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Health & Medicine

2001-07-01 09:02:00

Take your health to heart

Dr. Joseph Galichia Question:  What causes blockages to form in arteries?Answer:  The build up of plaque can occur in any artery of the body.  However, in the United States these blockages are prone to occur in the small arteries of the heart.  These small arteries are called coronary arteries.  Blockages can also form in the arteries in the brain, the neck, the legs, and any other organ system.  We do not understand all of the reasons for the build up of plaque or blockages, but we do know that some factors predispose us to having this problem develop.For example, we know that smoking puts us at a high risk for developing vascular disease of all types, and in particular, coronary artery disease.  It is felt that smoker's may have 5 times greater risk of having a heart attack or stroke than their counterparts who do not smoke.  Furthermore, a combination of other risk factors makes smoking even more of a lethal problem.  Aside from that, high cholesterol levels, particularly if the LDL, or bad cholesterol, level is elevated, makes us more susceptible to vascular disease.  Diabetes, smoking, a lack of physical activity, being overweight, and high blood pressure also predispose us to developing blockages within our arteries.There are some risk factors which can be altered, including the ones mentioned above. However, a family history of heart disease also puts us at greater risk, and being of the male gender creates a risk earlier in life for developing plaque within arterial walls.  For instance, men tend to have heart attacks about 10 years earlier in life than women and it is felt that the difference is due to estrogen production in women prior to menopause.  After menopause, things even out and the risk of heart disease in women approximates men for the rest of their lives.There are certainly things we can do to lower our risk factors, including maintaining a normal blood pressure, maintaining a normal body weight, exercising at least 45 minutes five days a week, and doing our best to handle stress in our lives.  Unfortunately, no simple formula will eliminate the risk of atherosclerosis (hardening of the arteries), and as one ages, the probability of developing changes within the arterial walls becomes greater.  Being aware of the risk factors, maintaining close contact with you doctor, and developing a sound surveillance system is absolutely crucial to minimize the risk of heart disease and stroke.Question:  I have been on Lipitor for several months and my cholesterol has come down. When can I stop taking this drug?Answer:  Drugs like Lipitor, Zocor, Pravachol and other drugs, which we call statins, are very short acting drugs and do not give any long term protection.  The cholesterol lowering affect only happens while you are taking the medications.  Unfortunately, upon stopping the drug, the cholesterol will zoom back to its previous level.  There is no long term or curative affect from any of the drugs available to us today to treat cholesterol. Thus, it becomes a problem of daily maintenance including dietary restriction of fat and continuing to take your medications.If you are taking a drug like Lipitor, or one of the other statins, you should monitor cholesterol at least once a year and also have monitoring of your liver function tests.  The possibility of developing liver disease due to these drugs is extremely low, but nevertheless, long-term surveillance is strongly indicated.   Question:  I recently had a frightening experience of being unable to move my right hand for approximately 10 minutes.  The symptom passed and I was able to regain the use of my hand without any problems whatsoever and I have not experienced the immobility since.  I told my doctor a couple of weeks later about the episode and he became very alarmed and ordered some tests. He said he thought I had a TIA.  Can you explain the significance of a TIA?Answer:  What you described is an example of a TIA, or in medical terms, a transient ischemic attack.  It simply means that you lost some neurologic function momentarily.  People who have TIA's are often very frightened, and unfortunately, fail to seek urgent medical care for this problem.  Either a small clot passing through an artery or some other problem, often consisting of a spasm in an area of a blocked artery in the brain, usually cause these problems.  Unfortunately, a TIA is simply a warning sign that you may be about to have a serious and completed stroke.  The significance of this event is that very strong efforts need to be undertaken to find out if there is some correctable anatomical problem that will lead to a major stroke.   People with arterial narrowing in their neck arteries may have a part of the plaque break off and go to their central nervous system causing an event just like you described.   Small clots in the heart or even clots that come from the legs can, in some cases, migrate into the brain causing such a reaction. Fortunately, in your case, your body helped dissolve this clot quickly and you did not proceed to have permanent neurologic damage. It is best to think of a TIA as merely a warning signal that you are about to have a stroke. I recommend the following to all patients:1. If there is any question about the loss of any neurologic function, even for a period so brief as a minute or two, call 911 and go to the hospital immediately.2. Physicians who see patients with these complaints must be very cognoscente (a person having expert knowledge) of any findings on the examination, such as sounds called bruits in the neck arteries, or the presence of a heart murmur or any defect in the cardiovascular system.  Such an evaluation most often consists of a Duplex scan or Doppler study of the neck and also an echocardiogram.  Furthermore, an MRI or CAT scan of the brain, and often a relatively new test called MR-angiography, a test used to look at the smaller arteries in the brain, may also help us understand this problem.People who have blocked arteries in their neck may benefit tremendously from surgery to eliminate the plaque in these vessels and that will decrease their risk of a stroke immensely.  In other situations, we are unable to correct the problem anatomically but may be inclined to give drugs to prevent clot formation including aspirin, a newer drug called Plavix or perhaps cholesterol lowering drugs to stabilize the lining of the blood vessels.  Fortunately, if you have a TIA and you heed the warning signs, most people can avoid proceeding towards a major stroke.Question:  I have been very sedentary most of my life but I recently had bypass surgery and was told by my doctors to exercise daily.  I can't seem to carry out their instructions because I get pain in my right leg when I walk quickly.  I have spoken with my doctor and he says I simply need to "get in shape".  What should I do?Answer:  The symptom of pain in the leg on exertion, relieved with rest, is known in the medical world as claudication.  This is simply a medical term that implies to your doctor that there is most likely a deficit of blood flow to your leg.  Classically, this pain occurs in the calf but may also occur in the buttocks or the thigh area.  Most people can walk a certain distance, then experience cramping in their leg to the point where they have to stop walking.  If they rest for a while, they can usually walk about the same distance before the symptom recurs.  This complaint is highly significant as it implies that there is a blocked artery to that extremity and immediate evaluation is indicated. In our clinic, we begin by feeling for the pulses in the legs, but proceed almost immediately with a test called a Doppler examination where we can ascertain whether or not there is a blood flow deficiency in an extremity. This is a very simple, non-invasive test and can be done in a few minutes.  If blockages exist in the legs, most of the time they can be improved markedly by doing balloon dilatation or stenting of one of the vessels. In certain instances, a bypass procedure can be done in the leg to restore blood flow to the leg.It is very common with people who have heart disease, namely blocked arteries in their heart, to have blocked arteries in other areas including the legs.  By the same token, most people who have a blocked artery in the leg,  neck or a part of the body away from the heart, do have underlying heart disease.You should have an immediate evaluation for this problem. Fortunately for you, most of the time these arteries can be repaired non-surgically. By Dr. Joseph Galichia