Heart Failure

In the past, niacin, fenofibrates, bile acid sequestrants and fish oil were widely used to help normalize blood lipid levels. Most have fallen out of favor. But in November, physicians were wowed when a key study revealed that prescription-strength doses of eicosapentaenoic acid (EPA), a form of omega-3 fish oil, reduced the risk of cardiovascular death, heart attack, stroke, revascularization and unstable angina by 25 percent in patients with CAD or diabetes and high triglyceride levels.

If there are specific concerns that you would like to have addressed, please write them down before you leave home and raise them early in the appointment. Please don't wait until the end of the visit to speak up. Knowing what's on your mind helps us plan our time with you, and you will be more likely to leave the office satisfied, if your questions have been answered.

You're standing in a friend's dining room with a magnificent spread before you. On a table sparkling with ornaments and candles, you see an endless array of food. In an instant, you are seduced by the sights and smells of the holiday season. You reach out and pick up a plate-and your resolve to eat sensibly flies out the window.

People with type 2 diabetes cannot absorb sugar and convert it to a form that can be stored and used for energy. Instead, sugar continues to circulate in their blood.

Many of us know that cholesterol, blood sugar, blood pressure, body-mass index and smoking are modifiable risk factors for heart disease. If you smoke or have high levels of the other risk factors, you will need to make lifestyle changes and/or take medications to prevent a heart attack. But these measures don't always stop a serious cardiac event fromoccurring.

Whether to continue taking clopidogrel with aspirin over the long term is a different issue. Aspirin alone can increase the risk of bleeding, and this risk increases with the combination of medications. Low-dose aspirin plus clopidogrel or other anti-platelet drug is recommended for up to one year after MI. Continuing the combination beyond that point is not common practice in all patients, since the increased bleeding risk may outweigh the benefits. However, the combination may be continued in certain patients, including those who received a left main artery stent, complex overlapping or branch-point stents, recurrent MI, in-stent clots or vascular events such as a transient ischemic attack while on aspirin alone. Even in these situations, an individuals bleeding risk needs to be considered to ensure safety.

Each year, about 1 million people in this country receive a pacemaker to regulate their slowing heart rate. These pacemakers are implanted in a pocket of tissue under the skin and send electrical pulses down a lead (wire) inserted into the heart muscle. Pockets can be a source of infection, which then spreads into the bloodstream via the lead and can infect the heart.

Patients with heart failure with preserved ejection fraction (HFpEF) find their ability to walk and carry out the American Journal of Medicine suggests lack of vitamin D may be partly responsible. Vitamin D is thought to play a role in cardiovascular and muscle function, but its relationship with exercise capacity has been unknown. Researchers measured vitamin D levels in 112 HFpEF patients and 37 matched controls, all of whom took a six-minute walk test and had their peak oxygen capacity measured. Vitamin D levels were found to be significantly lower in HFpEF patients than in controls. More than 90 percent of HFpEF patients had insufficient vitamin D levels or were frankly deficient. These low levels were associated with more severe exercise intolerance. This study laid the groundwork for a randomized, controlled clinical trial to evaluate whether vitamin D supplementation could be effective in improving exercise tolerance.

Immediate testing is done to determine whether or not a heart attack has occurred. These include an electrocardiogram (ECG) and a blood test for troponin, a protein that spills into the blood when heart muscle dies. If the troponin test is negative, a heart attack has likely not yet occurred. These patients are given several types of medication to prevent their condition from deteriorating.

How involved a patient wants to be in music therapy depends on their diagnosis and whether they sing or play an instrument. Many simply want to listen to music. For these patients, the music therapist will select works likely to be therapeutic. When McFee sees the potential to help improve a patients medical condition, she encourages them to participate in music-making using an instrument on her cart that doesnt require special training or talent to play.

How involved a patient wants to be in music therapy depends on their diagnosis and whether they sing or play an instrument. Many simply want to listen to music. For these patients, the music therapist will select works likely to be therapeutic. When McFee sees the potential to help improve a patients medical condition, she encourages them to participate in music-making using an instrument on her cart that doesnt require special training or talent to play.

Cleveland Clinic offers heart-failure education classes designed to teach patients and their families what they need to know about the condition, its progression, its impact on day-to-day life and its medications. Ask your cardiologist if theres a similar program in your area. If not, ask for information in writing.