#108 5 Reasons To Get Off Acid Reducing Meds

June 13th, 2015 by

5 Reasons To Get Off Acid Reducing Meds

Worldwide headlines reported that the popular acid reducing medications, such as Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium double your risk of dying from a heart condition.  What should you do if you are part of the 60% of Americans who has heart burn, or acid reflux symptoms, each year?

What is worse, acid reflux or a heart attack?

In this article, I will share 5 reasons to get off acid reducing meds.  I will also give you 5 natural strategies to prevent acid reflux in the first place so that you will never miss these medications.

Acid Reducing Medications and Heart Attacks

As a cardiologist, I see a lot of patients on acid reducing medications.  In my experience, most of the patients I see with chest pain have chest pain due to acid reflux.

The study which got the world talking about the dangers of proton pump inhibitors (Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium) came from Stanford University.  In this study, researchers reviewed the records of 2.9 million Americans taking these medications.

Dr. Nigam H. Shah and colleagues found that people taking these acid reducing medications were twice as likely to die from heart related conditions.  Interestingly, if people took the older acid reducing medications, such as Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine) they did not see this risk.

There are many possible reasons why proton pump inhibitors may cause heart attacks. For example, these medications are known to alter gut bacteria.  These medications also block the absorption of key nutrients like, magnesium and vitamin B12, which are critically important for heart health.  In addition, these medications may increase the risk of blood clots.

If you are on a proton pump inhibitor, don’t panic.  This study was not confirmatory and there are certainly many limitations of this study.  For example, the people included in this study tended to have more chronic medical conditions.

Also, this was an observational study.  Just because proton pump inhibitors are associated with dying from heart disease does not mean that the proton pump inhibitors caused their deaths.

I Was Once Dependent on Prilosec (Omeprazole)

Yes, it is true.  I used to buy the large Costco pack of Prilosec (omeprazole).  I could not survive without this medication.  Sometimes my chest would hurt so much I had to take Aleve with my Prilosec.

Interestingly, after I completely changed my lifestyle several years ago, my acid reflux seemed to have mysteriously gone away.  In fact, I can’t remember the last time I had acid reflux.

I’m not sure the exact reason why my acid reflux resolved.  It probably had something to do with eliminating dairy (I have a dairy food allergy), losing weight, and eliminating most processed foods from my diet.

Acid Reflux Is Rarely Seen In The Developing World

In 2010, Americans spent 14 billion dollars on medications like Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium.  Each year more and more Americans are getting heart burn symptoms.

Historically, heart burn symptoms were rarely seen in the developing world.  For example, in a review of 36 published studies, the risk of having acid reflux symptoms in China was less than 5% in any given week.  The risk of acid reflux is also extremely low in Africa.

The fact that acid reflux is rarely seen in the developing world is reason for hope.  It suggests that there is something about the American lifestyle which contributes to this condition.  Based on these studies, if we can change our lifestyles then most people can avoid acid reflux.

5 Reasons To Get Off Acid Reducing Meds

Proton pump inhibitors, or PPIs, such as Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium) were never meant to be taken long term.  The problem, is that so many people become “addicted” to PPIs.  While these medications are effective in reducing symptoms from acid reflux, the long term consequences of these medications may far outweigh any potential short term benefits.

PPIs can be very helpful for short term episodes of severe acid reflux.  Indeed, the 5 reasons I list to get off acid reducing medications all tend to occur with long-term use.

Please note that I am not recommending that you stop these medications on your own.  This is a shared decision you have to make with your physician after carefully weighing the risks and benefits of these medications.  This shared decision should also take into account that most people can control heart burn symptoms with simple lifestyle changes.  Also, these risks may not apply to the older acid reducing medications such as Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine).

1. To Prevent Heart Disease

As discussed above, proton pump inhibitors (PPIs) such as Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium may double your risk of dying from a heart condition.

2. To Prevent Dementia

Proton pump inhibitors (PPIs) block the absorption of vitamin B12 in the gut.  Vitamin B12 is critical to keep homocysteine levels low.  When homocysteine levels are high, dementia, strokes, and heart attacks are much more common.

3. To Prevent Fractures

In addition to blocking the absorption of vitamin B12, PPIs may also block calcium absorption.  Thus, people taking these acid reducing medications long-term are at a 78% higher risk of breaking their hips.

4. To Prevent Anemia

PPIs are well known to block iron absorption.  If your iron levels are too low you may become anemic.  This is especially dangerous for menstruating women as they already tend to be low in iron.

5. To Prevent Magnesium Deficiency

Fully 60% of Americans are deficient in magnesium.  This problem is magnified in people taking PPIs.  Magnesium is critical for proper heart function and to prevent DNA mutations which could cause cancer.  To learn more about the symptoms of magnesium deficiency, please read this article I wrote.

Do PPIs Prevent Esophageal Cancer?

One reason why your physician may put you on a PPI is to prevent the potential risk of acid reflux causing cancer of the esophagus.  While Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium certainly block acid production in the stomach, it is unclear how much benefit there may actually may be when it comes to preventing esophageal cancer.

It is interesting to note that even though 119 million prescriptions are written every year in the U.S. for PPIs, esophageal adenocarcinoma has increased more than 350% since the mid-1970s!  Once again, do not stop PPIs on your own as your physician may be using this medication to prevent cancer of the esophagus for you.

6 Ways to Prevent Acid Reflux Without Meds

1. Avoid Your Food Triggers

Food allergies can be a big cause of acid reflux.  I know that was the case with me.  Eliminating dairy helped me tremendously with symptoms of acid reflux.  Another common cause of acid reflux is gluten sensitivity.

Outside of food allergies, the main triggers of acid reflux are pizza, soda pop, alcohol, chocolate, fried foods, fatty meats, citrus fruits, tomatoes, or spicy foods.  The key is to figure out your own triggers.  While I listed the most common culprits, your triggers may be different.

2. Keep Your BMI Below 25

Our Western Diet and our expanding waist lines are the primary reason why the U.S. is the acid reflux capital of the world.  Interestingly, we don’t even know when we are overweight anymore.  For example, in a recent study, 78% of parents of obese children thought their child was at a normal weight.

I see this in my cardiology practice as well.  Many of my patients have no idea what their ideal weight is.  Here is a BMI calculator to see if you are overweight.  The goal is to keep your BMI below 25 to help with acid reflux.

3. Eat Early and Light Dinners

The bigger your meal the more likely you will have heart burn.  Also, eating before bed is a recipe for acid reflux.  As soon as you lie down, and gravity no longer keeps your stomach acid in your stomach, you may start to feel the heart burn.

In fact, I routinely tell my patients to stop eating after 7 pm for a variety of reasons.  According to studies, eating late at night may also cause weight gain, strokes, and heart attacks.

4. Review Your Medications with Your Doctor

Many medications can cause acid reflux.  The most common medications to cause heart burn include the following: calcium channel blockers, antibiotics, anti-inflammatory medications, bisphosphonates, pain medications, and sedatives.  It is critical to always review your medication list with your doctor as you may be taking a medication you may no longer need.

5. Don’t Constrict Your Stomach

Wearing tight clothes can be a mechanical cause of acid reflux.  If you suffer from frequent heart burn, see if loose fitting clothing helps.

6. Consider an Older Acid Reducing Medication

If you absolutely must take an acid reducing medication long-term, you could talk with your doctor about whether one of the older medications, such as Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine), might be safer for you.

Do you take acid reducing medications?  Is there anything you have found which helps to prevent acid reflux?

#101 Why Do More Women Die From Atrial Fibrillation Than Men?

May 10th, 2015 by

Why Do More Women Die From Atrial Fibrillation Than Men?

In this podcast, I interview Dr. Jared Bunch about the recent article he wrote for Everyday Health on this subject.  Given that 1 in 4 adults in the U.S. will experience atrial fibrillation at some point in their lives, this is an especially important topic.

How Do I Listen To This Podcast?

To listen to this podcast you can click on the sound icon above.  Alternatively, you can subscribe to my podcast on iTunes or Stitcher Radio so that you never miss an episode.

What is Atrial Fibrillation?

Atrial fibrillation is the most common heart rhythm abnormality.  In atrial fibrillation, the two upper chambers of the heart are in complete electrical chaos.  This typically results in a very fast and irregular pulse.  Patients often experience palpitations, shortness of breath, chest discomfort, and fatigue.  Surprisingly, in the inactive and elderly, people may not have any symptoms at all.

Is Atrial Fibrillation Dangerous?

Even if you have no symptoms at all, atrial fibrillation is still a very dangerous heart condition.  Patients suffering from atrial fibrillation are much more likely to have a stroke, develop dementia, or experience heart failure or a heart attack.

What is the #1 Risk for Women?

Contrary to conventional wisdom, the number one cause of death for women is not breast cancer.  In fact, it’s not even all of the cancers combined.  Rather, the number one cause of death for women is still heart disease.

Why Do Women Die More From Atrial Fibrillation Than Men?

Many studies have shown that women are more at risk from dying from atrial fibrillation than men.  We still don’t know exactly why women are more at risk than men.  There are many possible theories.

1. Women tend to be 4 years older at the time of being diagnosed with atrial fibrillation.

2. Women are less likely to be prescribed blood thinners with atrial fibrillation.

3. Women may respond differently to blood thinners than men.

4. Women with atrial fibrillation have a higher heart attack risk than men.

Two Types of Heart Attacks

In general, there are two different kinds of heart attacks.  The first is the classic form of a heart attack where a plaque in one of the arteries of the heart ruptures and blocks off blood flow in that artery.  All of the heart muscle downstream of that clot is at risk of dying.  Physicians call this kind of a heart attack a “ST elevation” myocardial infarction (STEMI) because the ST segment of the ECG is elevated.

The other form of a heart attack is where the demands of the heart exceed blood flow available.  This would be the same concept as “red lining” your car’s engine.  If you run your heart too hard for too long this can also cause heart muscle to die or a heart attack.  Physicians call this kind of a heart attack a “Non ST elevation” myocardial infarction (NSTEMI) because the ST segment of the ECG is not elevated.

Why Do Women Have More Heart Attacks With Atrial Fibrillation?

In a recently published medical study of 14,462 people that were followed for 21.6 years, researchers observed 1,374 heart attacks.  Overall, people suffering from atrial fibrillation were 63% more likely to suffer a heart attack.

These atrial fibrillation induced heart attacks appeared to be primarily the NSTEMI form where heart demands exceed blood flow to the heart rather than the classic blood clot.  Even more surprising is that most of these atrial fibrillation heart attacks occurred in women.

Just to clarify, atrial fibrillation is an electrical problem with the heart whereas a heart attack is a plumbing problem with the heart.  However, if the electrical problem (atrial fibrillation) drives the heart rate too fast for too long it can trigger a heart attack or a plumbing problem with the heart.

While a 63% increased risk of a heart attack from atrial fibrillation sounds frightening, the numbers were even more frightening if you break them down by gender.  For example, men were just 21% more likely to suffer a heart attack from their atrial fibrillation whereas women were 172% more likely to suffer a heart attack from atrial fibrillation.  Approximately 10% of people suffering from this type of a heart attack never make it out of the hospital alive.

The question then naturally arises, why were women so much more likely to suffer heart attacks from their atrial fibrillation?  Researchers were unsure exactly why women were so much more at risk.  Some theories include poor control of atrial fibrillation, untreated other medical problems, or lack of blood thinners.

What Can Women Do?

1. If you have atrial fibrillation get it treated so that you can avoid a heart attack.

2. Breathe clean air. This means no smoking or exposure to second hand smoking.

3. Reverse or control the other risk factors.  The common cardiac risk factors include high blood pressure, cholesterol, and diabetes.

4. Maintain a healthy weight.

5. Exercise every day.

6. Eat a healthy diet.

7. Manage stress, stay socially connected, and get restorative sleep at night.

#061 How to Bulletproof Your Heart: The Roseto Effect

January 12th, 2015 by

How to Bulletproof Your Heart: The Roseto Effect

More than four in 10 Americans will die from a heart attack or other heart problems.  Not only is heart disease still the number one killer for both men and women but the same people who suffer from heart problems are also the ones more likely to suffer from Alzheimer’s Disease, strokes, and poor brain function later in life.

Is it possible to bulletproof your heart so that regardless of your diet or how much you exercise you won’t suffer from heart or brain problems later in life?

What I Was Taught at Johns Hopkins Medical School

When I was a medical student at Johns Hopkins in the early 1990s we were all taught the risk factors for heart disease.  Namely, if you don’t smoke, you don’t have diabetes, your cholesterol and blood pressure are in check, and there is no family history of heart disease then it would be very unlikely for you to have a heart attack.

As I have progressed further in my career and research I have come to learn that there are far more factors at play.  Indeed, these “other factors” may be just as important as the big five I was taught in medical school.   Let’s explore this concept further.  Welcome to a small mysterious town in Pennsylvania where people seemed to magically be protected from heart problems despite a poor diet, high rates of smoking, high cholesterol, and a lack of exercise.

Roseto, Pennsylvania: The Village of “Bulletproof Hearts”

In 1961, at the height of the heart disease epidemic in the U.S., a local Roseto doctor happened to mention to Dr. Stewart Wolf from the University of Oklahoma  that heart disease was virtually nonexistent in Roseto.  From this chance conversation, outside researchers quickly converged on this small town.

With the blessing of the mayor of Roseto, everyone in the village was studied.  They collected blood samples, monitored what they ate, and basically how they lived their lives.  Researchers poured over every death certificate and interviewed everyone.  After spending several years in this small town they had their answer.

As reported in the prestigious Journal of the American Medical Association in 1964, and later by Malcolm Gladwell in his bestselling book Outliers (affiliate link), Roseto was a small community where people ate all of the wrong foods and had high rates of obesity and smoking, had high cholesterol, breathed toxic fumes from working in the slate quarries, and yet somehow were protected against heart disease.  Indeed, the risk of a heart attack in this small Italian village in Pennsylvania was just half as much as the five surrounding towns.

How can this be?  How can you do everything apparently “wrong” for your heart and yet be protected from a heart attack?  There had to be an explanation for this paradox.

At the time, Roseto was a small tightly knit community of Italian immigrants living about 75 miles west of New York City.  This village was settled in 1882 by Italian immigrants from Roseto Valfortore in Italy.  When they immigrated to the New World they kept their exact same social structure as they did in Italy.

This was a socially isolated village.  They only married within the community, kept to themselves, spoke Italian, worshiped God, only shopped at their own local small stores, and lived as three generational families under the same roof.  The worked at the numerous local slate quarries and lived the “old” Italian way even though the rest of the country had already gone through rapid changes in the years following World War II.

The Roseto Mystery Explained

You may be wondering, how can you eat all of the wrong foods, gain weight, smoke, and have a high cholesterol but yet not develop any heart problems?  Let me outline the key factors as to why a heart attack was an incredibly rare event in Roseto.  If we can maintain a healthy lifestyle, unlike the Rosetans, and incorporate these additional four factors then we can truly “bulletproof” our hearts.

1. Family Centered Life

For the Rosetans, family was everything.  Families were close and multiple generations all lived within the same home. Families were self sufficient and took care of their own.

Indeed, there have been countless studies in the medical literature supporting the fact that strong marriage and family relationships can protect us from heart attacks.  As the quality of our family relationships has such a profound effect on our heart health the question is what can we do to strengthen these relationships?

For me, what has helped the most is to put the needs of my family ahead of my own.  As I give of myself it always seems that in the end my needs are met as well.

Also, given my busy lifestyle, I have found that what gets scheduled gets done.  In other words, the calendar on my iPhone is also filled with many family events including scheduled one on one time with family members.

2. Spirituality and Religious Ties

On Sundays, everyone in Roseto went to church.  It was a God fearing community.  They had strong Christian values and were very spiritual people.  They cared for their neighbors and looked after each other.

As with strong family relationships, many studies have shown that religion and spirituality can protect us not only from heart disease but many other chronic medical conditions as well.  Even if you are not religious, taking time to care for your spiritual needs can be very therapeutic.

In our family, we worship together at church each Sunday.  Even if it is a boring sermon at least you can tell yourself that, based on medical studies, you are getting healthier each time you go to church.

3. Strong Community

From a socioeconomic standpoint, you did not know in Roseto who was rich or poor.  There was no keeping up with your neighbors.  Even if you were wealthy it was socially taboo to display your wealth.

The community cared for everyone.  If a neighbor was in need, everyone came to help.  They were all “brothers” and “sisters” in the community.

Once again, there is a vast body of scientific data that socioeconomic disparities or even perceived disparities can lead to heart attacks.  Trying to keep up with your neighbors or peer group will drive you crazy and cause undo stress on your heart.  At the end of the day, all we really need to be happy is a safe home with enough food and loving relationships.

4. Low Stress

Despite difficult working environments at the slate quarries, Rosetans perceived very low levels of stress.  They put their worries into God’s hands and knew that whatever happened in life their family and community would always be there to help.  Crime was nonexistent in this village.

Based on all of the studies published to date, it goes without question that perceived stress is a powerful predictor of who will get a heart attack.  Much has been said about stress and I have published many blog articles on the subject as well.

For me, the three most important things in keeping my stress levels in check are to live as healthy as possible, always plan to arrive or be ready 15 minutes early, and to always look for ways to simplify my life.  As we can eliminate the “clutter” in our lives and focus on that which is truly essential we can minimize our perceived stress.

Roseto Today

By now you are probably considering moving to Roseto, PA and living a utopian life free of heart disease, stress, and worries.  Indeed, this is where Malcolm Gladwell left off in his book Outliers (affiliate link).

I wish this is where the story ended but unfortunately there was an unravelling of the Roseto Effect.  Today, Rosetans no longer have “bulletproof” hearts.  Let me now share with you what happened in the late 1960s.

By the time the late 196os rolled around, the American way of life had infiltrated the village.  They still ate poorly, smoked, and failed to exercise.  However, now they began intermarrying, families started to split up, religion was no longer the glue to the community, and the pursuit of wealth and materialism was in full swing.

Indeed, by the 1970s Roseto was no different than the neighboring towns and their heart attack risk became the same as everyone else as well.  They were no longer bulletproof.

What is the lesson of the Roseto Effect?

In medical circles, the term “Roseto Effect” has come to describe how a close-knit community can escape the risks of heart attacks.  When Rosetans lost the Roseto Effect they then fell victim to the consequences of their unhealthy lifestyles.

While the Roseto Effect is NOT an excuse to live an unhealthy lifestyle, it does show that by having close family relationships, living a spiritual life, caring for neighbors, and minimizing the effect of stress in our lives, we can escape many of the unnecessary chronic medical conditions like heart disease.

Do you have the Roseto Effect working in your life?  Is your heart bulletproof?

#053 Sense of Time Urgency and Heart Attack Risk

December 7th, 2014 by

Sense of Time Urgency and Heart Attack Risk

Do any of these statements describe you?

1. I usually feel pressed for time.
2. I eat too quickly.
3. I get upset if I have to wait.

If any of these statements describe you then your risk of a heart attack is four times higher according to the results of this study.

Time Urgency and Risk of Heart Attack Study

In this study, researchers evaluated 680 people. Of these 680 people, 340 had suffered a heart attack and 340 had not. These researchers found that those people who had suffered a heart attack were much more likely to identify with these three statements.

The Stress Response

What makes someone who answered “yes” to these three statements more at risk for a heart attack? I suspect that it is due to the stress response.

People who are experiencing chronic stress have much higher levels of cortisol and adrenalin. While these stress hormones can be beneficial during short periods of stress, the problem is that if the stress never goes away these same stress hormones can wear out the heart and the body.

My Three Strategies to Answer “No” to These Three Statements

How can we turn a “yes” to the three statements above into a “no?” Let me share with you the three things that I have found to help me control my sense of time urgency and impatience.

1. Try to Arrive 15 Minutes Early

I admit that I am guilty of racing the clock or a sense of time urgency. I have found that if I try to arrive somewhere 15 minutes early then my stress levels are much lower and I can be “in the moment.”

This extra 15 minutes allows for unexpected things that may arise.  It buffers in extra time if traffic is slow or your child cannot find where they placed their shoes.

2. Engage in Meaningful Conversation While Eating

Once again, if I am not careful I can literally inhale my food. Eating fast is not only bad for our heart but also leads to overeating, which creates a myriad of health problems.

To help me slow down I try to engage in meaningful conversation. I try to engage colleagues while eating at work and my family while eating at home.

3. Always Bring Something to Do

If we always have something with us that we can do, then if an unexpected delay arises, we won’t mind waiting.  It always amazes me that most of my patients who come to see me in clinic don’t bring something to do.  I would like to think this is because they know I am always running on time but I know this is not the case.

Always bring along a good book or even your iPad or a laptop. You might actually enjoy an extra minute or two to yourself while waiting.

What will you do to help you answer “no” to these three statements?

1. I usually feel pressed for time.

2. I eat too quickly.

3. I get upset if I have to wait.

How is slowing down and reducing your sense of time urgency helping you?

#050 Is it a Panic Attack or a Heart Attack?

December 5th, 2014 by

Is it a Panic Attack or a Heart Attack?

On a Saturday night many years ago, Mary suddenly felt a pain in her chest and her heart was racing.  She immediately thought, this is it I must be having a heart attack. Am I going to die?  She was naturally very anxious while this was happening.

Her husband immediately dialed 911.  Just as the paramedics arrived to her house her symptoms started to ease up.  The paramedics hooked her up to an EKG machine and her heart rhythm was back to normal.  For precaution, they took her by ambulance to the ER.

As they could find nothing wrong with her she was given the diagnosis of panic attacks.  For many years she was given many anti-anxiety medications but nothing seemed to work.  Despite a normal stress test her intermittent symptoms of chest pain and rapid heart beat just kept getting worse.

She thought she was losing her mind and none of her doctors could figure out what was going on.  That was until last Saturday night.  This time it was different.  The pain was much worse and this time her heart did not stop beating fast.

Once again her husband called 911 and this time when they hooked her up to an EKG they saw that her heart was in an abnormal rhythm called supraventricular tachycardia (SVT) and it was beating at 240 beats per minute.

The paramedics immediately gave her an intravenous medication, adenosine, to stop her heart and get it back to normal rhythm.  For many years she had been prescribed anti-anxiety medications for these very same symptoms when in reality the problem was that she had an intermittent heart arrhythmia.

Is it any wonder she panicked during these episodes?  I would panic too if my heart was beating at 240 beats per minute!  Fortunately, once the diagnosis was made, I was able to perform a simple procedure, called an SVT catheter ablation, which allowed her to be cured of this heart condition.  Best of all she no longer needs drugs for anxiety!

This is not an isolated experience.  Rather this is something that I see every week in my cardiology practice.  Generally, it is a younger woman with a cardiac arrhythmia who is misdiagnosed as having panic attacks.

Three Steps to Answer Is it a Panic Attack or a Heart Attack

Since the symptoms of a panic attack and a heart attack are often the same, how can you tell the difference?  Let me give you three things to consider when trying to determine if the intermittent chest pain, rapid heart beat, and anxiety are coming from the heart or not.

1. Don’t ignore your symptoms.

If it really is a heart attack then any delay in getting to the hospital could mean the difference between life and death.  Don’t delay in getting to the hospital, dial 911 if you think you might be having a heart attack.

2. Get a stress test

A simple stress test can help to determine whether or not you have a significant blockage in the arteries of your heart or a different heart condition.  My favorite stress test to perform is a stress echocardiogram or “stress echo”.  I like a stress echo because there is no radiation, no IV in your arm, and it gives you so much more information like heart chamber sizes, heart valve function, etc.

While a normal stress test can make the likelihood of a heart attack very low, it does not rule out an abnormal heart rhythm or arrhythmia problem.  One thing to remember is that in women life stressors can trigger heart attacks.  Mental stress is not fully evaluated with the standard stress test.  If you are under a lot of mental stress this is something that you will need to discuss with your physician.  To rule out an arrhythmia issue you will need an EKG while your heart is beating fast and while you are having symptoms.

3. Get an EKG During the Attack

As heart arrhythmias like SVT or atrial fibrillation are often misdiagnosed as panic attacks in women, it is critical that you get an EKG while you are having symptoms.  Unfortunately, “Murphy’s Law” dictates that your heart rhythm will probably return back to normal before you can rush in to the ER fast enough for an EKG.

As arrhythmias are often episodic, the best way to diagnose this is to have your doctor prescribe a Holter monitor or an event monitor.  A Holter monitor is a monitor that is attached to your chest for 24 to 48 hours.  If your rapid heart beats happen during this period of time then you can easily make the diagnosis.

For people whose symptoms may only happen once or twice a month, the event monitor is usually the better test to order.  Generally speaking, the event monitor is prescribed to you for one month.  You take it off when you shower or go swimming.  The rest of the time your heart is being continuously monitored.

Even with a month long event monitor many people will not have any attacks during this month.  Fortunately, we now have newer options.  For example, the company Alivecor makes an FDA-approved EKG machine for the iPhone and the Android smart phone (I have no financial relationship with this company).

For $199 and a doctor’s prescription you can have your own EKG machine on your smart phone.  As most people always keep their phones with them at all times now you won’t miss this diagnosis.  Currently, I have about 30 patients using this device and all of them have recorded high quality EKG rhythm strips for me to review.

There you have it, my three simple steps to determine is it a panic attack or a heart attack.  Do you suffer from chest pain, rapid heart beat, and anxiety?


#048 Should I Take an Aspirin Every Day?

November 22nd, 2014 by

Should I Take an Aspirin Every Day?

For many years, physicians have asked people with risk factors for heart disease or stroke to take an aspirin every day.  The idea was that an aspirin every day might prevent a heart attack, stroke, or even premature death.  Millions have followed their doctor’s advice and have faithfully taken their aspirin every day.

This past week at the annual American Heart Association meetings in Chicago this philosophy was turned completely upside down.  The results of this study hit the worldwide press and, as I can attest, created quite a buzz after the results were presented.  In addition to being presented in Chicago this past week this study was also simultaneously published in the prestigious Journal of the American Medical Association.

The Daily Aspirin Study

In this study, 14,646 Japanese were evenly randomized to either 100 mg of aspirin or no aspirin and were following for an average of about 5 years.  None of these people had heart problems or a stroke prior to entering into this study.  All of these people were definitely at risk for a heart attack or stroke as they were all at least 60 years old and had high blood pressure, high cholesterol, or diabetes.

At the end of 5 years they found that 2.77% of the people taking aspirin had a heart attack, stroke, or died.  Similarly, they found that 2.96% of the people not taking an aspirin suffered a heart attack, stroke, or died.  Statistically, there was no difference between these numbers.

While aspirin did not prevent heart attacks, strokes, or premature death it did put the people taking an aspirin at much higher risk of a bleeding complication.  The most serious bleeding complication, bleeding inside the brain or skull, was seen in 31 people in the aspirin group compared to just 14 people in the no aspirin group.  Major bleeding elsewhere in the body was also about twice higher in the aspirin group.

The bottom line from this study of more than 14,000 people was that in people with no prior history of cardiovascular problems, an aspirin a day does not offer any benefit.  Moreover, an aspirin every day puts people at a much higher risk of major bleeding.

Should I Take an Aspirin Every Day?

The question now is should I take an aspirin every day?  The answer is it depends.  Here is my take on this study and how I will advise my patients.

1. If you already have cardiovascular disease then this study does not apply to you.

If you are on an aspirin, please continue to take your aspirin under the direction of your physician.  Aspirin has been shown to be protective in people who already have cardiovascular disease.

2. If you take an aspirin each day just to “prevent” a heart attack, stroke, or premature death then the results of this study would argue that aspirin does not offer any benefit and may even put you at risk of a catastrophic bleed.

If your physician has prescribed an aspirin for “preventative” reasons, please discuss with your physician whether or not you should continue this medication based on the results of this study.  I have a link to this study above if you want to share it with your physician.

3. Medications, including relatively “benign” over-the-counter medications like aspirin, can have serious life-threatening complications.

This also applies to supplements which are unregulated and can also have life-threatening side effects.  Medications or supplements should only be taken under the careful supervision of a healthcare provider.

4. The best way to prevent a heart attack, stroke, or premature death is through a healthy lifestyle.

Eating plenty of fruits, vegetables, nuts, seeds, legumes, oily fish in combination with daily physical activity, stress management, restorative sleep, and close relationships is far more effective than any pill at preventing a heart attack, stroke, or premature death.

Have you or a loved one been prescribed an aspirin to prevent cardiovascular disease?  Did the results of this study surprise you?