I’ve been to the VA doctors. They say whatever I’m doing, I should keep it up. I have no symptoms, none! When you quit smoking, they have classes and support. When you get cancer, they have classes and support. When you have diabetes, they have classes and support. When you have heart disease, there is silence. I don’t know what or how much to eat. Can I run or lift weights? I’m taking a baby aspirin and 40 milligrams of Zocor. I’ve gone 10 years with worrying and waiting for the big one. What’s your advice?

DEAR READER: My initial guess is that your doctor either misspoke or you heard him incorrectly. I don’t doubt you one bit, but I think you were misled. I’ve not known anyone with even potential cardiac problems who was not referred to a cardiologist for regular follow-up. The decision of whether to perform bypass surgery or angioplasty would have depended on your general overall condition and the extent of the heart disease. That leads me to believe you were not a candidate for surgery at that time.

Part of heart health is exercise and a healthful diet. Therefore, include fresh fruits and steamed vegetables, broiled fish and chicken. If you are a beef eater, cut away the fat prior to cooking the meat. Switch to fat-free milk. Substitute low-fat or frozen yogurt for iced cream. Avoid fried foods, hot dogs, sausage, luncheon meats from the deli case of your local grocery store and tropical oils readily found in cookies and pastries. Your total cholesterol intake should be less than 200 milligrams daily. Read labels. Become a savvy shopper.

If you haven’t had any symptoms of a cardiac disorder for 10 years, the condition probably didn’t or doesn’t exist or isn’t/wasn’t as severe as you believe. However, to play it safe, make an appointment with a new physician for a complete physical examination and appropriate laboratory and X-ray testing. After all this time, I am sure you are convinced there is an underlying cardiac issue. Request a referral to a cardiologist. Present your problems and ask for answers. If additional testing is called for, have it scheduled. If something comes to light, pursue it. If not, get on with your life and put this 10-year nightmare behind you.

To give you related information, I am sending you a copy of my Health Reports “Understanding Cholesterol” and 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 for each report made payable to Newsletter and forwarded to PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print out an order form from my website www.AskDrGottMD.com.

I recently came across an article on the topic of isolated systolic hypertension, in which a physician pointed out that this form of hypertension can lead to serious problems — stroke, heart disease, chronic kidney disease and dementia. The doctors and nurses who have taken my blood pressure have universally said that the diastolic reading was not a consideration; however, this report indicated that medications to control systolic hypertension should not be allowed to cause the diastolic pressure to go below 70 mmHg.

I am an 82-year-old diabetic male off medications for three years now due to exercise and diet. I also have symptom-free bradycardia. I would very much appreciate your comments on this report.

DEAR READER: I am a little confused. You indicate you are a diabetic and have hypertension that was treated with two medications. You then go on to state that you have been off medications for three years. Does this mean the antihypertensives, diabetes meds or both? In any case, I congratulate you on taking control and maintaining a healthier lifestyle.

Isolated systolic hypertension is defined as a systolic reading of greater than 140 and a diastolic reading of less than 90. The condition can result from hyperthyroidism, a leaky heart valve or other causes.

There was a time when doctors devoted their attention to the second number, the diastolic, with the thought the body could tolerate fluctuations in the first reading. Then there was the “blanket rule” that the first reading would be normal at 100 plus the age of the patient, i.e., 175 in a 75-year-old male. Both schools of thought have been modified. Today, the systolic and diastolic are of equal importance, and the 100-plus reading has been totally abandoned.

Of concern in patients with isolated systolic hypertension is that prescribed medications may affect the second number, lowering it to the point that it might increase the risk of heart attack or stroke. The fine line then becomes keeping the diastolic at no less than 70 mmHg, while simultaneously keeping the systolic at an appropriate figure, just as the report indicated.

My guess is that your diastolic readings are too low, and that you might require medication to bring both numbers into line. Take a copy of the article to your physician for his or her review. A determination can then be made about whether you should be back on the two medications or not. No matter what, I would continue the exercise and diet modification.

The lisinopril you are/were taking is an ACE inhibitor used to treat hypertension and congestive heart failure. It can be used alone or in conjunction with other drugs for the same purpose. The amlodipine is a calcium channel blocker that works to lower blood pressure and decrease the heart rate. It, too, can be used in conjunction with other drugs for best results.

To provide related information, I am sending you a copy of my Health Report “Hypertension.” 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 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Three years ago my doctor prescribed clindamycin to be taken before dental procedures. I have since switched doctors and now my new doctor says this is not necessary. I am willing to discontinue using the antibiotic but am wondering if 1.) use in the past has any harmful effect and 2.) how do I get the dental staff convinced I don’t need it?

DEAR READER: For many years dentists and physicians have been routinely prescribing one or two doses of antibiotics prior to dental work if the patient has heart disease, stents or deformed heart valves. Recent studies have shown that such antibiotic coverage is not particularly useful in helping patients to avoid heart infections, so antibiotic therapy is now only recognized as appropriate in certain instances. Your doctor can advise you in more detail.

You have not been harmed by your previous antibiotic usage and I am certain that your dentist is now aware of the current guidelines. He or she can work with your primary care physician to decide if you need to continue preventive measures or if you truly don’t need the medication anymore.