Diseases & Conditions Archive

Ask the Doctor

Q. My primary care doctor referred me to a cardiologist, and I just found out that I have a bicuspid aortic valve. What does that mean for me?

A. The aortic valve sits between the heart and the aorta, the main artery from the heart that distributes oxygen-rich blood throughout the body. A normal aortic valve has three leaflets, or flaps, that open and close tightly to regulate the flow of blood. But between 1% and 2% of people are born with an aortic valve that has only two flaps, known as a bicuspid valve. This defect is twice as common in males as in females and often runs in families.

Even the newer, targeted cancer therapies may harm the heart.

Image: Bigstock

About 14 million people in the United States are living with cancer, a number that reflects the steady rise in cancer survivorship in recent decades. In 1980, only about half of people with cancer lived five years after diagnosis. Today, five-year cancer survival rates are greater than 70%.

Unfortunately, many cancer-suppressing treatments can have undesirable effects on the heart and blood vessels. The increasing awareness of these effects—coupled with the surge of older people being diagnosed with and surviving cancer—has spurred a new specialty known as cardio-oncology. Experts in this burgeoning field focus on promoting heart health in people with cancer, both during and after their treatment.

Ask the doctor

Q: I have developed numerous small, thin veins over my legs. I would like to get rid of them. What is the most effective treatment?

A: Dilated superficial veins, known as reticular or "spider" veins, are a common problem as men get older. The preferred treatment is sclerotherapy, but laser therapy is gaining popularity. Sclerotherapy involves injecting fluid into the veins with a small needle. This liquid causes irritation and inflammation of the vein, leading to its collapse. Laser therapy uses intense pulsed light to cause heat-related damage to the veins. Both treatments involve some discomfort. Wearing compression stockings afterwards appears to help improve outcome.

Men are more likely than women to develop atrial fibrillation (afib)—a rapid, erratic beat in which the heart's upper chamber doesn't contract forcefully, allowing blood to pool and increasing the risk of clotting. However, some—but not all—studies have indicated that afib poses a greater stroke risk in women than in men. To settle the question, an international team of researchers looked at 30 studies with 4.4 million participants. They found that compared with men who have afib, women with afib have a 12% higher risk of death from all causes and almost double the risk of having a stroke or dying from one. The results were published online Jan. 20, 2016, by the journal BMJ.

Women notoriously neglect the symptoms of afib—feeling weak, breathless, or unusually fatigued. If you have afib symptoms, get medical attention, even if you think it's only a virus. There are several successful treatments for afib as well as for preventing stroke in women who have afib.

Mosquitoes can transmit many viruses, such as, Zika, West Nile, dengue, and yellow fever.
Image: Thinkstock

Ask the Doctor

Q. Why is it that we suddenly have epidemics of things like Zika virus that we've never heard about, and that we have no treatments or vaccines for? It feels like we should be better prepared than we apparently are. This worries me more than terrorism.

A painful, blistering rash known as shingles may temporarily increase a person's risk of a stroke or heart attack, according to a study in the Dec. 15, 2015 PLOS Medicine. Also known as herpes zoster, shingles results from a reactivation of the virus that causes chickenpox, which most adults had during childhood.

For the study, researchers analyzed the records of more than 67,000 people ages 65 and older diagnosed with shingles and either a heart attack or stroke from 2006 through 2011. They then compared the rates of cardiovascular events before and after a shingles attack. In the first week after a shingles diagnosis, the risk of a stroke rose 2.4 times and the risk of a heart attack increased 1.7 times compared with baseline risk.

Turmeric, coriander, and cumin may boost your health and breathe new life into tired dishes.

The health benefits of foods such as berries, broccoli, and salmon are well known. But your kitchen's spice rack may also hold some secret weapons against conditions such as inflammation, heart disease, cancer, and more. "Spices are underused, but it would be very easy to take advantage of them and improve health," says Dr. Lipi Roy, an internal medicine physician at Harvard-affiliated Massachusetts General Hospital.

There are few large randomized trials that demonstrate spices' health effects. But many studies in animals suggest that several spices offer benefits. So instead of flavoring your food with salt and butter, which can contribute to high blood pressure and heart disease, consider using the following spices.

Thorough risk assessment and family assistance may help you take them more safely.

Prescription pain pills such as oxycodone (Oxycontin) and hydrocodone (Vicodin) are in a class of drugs known as opioids. They're typically used to treat severe pain after surgery, and sometimes to treat chronic pain. But these drugs come with many risks, including addiction. Does that put you at risk if you take opioids? "You have to look at it on a case-by-case basis," says Dr. Hilary Connery, an addiction psychiatrist at Harvard-affiliated McLean Hospital.

Risks and benefits

Opioids are powerful painkillers that block messages of pain to the brain and decrease the body's perception of discomfort. They may also create a feeling of euphoria. Opioids are especially useful in the short term, such as the initial weeks following joint replacement. Common side effects include nausea, itching, drowsiness, or constipation.

You may assume that there aren't any symptoms for sudden cardiac arrest (SCA), the deadly condition that occurs when your heart suddenly stops pumping. But a study published Jan. 5, 2016, in Annals of Internal Medicine suggests that warning signs are common and often ignored. The most common warning signs were chest pain, breathlessness, palpitations, lightheadedness or fainting, nausea, and vomiting.

Researchers looked at the health information of more than 800 people who experienced SCA, mostly middle-aged men, and discovered that about half of the people had warning signs during the four weeks leading up to SCA and even 24 hours before their hearts stopped. But most of those with warning signs ignored the symptoms. Thirty-two percent of those who called 911 before SCA survived, compared with only 6% among those who didn't call for help. That's because many of the symptoms that led people to call 911 occurred in the hours just before the SCA, so these people were likely to be in a medical care setting when their hearts stopped.

Exercises, lifestyle change, medications, and procedures can alleviate incontinence and give you your life back.

A leaky bladder or a sudden urge to go to the bathroom is uncomfortable andembarrassing. But you can take steps to alleviate the problem. "Some people tell me they would have sought treatment sooner if they'd known it was this simple," says Dr. Anurag Das, director of the Center for Neurourology and Continence at Harvard-affiliated Beth Israel Deaconess Medical Center.

Lifestyle changes

One of the first lines of defense is pill-free and costs nothing: lifestyle change. For urge incontinence (see "Types of incontinence"), you can try timed voiding (urinating on a schedule) and bladder guarding, which teaches you to cope with triggers that set off the urge to go, such as washing dishes or hearing water. "You squeeze your muscles to hold in urine before a trigger, which sends a message to the brain that this is not the time to go," says Dr. Das. Other lifestyle changes include watching fluid intake; quitting smoking, to reduce coughing and pressure on the bladder; and minimizing bladder irritants such as caffeine, alcohol, and carbonated drinks.