Heart Health Archive

Work-related stress may be a risk factor for heart problems. So what do we do about it?

Harvard researchers have uncovered strong links between women's job stress and cardiovascular disease. Findings from the Women's Health Study (WHS) — a landmark inquiry into disease prevention involving more than 17,000 female health professionals — show that women whose work is highly stressful have a 40% increased risk of heart disease (including heart attacks and the need for coronary artery surgery), compared with their less stressed colleagues. The results, which were presented at an American Heart Association meeting in 2010, also showed that women who worry about losing their jobs are more likely to have high blood pressure and unhealthy cholesterol levels and to be obese. These findings are especially distressing in the current economic climate.

Acetaminophen may boost blood pressure

Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation 2007; 115:1634-42.

Sudano I, Flammer AJ, Periat D, et al. Acetaminophen increases blood pressure in patients with coronary artery disease. Circulation 2010; 122:1789-96.

The electrocardiogram (ECG) is one of the most common, enduring, and important tests in all of medicine. It's easy to perform, noninvasive, produces results right away, and is useful in diagnosing dozens of heart conditions. The ECG has taken on even more importance lately because a particular ECG pattern, called ST elevation, is a strong indication that a serious heart attack has occurred, and there's more emphasis than ever on treating heart attacks as soon as possible. An ECG isn't necessarily going to be part of a routine physical, but if you need medical attention because you have chest pain, sudden unexplained shortness of breath, or other symptoms that suggest a possible heart attack, you will almost certainly get an ECG.

The ECG is a reading of the electrical impulses in the heart that activate the heart muscle and its blood-pumping action. Twelve electrodes affixed to the skin on the chest, arms, and legs sense those impulses from various vantage points. Part of the reason the ECG has had such staying power is that the output is visual: a line graph with peaks and valleys, not a stream of numbers. As a result, reading an ECG is a matter of pattern recognition, not computation. There are many permutations, but someone can be trained to recognize the most common patterns relatively quickly.

Food, and maybe a multivitamin, should provide all the Mg you need.

Magnesium deficits have been linked with a long list of cardiovascular and other disorders: high blood pressure, heart rhythm problems such as atrial fibrillation, cholesterol-clogged coronary arteries, painful spasms of coronary arteries, sudden cardiac arrest, diabetes, osteoporosis, and more. But whether modestly low magnesium stores are the cause of these conditions or the result of them is up in the air.

Don't stop taking aspirin, Plavix, or any other antiplatelet before dental work without asking your cardiologist.

The physical, emotional, and psychological stresses of surgery create conditions inside arteries that sometimes lead to a heart attack or stroke. This has long been known for coronary artery bypass grafting, hip replacement, and other major operations. Now it appears that tooth extraction and other oral surgeries also temporarily — but slightly — increase the risk of a heart attack or stroke.

New guidelines suggest treatments for the shortness of breath that can accompany advanced heart failure.

One of the most distressing complications of advanced heart failure is the feeling that you can't get enough air. This shortness of breath — dyspnea (DISp-knee-uh) in medicalese — has been defined in the cool language of clinicians as "a subjective experience of breathing discomfort" and "an uncomfortable sensation or awareness of breathing." People who have chronic shortness of breath describe it as suffocating, smothering, and hungering for air.

An immediate switch is right for some people, but not necessary for all.

A newly approved alternative to warfarin, a drug called dabigatran (sold under the brand name Pradaxa), fights stroke better than warfarin, with less bleeding into the brain, among people with atrial fibrillation. It could also make life a little bit easier for them.

The approach of Valentine's Day each year brings the latest crop of "chocolate is good for your heart" articles. We would all like to believe that a sweet treat protects the heart and arteries. But that notion isn't completely supported by the evidence.

Some studies show a strong connection between eating chocolate and less heart disease. In a survey of nearly 5,000 American adults, those who said they ate chocolate five times a week were 40% less likely to have ever had a heart attack or to have needed an artery-opening procedure (Clinical Nutrition, December 2010). A similar trend was seen in a large German study. In these types of studies, though, it is impossible to tell if eating chocolate protects the heart and arteries or if people who eat chocolate also do other things that are responsible for this protection.

Cough and ACE inhibitors. About one in nine people (11.5%) who take an ACE inhibitor such as enalapril or ramipril develops a dry cough. That's about 10 times higher than listed in the fine print of the drug's prescribing information or in the Physicians' Desk Reference, a commonly used resource for drug information (American Journal of Medicine, November 2010). For some people, the cough is a mild nuisance. For others, it is so aggravating they stop taking the drug. If you take an ACE inhibitor and are bothered by a dry cough, ask your doctor about switching to an angiotensin-receptor blocker or another medication.

Waist circumference and longevity. A bigger waist isn't a good sign for living to a healthy old age. Among 105,000 middle-aged men and women taking part in the Cancer Prevention Study II, the larger the waist, the greater the chances of dying over the nine-year study. As expected, the connection was seen among individuals who were overweight or obese. But it was also seen in those with healthy weights (Archives of Internal Medicine, Aug. 9/23, 2010). The increased risk of dying was most pronounced in men with waists greater than 43 inches and women with waists greater than 37 inches.

Q. At 80 years old, I am in relatively good health, aside from a recent diagnosis of high blood pressure. Taking a beta blocker and watching my salt has brought my blood pressure down into the normal range. During a period of extreme heat this summer, my ankles were more swollen than usual, and my weight jumped three pounds in just two days. Was that because of the heat, or did salt have something to do with it?

A. Congratulations on getting good control of your blood pressure with a medication and salt restriction. Most people require two or three medications to control high blood pressure, but you are a good example of what salt restriction can do.