Ask the Doctors June 2011 Issue

Ask The Doctors: June 2011

Having recently had a bypass operation, Iíve heard various opinions about resuming "normal activities." My cardiologist had one estimate and the rehab folks gave a different time frame. I know every patient is different, but are there minimum time frames for returning to activities like tennis and yard work? And what are the warning signs Iím doing too much? When are symptoms serious enough that I should see a doctor?

Itís essential that you placed quotes around the term "normal activities," because this vague expression means different things to different people. For some, it indicates walking around the house and doing mild physical exertion. For others, it may mean using the elliptical machine at the highest setting for an hour. In general, we take the common sense approach that the higher the level of exertion, the longer it will take to start doing it again. For people who are sedentary before heart surgery, walking a short distance or climbing a flight of stairs may be achievable within a couple weeks of surgery. On the other hand, regular athletes will have to wait several months before resuming "normal activities" like running. Most patients would fall somewhere between these two extremes.

A slow but steady increase in exercise tolerance shows that you are getting closer to resuming normal activities. Extreme shortness of breath or fatigue are symptoms that indicate one should take a break. Exertional chest pain or palpitations are also indications to slow down.

Itís okay to push yourself, but this should be in a gradual, gentle way, which does not cause severe physical discomfort. If you experience extreme shortness of breath or other concerning symptoms which do not relieve with rest, or if you donít seem to be making progress in your exercise ability, then you should speak to your cardiologist. As for activities such as tennis and yardwork, which can be quite strenuous, and tend to place considerable strain on the breastbone (sternum), you should definitely complete cardiac rehab first. Then, obtain the go-ahead from both the exercise physiologist and the cardiologist before you proceed.

Iíve taken vitamins my whole life and I see reports frequently about the importance of vitamin D for heart health and similar articles about other nutrients. As someone with two stents and hypertension controlled with exercise and medications, are there certain vitamins I should definitely be taking and any I should avoid?

The clinical data on dietary supplements, which include vitamins, is mixed. Some have definitely shown benefit in helping to prevent cardiovascular disease (CVD) and events, such as unstable angina, myocardial infarction (MI), transient ischemic attack (TIA), and stroke. Others have no observable effect, and may be potentially harmful. A low level of Vitamin D is a proven risk factor for CVD, and study results demonstrate that normalizing these levels with supplementation helps to reduce that risk. There is no evidence, however, to suggest that people with normal Vitamin D levels would benefit from taking a supplement. It is also important to have your blood levels of Vitamin D checked every few months or so, in order to avoid overtreatment, which is dangerous.

Antioxidant vitamins such as Vitamin C and E, despite being touted for years as "heart healthy," have shown absolutely no benefit in the prevention or treatment of CVD. In fact, some patient studies have suggested the possibility of harm, since antioxidants appear to blunt the useful effects of statins and niacin. Supplementation with B-complex vitamins (B1, B6, and B12), generally coupled with folate, are almost always unnecessary in people with a typical diet. Large patient trials such as HOPE-2 and NORVIT have demonstrated no cardiovascular benefit from supplementation with B-complex vitamins plus folate, and suggest the possibility of harm.