It is important to keep your cholesterol under control. There are drugs other than Lipitor (atorvastatin) that could be tried if your lipids are elevated. The presence of PAD is easily evaluated with a noninvasive Doppler flow probe placed over the artery. Check with your cardiologist if you are concerned. Usually, patients are symptomatic before we intervene with stents or surgery depending on the particular problem. Elevated lipids contribute to the development of PAD, so be sure to keep your cholesterol low.

Peripheral Artery Disease The Saturday Evening Post

I am glad you like my column, and that you plan to subscribe to the Post to read it. Thank you. Porcine heart valves (made from pig hearts) have been used to replace narrowed and/or leaking human aortic and mitral valves since about 1965. Tissue valves eliminate the need for anticoagulation with warfarin that is required for mechanical prostheses. On the downside, they are not as durable as mechanical valves and therefore do not last as long. In several studies, by 15 years the porcine valve has failed in 30 percent to 60 percent of patients. Elevated cholesterol seems to contribute to valve degeneration. Valve failure is more frequent in the mitral than aortic position. Also, the rate of valve failure is significantly less in patients older than 65, with more than 90 percent of the valves functioning well at 10 years. Degeneration is rare in patients past 70 years old. Your choice of valve was excellent because your age and the fact that the valve is in the aortic position make it very likely the valve will last as long as you do!

Artificial Heart Valves The Saturday Evening Post

I am not certain about what is causing your symptoms. My first thought is that patients with heart failure are often more short of breath lying down than sitting or standing. A check by your cardiologist would resolve that issue. I assume that by “heart flutter” you mean atrial flutter, not just a fluttering feeling in your chest. If you had successful ablation of the AV node, then the atria (top portion of your heart) should not be conducting to the ventricles (bottom chambers), whether you have atrial fibrillation or atrial flutter. If there is conduction, then the atrial flutter can be ablated also. If my comments do not answer your questions, find out more about your condition from your doctor and write in again.

Ablation Helps Flutter, Too The Saturday Evening Post

On the contrary, statins are routinely taken by people with heart problems to lower elevated lipids. The statin should not affect your pacemaker at all. Simvastatin (Zocor) can be substituted for Lipitor (atorvastatin) as long as you check your lipids to be sure the new drug effectively reduces your cholesterol.

Statins and Heart Health The Saturday Evening Post

I walk past the patient with the mechanical heart to visit his roommate, on whom I performed open-heart surgery earlier in the week. I am surprised to see a woman slowly waving her hands over the victim’s chest. Wearing a purple turban on her head and several large silver medallions interspersed with crystal pendants draped around her neck, she asks, “Do you believe energy meridians affect your health?”

In the West, we have adapted a biomedical understanding of illness. We seek the cause of ailments by evaluating their concrete manifestations or symptoms. When gladiators in my ancestral home of southern Asia Minor were mortally injured, Galen—a father of Western medicine—would vivisect the athlete and identify the cause of injury. Modern equivalents, such as physicians in the Framingham study, perform autopsies on deceased middle-aged executives, observe a blockage in the main vessel of the heart, and claim that the death was caused by the sudden closure of a vessel, resulting in a heart attack. We seek concrete explanations with easy-to-identify causes, then educate our population about how to avoid those risk factors. Fine. However, a global world demands that we be less provincial in seeking answers to health—a reality driven home by the observation that half of the heart attacks in this country occur in individuals without traditional risk factors that one would predict.

For centuries, Ayurvedic, traditional Chinese medicine, and related traditions in Asia assessed health by the individual’s energy state. As a physician proud of my tradition, I join my colleagues in scoffing at the notion that energy meridians, which cannot be measured or seen, could cause a disease as seemingly concrete as a heart attack or broken arm. But what of ailments that are less tangible and challenge modern Western medicine? More important, do the solutions we offer in the West help the public to maintain health?

The quandary leads to an even more profound question: What is life? Philosophers, artists, or lawyers may quibble over a definition, but the scientist has the advantage (and limitation) of drawing conclusions from the study of the most basic element of a living being—the cell. Several million years ago, a random aggregation of minerals somehow coalesced into a single entity, which was able to maintain an energy gradient across a membrane that gave birth to life on Earth. Differentiation of inside from outside and self from non-self still occupies our cells. The cells know if they are doing a good job by the energy gradient maintained. The simple rule is: no energy gradient, no life. If we unify cells into organs, in theory, their energies could aggregate as well. Likewise, placement of organs into a living mammal-like man should result in discernible energy patterns. Why are we so reluctant to even study energy fields? Medicine and our vision of healing is a culturally based and limited approach. If our society is unwilling to submit to beliefs that demand trust in an invisible force, our scientists will share this bias and focus on more scientifically recognized pursuits.

Whether an advanced physicist or a casual Internet user, we are becoming more comfortable living life without mechanistic explanations for the world around us. There is a growing belief that health and illness are more than states defined in a pathology lab or petri dish. The net result is a growing acceptance that something else is out there that we need to discover to find true health and address disease in a more comprehensive manner.

This something else has always been a driving force in my study of medicine and carries over into the young visionaries looking for answers in my Columbia University lab. Over the last few years, we have created models for studying the role of energy in effecting fundamental physiologic changes. Although our results are enticing, they have not yet been duplicated in another center, which is imperative prior to publicizing controversial data. But no matter what we prove today, for the foreseeable future, you and almost everyone you know will live life without really knowing the right answer. At some point, we reach an impasse reminiscent of the argument over the existence of God. There is no clearly correct answer, but everyone should search for a solution and ultimately select an answer—part of your life’s mission. After all, it is often not the destination, but the journey that really counts. So get going! Doctor’s orders.

The Healing Power of Energy The Saturday Evening Post

Pat later learned that gasping, also called agonal breathing, is relatively common in victims of cardiac arrest. Since her daughter’s death, Pat has become a CPR instructor and is now sharing her story to help educate and save lives.

“I don’t want people to have to go through the pain or guilt of losing a loved one because they weren’t sure what to do,” Pat explains. “Get trained in CPR, and don’t be afraid to act if you see someone who is unresponsive and gasping. It’s critical that you act quickly—seconds count.”

Gasping indicates that the brain is functioning, yet it is not normal respiration. If someone collapses and is unresponsive, the American Heart Association recommends calling 911 and getting an AED (automated external defibrillator), if available. Then, check whether the victim is breathing normally. If not, start CPR immediately.

Agonal breathing may also be mistaken for snorting, moaning, or labored breathing. For a video reenactment of how agonal breathing may look and sound, visit americanheart.org/agonal.

Neighborhood Heart Watch, the brainchild of Dr. Douglas Zipes, is a grass roots initiative to place AEDs in homes and neighborhoods.

Neighborhood Heart Watch: Remembering Maggie The Saturday Evening Post

Your left ventricular ejection fraction is indeed low, and it does not always correlate with symptoms, as you have found out. However, that amount of heart damage does put you in a high-risk category for a subsequent cardiovascular event, including sudden death. In fact, when the EF falls below about 35 percent, we generally recommend an implantable cardioverter defibrillator like the one Vice President Cheney received shortly after taking office. If your heart function remains stable and you continue to be asymptomatic, that (along with your medications) may be all that is necessary to do at present.

You don’t mention your age or the type of heart disease you have, both of which need to be considered before making any recommendations. However, should you experience further deterioration or become symptomatic and unable to function, a heart transplant or some other intervention might be considered.

Heart Weak But Stable The Saturday Evening Post

• The PLAC Test measures blood levels of an enzyme called Lp-PLA2 that, when elevated, may trigger an inflammatory response inside an artery and set the stage for plaque rupture. Clots from ruptured plaque cause more heart at tacks than do narrowed arteries. In clinical testing, having elevated Lp-PLA2 levels doubled one’s risk of heart attack. People with an elevated Lp-PLA2 com bined with high blood pressure were about seven times more likely to have a stroke than those without the risk factors.

• The ArterioVision ultrasound exam measures the thickness of two inner layers of the carotid artery, the major blood vessel that provides blood to the brain. Studies suggest that the carotid intima media thickness (CIMT) test may detect early signs of atherosclerosis and vascular disease not evident on conventional testing.


For more information about the PLAC Test, visit plactest.com . 


For more information about ArterioVision, visit i-mti.com .

Are You As Healthy As You Think? The Saturday Evening Post

I am glad my articles are of interest to you. There is much research going on in the field of angiogenesis—that is, the creation of new blood vessels in the body. The goal of angiogenesis is to improve blood flow to areas of the body supplied by partially or totally blocked arteries. Naturally, this includes the heart, in patients with coronary artery disease, and peripheral muscles (such as the legs), in patients with peripheral vascular disease. Approaches include injecting genes and altered cells that can encourage new blood vessel growth. Ask your doctor to investigate the many trials that are going on in these areas to see if you might be a candidate to participate in one of them.

Advances in treating heart failure have also improved in recent years. While you may not be a candidate for a heart transplant at your age, there are other options that can be explored. Above all, do not give up hope, and be sure to keep on working. New procedures are being developed all the time. In fact, we have explored a procedure called spinal cord stimulation that we have shown to improve heart failure in dogs (Heart Rhythm 2008; 5:S53) and hope to test in humans in the coming year.

Heart Health and Hope The Saturday Evening Post

Tortuous coronary arteries are usually a normal variant of no concern. Sometimes they can be associated with high blood pressure. There is no need for routine testing of your children or grandchildren unless they have symptoms.

Convoluted Heart Vessels The Saturday Evening Post

Ablation procedures are usually catheter approaches designed to eliminate tissue in the heart responsible for causing, or contributing to, an arrhythmia—in your case, atrial fibrillation. This is commonly achieved with radio-frequency-produced burns and sometimes by freezing, delivered over the catheter tip. At times the first ablation procedure doesn’t destroy all the necessary tissue, and the arrhythmia recurs. Other times, the tissue appears dead during the first procedure but recovers over time to cause the arrhythmia again.

Whichever, a second ablation attempt is often successful. We perform such procedures in octogenarian patients, but it depends on how “young” the 80-year-old is. Your own doctor is in the best position to make that judgment call. Without question it would be nice for you to be able to stop your medications. That is why ablation procedures have become so popular. In fact, electrophysiologists are among the very few physicians in cardiovascular medicine who can produce an actual cure of a problem. However, there are some risks, particularly in the elderly and with second procedures, which is why your doctor is being cautious. I would suggest you and your doctor discuss the pros and cons and come to a decision with which you are both happy.

Second Ablations Often Succeed The Saturday Evening Post

These are excellent questions to also discuss with the doctor who implanted your pacemaker. I may be unaware of things about your medical condition that may make using your electric bed/massager or spa dangerous to you. Please talk to your doctor before proceeding with these activities.

My answers apply to the Adapta DR pacemaker and not necessarily to other types of pacemakers. Electric massage beds produce mechanical vibrations that may activate a special sensor in your pacemaker that detects motion. This can fool the pacemaker into “thinking” you are engaged in some sort of physical activity and require a faster heart rate. Consequently, the discharge rate of the pacemaker can increase. If this is a problem, your doctor can turn off the rate-responsive function of the pacemaker. Massage from your electrical bed and pulsations from a bath spa should never be applied directly over the pacemaker because that can contribute to mechanical damage of the device or leads. The pressure jets can also fool your pacemaker into thinking you are being physically active, and trigger a faster pacemaker rate. You can avoid this response by not allowing the pressure jet to directly hit the pacemaker area. The pulsations will not affect the valve replacement. Rarely, electrical current leaking into spas from faulty lights and motors can affect pacemaker function. Finally, keep the pacemaker at least six inches from all motors and magnets, either as a part of your bed or in the spa. If you have any unusual symptoms, turn off the bed or remove yourself from the spa and consult with your doctor. All in all, these are very simple things to consider and/or avoid, and you should be able to enjoy your bed and bath without a problem.

Pacemaker Safety The Saturday Evening Post

Changes in mentation (mental activity) can occur in a minority of patients after coronary artery bypass surgery. The reason(s) for this are not entirely clear but may relate to use of the heart-lung machine to which your blood circulation was connected as a “substitute heart” when your own heart was stopped to make repairs. In some patients it is thought that very tiny clots form in the tubes of this machine and travel to the brain, affecting its function. A second possibility for your hallucinations is a side effect from medications. You don’t mention taking any drugs, but sometimes narcotics like Percocet or other medications can be responsible. Whatever the cause, if these hallucinations continue, you should definitely tell your doctor about them so you can be evaluated. They are not fun to have.

Hallucinations and Heart Surgery The Saturday Evening Post

It sounds like you underwent an electrical cardioversion (a shock to the heart delivered through patches on the chest, or done with drugs) for atrial fibrillation, and your heart is now in a regular (sinus) rhythm. If that is not the case, or your heart is no longer in a sinus rhythm, perhaps the cardioversion needs to be repeated. Many heart murmurs are “functional,” that is, noises caused by swirling blood, and are unimportant. Also, some heart defects that cause a murmur at birth correct themselves over time. Regardless, you are now seventy-six, so it is possible that the heart murmur heard at birth is related to your present problem. A careful physical examination or echocardiogram would tell.

Swelling of the legs and knees is usually due to fluid that escapes from the blood vessels and leaks into the tissue, making them “puff up.” The most common causes of the edema you describe include heart problems such as heart failure, kidney troubles, and local leg problems such as phlebitis, or stasis—that is, legs in a dependent position (such as when you are sitting down) for prolonged time periods. The latter is common in older women who have had children. If the edema is due to stasis, the fluid is usually noticeably less in the morning after being recumbent during sleep. Sitting with your legs elevated on a hassock or something similar, and the use of elastic support hose available in most drugstores, can be helpful. If that doesn’t work, a mild diuretic can be tried. However, if the swelling is due to heart or kidney disease (atrial fibrillation can cause heart failure that can cause edema), you need to see your doctor and get professional advice from a specialist.

Leg Swelling The Saturday Evening Post

An IMT ultrasonic (echo) scan, or an intima-media thickness measurement of the wall of the carotid artery in the neck, is often used as a surrogate marker for the development of atherosclerosis. When cholesterol gets deposited into arteries, the inner (intima) and middle (media) parts of the arterial wall thicken, so that a thicker wall produces a higher IMT score, which indicates the presence of increased cholesterol deposition and, therefore, more advanced atherosclerosis. What happens in the carotid artery in the neck appears to correlate with what is happening to arteries in the heart and head and, therefore, indicates a greater propensity for developing problems like a heart attack or stroke.

However, the IMT score is only one piece of an overall evaluation, and there are no studies showing that such a measurement alone improves patient outcomes. Nevertheless, given your family history and the fact that you have plaque in your carotid arteries (and assuming your lipids are abnormal), treatment with a statin would be indicated. If you were my patient, I would also address other risk factors such as diet, activity, smoking, blood pressure, weight, diabetes, and so on, and not consider a statin in isolation.

IMT Scan vs. Other Factors The Saturday Evening Post