Heart Health Archive

Q. For several years, I have been taking warfarin because of atrial fibrillation. I recently suffered several nosebleeds, which took two days to control. The trauma of those episodes makes me want to swear off warfarin, but I am not sure what other options I have.

A. People with atrial fibrillation are at risk of having a stroke because when the atria (the top two chambers of the heart) fibrillate (beat chaotically), blood collects in the heart, giving clots a chance to form. One of those clots can travel to the head, get stuck in a blood vessel there, and cause a stroke.

Q. I recently had a nuclear stress test and the contrast agent got stuck in my gut, so the image couldn't be read. Is this a common problem, and is there anything that can be done about it?

A. The purpose of a stress test is to identify problems with blood supply to the heart muscle or the coronary arteries that supply it with blood. The standard test involves measuring the heart's electrical activity with an electrocardiogram (ECG) while the patient "stresses" his or her heart with exercise, which usually means walking on a treadmill or pedaling a stationary bike.

Stepping up prevention efforts could brighten up predictions.

Baby boomers have been blamed for a litany of social woes, from the breakdown of the American family to global warming. The American Heart Association (AHA) adds another: sparking a huge increase in cardiovascular disease and health care costs over the coming decades. But this one boomers could walk away from — literally.

The baby boom began in 1946 and ended in 1964. By 2030, anyone born during that period will be ages 65 and older, the key years for cardiovascular disease to blossom. (We use the term "cardiovascular disease" to cover a range of heart and artery conditions, including heart attack, stroke, heart failure, and peripheral artery disease, among others.)

A sudden and dramatic reduction in female hormones after the procedure may explain why.

An astounding one in three American women has a hysterectomy (the surgical removal of the uterus) before age 60. Only a small percentage undergo the operation to fight uterine cancer or other life-threatening conditions. Most have a hysterectomy to halt heavy menstrual bleeding, combat endometriosis, or stop pelvic pain.

Whether the check-up should include an electrocardiogram is an unanswered question.

Sports, and the physical fitness needed to participate in them, provide an extra layer of cardiovascular protection by strengthening the heart, improving the lungs, and making arteries more supple. Sometimes, though, something goes horribly wrong and an athlete suddenly dies while engaged in his or her sport.

When it comes to protective high-density lipoprotein (HDL) cholesterol, the most important question has long been "How much do you have?" Numerous studies have shown that the more HDL you have in your bloodstream, the more protected you are from heart attack and the most common kind of stroke. The day may be coming, though, when "How powerful is your HDL?" is an equally important question.

We've known for some time that not all HDL is created equal. Some HDL is better at pulling cholesterol out of white blood cells called macrophages. Less cholesterol inside macrophages means less cholesterol deposited into artery-clogging plaque. Work from the University of Pennsylvania indicates that folks with more powerful HDL have less cholesterol-filled plaque in the coronary arteries nourishing the heart and the carotid arteries that nourish the brain (New England Journal of Medicine, Jan. 13, 2011).

What happens to a perfectly functioning pacemaker or implantable cardioverter-defibrillator (ICD) when its owner dies? Some end up in the grave. Others are removed in a funeral home so they won't explode during cremation, and then sit in a drawer or are discarded as medical waste. A few get new life when they are cleaned, sterilized, and implanted in someone in a low-income country who could never have afforded such a device.

Over the years, ad-hoc programs have recycled a small number of pacemakers and ICDs for use in low-income countries. Now an ambitious program aims to expand the number of devices that will have an afterlife. Project My Heart–Your Heart is a collaboration between the state of Michigan's citizens, physicians, and funeral directors, along with the University of Michigan Cardiovascular Center and World Medical Relief, a nonprofit organization that distributes donated medical goods in low-income countries. The group plans to work with a hospital in Manila and one in Hanoi, both of which have met the project's strict standards as implant centers. Recipients of the donated devices would not be charged for them.

Exercise is one of the best all-around treatments for diabetes, a condition that often accompanies heart disease. Here's an interesting question: if you have only a limited amount of time each week for exercise, should you spend it all on aerobic exercise (like walking or swimming), strength training (like weight lifting), or a combination of the two?

Do both, say researchers with the Pennington Biomedical Research Center in Baton Rouge. They looked at changes in blood sugar — a key health measure for people with diabetes — during a nine-month exercise trial. All of the volunteers exercised for about 140 minutes a week. Compared with a control group of non-exercisers, those who combined aerobic exercise with strength training had the biggest decrease in hemoglobin A1c, a measure of average blood sugar over the preceding two to three months. Hemoglobin A1c fell significantly less in volunteers who did only aerobic exercise or only strength training (Journal of the American Medical Association, Nov. 24, 2010).

Q. You have said that alcohol can cause heart rhythm problems. I have an implanted defibrillator. Is it okay for me to drink alcohol?

A. Alcohol can, indeed, cause heart rhythm problems in people who drink too much or who are extra-sensitive to the effects of alcohol. It can trigger atrial fibrillation, which can make an implantable cardioverter-defibrillator (ICD) deliver a shock when it shouldn't.

Q. I have heard that one symptom of a stroke is "the worst headache you can imagine." I recently had a migraine that was so much more painful than previous ones that I worried it was a stroke. Is there any way to tell a migraine from a "stroke headache"?

A. The term "stroke" covers several distinct events that differ in location and cause. Some types of stroke can trigger a headache; others usually don't. To understand the connection, it's helpful to know a bit about the brain and pain. Brain tissue, and the blood vessels embedded in it, doesn't register pain. But the membranes that surround the brain and the blood vessels that run through them do register pain.