should have their blood pressure checked every 1-2 years.
When taking blood pressure, there are two numbers to note: the “systolic,” which is the top number, and the “diastolic,” which is the bottom number. Hypertension is defined as having either a systolic blood pressure greater than 140 mmHg, or a diastolic blood pressure greater than 90 mmHg. If you have an elevated blood pressure at more than one office visit, it may need to be treated. This is especially important if the hypertension is confirmed by self measurements at home.
Many factors contribute to the development of hypertension including a family history of high blood pressure, excessive salt or alcohol use, weight gain, physical inactivity and ethnicity. In particular, African Americans have higher rates of hypertension.
Other factors include, kidney disease, use of oral contraceptives, hormone abnormalities, sleep apnea, vascular disease, deficiency of Vitamin D, and illicit drug use which can all increase the risk for hypertension.
It is important to treat hypertension to avoid many of its long term complications. Serious complications associated with hypertension include stroke and intracerebral hemorrhage (bleeding in the brain). Other complications include coronary heart disease, heart failure, arrhythmias, chronic kidney disease and vision problems. Hypertension can even contribute to cognitive difficulties with memory. If hypertension is treated appropriately, however, the risk of these complications can be significantly reduced.
Although medications are commonly used, lifestyle changes can also reduce high blood pressure. It is important to limit salt intake, increase fruits and vegetables, exercising on a regular basis and minimizing stress. Limited use of alcohol and smoking can also be beneficial. In addition, medications can successfully reduce high blood pressure. Your doctor will help you determine which one is best for you. If you suspect or are unsure of your blood pressure, please have it checked regularly. If it is approaching 140/90, you should consult your physician.

 Dr. Gautam Kedia Gautam Kedia is one of our newest staff members. He is an Arizona native who completed medical school at the University of Arizona in Tucson. He then was accepted to an Internal Medicine internship and residency at Cedars-Sinai Medical Center in Los Angeles, California. He completed his residency in 2008. Dr. Kedia went on to participate in a Cardiovascular Disease Fellowship also at Cedars-Sinai Medical Center and the Greater Los Angeles VA Medical Center, where he served as Chief Fellow from 2010 to 2011.
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Author: Dr. Roger Bies
Question: My father died from a heart attack. How do I know if I am at risk for heart disease?
Answer: It is important to know your risk factors for heart disease. Early detection and aggressive risk management for patients with undiagnosed coronary artery disease (CAD) is an important mandate for modern medicine. A sudden heart attack – or worse, sudden death – is still an unfortunate first symptom for patients with previously unknown heart disease. Unfortunately, traditional heart attack risk assessment, like a history of high blood pressure, smoking, high cholesterol, or a family history of heart attacks, don’t tell you if you have heart disease. In fact, the absence of known risks may be misleading when it comes to determining your individual risk of hidden heart problems.
Patients with partially clogged arteries may not have any symptoms and represent the largest group of missed opportunities for life saving treatment. Even a negative stress test does not eliminate the presence of heart disease and may wrongly reassure patients that they are not at risk. A new test called a coronary calcium score demonstrates the presence of fatty plaque in the heart in a completely non-invasive way, and takes only five seconds to complete.
Calcium, normally found in bones, lights up on these high resolution scans of the heart, indicating hardening of the arteries. If you are found to have calcified fatty plaque on one of these heart scans, you have heart disease, even if you don’t feel it. The advantage is that you can treat it and prevent it from becoming worse, possibly preventing future invasive heart procedures.
Aggressive cholesterol lowering and lifestyle modification has been shown to prevent progression of heart disease and future heart attacks.
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Author: Robert Hamburg, MD
Question: How can I be sure I’m in the best health for physical activity?
Answer: Every athlete – from weekend warrior to Olympian – asks this question in one way or another. The evaluation of the individual varies depending on age, symptoms, and family history. The most important step is visiting your cardiologist.
Young athletes are often required to get clearance to participate in athletics. They’re typically asked critical screening questions, including a family history of sudden cardiac death before age 50. Any symptoms such as syncope (passing out), chest pain, shortness of breath, and/or palpitations will help the cardiologist focus the exam. The cardiologist will perform a history and physical exam, concentrating on the cardiovascular system, and may do a routine 12-Lead Electrocardiography (ECG) to look for unusual patterns that hint at potential problems.
In a young athlete, the goal is to exclude the most common causes of sudden cardiac death. Hypertrophic Cardiomyopathy (HCM) is the most common cause in the United States, along with congenital abnormalities and inherited arrhythmias. HCM is a genetic disease with increased and uneven growth of the cardiac muscle, leading to an obstructed flow of blood out of the heart, with possible fatal arrhythmias. Genetic testing is getting better and might be necessary. Although the incidence of sudden cardiac death is rare in young people involved in sports, the cardiologist will use the data collected to clear the young athlete to participate based on medical guidelines.
The weekend warrior, at any age, is more important to clear for physical activity, because myocardial infarction (heart attack) from coronary artery disease is more prevalent. Again, the medical history and exam performed by the cardiologist is the most important step of the work-up.
Depending on the symptoms, findings, and risk assessment, you may require an ECG, stress test, echocardiogram, or heart rhythm monitoring. Other tests may include Cardiac CT scan (calcium score and/or coronary artery evaluation) and/or coronary angiogram. In the end, the weekend warrior and the Olympic athlete will be informed about their cardiac health, and their risks of exercise.
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Author: Dr. Estela Apolinar
Question: As a woman, am I at equal risk for having a stroke as my husband?
Answer: Men and women share many risk factors for stroke, including diabetes, high blood pressure, smoking, and high cholesterol. But, we also face separate issues that contribute to our risk. In fact, according to the American Heart Association (AHA), more than half of the estimated 800,000 annual strokes occur in women, and while stroke is the fifth leading cause of death for men, it’s the third leading cause of death for women.
The AHA recently released stroke guidelines specific to women’s heart health. Their advice on how to treat these factors unique to females includes:
Women with a history of high blood pressure before pregnancy should be considered for a low-dose aspirin/calcium supplement to lower preeclampsia risks.
Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
Preeclampsia before pregnancy should be recognized as a risk afterwards as well. High cholesterol and obesity should be treated early.
Pregnant women with moderately-high or severely-high blood pressure should be considered for medication during pregnancy.
Women with migraines with aura should stop smoking.
Women over 75 should be screened for atrial fibrillation.
While stroke is largely beatable and treatable, time is important. To identify if a person is having a stroke, remember F.A.S.T.:
Face drooping. Does one side of the face droop or is it numb? Ask the person to smile. Is their smile lopsided?
Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
Speech difficulty. Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence like “The sky is blue.” Is the sentence repeated correctly?
Time to call 911. If a person shows any of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately.
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Author: Dr. Himal Shah
Question: I was diagnosed with high blood pressure. What is it and what can I do to try and lower it?
Answer: Blood pressure is the force of blood pushing against the artery walls. Each time your heart beats, it pumps blood into your arteries generating recorded blood pressure. With high blood pressure, your arteries may have an increased resistance against the flow of blood. This is most commonly a result of hardening that occurs with age and/or calcium build up causing your heart to pump harder to circulate blood. High blood pressure, also known as hypertension, directly increases the risk of heart attack, stroke and aortic aneurysms.
Two numbers are recorded when measuring blood pressure. The top number is called the systolic pressure, which is the pressure inside the artery when the heart contracts and pumps blood through the body. The diastolic pressure is the bottom number and it refers to the pressure inside the artery when the heart is at rest and is filling with blood.
Both numbers are recorded as “mm Hg” (millimeters of mercury). The numbers represent how high the mercury column is raised by the pressure of the blood. Normal blood pressure is considered less than 120 mm Hg systolic and less than 80 mm Hg diastolic pressure or less than 120/80.
There are several ways you can lower your blood pressure in addition to taking a prescribed medication. The American Heart Association (AHA) recommends eating a heart healthy diet; eating less salt; maintaining a healthy weight, managing stress; not smoking; limiting alcohol; and exercising regularly. A good diet and exercise regimen along with carefully managing your oral blood pressure medications will play a key role in controlling high blood pressure.
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Author: Dr. Zaki Lababidi
Question: What is a stress test and why might I need one?
Answer: A stress test is used to obtain information about how well your heart works during physical activity or exercise. Your heart pumps harder and faster during times of physical activity than it does at rest or with typical daily activities. Monitoring your heart during a period of exercise may help your doctor discover a problem with your heart that you may not know about otherwise.
A stress test may be ordered by your physician to diagnose blockages in the heart vessels (Coronary Artery Disease), diagnose heart rhythm problems, or to test the effectiveness of a treatment.  A stress test may be performed using a treadmill or stationary bike. Your cardiologist may order a nuclear stress test which involves the use of radioactive dye and a special scanning machine to obtain images of your heart. This helps to identify if there is an area of your heart that is not receiving enough blood flow.  If you are unable to exercise at all or for a long enough time to raise your heart rate, your cardiologist may recommend the use of a medication to increase the blood flow to your coronary arteries. This is called a pharmacologic stress test.
Complications from a stress test are quite uncommon but they can happen.  Irregular heartbeats, abnormal rise or drop in blood pressure, and very rarely a heart attack, may occur. Your cardiologist will determine the best type of stress test given your history and current medical condition. Once your stress test is completed, your cardiologist will interpret the results and work with you to establish the next best steps in caring for your heart.
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Author: Dr. Ahtisham Shakoor
Question: I sometimes feel pain in my legs when I walk.  It feels like cramping but it usually goes away when I rest.  What should I do?
Answer: The leg pain and cramping you’re describing is called claudication and it’s the most common symptom associated with peripheral artery disease (PAD).  People with PAD can experience cramping in the legs, especially when walking.  Other symptoms include muscle fatigue; feeling of heaviness in the legs and feet; tingling or burning sensation; and cold or numbness in the limbs.  PAD is caused by atherosclerosis, a hardening of the arteries from plaque which limits blood flow to the muscles of the legs.  People with PAD are at increased risk for stroke, heart attack and limb problems such as non-healing wounds, ulcers, gangrene or loss of a limb.
When PAD becomes severe, you may have:
Pain and cramps at night
Pain in your feet or toes that intensifies with even the weight of clothes or bed sheets
Skin that looks pale or blue
Sores that do not heal
An Ankle-Brachial Index test (ABI) is a simple and reliable test for diagnosing PAD.  The test measures the blood pressure in your ankles and compares it to the blood pressure in your arms.  If the blood pressure is lower in your legs than in your arms, it may indicate you have PAD.
September is National Peripheral Arterial Disease Awareness Month. Ask your doctor if you should have an ABI test if you are over the age of 50 and have any of these risk factors for PAD:
Smoking
Diabetes
High blood pressure
High cholesterol
Overweight
History of heart problems
Depending on the severity of your blockage, your doctor may recommend lifestyle changes, medications or surgery to treat PAD.
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Author: Dr. Andrew Cassar
Question: What is Coronary Artery Disease, do I have it and what can I do about it?
Answer: Coronary artery disease (CAD) affects about 16.8 million people in the U.S. CAD is caused by the accumulation of cholesterol (plaque) in the walls of heart arteries resulting in their narrowing and decreased blood flow to the heart. This may cause angina which usually presents as chest pain on exertion as well as shortness of breath or fatigue. If a clot forms on the plaque, it may result in 100 percent blockage of the coronary artery resulting in a heart attack with sudden onset chest pain, shortness of breath and sweating. CAD is responsible for 600,000 deaths every year in the U.S., which is one fifth of all deaths.
Keeping to a healthy diet, exercising, losing excess weight and not smoking are the best ways to prevent CAD. Regular visits with your primary care doctor or cardiologist are important to treat other risk factors like high blood pressure, high cholesterol levels and diabetes that increase your risk of CAD. This is especially important if you have a family history of CAD.
Tests to detect CAD include EKG, echocardiogram (ultrasound), or stress test (exercise or medical stimulation). A CT scan can be used to look at the amount of calcium present in the heart arteries which is associated with the amount of plaque present. A CT angiogram can be performed when contrast dye is injected into your veins to look at the blood flow in the arteries.
People with CAD may be given medications to help relieve symptoms and prevent heart attacks. For some, these medications are not adequate and further testing and treatment is required. People with abnormal tests or who are having an acute heart attack, are often taken to cardiac catheterization, a minimally-invasive procedure where a catheter is placed from the groin or wrist up to the heart arteries and contrast dye is used to look for blockages. Ballons and stents may then be used to open any blockages.
It is important that you speak with your doctor about your risk of having CAD. Early prevention and treatment are key.
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