Ask the Doctors June 2013 Issue

Ask The Doctors: June 2013

I read a lot about stents for arteries in the heart, but I’m wondering about stents for leg arteries. I have critical limb ischemia and my doctor thinks that stenting in my right leg will help improve symptoms and prevent amputation. What should I know about this kind of approach? It sounds encouraging.

This is a great point, because doctors at many institutions including Cleveland Clinic are pushing the envelope for stent usage in peripheral vascular disease (PVD), particularly in the arteries of the legs. In the course of the last 10 to15 years, there has been increasingly more focus on minimally-invasive revascularization techniques, rather than traditional open surgical methods.  Both cardiologists and vascular surgeons are doing more stenting procedures, which are lower-risk to patients, and generally allow quicker recovery times. And patients often recognize a tangible difference in symptoms shortly after the procedure.

In the past, open vascular surgery was the primary therapeutic option for nearly all cases of severe peripheral arterial disease.  Balloon angioplasty was often reserved for patients felt to be too ill or weak to undergo vascular surgery. However, stent technology has progressed tremendously, from the initial bare-metal stents, through the latest generation drug-eluting stents (DES). In November 2012, the FDA approved the first DES for use in PVD (other countries have allowed such DES use longer). Also important in stent design has been the development of tinier, more flexible lattice-structures.  Stenting as a first choice has now become a reality.  While we still await large clinical trials comparing surgery to stenting, many reports of stents to treat critical limb ischemia have been published. This is certainly hopeful information, and I’m glad you are having a fruitful discussion with your doctor about whether or not stenting is the right choice for you.

Heart patients are advised to take it easy in cold weather. But what are the concerns about heart health in hot weather? I had a heart attack last fall and am becoming much more active these days. Any advice on staying heart healthy in the summer?

I am glad you asked this question, because a change in the seasons should not force you to stop the outdoor activities you enjoy. There are several concerns a heart patient should have about exercising during hot weather, which are not terribly different from the concerns of the rest of the population. During very warm weather, blood vessels in the skin tend to dilate, allowing more blood to flow there and be cooled. This process, known as “cutaneous vasodilatation,” can lead to shunting of blood away from vital organs, including the heart.  Persons with a history of angina can experience worsened chest discomfort under such conditions. Those individuals with a history of hypertension or heart failure are often prescribed medications which function to open blood vessels wider. When heat is added into the equation, blood pressure may drop even lower, to the point where one may experience lightheadedness or even loss of consciousness.

In order to avoid such hazards, it’s best to avoid staying in the direct sunlight for a prolonged period of time. Taking frequent breaks in cooler, shady areas, or air-conditioned interior spaces, is recommended. When outside, wearing a hat, pants, and long-sleeved shirts that protect skin from the hot sun are important, as well. People talk a lot about “staying hydrated,” but the fact of the matter is that when faced with high temperatures, maintaining normal fluid volume inside your body requires more than just plain water. Those with heart conditions should probably not drink high-sodium sports beverages. But a good rule of thumb is to take in some electrolytes and sugar along with the water, which can be accomplished by eating fruit or other healthy snack.

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