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Ask The Doctors: December 2019

Why is it important to get a flu shot if you have heart disease? When is it too late to get it?Flu season can begin as early as October and extend as late as May, but typically peaks from December to February. Antibodies to the flu peak four to six weeks after getting vaccinated and then slowly decline for six months. The Centers for Disease Control & Prevention recommends that everyone over 6 months of age without a specific reason not to get vaccinated, such as a history of allergic reactions to the shot, get vaccinated by the end of October. However, getting vaccinated any time before January can still be beneficial.
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Ask The Doctors: November 2019

The duration of DAPT depends on the reason for stenting (stable heart disease versus acute heart attack), the type of stent used and the patient's clotting and bleeding risks. Because the clotting risk is high after a recent heart attack, in your case there is strong data to support DAPT for at least one year. One recent clinical trial demonstrated a lower late clotting risk but more bleeding events with 30 versus 12 months of DAPT. This suggests patients with high clotting risk but low bleeding risk may benefit from taking DAPT longer.
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Ask The Doctors: October 2019

Heart failure (HF) can be caused by a heart attack or similar event that impairs the heart's pumping function and reduces the amount of blood ejected with each beat (heart failure with reduced ejection fraction, or HFrEF). There is also a second form called heart failure with preserved ejection fraction (HFpEF). These patients typically suffer from heart failure symptoms, but their ejection fraction is normal. Morbidity and mortality are similar in both forms.
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Ask The Doctors: September 2019

Such a group was studied in REDUCE-IT. This trial involved 8,179 patients with CVD or diabetes plus other risk factors and LDL levels of 40-100 mg/dL on statin therapy. Over five years, 4 grams a day of the fish oil icosapent ethyl reduced both first and subsequent heart attacks and strokes as well as CVD deaths by 25%. Although icosapent ethyl is a TG-lowering agent, the results appeared to be independent of patients' baseline TG levels. This suggests some benefit was due to independent actions, such as potent plaque-stabilizing properties. This fish oil product is currently FDA-approved only for treating TG levels above 500 mg/dL.
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If You Have Trouble Controlling Your Blood Sugar, Don’t Give Up

Between a Rock and a Hard PlaceSymptoms caused by very high and very low blood sugar levels can be frightening, and even dangerous. The extent and severity of symptoms interfere with quality of life. Many patients are unable to hold a job, or even make advance plans with confidence. Personal relationships can suffer. Some patients end up in the emergency department multiple times aweek.
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Ask The Doctors: August 2019

Although the effects of ASA are not fully understood, they may be a possible risk factor for an unexplained ("cryptogenic") stroke, since the occurrence is higher in patients undergoing echo in this setting. In these cases, the ASA is usually large and/or hyper mobile and is associated with a large amount of blood being shunted between the atria due to a PFO or septal defect. Identifying these abnormalities in a stroke patient does not necessarily prove a causal relationship, since other stroke causes may be present.
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Ask The Doctors: July 2019

In a 2016 study of 23,000 patients, opioid users were twice as likely to die from cardiovascular (CV) and respiratory problems than from an overdose. A 2019 study found that at 90 days after discharge, there was a slight increase in the death rate among heart patients, mostly from breathing difficulties during sleep, heart rhythm irregularities and other CV complications. Opioids can exacerbate sleep apnea, increase mortality from chronic obstructive pulmonary disease and depress heart muscle function when combined with benzodiazepines such as Valium.
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Ask The Doctors: June 2019

The American Heart Association recommends a minimum of 150 minutes of moderate activity or 75 minutes of vigorous activity weekly. Moderate is often defined as 50 to 70 percent of maximally predicted heart rate (MPHR); vigorous is 70 to 85 percent.
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Ask The Doctors: May 2019

The patients were divided into five groups based on level of fitness. The highest fitness category (comparable to endurance athletes) had the lowest mortality rate (80 percent lower than the least-fit group) even when the analysis controlled for age, gender and heart risk factors. Mortality dropped with each progressive level of CRF, with no upper limit at which the benefits declined or flattened. The benefit of high performance was seen in both genders and in subgroups older than70.
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Ask The Doctors: April 2019

A: It is normal for heart rate (HR) to increase during activity in order to provide nutrients and oxygen to exercising muscles. The formula for obtaining your maximum predicted HR-220 minus your age-tends to underestimate maximal HR by as much as 10 to 20 beats, particularly at older ages. However, an exercise HR of 160 seems high, particularly since a lack of symptoms and ability to talk normally with exercise does not suggest a very high exertion level.
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Ask The Doctors: March 2019

The irregular heart rhythm called atrial fibrillation (A-fib) is associated with increased risk of stroke. Since many individuals are unaware they have A-fib, early identification can improve outcomes. The U.S. Food & Drug Administration has designated the ECG app on the Apple Watch Series 4 as a class II medical device. This means it can be used to determine the presence of A-fib, but is not recommended for users with other known arrhythmias. In other words, it is for informational use only.
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Ask The Doctors: February 2019

In this era of growing concern over opioids, individuals with osteoarthritis (OA) and rheumatoid arthritis (RA) commonly use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. After the NSAID rofecoxib (Vioxx) was found to increase the risk of herat attack and stroke, adverse cardiovascular (CV) events from other NSAIDs have remained a concern. Clinical studies suggest NSAIDs may, indeed, increase CV events.
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