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Health & Medicine

2003-07-01 13:54:00

Take your health to heart

Dr. Joseph Galichia Question:  I have on again, off again chest discomfort. I am concerned that it may be angina? But, I also have a "pre-ulcer" in the esophageal lining to my stomach, so I have a lot of heartburn trouble? It's difficult to determine which is which. Should I be concerned?  If I exert a fast run to the mail box, I do experience discomfort in the chest. I know I need to reduce my weight and start an exercise program. I had heart exams (cardiac) in 1996 and again in 2000, they couldn't find anything. However, my cholesterol has risen to 195, from 155 a year ago. I am a 46 year. old female. I weigh 210 pounds.  I'm 5'9” tall. I feel a dull, pressure under my left breast.  When I put my hand over it and push down it feels better. I wonder if this is the start of something?Answer:  Any pain above the waist is potentially related to the heart.  However, the strict definition of angina pectoris is pain in the center of the chest brought on by exertion and relieved with rest or nitroglycerin.  The pain may radiate to the neck, jaw or left arm and is most often a pressing sensation or a burning pain.  The significance of this type of symptom is that it best correlates with chest pain of cardiac origin.  Your complaint of pain running to the mailbox is certainly suggestive of cardiac pain by this definition.  Like most patients, however, you do not present with a simple situation.  You have a known gastrointestinal problem, possibly esophagitis which may cause similar symptoms.  People with ulcers, gastritis, or esophagitis may also experience chest pain, sometimes with exertion.  In this regard, I always tell my patients that no one ever read the textbook and told me a perfect story for one condition or the other and thus, I must always get more objective information.  A good physical exam and some basic tests such as a treadmill test, echocardiogram and a chest film may steer me towards the diagnosis of heart disease.  Looking into the stomach and esophagus with an endoscope and doing a gallbladder sonogram are usually part of a good examination of the G.I. tract.Certainly, losing weight and lowering your cholesterol are part of a good long-term strategy for wellness, but establishing a diagnosis of your condition now is critical.  Missing the diagnosis of heart disease could result in a heart attack or sudden death.  Failure to diagnose a gastrointestinal problem or other cause of your pain could result in bleeding or a host of other serious problems.  Making the diagnosis early is always to your advantage.Question:  I am 68 years old and I noticed that I get short of breath when I try to do anything quickly.  Also, I am more fatigued than I have ever been in my life. Could this be my heart?Answer:  Increasingly, we find that people with shortness of breath do indeed have underlying heart disease.  There are many other things that can cause us to feel short of breath and fatigued, including anemia, chronic lung disease, a lack of physical conditioning, or being overweight to name a few.  However, in my practice I have found that when people come to me with this complaint, there is usually something serious going on.  I always look to see if the patient has anemia and evaluate for lung disease.  But in many instances, we find that, indeed, the problem lies in the heart.  Most of these patients have blocked arteries that are causing their heart to function poorly when they exercise, thus causing them to get short of breath.  Similarly, a feeling of extreme fatigue may be the first warning sign that you have heart disease.   Many of our patients have heart murmurs caused by valvular problems, which may also cause these symptoms. A thorough evaluation is always indicated, in my opinion, if someone even thinks they are more short of breath than they have been in the  past.  A good physical examination, a Treadmill test, chest x-ray, and quite often, an echocardiogram, help to rule out heart disease and a pulmonary function test helps us understand if the lungs are functioning properly. These are all simple tests with little or no risk to the patient.  Of course, a simple blood test, including a blood count to rule out anemia, and a quick assessment of the kidney function, liver function and the patient's cholesterol level, help guide me towards a more complete understanding of why the patient is experiencing shortness of breath.  Question:  I have had high blood pressure for 15 years and I have faithfully taken my medications maintaining my blood pressure.  Recently, however, for no reason whatsoever, my blood pressure has started to get out of control and my doctor  had to add a new medication.  Still my blood pressure tends to run high and I am worried that something new may be going on to cause this.  What should I do next?Answer:  I view a sudden change in blood pressure as a tip off that something new is happening in the body to cause this problem.  One in every four American adults has high blood pressure and 9% of those patients have what we call essential hypertension.  Essential hypertension simply means that there is no known cause of the blood pressure elevation.  No tumor, no blocked artery and no other underlying condition exists to cause the blood pressure to go up.  In many of these patients, it is hereditary and in some individuals, it may be related to inactivity or being overweight.However, in a smaller number of patients in my own practice, in about 15 to 20 percent, there is indeed something causing the blood pressure to be elevated.  In many instances, we are dealing with a blocked artery in the kidney that is narrowed and disturbs the blood flow to the kidney. This causes the rise of certain hormones that are produced by the kidney and they cause vasoconstriction (narrowing of the cavity of a blood vessel) and the retention of sodium in the body, which tends to raise the blood pressure. This condition is known as renal artery stenosis and must always be considered in someone who suddenly has a rise in his or her blood pressure.  I find that it is something I consider in all patients who present me with new onset hypertension, including younger patients, even in their teen's and twenties.  In older patients, particularly those who have been stable for some period of time and have a sudden change in their blood pressure, I am always concerned about the possibility of renal artery stenosis (narrowing of the arteries to the kidney).Renal artery stenosis can cause both the top number (systolic pressure) and the bottom number (diastolic pressure) to rise dramatically.There is a non-invasive test, which is called a renal Duplex scan, used often in our clinic to help make this diagnosis.  In some instances, the renal Duplex scan simply cannot see the artery well enough for us to be certain about it and a dye test may be necessary to make the diagnosis.  Fortunately, balloon dilatation of the narrowed vessel, most often also entailing putting a stent in the artery, will usually cause the blood pressure to be more manageable.  A second benefit of finding a blocked kidney artery and addressing the problem is that, in many instances, we actually save the kidney and also enable to the patient to prevent kidney failure.If your blood pressure is difficult to manage, or if you have new onset of high blood pressure, you should ask your doctor about the possibility of a blocked kidney.