Heart Health Archive

Q. One day while I was gardening, I either slipped, hit my head, and passed out, or I passed out, fell, and hit my head. Since we couldn't tell, my doctors recommended I get a defibrillator as "insurance" in case a heart rhythm problem was the cause. I have had the defibrillator for eight years now, and it has never gone off. The battery is almost done and my doctor wants to put in a new battery. At age 86, I'd rather not have the procedure, the routine checkups are a hassle, and all of this is expensive. Could I just let the battery run down, then either leave the device in place or have it taken out?

A. Your question about continued use of an implantable cardioverter-defibrillator (ICD) is an important one that patients and doctors across the country are grappling with.

Q. I am a 72-year-old with diabetes, and I need to have a hip replaced. Does my diabetes make this surgery too dangerous for my heart?

A. While people with diabetes have a generally higher risk of cardiac problems than those without this condition, the increase in risk for cardiac complications with major surgery is quite low — and there may be no increase at all with good care. People with diabetes have higher rates of atherosclerosis, of course, and if you've already had a heart attack or kidney problems, those risk factors do increase your risk of heart problems with surgery. But after taking those factors into account, diabetes is not clearly linked to short-term complications with surgery.

Q. My doctor told me I have pericardial effusion. I know it has something to do with fluid in the heart. Can you tell me more?

A. Pericardial effusion is the medical term for a buildup of fluid inside the sac that surrounds the heart. This sac, called the pericardium, protects the heart, helps hold it in shape, and prevents it from expanding too much when blood volume increases.

Q. I am 92 years old. I have atrial fibrillation and high blood pressure, both controlled by medication. Every so often when I am relaxed in my chair after dinner, my heart feels like it stops and then starts up again with a jerk. Is this something I should worry about?

A. If you have atrial fibrillation, it is common to feel your heart pause and then start up with a bit of a kick. Here's why:

Q. I have a family history of cardiovascular disease. Although I don't have high blood pressure, high cholesterol, diabetes, or any other risk factor, I'm concerned about how my cardiologist is screening me, because women can have small-vessel disease and not necessarily arterial disease. How should I be screened?

A. In general, the decision to screen a woman for cardiovascular disease depends on her risk for the disease and whether she has symptoms. The risks include some things that are out of our control, such as a strong family history (that is, heart attack or stroke in a father or brother before age 55 or in a mother or sister before age 65). But we can prevent or lessen many other risks through lifestyle changes, or, if necessary, medications. Major risk factors include obesity, smoking, physical inactivity, high blood pressure, high cholesterol, and diabetes. All of these affect both genders, but several have a greater impact on women. For example, diabetes raises the risk of heart disease in women more than in men.

Digoxin (Lanoxin), a drug long used to treat heart failure and heart rhythm abnormalities, may control prostate cancer.

A new study linking painkiller use by heart attack survivors to increased risk of heart attack or death generated some pretty scary headlines, like “NSAIDs following a heart attack greatly increase risk of a repeat heart attack” and “Painkillers risky for heart attack patients.” Although correct, they overstate the danger. Taking a nonsteroidal anti-inflammatory drug like ibuprofen, diclofenac, or Celebrex increased the chances of having a heart attack or dying from 3 to 4 per 10,000 people per year to 5 to 6 per 10,000 people per year. The results are in line with an American Heart Association recommendation to limit the use of NSAIDs if possible.

A new study from Europe published in the May 4 Journal of the American Medical Association shows that taking in less salt may increase the risk of heart disease and has little effect on the development of high blood pressure. The findings contradict results of many other studies showing that less salt prevents heart disease. Flaws in the new study, from the young age of the participants to the small number of heart attacks, strokes, and other cardiovascular problems that occurred over the course of the study, suggest that it is not a game changer. If you are leery about the low-salt message for whatever reason, there are other ways to keep your blood pressure in check, like more exercise, weight loss, and following a diet like the DASH diet.

Many people say they would shy away from using a defibrillator.

If you were in a public place and saw someone suddenly collapse, would you use a nearby defibrillator to revive him or her? In a survey of 1,000 adults, more than half answered "no."

Gloomy forecast on heart disease

Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011; 123:933-44.

Let’s put the "public" in public defibrillation

Schober P, van Dehn FB, Bierens JJ, Loer SA, Schwarte LA. Public Access Defibrillation: Time to Access the Public. Annals of Emergency Medicine, published online Feb. 2, 2011