OMG! CardiacConsult is now on Twitter!

If you understood that article title than this might be relevant to you. Otherwise, let me clarify for the less social media-inclined.

Twitter.com is a service that allows you to tell your "followers" what you are doing, reading, liking, cringing at, in less than 140 characters.

All sorts are tweeting these days form the Queen of England to... your neighbor.

Our Twitter handle is @CardiacConsult, so meet us there to find out interesting health news and related items that may, or may not, suit your fancy. It's only about a sentence worth so how bad could it be? See you there...

Would You Want to Read What Your Doctors Write?

Of course you would. And 95% of the patients surveyed agreed with you. And even stranger, so do most physicians. At least, that's what Tom Delbanco and his colleagues asserted in a questionnaire-based study using Open Notes, a system that allows patients to review all of the notes there docs are scribing.

View the abstract here from the Annals of Internal Medicine

But how much open-ness is too much? Will the doctors be reluctant to be blatantly honest in their assessment of patients if they know it will be read? And will patients fear being completely open when they know that their chart is more visible now - even if it's just to them?

Here's a quick article from the Atlantic on the topic.

Let's hear your comments...

Another Health App I Love

I have a feeling you're going to start to get sick of me posting about new health-related apps, but if you have an iPhone, iPod touch or iPad, this is just a wonderfully simple and effective device - and one that can be easily brought to the doc's office!

The iHealth Blood Pressure Dock is about as simple and straightforward as it gets. And at $99.95, it's not too pricey (only about $50 more than a typical digital cuff that you can buy at the pharmacy). There are 2 cuff sizes (standard and large) and they also have a scale available to record your daily weights.

Check it out here: http://www.ihealth99.com/

Don’t Be a Holiday Heart Attack

Don’t Be a Holiday Heart Attack
We don't want to be too much of a downer but it's hard to argue with cold hard facts and unfortunately, the data shows that you are more likely to die of a myocardial infarction on Chritsmas or New Year's than on other days.

This does not mean you are more likely to have an MI, though. So why would people perish more often on these days? Are the docs and RNs frolicking in the ER? Unlikely. The most reasonable explanation is that people are relucttant to ruin their own good time (and embarassed to ruin other people's good time) by admitting that something may be seriously wrong. 

Waiting the additional 30 minutes to present to the ER may ruin the Holidays for years to come as delay in presentation is one of the leading causes of death, associated with a heart attack. The quicker you call 911, the sooner an ECG can be done and the sooner a diagnosis can be made. As we say in the cardiac cath lab, time is muscle.

Saddest Cities in America | Yahoo! Health

Saddest Cities in America | Yahoo! Health

You might think that lots of sun equals more happiness - but you would be wrong. An interesting article on which cities rank "saddest".

Medicare Will Cover Obesity Education

Obama and Medicare have done good. For the most part.

The US government will now pay for a year's worth of obesity counseling for Medicare patients, putting an emphasis on lifestyle modification and education, knowing that in the long term, those who fare the best are the ones who have an understanding of the problem.


From TheHeart.org:
Tuesday, the Centers for Medicare & Medicaid Services (CMS) announced that it will cover obesity screening and counseling as a preventive service under Medicare. The services will be free to beneficiaries; the Medicare deductible and copay will not apply.

Medicare patients are eligible for "intensive behavioral therapy for obesity" from primary-care providers—nonphysicians included—in a primary-care setting if their body-mass index (BMI) is >30 kg/m2. They are entitled to one face-to-face counseling visit each week for a month, followed by a face-to-face session every other week for an additional five months.


There's also an incentive built in, wherein if a patient loses more than 6.6 lbs over 6 months, they qualify for another 6 months of education - and those who do not? Prison. Nah, just a 6 month period of the patient's "readiness to change".

Specific items covered under the new law:
- an obesity screening,
- an assessment of the patient's diet, and
- behavioral counseling and therapy to promote sustained weight loss through diet and exercise.

This course of treatment does not include medications for losing weight. How much Medicare will actually pay out to the healthcare professionals educating has not been established.

See the official decision memo published online by the Centers for Medicare and Medicaid Services (CMS).

Medication Compliance: Not A Money Issue?

It's no secret that adherence to medications is not great in America - or the rest of the world, for that matter. But you would think that if the medications were shown in numerous studies to actually save lives people would take them, right? And, if these patients had just had a heart attack then you would think that they would really take them, right? And if you offered these life-saving prescription medications to these heart attack patients for FREE then they would absolutely positively take them, right?

Wrong.

In fact, barely half of the patients who received prescriptions for standard, post-heart attack medications, free of cost, were filling them after one year. The other group, the ones who had to pay about $50 per month (the average copay) fared only slightly worse. 

Dr. Niteesh Choudhry of Brigham and Women's presented his study's findings Monday at an American Heart Association conference in Florida. They also were published online by The New England Journal of Medicine.

The study did not examine why people didn't take their medications, but was funded by Aetna (yes, that Aetna) in an effort to see if providing free medications would impart clinical benefit to their patients, and decrease long term costs as a potential aide effect.  But it appears money is not the major issue limiting medical compliance in this country.

As a physician, and a patient, I can attest to the fact that compliance with doctors' instructions is affected by so many things, money often playing a minor role.

Why is it so hard to take the medications doctors precribe? Is it because it makes us actually feel the opposite of healthy to take a medication? Is it that we're too busy? Too forgetful? Maybe it's because we can't actually feel the positive effects that it has on our bodies - there's no tangible reward like there are with dangerous drugs that we can't stop people from taking, e.g. weight loss pills and anabolic steroids.

Perhaps doctors have to do a better job explaining what it is that patients are ingesting and why these medications will help them down the line - even if they can't feel it.

Instead of subsidizing co-pays, perhaps insurance companies could spend that money on patient education or programs that reward compliance, encourage physical activity and emphasize healthy milestones.

Are you compliant with your medications? If not, why? Tell us what makes it so hard to follow instructions that should ostensibly improve your health.

Happy Holidays: Generic Lipitor Hits Pharmacies This Month

After a five-year reign as the #1 selling drug on the market, mighty Lipitor (aka atorvastatin) will come off patent on November 30th, 2011. Lipitor had more than $10 billion dollars in sales last year and has been prescribed to more than 17 million patients in the United States, alone.

In time for the Holiday Season, all those using the lipid-lowering blockbuster will be able to get their prescriptions filled for $30-$50/month shortly after Thanksgiving, as opposed to the nearly $200/month that they had payed on Halloween.

Despite several other statins already available in generic form (e.g. simvastatin, lovatstatin, etc), generic Lipitor, atorvastatin, will be the most potent to join the crew.

You can watch Dr. Howard Weintraub from NYU discuss it here.

Apps for Your Health

We have noticed in the office that an increasing number of patients have made the switch from standard mobile phones to "smart" phones - as have most doctors.

Besides functioning as phones, iPods, cameras, email receptacles and GPS systems, these devices and the apps designed for them, have also become an asset to both patients and their physicians.

If not only as a great place to keep your medication list, patients can also download as assortment of apps to

• Record and track blood pressure,
• Monitor your blood sugar trends,
• Count calories and break down food labels
• Take your pulse!

We have highlighted below just a few of the hundreds that are out there, but there are such a diverse array of helpful apps out there that we leave it to you to give us some other good ones!

iTriage - What they say: Created by two ER docs, iTriage helps you answer the questions: “What medical condition could I have?” and “Where should I go for treatment?” It also lets you save, easily access, and share the healthcare information most important to you. iTriage has been downloaded millions of times in over 80 countries and consistently receives a 4.5 (out of 5).

Glucose Buddy - Using Glucose Buddy, people with diabetes can manually enter their glucose numbers, carbohydrate consumption, insulin dosages and activities. Once the data has been entered, users are able to see trends and adjust their diets, meds and even activity, to better control their blood sugar.

Fooducate - Just pick up a product from the shelf, scan it, and let Fooducate do the rest. Scan and choose healthy groceries. Over 200,000 unique UPCs! As featured in USAToday, NYTimes, WSJ, Lifehacker, Gizmodo and on ABC, FOX, NBC and more...

BPMontior - The BPMonitor keeps track of your important health stats, right on your iPhone or iPod touch. It is one of the best health tracking apps, with features hard to find anywhere else. These include:
1. Ease-to-use interface to record your blood pressure, weight and heart rate
2. Support tracking for multiple people; one program for your entire family
3. Graphical charts for visual trend and warning
4. Stats table with average values for the past weeks
These are the ones we like but there are literally hundreds more out there for every health-related topic from assessing visual acuity to interpreting x-rays. The Medical category in the iTunes App store is a wonderful resource and we hope that you can point us to some additional great finds.

Drug-coated Stents Find New Places to Help

The introduction of drug-coated, or drug-eluting, stents for the heart arteries was a major advance in the field of interventional cardiology and the treatment of patients with coronary blockages.

These stents dramatically reduced the incidence of in-stent restenosis in which scar tissue accumulates within the stent eventually causing a re-blockage of the treated area.

Now these stents are going to be used for blckages in the leg arteries as well, potentially a major advance in non-surgical treatment of peripheral artery disease (PAD).

http://news.yahoo.com/fda-advisers-back-cook-stent-leg-arteries-002142384.html

Dr. Safirstein Featured on News 12

Our own Dr. Jordan Safirstein will be featured this weekend on News 12's health segment 12 To Your Health. It will appear on Saturday and Sunday, August 6th and 7th, at 6:30am, 9:30am and 1:30pm.

The host, Dr. Derrick DeSilva will be briefly discussing the benefits of the transradial approach to cardiac catheterization. Cardiac catheterization is a procedure that allows cardiologists to assess and fix blocked coronary arteries. The radial approach uses a small artery in the wrist, and allows patient to sit up immediately after the procedure, as opposed to the standard groin access where patients lie flat up to 6 hours after the procedure.

Numerous studies have shown improved patient comfort as well as a significant decrease in bleeding complications when the radial approach is used.

Should Your Doctor Be Forbidden to Ask You Certain Questions?

A new law in Florida restricting physicians' ability to interview their patients has the local medical community up in arms.

In early June,  Governor Rick Scott signed a law prohibiting any written or verbal questioning regarding owndership of a firearm.

As a physician, I feel it is my job to look out for the safety of my patients and the thousands of family practitioners and pediatricians in Florida I'm sure feel similarly. Preventing a child's doctor from attempting to educate a parent or teenager about gun safety seems not much different from asking and etaching patients about safe sexual practices or drug use or eating habits. Why would gun owners want to hide this information? And it amazes me that an ostensiblyu intelligent man and accomplished politician would try to prevent physicians from asking this question. Well, some local doctors and medical societies agree with me and have filed suit in Miami Federal COurt to overturn this law.

Please read more below from TheHeart.org...

Miami, FL - A group of physicians and several medical societies have sued Florida Gov Rick Scott and other state officials in a Miami federal court to overturn a new Florida law forbidding clinicians from asking patients if they own a gun.

The physicians argue that this "gag law" will prevent them from counseling patients about keeping guns unloaded and locked up, which can spare children and adults from shooting deaths, accidental and otherwise. Supporters of the law such as the National Rifle Association (NRA) counter that it will protect the privacy of gun owners and "keep politics out of the examination room."

The lawsuit seeks a temporary injunction against the new law and a declaration that it violates the plaintiffs' constitutional right to free speech as well as due process. The outcome of the case could have a bearing on a "don't-ask" bill pending in North Carolina and future legislation in other states.

"If the court upholds our law, it's free rein everywhere," said Dr Louis St Petery, a pediatric cardiologist in Tallahassee, FL and executive vice president of the Florida chapter of the American Academy of Pediatrics (AAP), one of the plaintiffs in the suit.

The cause of safe gun storage became dear to him, he said, after he and his wife Dr Julia St Petery, also a pediatrician, attended the funeral early in their careers of a two-year-old child who was shot by a five-year-old sibling with a handgun plucked from their parents' bedside drawer.

"It impressed me for life," St Petery said about the shooting. "I thought to myself, 'This is an issue I have to pay attention to.' "

No questions, no trust

The suit, filed on June 6, comes four days after Scott signed the law. The measure prohibits written as well as oral inquiries regarding firearms ownership, entering such information into a medical record, "unnecessarily harassing" gun owners, or turning away patients who refuse to answer gun questions.

That last provision speaks to what supposedly prompted the Florida law. In 2007, a pediatrician in Ocala, FL, told a young mother to find a new physician after she refused to say whether she had a gun in the house, according to a local newspaper. The pediatrician was quoted as saying that his question was merely one part of a general discussion about household safety and that physicians have a right to drop patients who do not trust them.

An early version of the legislation stipulated that a violation would amount to a third-degree felony punishable by up to five years in prison, in addition to a fine as high as $5 million. An amendment scaled down the consequences to possible disciplinary action by the state health department.

Many patients lack knowledge about gun safety, says suit

Three physicians, along with the Florida chapters of the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the AAP, filed the suit, with national organizations also going on record opposing the law.

"Every year, thousands of Americans are seriously injured or killed when a child finds a gun and accidentally pulls the trigger, an argument between acquaintances or family members spins out of control, or a depressed teenager or adult becomes suicidal," the suit states.

The risk of those tragedies increases when guns are too handy, according to the suit, which asserts that one-third of US homes with children younger than age 18 have a firearm, and of these, more than 40% store them unlocked. Of this last subset, one-fourth store their guns loaded.

One of the physicians filing the suit, Dr Bernd Wollschlaeger (Ventura Family Health Center, North Miami Beach, FL), himself a gun owner and a concealed-weapon permit holder, noted that "many patients and parents are unaware of how to use child safety mechanisms and lockboxes and the importance of separately storing guns and ammunition."

Besides objecting to what they consider to be infringement upon the physician-patient relationship, the plaintiffs criticize the new Florida law as vague. For example, the law makes an exception for questions about firearms if a clinician in good faith believes "that this information is relevant to the patient's medical care or safety or the safety of others." The plaintiffs complain that the law never defines the criteria for relevance—or for harassment, for that matter.

Two of the physician plaintiffs said they will continue to ask about guns in the home because they consider the subject always relevant but would refrain from posing follow-up questions when patients respond unfavorably. In contrast, Wollschlaeger said that as long as the law is on the books, he would never bring up guns for fear a patient will complain to the Florida Board of Medicine.

NRA sees gun-ban agenda

To physicians, talking with patients about gun safety has a noble goal—averting injury or death. The NRA, however, views these discussions in a more sinister light. Its website speaks of pediatricians and other physicians "prying into our personal lives." Patients receive an "arrogant berating" if they refuse to answer questions "that violate privacy rights and offend common decency." And "horrified parents" worry that the federal government or private insurers will tap into computerized medical records, discover that they own firearms, and consequently deny them healthcare coverage.

More than anything, a distrustful NRA sees a political agenda in questions about gun ownership.

"This is not about safety, but the gun-ban politics of the American Academy of Pediatrics," said NRA board member and former president Marion Hammer in a recent interview posted on the group's website. Hammer, also the executive director of a Florida gun-rights lobbying group, points to AAP statements of support for banning handguns and assault rifles as well as the academy's advice that "the best way to keep your children safe from injury or death from guns is to never have a gun in the home."

In an interview, St Petery said that the NRA takes those AAP pronouncements out of context. "The NRA says we're out to wipe guns from the face of the earth," he said. "That's not true."

While the scientific evidence points to children being safer when homes are gun-free, he said, pediatricians also accept the reality that many parents own pistols and rifles. "If you have a gun, let's talk about how to store it," said St Petery, a father of three and a shotgun owner. He added that he has never heard of a pediatrician attempting to convince parents to get rid of their firearms.

The NRA also acknowledges the need to teach people about storing and handling firearms but contends that this job belongs to parents and private groups like itself. It claims that "voluntary firearms safety training, not government intrusion," is responsible for a dramatic decrease in firearm accidents. According to the NRA, the rate of accidental deaths related to firearms has declined 94% since an all-time high in 1904, while the annual number of these accidents has decreased by 80% since 1930.

The new Florida law, Hammer said, does not completely silence physicians on the subject of gun ownership. The "relevance" exception could come into play when doctors fear, for example, that a depressed person may be a danger to himself or others. In addition, the law leaves physicians free to distribute brochures on gun safety and any other public-health issue to all their patients, without asking any questions.

The physicians who sued in federal court to overturn the law find little benefit in these prerogatives. Again, they argue that the relevance exception is too vague to give them any assurance that they are obeying the law. They also consider it bad medicine to give gun-safety advice to every patient without asking questions to personalize their care.

"Such counseling, to be effective, requires a back-and-forth between patient and practitioner," their suit states. "Healthcare practitioners are not effective when they simply lecture their patients or hand them a pamphlet."

Cardiac Rehab After Stenting Saves Lives

For those of you who have had a heart stent, there is very interesting news out of the prestigious Mayo Clinic. According to Dr. Randal Thomas, the principle investigator of a new study published in the most recent issue of Circulation, participation in a formal cardiac rehabilitation program following stenting is associated with a significant reduction in all-cause mortality!

Says the Exercise Expert: "There is ample evidence, including from our study, to show that there is much work to do in prevention and improving outcomes. Second, it's important for patients and providers to recognize that not only is rehabilitation important and provides significant benefit, it's also covered by insurance companies."

That's right! Since 2006, in the majority of cases, insurance companies will pay for up to 36 sessions of cardiac rehab for any patient who has undergone any type of coronary intervention. The benefits of cardiac rehab go beyond the thrice weekly treadmill requirement. There is also the peer support that develops between patients who attend regularly, supervision by caring and knowledgeable rehab professionals, weight loss, and of course, a feeling of normalcy and reassurance that after a stent you can perform as well, if not better, than one could before the stent was placed.

Most hospitals and many independent facilities offer these services and accept a host of insurances.

SCAI Releases First Report on Transradial Access for Angioplasty and Stenting

SCAI Releases First Report on Transradial Access for Angioplasty and Stenting

Which State is the Healthiest? Where Does Jersey Stand?

All this talk about Disney's lack of healthy food options made me curious about which states are actually the healthiest overall.

It turns out that there is extensive data cultivated by the United Health Foundation on how states fare in a variety of outcome measures including smoking, obesity, cardiovascular deaths, etc etc

Well, we love a good rank list so we picked the most interesting points to share with you and then you're on your own to peruse the entire report on their website at America's Health Ranking.

First, let's look at the 2010 national numbers and then we'll go local.

Besides bucolic scenery, bed and breakfasts, old liberal arts colleges, and Yankee-hating, the New England states also excel at many of the important health measures. All six New England states, with Vermont leading the way, were in the Top 10 in overall health outcomes, in part because of their low rates of smoking and obesity, as well as a large number of doctors per capita, and strong emphasis on public health.

The southern states, while also excelling at Yankee-hating (of a different sort) unfortunately did not fare so well as they comprised 8 of the bottom 10. And Mississippi has the dubious honor of finishing at rock bottom for the 9th consecutive year because of its disproportionately high rates of cardiovascular deaths, obesity, prevalence of smoking and lack of insurance coverage - add to that a relatively low density of physicians per capita, plus child poverty and it's a perfect storm for bad health. To be fair, most of the poorly performing states did show significant improvement from 2009.

So how does the Garden State compare in all these measures? In 2010, we were ranked 17th overall, up 1 place from 2009. North Dakota is a little better and Wisconsin is a little worse. According to America's Health Rankings, our strengths are lower rates of obesity and impoverished children as well as higher rates of high school graduation and  ready availability of primary care MDs.

When you look a little deeper though it's scary that our percentage of obesity (23.9%), almost one-quarter of the population, is comparatively low - Mississippi's rate is 35.3%. Other Jersey high notes include improvements in our air quality and decreasing rates of children in poverty and violent crime.

While we write about things with a sense of humor,  healthy eating and obesity is an enormous problem in this country (pun intended) - and it's not getting any smaller. Look at the graphic above depicting percentage of obese US citizens over the past 20 years. Scary. Along with obesity comes increasing rates of diabetes, heart disease, and a host of other health issues is that's not enough. Education and proper eating habits are the groundwork for a healthier generation of children.

Stay tuned for our next post about peripheral artery disease and if you have suggestions for other topics please feel free to post them in the comments section. Stay healthy!


America's Health Rankings® employs a unique methodology, developed and periodically reviewed by a panel of leading public health scholars, which balances the contributions of various factors, such as smoking, obesity, binge drinking, high school graduation rates, children in poverty, access to care and incidence of preventable disease, to a state's health. The report is based on data from the U.S. Departments of Health and Human Services, Commerce, Education and Labor; U.S. Environmental Protection Agency;the American Medical Association;the Dartmouth Atlas Project; the Trust for America's Health;the World Health Organization; and the Organisation for Economic Co-operation and Development (OECD).

Disney: Let the Memories (and the diet) Begin



Longingly wishing that their dad would just buy them ice cream


I just returned from Disney World and while it was super packed, very hot, and kind of expensive, it was also awesome. The parks are immaculate, the staff is patient beyond what normal people should be, and despite the waiting (and a little whining), all 3 of my children thoroughly enjoyed it.

But as I schlepped my 5, 3 and 2 year old children along sun-baked paths, through crowds and onto various rides, I noticed that I was one of the younger (and thankfully thinner) child-schleppers out there. The percentage of obese grandparents, parents, and children that populate Disney World was somehwhat disheartening but not as much as the remarkably limited food options for the Disney goers.

It first hit me when I saw an elderly couple dividing up their pill box contents at lunch. I thought that many of these generous and loving grandparents were likely diabetic and hypertensive. And what would they eat? Finding healthy food options in Disney is harder than getting seats at the Princess Breakfast. I am certainly no Disney expert and this is just an opinion, but the vast majority of nourishment options were of the hamburger/hot dog/fried variety. There was a definite lack of fresh fruit and vegetables but you couldn't spit without hitting an ice cream/candy/frozen sugary concoction stand.

I know, I know. What should I expect? It's an amusement park, not a wellness center. But it also is supposed to be a magical place and it is indeed a family-oriented destination that prides itslef on making memories. It would be my hope that in the future they begin to provide healthier options for those grandparents and parents who may not want to bring their own food and stay healthy. There is a a movement afoot in this country to get healhtier and greener and our children are learning this in school. So where better than Disney World to set the example and begin providing healthier lunch, dinner and snack options to all those millions of people who love to make memories.

If any of you have differing opinions, or similar ones, we always love to hear from you! Comment below...

The Future of Valve Replacments

Every year, tens of thousands of cardiologists, cardiovascular surgeons, and healthcare professionals gather to hear wonderful lectures from international experts, debate dozens of controversies in cardiology, and hear the latest study results in the Late Breaking Trials sessions.

One of this year's most interesting presentations at the American College of Cardiology (ACC) 2011 Scientific Sessions concerned the the replacement of aortic valves using a catheter from the groin arteries as opposed to open heart surgery. Amazingly, this relatively new and incredibly cool technology was shown to be just as good as the tried and true standard surgical method of aortic valve replacement for the primary end point of mortality.

"These results indicate that [transcatheter aortic-valve replacement] TAVR is an acceptable alternative to AVR in selected high-risk operable patients," said Dr. Craig Smith, the principle investigator for the trial. "Future randomized studies should focus on lower-risk patients who are candidates for operation."

Dr David Moliterno (University of Kentucky, Lexington), another panelist who was not involved in the study, told members of the press: "You really are witnessing history in the making. This is one of the biggest steps in cardiovascular medicine in our lifetime."

Interestingly, these procedures are only done at selected major cardiovascular centers across the country, one of which is The Gagnon Cardiovascular Institute at Morristown Memorial Hospital, the only hospital in New Jersey to do so.

Home Blood Pressure Monitoring: Who, Why and How

More and more, our patients are becoming proactive about their health and increased access to affordable, reliable and portable home health tools like glucometers and blood pressure monitors only makes the doctors' job easier. Sort of. If done correctly, these tools can be an invaluable asset to your physician and your health. However, when they are done at inappropriate times or done incorrectly they can adversely affect the way you are treated and cause more harm than good.

Why is home monitoring important?

Going to your scheduled doctors' appointments and having your BP checked is indeed a necessary and important feature of your healthcare but it is only one snapshot of your blood pressure. Our circulatory systems are not a static object - they are constantly changing and accommodating external forces like what we eat and drink, our anxiety and stress levels, the ambient temperature, medications etc etc. A well-kept log of your readings taken regularly, at similar times every day, can provide us doctors with a much clearer picture of your blood pressure. It also eliminates those falsely high BP readings.

Who should home monitor?

• Patients starting meds for high blood pressure to determine its effectiveness
• Patients that need closer monitoring than occasional office visits provide, especially individuals with coronary heart disease, diabetes and/or kidney disease
• Pregnant women since preeclampsia or pregnancy-induced hypertension can develop rapidly
• People who have some high readings at the doctor's office, to rule out white-coat hypertension and confirm true HBP
• Elderly patients, because the white-coat effect increases progressively with age
• People suspected of having masked hypertension

Who should NOT home monitor?

People with atrial fibrillation or other arrhythmias may not be good candidates for home monitoring. Why? Oscillometric-method monitoring devices recommended for use at home may not be able to give accurate measurements for people with these conditions. If your doctor recommends home monitoring, have your monitor's readings compared to readings taken by your office using the manual approach.


What type of monitor should I get and where?

The American Heart Association recommends an automatic, cuff-style, bicep (upper-arm) monitor. Wrist and finger monitors are not recommended because they yield less reliable readings.

A quick look on Amazon.com yielded a variety of automatic cuffs ranging from about $30 - $60.

 Search Amazon.com for bp monitor automatic

Your local pharmacy would also be a good resource but you should not have to pay more than $60 for a reliable cuff. Make sure it is automatic and not aneroid. If you have extra large arms, make sure the cuff fits before you purchase it.


What is the best way to measure my BP?

• Measure around your upper arm and choose a monitor that comes with the correct size cuff.
• Be still.
• Don't smoke, drink caffeinated beverages or exercise within the 30 minutes before measuring your blood pressure.
• Sit correctly.
• Sit with your back straight and supported (on a dining chair, for example, rather than a sofa). Your feet should be flat on the floor; don't cross your legs. Your arm should be supported on a flat surface (such as a table) with the upper arm at heart level. Make sure the middle of the cuff is placed directly over your brachial artery. Check your monitor's instructions for an illustration or have your healthcare provider show you how.
• Measure at the same time daily.
• It's important to take the readings at the same time each day, such as morning and evening, or as your healthcare professional recommends.
• Accurately record all your results.
• Record all of your readings, including the date and time taken. Share your blood pressure records with your healthcare team. Some monitors have built-in memory to store your readings; if yours does, take it with you to your appointments. Some monitors may also allow you to upload your readings to a secure Web site after you register your profile.
• Take advantage of the American Heart Association's BP tracking tools. Heart360 allows you to track your blood pressure and the steps you're taking to manage it online. You can print your readings to take or fax to your doctor.
• Understand the readings. Optimal blood pressure is less than 120/80 mm Hg (systolic pressure is 120 AND diastolic pressure is less than 80). Read Understanding Blood Pressure Readings to learn more about what the numbers mean. Consult your healthcare professional if you get several high readings.
• A single high reading of blood pressure is not an immediate cause for alarm. However, if you get a high reading, take your blood pressure several more times and consult your healthcare professional to make sure you (or your monitor) don't have a problem. When blood pressure reaches a systolic (top number) of 180 or higher OR diastolic (bottom number) of 110 or higher, emergency medical treatment is required for hypertensive crisis.

OK! You got all that? If not, it is always here on our blog for your reference. Beyond all that is said above it is also critical to keep your doctors involved and aware.

Stay healthy!

Cholesterol-Lowering Foods: They Do Exist

So, we've talked about the No-brainer bad foods, and the High-cholesterol surprises,  but there are rumors out there that all foods are not created equal and that you can actually improve your LDL by eating more of certain food items. It's true! Some of them decrease your LDL (should be <100 mg/dL), some increase your HDL (should be >35 mg/dL), and some do both.

"These foods may not be magic, but they're close to it," says Ruth Frechman, RD, a spokeswoman for the American Dietetic Association.

1. Nuts - Let's not get crazy here, only some nuts and in their healthiest form are good for you. Summarily discount anything that is honey-roasted, salted, or candied. The raw versions, and to a lesser extent, the dry roasted are your best bets. Believe it or not, the esteemed cardiac journal Circulation published a study
demonstrating that people who had two handfuls of almonds, lowered their LDL by more than 9%!
Along with almonds and walnuts, the FDA gave its qualified health claim to peanuts, hazelnuts, pecans, some pine nuts, and pistachios. Another study, published in the Journal of Nutrition, examined a standard low fat/low cholesterol diet with a diet that replaced one-fifth of the calories with pecans. When compared to the standard diet, the pecan diet lowered bad LDL cholesterol by 10.4% and decreased triglycerides by 11.1%. It also raised the levels of good HDL cholesterol by 5.6%.

2. Oatmeal - Yes, those annoying breakfast commercials are partially true. Oatmeal actually decreases the bad cholesterol (LDL) without affecting HDL. It is also a recipient of the illustrious FDA's "health claim" status, granted in 1997. Most adults should get at least 25 grams of fiber a day.There are 3 grams of soluble fiber in 1.5 cups of oatmeal -- enough to lower your cholesterol, according to the American Dietetic Association. It may be a bit much for breakfast, so just add in oatmeal or bran to dishes at other times of the day.

3. Plant sterols - "Eating sterol and stanol-containing foods is an easy way to lower your LDL cholesterol, which helps reduce the risk of heart disease," says Ruth Frechman, RD, a spokeswoman for the American Dietetic Association (ADA). A more recent study from the University of California Davis Medical Center looked at the effects of sterol-fortified orange juice. Of 72 adults, half received regular orange juice and half the fortified OJ. After just two weeks, the people who drank the stanol-fortified juice had a 12.4% drop in their LDL levels. The results were published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology. Ok, that's easy enough, but what are they? And where do I find them? Many of the butter, or better even, margarines that you smear on bread have sterols added - check the labels! Sterols and stanols are also found in some cooking oils, salad dressings, milk, yogurt, and juices.

4. Fish - Because of the high levels of the oft praised Omega-3 fatty acids, which have been shown to reduce the risk of heart disease and stroke while helping to reduce symptoms of hypertension, the American Heart Association recommends eating a variety of types of fatty fish (such as salmon, tuna, and mackerel) at least twice a week. You should be grilling or baking that fish though and not eating out of a can, covered in oil, or frying it!

5. Olive Oil - The cholesterol-lowering effects of this Mediterranean Diet staple is most effective when it is the extra virgin variety, meaning the oil is less processed, thereby leaving many of the beneficial nutrients. Careful though, the caloric content is high so only use the recommended amount.

High Cholsterol Surprises

Not all of the high cholesterol foods are as obvious as milk, ice cream and egg yolks. Staying heart healthy is all about being aware of the not-so-obvious things that put you at elevated risk for coronary artery disease. So here's a few more clandestine cholesterol-containing food items:

1. Lobster - If you listen to most of my patients, they will tell you that anything that tastes good, is probably not good for you. And sure enough, this most prized crustacean packs a walloping 61 mg of cholesterol in every 3 oz bite! Add the melted butter and you might as well schedule your stress test for the following week. If you're going to splurge, avoid the butter (or most any "dipping" sauce for that matter), steam that sucker and watch your portions! By the way, processed shrimp, crab cakes and anything fried also have super high levels of cholesterol as well.

2. Chicken - But you were told it's so healthy, right? Well, it all depends on how it's prepared. With the skin on, a drumstick has more cholesterol than a cup of ice cream or a burger. Also, the dark meat, which tends to contain more fat, is higher on cholesterol. When the chicken is breaded, egg-dipped, fried, sauteed in butter/oil it becomes no more healthy than any of the other offenders above. Bake or broil it, stick to the white, skinless meat and surround it with vegetables - not batter.

3. Liver - While most of the younger readers will cringe at the thought of eating liver there are still many out there who gladly smother it in onions, spread it on a cracker or choose it in a fine dining establishment where it gains the much prettier title of foie gras. But no matter what name it is give, this organ meat is like the motherload of cholesterol, amassing more than a single day's daily allowance in one 3 oz chunk. Yikes! If you need further discouragement, just picture it when it's raw and that should do the trick.

4. Mashed potatoes - Surprise! They're not really much healthier than fries. The majority of recipes for this classic American side dish involve whole milk, lots of butter, and sour cream - the perfect storm. Throw some liver on top and you might break some kind of record.

5. Movie theatre popcorn - There seems to be a popular myth that popcorn is a healthy snack. This is very untrue unless you're popping those kernels in a pan by yourself, without oil. WebMD reports that Regal Cinema's medium-sized popcorn has a whopping 60 grams of saturated fat and 1,200 calories. Not healthy! Definitely do not add any of the liquid coronary-clogging butter and go for the small - we want you to have some enjoyment!

Stay tuned for the next installment where we discuss foods that may actually improve your cholesterol profile.

The Cholsterol Offenders - The No Brainers

Many of you out there already take a medicine for high cholesterol or have been instructed to eat a healthier diet in order to avoid medication in the future, aka the "borderliners". Both the frankly dyslipidemic and the borderliners will see heart docs like us in the office and tell us 'my doctor told me to avoid foods high in cholesterol - but I'm not sure what those foods are.' So, for your reading pleasure, we present The Cholesterol Offenders:

THE NO-BRAINERS

1. Eggs - The yolk's on you if you didn't know this one. (Sorry, but I couldn't resist). Turns out that an egg yolk has an offensive 1234 mg per 100 gram serving of cholesterol, or 411% of the recommneded daily allowance (RDA) of cholesterol. That means that just one little yolk will give you 70% of the day's RDA and if you're lucky enough to get the double yolk - well, you can do the math. By the way, the rest of the egg only provides an addition 1% of the RDA so no need to avoid the egg whites.

2. Butter - On bread, in a pan, or used in cookies, cakes and muffins, butter is a huge offender. 1 stick has 243 mg and 1 TBS contains 30 mg, 10% of the RDA. Switch to something healthier like olive oil.

3. Fast food - There's no denying that some fast food, at the right time tastes good; and its cheap. But it is flat out unhealthy. Everdayhealth.com reports that a a McDonald's Big Mac has 85 mg of cholesterol, 33 grams of fat and 600 calories. Throw in a large fries and you add 525 more calories, 24 grams of fat and 21 mg of cholesterol for a grand total of 1125 calories, 57 grams of fat and 106 mg of cholesterol. Can you feel your arteries clogging? But the true cholesterol killers in the fast food family are the breakfast sandwiches. The classic Egg McMuffin which most adult males can take down in 5 bites has a whopping.... wait for it.....235 mg of cholesterol in one small sandwich. That is almost the entire day's tolerated cholesterol before 9 am. Ouch, my chest. Other chains are just as bad, and some are even worse so don't think that it's better at BK or Wendy's no matter what the ad campaigns tell you. Check out

4. Cheese - When you say Wisconsin, I think of 2 things: cheese and offensive linemen. Both come in large quantities and high quality in The Badger State and there's a reason for it. While cheese can be a great source of protein, it is also a hefty cholesterol load. Cheddar, gouda and of course, cream cheese, and any whole milk-based cheese are ones to avoid if possible. And by the way, this also includes Mac and Cheese, which combines whole milk and butter with cheese to make a cholesterol nightmare.

5. Ice Cream - We are taking down all the good Ol' American comfort foods. While it may seem refreshing and delicious on a hot day, it's a cold-blooded coronary assasin. One cup of the smooth dessert has more fat than a hamburger and more cholesterol than 10 glazed doughnuts. Egads, pass on the ice cream and go with yogurt or fruit.

Stay tuned for our next post when we point out 5 high cholesterol foods that will surprise you...

Tracking Your Heart Health

Record your health data with our online trackers, access additional information and resources on how to be heart healthy, and even share your results with your provider.

The American Heart Association (AHA) has unveiled a new interactive tool that allows you to manage and track some important cardiac risk factors by teaming up with Microsoft HEalth Vault to track your health, and the health of your loved ones.

Heart360 allows you to enter your blood pressure, blood sugar, cholesterol and weight. Record your health data with online trackers, access additional information and resources on how to be heart healthy, and even share your results with your provider.

It is private, secure and easy to use.

Did Reporter Suffer Stroke on Live TV?

This is a very scary video of what looks very similar to the classic signs of a mini-stroke, or transient ischemic attack (TIA). While dozens of medical specialists across the country have speculated on what exactly she had, no conclusive diagnosis has been released in the media. The difficulty finding or forming words is known as aphasia and can be a harbinger of worrisome neurologic events to come.

Strokes and TIAs are too common in this country and we now have the ability to screen most people to see if they are at increased risk for such events. But start with the basics by controlling your blood pressure, eating healthily and asking your doctor lots of questions.

*************** UPDATE*******************

Turns out that the working diagnosis of this newscaster's acute aphasia was a complex migraine.

Branson said in a TV interview with her station that the cause was most likely migraine.

That night, she said, she started to get "a really bad headache," and things got strange from there.

"At around 10 o'clock that night I was sitting in the live truck with my field producer and the photographer and I was starting to look at some of my notes," she said in the interview. "I started to think, the words on the page are blurry and I could notice that my thoughts were not forming the way they normally do."

Go Red for Women!

Cardiovascular disease claimed the lives of nearly 500,000 American women each year, yet women were not paying attention. In fact, many even dismissed it as an “older man’s disease.” To dispel the myths and raise awareness of heart disease as the number one killer of women, the American Heart Association created Go Red For Women – a passionate, emotional, social initiative designed to empower women to take charge of their heart health.

To make sure your cardiovascular health is where it should be, please visit our website and make an appointment today!

Just 30 Minutes Every Day - And Your Government Can Help!

Its true! Believe it or not, the government has world class scientists studying fitness and health every day. And they make their research and recommendations available to the public for free, as long as you have a computer. The pure volume of healthy articles on the CDC, NIH, and other federally sponsored institutions almost makes me break out in a sweat.

 

Visit the Centers for Disease Control web page for physical activity recommendations:

http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html#Aerobic

 

 

They will tell you how much you need to do, good ideas on how to do it and even video instructions on options for different people. Here's one of my favorite snippets:

 

Aerobic activity – what counts?

 

Aerobic activity or "cardio" gets you breathing harder and your heart beating faster. From pushing a lawn mower, to taking a dance class, to biking to the store – all types of activities count. As long as you're doing them at a moderate or vigorous intensity for at least 10 minutes at a time.

 

Intensity is how hard your body is working during aerobic activity.

 

How do you know if you're doing light, moderate, or vigorous intensity aerobic activities?

For most people, light daily activities such as shopping, cooking, or doing the laundry doesn't count toward the guidelines. Why? Your body isn't working hard enough to get your heart rate up.

 

Moderate-intensity aerobic activity means you're working hard enough to raise your heart rate and break a sweat. One way to tell is that you'll be able to talk, but not sing the words to your favorite song. Here are some examples of activities that require moderate effort:

• Walking fast
• Doing water aerobics
• Riding a bike on level ground or with few hills
• Playing doubles tennis
• Pushing a lawn mower

There is so much more there for the learning. Exercise is as, if not more, important than proper nutrition and compliance with your physicians' recommendations. Weight loss, improved glucose tolerance, mental well-being and improved physical appearance are just some of the benefits you can achieve with 30 MINUTES EACH DAY. That's it! Just 30.

Red and Blue Berries Good for your Blood Pressure?

A recently published study has suggested that fruits and vegetables that are rich in anthocyanins--such as blueberries, strawberries, and blood oranges--may help prevent the development of high blood pressure, new research suggests.

It seems like every week we hear about a new food that is good, or bad, for your health and even the same foods have sometimes been linked with both good and bad data. What is most important is to see HOW the scientists performed the study and what their actual conclusions were. In other words, you must take these news snippets with a grain of salt (pun totally intended).

The media is very fond of stories like this because they are widely applicable to the general public and everyone can relate to eating berries, etc. However, just because a newspaper or Yahoo! publishes a study, it does not mean that it was well done or even clinically relevant. Sometimes, it's just interesting.

In this most recent food-for-therapy study, the subjects, who did not have high blood pressure at baseline, were asked to complete health questionnaires every two years, and their dietary intake was assessed every four years through a food frequency questionnaire. But this does not account for so many factors that also may have contributed to their blood pressure or health changes, e.g. drinking, smoking, social factors, other illnesses etc. In scientific lingo, these are known as confounding variables, ie factors that may impact the results of a study that cannot be controlled. There are ways, in a questionnaire-based study to try and make up for these variables but inevitably the study becomes less accurate because of it.

The most accurate studies are those that analyze 2 groups of patients, one which uses the treatment and one that does not - and neither group, nor the scientists are aware who is getting what. This is known as a randomized, double-blinded, control trial.

This is not to say that the results culled from thousands of questionnaires and analyzed by very smart people should be completely discounted but what we do with the results and how we interpret them and integrate them into recommendations for patients is very important. Here's what the author of the trial, Dr. Aedin Cassidy, stated - which often gets buried under a bold, sexy headline:

"Our findings are exciting and suggest that an achievable dietary intake of anthocyanins may contribute to the prevention of hypertension."

OK. That's a fair statement. Weekly intake of these blueberries, strawberries and foods high in anthocyanins MAY prevent development of high blood pressure.

"In terms of guidance to patients, I think this can help us give a little bit more targeted advice. Rather than just telling them to eat more fruit and vegetables--which they are tired of hearing--we can try to refine messages about which dietary components are beneficial in terms of cardioprotective effects," she says.

She cautions, however, that these findings come from an observational study and so will require confirmation in interventional trials.

Dr. Cassidy concludes by nothing that the next stage of the research will be to conduct randomized controlled trials with different dietary sources of anthocyanins to define the optimal dose and sources for hypertension prevention, enabling the development of targeted public-health recommendations on how to reduce blood pressure.

So are the red and blue berries good for high blood pressure? The take home message is that they might be, but more refined studies would need to be performed to say this with any certainty.

Feel Good Moment of the Week

We deal with such weighty topics on this blog (no pun intended) that I felt it was time for some pure entertainment. After all, laughter and a positive outlook has often been associated in the medical literature with decreased rates of heart disease and hospitalizations. So here's our Feel Good Moment of the Week:

Quitting Smoking Great for Your Heart - And Wallet

According to a recent study by the University of Wisconsin's Center for Tobacco Research and Intervention, the cost of smoking cessation pales in comparison to the annual impact of cigarettes on your bank account. Oh yeah, and did we mention that smoking is horrible for you and causes lung cancer, coronary artery disease, impotence and peripheral artery disease?

The average cost of a pack of smokes is $5.51, which amounts to about $2,000 per year if you're anywhere close to a pack per day. If you're  living in one of the many places that has taxed cigarettes, then you are paying almost double that. A brief search on Expedia.com shows you that this is more than enough to take your spouse/friend/co-quitter with you on a Caribbean cruise on any major cruiseline. Hmmm, smell like smoke, increase my chance of multiple diseases or take a Caribbean cruise and improve my overall health substantially? It's a tough one.

Free Quitting Resources:

• Call the toll-free number (800) QUIT-NOW (1-800-784-8669)
• Smokefree.gov, a Department of Health and Human Services website.

More resources and the full body of the news article can be found by clicking here.