Ask Dr. Zipes
Blood Pressure Concerns
By Douglas Zipes, M.D.
From the March/April 2005 Issue
Reader: I am 91 years old and take atenolol 50 mg twice dally. My blood pressure is 135/53. The new suggested normal blood pressure is 120/80 or less. Is my top number (systolic) too high and the bottom (diastolic) number too low? Dr. Zipes: As people age, the systolic pressure rises and the separation between systolic and diastolic pressure widens because the arteries become stiffer. As long as you are not having any symptoms of low blood pressure, such as fatigue, lightheadedness, or blackouts, and your blood tests (easily checked by your doctor) are normal, I wouldn't worry about the low diastolic pressure. The new blood pressure values have been set lower because we now know that early deleterious changes to the body can occur with pressures less than 140/90, which was the previous cut-off. But, considering your age, your blood pressure is just about perfect! Not to worry.Family History And Heart Disease Reader: How much of a role does family history play in developing heart disease? My grandfather had his first heart attack when he was 50. My mother is in good health at age 59. I am 43 and only have premature beats. The only risk factor I have is smoking. Dr. Zipes: Family history is important, particularly if one of your parents had a heart attack at a young age, usually before 50. However, it has been said that inheritance, that is genetics, "loads the gun but the environment pulls the trigger." You are in the process of pulling the trigger by smoking. It is an extremely important risk factor and you should stop IMMEDIATELY! That is far more important than your grandfather's heart attack.Onset Of Dizziness Reader: I have severe coronary disease with two heart attacks in the past and numerous coronary intervention procedures, including stent placement in 2001 and four-vessel bypass surgery in 2002. I then had a problem with atrial fibrillation, which seems to have cleared up, but I am now having problems with low blood pressure and dizzy spells, despite implantation of a three-lead implantable cardioverter defibrillator (ICD) in September 2004. I take many medications, including sotalol 40 mg twice a day. Any advice would be appreciated. Dr. Zipes: Your problem is obviously quite complex, and I cannot do it justice in a brief reply. You really need expert cardiology advice. That said, it is clear that you have received the very latest ICD, which should be a help and can be lifesaving. Next, I would review all of your medications to be sure they all are necessary and none are causing or aggravating your problems. Sotalol, which you are taking to prevent atrial fibrillation recurrence, can contribute to your symptoms. Finally, there are some investigational approaches for patients who have advanced coronary disease and are no longer candidates for further revascularization attempts. Check with your doctor about them.Calcicum Recommendations Reader: I would like to pass on my experience with calcium. About 30 years ago I began having episodes of rapid heart beating that would come and go suddenly at any time or place, lasting as short as 4 minutes or as long as 2 hours. Around that time, I began taking calcium for deteriorating fingernails. While calcium didn't help my fingernails, I have not had another episode of rapid heartbeat since then and I am now 85. Dr. Zipes: It would indeed be unusual for calcium to suppress rapid heartbeats, unless the person's calcium was abnormally low in the first place. However, as the heart ages (I call it the heart's equivalent of gray hair and wrinkles!), the timing of the normal heartbeat can change by minute amounts of several thousandths of a second. That small change can make the difference between whether or not episodes of rapid heartbeats start. I think that is a more plausible explanation...but, just because I can't explain something with modern science, that doesn't mean it doesn't exist. So, keep taking the calcium!Questions About Diagnosis Reader: At age 70, I have just been diagnosed with an anomalous coronary artery, with a large fistula causing my heart to enlarge. Tests (including an ECG, echo, and catheterization) have failed to show where the artery goes. Can you explain the condition and is surgery necessary? Dr. Zipes: An anomalous coronary artery refers to an abnormal origin of the coronary artery, which is one of the vessels that supplies the heart muscle with blood. This can be a "normal variant," which means it is different from the majority of people but carries no risk. Or it can be potentially life threatening, depending on where the origin is located. The fistula is an abnormal connection between the coronary artery and another part of the heart, most commonly between the right coronary artery and the right ventricle (lower pumping chamber on the right), but occurring in other places as well. The fistula causes blood to shunt between the artery and ventricle, which puts extra strain on the heart and can cause it to enlarge. Careful imaging techniques usually reveal the origin of the coronary artery, site of the fistula and path of the shunt. Some shunts can be closed during a catheterization procedure, while others require surgery. The fact that your heart is enlarging would indicate that the shunt is large and most likely should be closed.
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