I’ve begun to work out recently with a personal trainer because I am about 80 pounds overweight. He is concerned that I have difficulty getting my heart rate up. After 20 to 30 minutes of cardio (3 miles per hour at a 2 percent incline on the treadmill), my heart rate is still around 98 to 105. Should I be working harder or could it be a result of taking Toprol XL even though I do not have high blood pressure, nor have I ever had it? My cardiologist thinks taking 1/2 of a 100-milligram tablet daily is a good idea to prevent future attacks.

I also take simvastatin, tizanidine and an 81-milligram aspirin each day. My triglyceride result just came back at 223, but the rest of my cholesterol was normal. My total was 180, and my heart rate while standing still is about 68. And I smoke cigars daily. Need I worry? My trainer is.

DEAR READER: For the benefit of those readers who may not know what a coronary spasm is, I will explain briefly. It is a contraction of the muscles in the wall of the artery. Because of the narrowing, blood flowing to the heart muscle could have been reduced or stopped briefly, resulting in chest pain and possible heart attack. Coronary spasms typically occur in people with an increased risk of heart disease, such as those who smoke, have a history of hypertension and/or hypercholesterolemia. Already, you are three for three.

Treatment involves smoking cessation, consuming a healthful low-fat, low-sodium diet, lowering blood pressure, exercising and taking medications to prevent recurrence. While I don’t know your complete medical history, I have some concerns and wonder whether more than one physician is involved in prescribing for you. For example, Toprol XL slows down the heart rate. Simvastatin can cause angina in 3 percent of treated patients. I am not in any way implying you have been incorrectly prescribed. I would simply feel more comfortable knowing all physicians involved have a complete game plan when it comes to your health.
While on simvastatin, your triglycerides remain high. Does your diet need revision? Are you reading labels, staying away from cold cuts, hot dogs, kielbasa, sausage, sweets or baked goods containing tropical oils, ice cream and cheeses? Have you substituted fresh fruits and vegetables and broiled fish? A modification in diet, if appropriate, might go a long way toward bringing down your blood pressure, cholesterol levels, weight and your risk of a repeat cardiac event. Beyond that, I suggest you give up the cigars.

Now, on to your heart. You indicate a normal rate is 68 when you are at rest. This climbs an impressive 37 points with exercise, which just might be normal for you. There may be an underlying condition, such as autonomic neuropathy, where the heart rate remains relatively unchanged in response to activity rather than fluctuating. You don’t suffer from exercise intolerance, yet you may have conditioned your body to tolerate the exercise without placing undue stress on your system. Compare yourself to a well-trained biker or runner who can seemingly exercise indefinitely without breaking a sweat.

Make an appointment with both your primary-care physician and cardiologist, and go over the issues you have presented to me.

To provide related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER:
The heart is enclosed in a two-layered sac-like structure called the pericardium. Pericardial effusion occurs when extra fluid gathers in between the two layers. Typically there is a small amount of fluid but damage, injury, inflammation and more can cause the amount of fluid to increase. As the fluid increases, it restricts the heart’s ability to pump efficiently.

Symptoms of pericardial effusion include shortness of breath, cough, fainting, dizziness, painful breathing, chest pain, rapid heart rate, low-grade fever, sense of weakness and more. In some cases symptoms may not be noticeable or present at all. This is especially true in individuals in whom the fluid has gradually increased due to certain disorders.

There are several causes including infection, cancer, autoimmune disorders, hypothyroidism, radiation, HIV, chemotherapy, trauma, some prescription medications, kidney failure and more. In some cases, the cause cannot be identified.

Treatment varies from person to person depending on the amount of fluid, the cause, and whether or not it is or could cause decreased heart function. Common treatments include anti-inflammatory medications and various procedures. These can include needle aspiration to remove the fluid, open heart surgery (primarily for bleeding into the space), sealing the two layers together, and removal of all or part of the pericardium.

If your friend is displaying symptoms and has recurrent effusion, he needs to follow his cardiologist’s advice. Severe or repeated episodes can cause heart weakening, heart failure and death if not properly treated.

To give you related information, I am sending you copies of my Health Reports “Coronary Artery Disease” and “An Informed Approach to Surgery”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092.

I later told one of my friends (a nurse) who said that her husband (a physician) had high cholesterol but he didn’t want to take statins because of the side effects. They discussed the cinnamon and decided to try it as he had nothing to lose. At the time he was also having terrible bouts of angina and ate nitro pills by the handful. The pain was so severe that his wife also had to give him injections of pain killers just to relieve the pain. Both the nitro and pain medication were prescribed by their primary care physician.

After taking the cinnamon every day for three months, his wife wrote to me to tell me that he had not had a single angina attack in over two weeks. I asked him, since he is a physician, if he thought the cinnamon played a role and he said he thought it had to be because he hadn’t changed anything else. I don’t know if his cholesterol dropped, but I knew I had to write you to tell you.

I don’t believe it will help every one, but since it is harmless, I hope you will print my letter in the hopes of helping others. We use one 1000 mg capsule daily. I get mine for about $4 for 100 pills at a local drug store.

DEAR READER:
I had not heard of this “side effect” of cinnamon therapy. I am printing your letter for reader interest.

My personal experience with cinnamon to lower cholesterol was not successful, nor was it for several of my patients. However, many of my readers have had dramatic reductions in their levels. Some use cinnamon capsules, others use ground cinnamon from the baking aisle of grocery stores. Still others say only true cinnamon works as most products labeled as cinnamon are really cassia, a cinnamon-like spice. Some feel it doesn’t matter whether it is cassia or cinnamon, but rather what the dosage is, endorsing sprinkling a teaspoon on food one to three times a day being better than one large or several small doses a day. In the end, what works for one doesn’t work for everyone and it is simply a matter of trial and error to find what works best for you.

As for the angina connection, I am intrigued — especially because it worked for a physician. As you may know, we doctors are notoriously difficult to treat and to convince of anything. Before using any supplement, I recommend discussing it with your personal physician to ensure it is safe and will not interact with any prescription or over-the-counter medicines you might be taking.

When I receive a number of responses, either negative or positive, I will be sure to write a follow-up.

To give you related information, I am sending you copies of my Health Reports “Coronary Artery Disease”, “Compelling Home Remedies” and “Understanding Cholesterol”. Other readers would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

Shortly after starting them I began having muscle pain in my legs and had heard warnings about statins, including those from your column. I was already taking co-enzyme Q10 so knew it wasn’t due to a depletion. I asked my cardiologist about a cholesterol lowering medication without statins but he said they weren’t any good and switched me to Crestor instead. It was still a statin and despite my concerns, I took it like a good patient. The pain returned so I stopped it and started watching my diet more closely. My cholesterol dropped to 217. During my next doctor visit, I again complained about the statins, hoping this time the doctor would listen. Instead he told me to find another cardiologist and left the room.

I left his office feeling pretty devastated. Was I wrong to refuse to take statins again or should I have just let him think I was still taking one even though I wasn’t? Should I really find another cardiologist?

DEAR READER:
You should absolutely find another cardiologist. Yours was rude and out of line. Having tried two separate brands and experiencing side effects from both, it is clear to me you cannot tolerate statins. While it is true that non-statin cholesterol lowering medications aren’t as effective as their statin counterparts, they are a a viable alternative given the situation. .

Find a new cardiologist, explain your situation and if he or she isn’t willing to work a little harder to help, then move on to another. Once you find someone willing to listen to and work with you, you should find your condition and outlook improving.

To give you related information, I am sending you copies of my Health Reports “Coronary Artery Disease” and “Understanding Cholesterol”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 per report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Could you please explain what this disease is, what happens to the body, any treatment options and what the prognosis is? I only know that somehow the heart doesn’t pump right.

DEAR READER:
Cardiomyopathy is a condition which causes the heart muscle to weaken leading to inadequate heart pumping and blood flow, as well as other problems such as palpitations.

There are several types of cardiomyopathy. Each is associated with a different cause. Some of these types include alcoholic, dilated, ischemic, restrictive, toxic, infectious, idiopathic and more. Causes include alcoholism, heart attacks, viral infections, lupus, celiac disease, long-term severe high blood pressure, and many others.

Because you don’t say what type your daughter has, I cannot give specific advice. However, I will briefly explain some general information including symptoms, treatment and prognosis (outlook).

Symptoms vary from person to person and from cause to cause. Some of the more common symptoms include fatigue, high blood pressure, palpitations, edema (swelling), cough (caused by fluid buildup in the lungs due to heart failure), shortness of breath and more.

If cardiomyopathy is suspected, a physician would likely order blood work to check for anemia, elevated cardiac enzymes, as well as imaging studies including a chest X-ray, echocardiogram, heart ultrasound and angiography.

Treatment often involves dietary and behavior modifications and medications. A low fat, low salt diet and daily exercise to increase stamina and heart strength can be extremely beneficial. It is important to make sure that your doctor approves of any diet and exercise plan before it is started.

Medications can include those to lower blood pressure, improve blood flow, reduce the workload of the heart while improving the heartbeat, relieve fluid buildup and slow the heart rate. What medications are given depend on which type of cardiomyopathy your daughter has.

In severe cases, heart transplant may be necessary. There are a few procedures that can be done to prolong life until a heart is available but are not a cure.

The prognosis depends on the severity of the damage, the cause and the response to treatment. Some individuals may worsen very quickly while others have mild symptoms. The condition is chronic and there is no cure.

Your daughter needs to be under the care of a cardiologist who can advise her further on possible treatment options and what steps she can take to improve her quality of life.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092.

DEAR READER:
I have written many times in the past that I cannot be used as a second opinion for upcoming procedures. I simply provide information to the writer that can be used to receive appropriate medical care from a physician that can examine him or her.

I regret I cannot respond to every letter I receive but due to sheer volume I must limit myself to answering letters that are of interest to the general public or can provide awareness of needy causes.

If you are reading this, you must now realize that it is far past the date of your procedure. Whether you are better or not, I do not know. I would imagine that the atrial fibrillation ablation did little to improve the pulsating in your head as the sensation is often caused by plaque buildup or narrowing of the carotid arteries in the neck.

Ablation is a medical procedure that essentially destroys tissue. In your case it was heart muscle. Atrial fibrillation is an abnormal heart beat and the ablation was used to destroy the area of the heart that was sending out abnormal signals.

You said you had confidence in the physician but couldn’t get an exact answer about the pulsating. I take this to mean that he or she attempted to answer but was unsure if it would help or not. No physician can give an exact answer about a medical procedure because situations and circumstances vary from person to person. What helps one may harm another.

If you continue to have problems, return to your physician and request further testing. Personal physicians are often the best source for information. They know your medical history, current health status and other vital information. I am merely here as a tool to aid patients who are experiencing difficulty in getting straight answers or have hit a brick wall as far as diagnosing a medical condition is concerned. My advice is not to be used as a replacement for appropriate medical care but as an adjunct to it. An outside, fresh perspective can sometimes shed light on a situation and thus leads to a positive finish. I hope that I am that perspective.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Why do they insist or believe they are in very good health? What do they consider poor health? I am a 72-year-old male. I’ve had a couple of stents put in my heart. I’m on Plavix and blood pressure medication. I also have skin cancer and have had several lesions removed. I wear a hearing aid.

I can still walk and mow the lawn, do work around my house and ride a bicycle, but I don’t consider myself to be in good health, just lucky and in better health than all those people who write to you. Whom are they kidding?

DEAR READER:
So much of life is in a person’s attitude. To some of us, the glass will always be half empty. For others, it will always be half full.

Hopefully we go through life eating and exercising properly, watching our weight and health, and visiting a physician for routine medical matters. Problems arise when our bodies don’t work as perfectly as we would like. We may be under stress and develop high blood pressure readings. A cancerous lesion may be discovered during a routine physical examination and needs to be removed. We may have a family history of heart disease, diabetes, stroke, and a host of other issues over which we have no control.

What isn’t beyond our control, though, is the attitude with which we approach health matters. By maintaining a positive attitude, we can learn to deal with some pretty gruesome issues and be grateful the situation isn’t worse. There are few promises in this world. When it comes to health, no amount of money can buy a perfect body that functions without mishap. Were this the case, we would then attempt to barter with the powers that be for an additional five or ten years because we haven’t done all the things we set out to do. The bottom line is to make the most of life despite the glitches and snags along the way. That’s what builds character.

You admit to remaining active and being in better health than many of my readers, despite your medical issues. Well, you’re a reader and still going strong. Work on your outlook, you’ll have much more fun. And your friends and family might just enjoy you more, too.

Because you mention stent insertion and hypertension, I am sending you copies of my Health Reports “Coronary Artery Disease” and “Hypertension“. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 for each report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR READER:
The heart is a muscular cone-shaped organ, approximately the size of a clenched fist that pumps oxygenated blood through the entire body. In essence, it is a natural pacemaker. The chambers of the heart include two ventricles with thick muscular walls and two atria with thin muscular walls. The heart is divided into right and left sides by an inner wall known as the septum. The purpose of the right side of the heart is to pump blood from which the oxygen has been removed into the lung arteries. The purpose of the left side of the heart is to pump re-oxygenated blood throughout the body.

Heart block occurs because of the interference of electric impulses that control the activity of the heart muscle. Sometimes the impulses cannot travel through the heart because of a blockage. When this occurs, an individual is said to have a bundle branch block. The rhythm and rate of the heartbeat will not be affected, but the event will take longer because of the slowed impulse.

If a block is located in the right bundle branch, it is medically referred to as a right bundle branch block. If located in the left bundle branch, it is known as a left bundle branch block. A blockage can be caused by coronary artery disease or other diseases that affect the heart muscle.

Without other conditions or symptoms, an individual may not even be aware of a heart block. Those who do experience symptoms may feel faint or actually experience syncopal episodes. It is known that individuals with a left bundle branch block may be at higher risk for heart disease than those without a known blockage.

A bundle branch block will be revealed through an electrocardiogram. In fact, the tracing read by your physician may provide the diagnosis and identify the location of the blockage.

In many instances, individuals can live without treatment. For those patients with a block and another cardiac condition, treatment may be required. This might include a pacemaker that will help regulate the heart’s rhythm, or with a pacer known as cardiac resynchronization treatment (CRT). A pacemaker ordinarily paces one of the lower heart chambers while CRT re-coordinates the beating of both ventricles by pacing them at the same time.

I cannot determine from your brief letter if you have anything to worry about. Only your primary care physician or cardiologist can determine what might be appropriate for you. Without a known cardiac condition, you might not require treatment and will continue to function with your blockage. With a known condition, you need to sit down to discuss the situation to determine what lies ahead.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 440902. Be sure to mention the title.

The fact is, he is the one off base. The tests are exactly what they say they are, “screening tests”.

I want you and this gentleman to know that these tests can be life saving screenings. In a group of five friends that had these screenings at different locations and times, three were saved by them. One had a serious aneurysm that was discovered and was notified immediately. He was advised to see his doctor who ran additional tests and performed surgery at once. Another friend’s screening showed a severely blocked carotid artery and was again immediately notified and sent to her doctor. After additional tests, she had to have surgery as well. The third friend had a different situation for which he was alerted and sent to his doctor. Thankfully he did not need surgery but is now on medication to control the condition.

I would say that three out of five success stores is a pretty good recommendation for this type of preventive and cost effective health care.

DEAR READER:
In this case I must agree with you. At least two of your friends certainly appear to have been saved from potentially fatal conditions.

To date I have continued to receive more negative comments about these screenings than positive, but the bad experiences are primarily based around the osteoporosis screenings.

I believe that Life Line Screening is a personal choice. It is indeed cost effective, especially for those with little or no health insurance but in some instances can lead to unnecessary additional testing. I would recommend individuals avoid the bone density scans available through this company and opt for the more expensive but more accurate hospital based bone density study. The other screenings, as long as they are performed by competent well trained individuals, preferably nurses, PAs or other medical personnel, are an appropriate option.

Thank you for writing to share your story and I hope it will help others to make better informed decisions about this service.

Because you mentioned carotid artery blockage, I am giving you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

What prompted me to write this note to you is the letter you received from another doctor challenging your right to put on paper advice as to what you felt could be done with a patient who needed an abdominal aortic aneurysm repaired. There are some points in the letter of this MD that are very disturbing.

One: The general manner that the letter is impolite, unworthy of a professional person. By the way it is worded, one gets the impression that this fellow has a superiority complex and/or he is envious that he/she is not writing your column.

Two: I have been reading your column for years now, and I have never read anything that would indicate a radical action by your readers about their health without consultation with a doctor of their choice. You simply give options.

Three: This MD seems to think that we, the common folk, have no intelligent sophistication in examining the options that you bring forward. He seems to believe that we cannot evaluate the dangers that are present in serious operations.

Four: There seems to be a hue of age discrimination in his remarks. Just because we are old — I am 80 — does not mean that we should not be able to avail ourselves to the modern methods of medicine and, furthermore, as I noted already, that we should not be allowed to have a part in the decision on a very risky operation.

A personal experience: I was hospitalized with heart problems when I was 79. It was a very fine cardiac hospital with excellent physicians. The cardiologists recommended by-pass surgery. My third day there, the leading heart surgeon walked into my room and with a brutal manner he told me, “About 99% of patients who had by-pass in 1980, when you had your first one, are dead. Because of your age and the special difficulty your case presents we will not operate.” I felt terrible and was angry. After all, I should have had a say in that decision. I asked a cardiologist to refer me to the Cleveland Clinic and forward all my records there. The clinic agreed to examine me and evaluate my condition. My wife and I journeyed there.

Following a few days of examinations, my wife and I were asked to a conference with the chief cardiologist. He asked me, “Do you want this operation because you want to live longer or because you desire to improve the quality of your life?” My answer was to improve my life’s quality. He then told me that they had serious concerns, yet he would recommend an operation if I still wanted it. I said yes. And the surgery was successful.

This is a long dissertation but this MD truly struck the wrong cord in me.

DEAR READER:
I agree with your observations about that particular letter. I am unsure if he or she was an MD, but can only hope that was not the case. This person should not be allowed to care for others with the attitude displayed.

As to your experience with the head cardiologist at the hospital, I am appalled at his behavior. You had the right to a potentially life saving operation and if he were uncomfortable with it, he did not need to do it, but he could have said as much and referred you to someone else who was willing.

I applaud your level-headedness in asking for and receiving a referral to another cardiologist. I am glad that the Cleveland Clinic was open enough to involve you in the decision about your life and risk you were willing to take. The physician there appears to be kind, compassionate and, given you are alive and well, very skilled.

Thank you for writing and expressing your well-thought out, considerate comments. I always enjoy receiving letters such as yours. Keep up the good work.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.