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:
You don’t need to worry. The fingernails can become ridged or curved as we get older or if a vitamin deficiency is present. This is normal. To my knowledge there is no relation between the fingernails and the heart.

If you had an acute MI, you should have been hospitalized and given a complete cardiac evaluation. On the other hand, if testing revealed an old MI, you should have been able to leave the hospital and see a cardiologist.

I recommend that you make an appointment with a cardiologist immediately. You need to be under the care of the specialist so that you can prevent another heart attack. During the appointment, you can ask about your platelets. I am sure that he or she will do a full work up, including blood work and testing such as a stress test. This will allow the physician to assess any damage to your heart and check if you have had other heart attacks. Your bizarre symptoms may actually be minor heart attacks.

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.