June 2006

Nancy asks:
Are heart murmurs something to be concerned about? I have a slight murmur that was detected about five years ago and has remained the same. It worries me. Please advise.

Dr. Demopoulos responds:
A heart murmur is made by the sound of blood passing through the heart. A murmur may have an innocent cause and be of no concern, or it may indicate an important abnormality. You should ask a doctor who knows you about the cause of your murmur, and whether it is a cause for concern.

If you would like to schedule an appointment with a Penn Cardiac Care doctor, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

Vickie asks:
I am a 46 year-old female. I do not eat right or exercise. I am overweight. I am in a very stressful job situation at work. I am worried about heart disease (father died at 61 from heart disease. Sister had heart attack at 50). I experience a tightness in my chest at times and I attribute it to anxiety. I would like to get a check up to make sure I am okay.

What steps should I take? I do not just want to go to my doctor, I would like to know what I should do? How should I proceed to get a complete check up for my heart?

Dr. Demopoulos responds:
Your primary care doctor is a good place to start, to have your blood pressure and cholesterol checked, and to have a baseline EKG done. You can then ask your primary care doctor for the name of a cardiologist in your area, and depending on the results of your evaluation, other tests might be indicated, like an echocardiogram (ultrasound of your heart) and/or a stress test. Most importantly, though, you need to make some lifestyle changes, including regular exercise (once your doctor says it is OK), a healthy diet, and weight loss.

If you would like to schedule an appointment with a Penn Cardiac Care doctor, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

Jen asks:
My PVCs are driving me crazy. My doctor said they are benign and last week they went from a few to over a hundred a day. My doctor continues to say I'm ok. I'm about ready to try anything. Will fish oil help?

Dr. Demopoulos responds:
PVCs, or premature ventricular contractions, are extra heart beats which cause annoying symptoms of skipped beats in many people. They are not usually a cause for concern, except if you have significant heart muscle damage. They tend to fluctuate in frequency, usually without a clear cause, although some people notice that things that stimulate the heart, like caffeine, cold medications, or even fatigue may make them worse.

Usually over-the-counter preparations like fish oils do not change symptoms, but they are not likely to cause harm either. When symptoms become very bothersome, prescription medications can be tried to suppress PVCs, but they do not work perfectly, and they do have some side effects of their own.

Carol asks:
After complete blood work up and a EKG, what is the next test that should be done to find out why you are having PVC's? Can PVC's cause extra gas in your stomach or diarrhea?

Dr. Demopoulos responds:
Depending on you medical history, an echocardiogram may also be done to check heart muscle function. PVCs do not generally cause GI symptoms.

Peggy asks:
I had a cardiac catheterization performed. The catheterization showed 2 blockages, one 50%, one 30-35%. They were not blocked enough to do anything about them. I continue to experience shortness of breath, lightheadedness, etc. I use crutches for walking. Isn't Medicare protocol flexible if person requires more than average amount of energy/oxygen to be mobile? I also have severe scoliosis - leaning to left (crunching heart?).

Dr. Demopoulos responds:
I am unable to comment on Medicare protocols. I am not sure what question you would like resources to investigate.

Betty asks:
My family doctor said I was in need of magnesium supplements. What are symptoms of low magnesium, if there are any?

Response:
Thank you for your question. We are currently only answering questions related to cardiovascular disease.

Laura asks:
I'm 39, 5'5", 170 lbs, active (I cycle, lift weights and do the treadmill and/or spin classes pretty much 2-5 days a week). Lately, I've had shortness of breath, getting up stairs winds me (although I can sprint for 1-2 minutes to catch a train), I have heartburn frequently (although I can almost completely associate it with bread and pasta products - gluten? wheat?), I have been anxious and feeling like I might be having a panic attack (I don't see why though), I sleep 7 hours a night, but wake up at least 2-3 times every night).

Dr. Demopoulos responds:
I am not sure what your specific question is, but there is no way to determine the cause of the symptoms you describe in an email. I suggest you start with your primary care doctor and go from there.

Faith asks:
Is it important for a 64 year-old woman to have an HPV test? How does this differ from a routine pap test?

Response:
Thank you for your question. We are currently only answering questions related to cardiovascular disease.

CMC asks:
I'm 37 and have been diagnosed with neuro-cardiogenic syncope. I'm currently taking 50mg of Atenolol to treat the tachycardia, and 5mg of Midodrine 3 times a day to increase my blood pressure. I still experience symptoms at least twice a week, including chest pain, dizziness, fluttering heart beats, and shortness of breath.

Can you suggest an alternative treatment that I should ask my doctor about? Also, I was not given a tilt table test; the diagnosis was made based on blood pressure readings and an event monitor.

Dr. Demopoulos responds:
This sounds like something to discuss further with your doctor. It is not possible to suggest other treatments or evaluations without more information.

If you would like to schedule an appointment with a Penn Cardiac Care doctor, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

Karley asks:
I know someone that had an echo done and they had a mean pulmonary artery pressure of 90mmHg. Is this pressure reading normal for a pap? What is a normal pap and what is the 90mm Hg indidcating? Would you explain ejection fraction and what a 23% EF means.

Dr. Demopoulos responds:
Ejection fraction (EF) is the percent of blood pumped out of the heart with each beat. It should be 55-75%, so 23% is severely reduced, meaning the heart is pumping out much less blood than usual.

Pulmonary artery pressure (PAP) is the pressure of blood in the vessels that feed the lungs. Mean PAP should be about 15 mmHg, so 90 mmHg is extremely high, meaning the pressure of blood in the lungs is severely increased.

Maggie asks:
I had PVCs 12 years ago. They went away with no treatment after about a year. Last week they came back, very strong. My appointment is not until the end of August! Is it safe to wait over two months to see a cardiologist when you have PVCs? Is it dangerous to wait? The anxiety of having the PVC's is making them worse.

Dr. Demopoulos responds:
Premature ventricular contractions (PVCs) may cause uncomfortable symptoms, but they are usually not a cause for concern. A full evaluation will be necessary to determine if they are of concern in you specifically. Call your primary care doctor if you need some guidance on this prior to your appointment.

Rebee asks:
Can you recommend a general internist who will help me?

Response:
In order to find a doctor at the University of Pennsylvania Health System, use the online physician search.

If you would like to schedule an appointment, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

DB asks:
I have been told that for heart health and prevention of high cholesterol, essentially all starches should be avoided. What is the current thinking on this?

Dr. Demopoulos responds:
There are many schools of thought on the best approach to a heart healthy diet, and very little good scientific data to determine which approach is best. In general, a diet emphasizing lean protein sources (chicken, fish, low fat dairy, tofu), fruits and vegetables, modest amounts of whole grain carbohydrates, and some "heart-healthy" fats (like olive oil) is reasonable.

Saturated fats and processed carbohydrates should be avoided. Portion control is a problem for many people, since consuming too many calories, even from healthy foods, can lead to obesity, diabetes, and heart disease. Your doctor can advise you on what diet is best for you, depending on what medical problems you may have.

Sadie asks:
My aortic valve is at a critical stage. I do not want to have surgery, even though it was recommended by my physician. In your experience have you seen patients in such a critical stage that have lived five years with no surgery? I have very little in the way of symptoms other then an echocardiogram that shows my valve condition is serious. In addition, if I don't have surgery are there any helpful suggestions you can give me to prolong my life. I'd appreciate any advice that doesn't not involve surgery.

Dr. Demopoulos responds:
Critical aortic valve narrowing can lead to death without warning symptoms, and the treatment is only surgical. It is impossible to give you an accurate idea of your 5 year survival rate. You should discuss this carefully with your doctor and seek a second opinion if you like.

If you would like to schedule an appointment with a Penn Cardiac Care doctor, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

Virginia asks:
Since there are gender based differences in arteriosclerosis, what tests can my cardiologist order? And what is the DASI (Duke Activity Status Index)?

Dr. Demopoulos responds:
Your cardiologist will decide what tests are appropriate for you based on your symptoms and your risk level. The Duke Activity Status Index is a questionnaire to determine how well you can do routine activities such as personal care, housework, yard work, etc. Your fitness level (which can be estimated by this index) is one part of evaluating the status of your heart.

Mary asks:
Is pounding (like a pulse beat) in the ear related to cardiovascular disease?

Dr. Demopoulos responds:
Awareness of your heart beat in your ears is usually normal. If you feel as if your heart is racing or beating erratically, that is not normal, and should be evaluated by your doctor.

Brand asks:
What are other signs and symptoms of a heart attack?

Dr. Demopoulos responds:
Symptoms (typical and atypical) which may be a sign of heart attack or risk of a future heart attack can include chest arm, back, shoulder, neck or jaw discomfort (dull, burning, or sharp); shortness of breath, nausea, sweating, dizziness. If you have questions about whether any symptom you have might be a warning sign, contact your doctor.

Rebee asks:
I have been treated for hypertension for over a year with various medications. I am drug intolerant and have a history of colitis and urinary incontinence. The medications have caused side effects. The last medication brought a return of the colitis which had been in remission for about 2 years. In addition, it reacts with statins that I take. Is there a physician who specializes in patients with these parameters?

Dr. Demopoulos responds:
Although there is no one specialty that is expert in all the body systems you describe, a general internist is usually able to recommend appropriate blood pressure treatment, taking your other illnesses into account. You should be aware, however, that finding blood pressure medications that are effective and well tolerated is often a matter of trial and error, and takes time and co-operation between the doctor and patient.

If you would like to schedule an appointment, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

Ellie asks:
I was told that I have an incomplete right bundle branch block. What is that and is it something that should be checked on periodically?

Dr. Demopoulos responds:
Incomplete right bundle branch block describes slow function of one part of the electrical system of the heart. It is usually considered to be a normal variant, but can occasionally be associated with other heart abnormalities.

If you would like to schedule an appointment with a Penn Cardiac Care doctor, please contact 1-800-789-PENN (7366) or you can also request an appointment online.

Unique asks:
Why does one take insulin?

Response:
Thank you for your question. We are currently only answering questions related to cardiovascular disease.

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