Answers from Our Experts

St. John's Ask the Expert is available to answer your questions about cardiovascular health. Selected questions and answers will be periodically displayed below throughout the month. You will not receive a personal reply. The information included in Ask the Expert is not intended for the purpose of diagnosing, prescribing or offering second opinions.

Remember to always consult your physician before undertaking or adopting any form of medical treatment, exercise program or dietary plan.

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New Questions

1.) I have developed ear lobe creases the last 2 years; the left one is very deep and pronounced.  Is there a link between these and CAD?  I have read this and have to look at myself every day. Also, is there a way I can order myself a CT angiography for my peace of mind since heart disease has run in the male side of my family?  I'm soon to be a 50-year-old male.

First question: While there has been some evidence connecting a pronounced ear lobe crease to a predisposition to development of CAD (coronary artery disease), it is definitely not a direct indicator of the disease process and the Cardiology community has not relied on this finding nor adopted it as a specific diagnostic finding to detect CAD in widespread practice.

Second question: While a screening CT angiography would be able to identify (and quantify) calcified plaque in your coronary arteries, it would not be able to identify any occlusion caused by “soft-plaque.”  Also, the radiation exposure that is required to obtain this data would be substantial, even if the procedure were done on a high speed CT scanner with dose-limiting software enhancements.  Since most screening scans are not considered diagnostic and, therefore, not reimbursed by insurance, a screening CT angiography can often be quite expensive, especially taking into consideration the information that it might provide.  Individuals who have multiple risk factors and/or a genetic predisposition to the disease may find a screening CT angiography to be of more value though this test is not done nor recommended as an initial screening test for the various reasons listed above.

For a 50-year-old male with a strong family history of heart disease (with or without earlobe creases), the initial approach would be evaluation by a primary physician or cardiologist to determine if there are other traditional risk factors such as hypertension, diabetes, etc., and/or symptoms suggestive of CAD. Initial testing, if needed, might include some form of stress testing. A cardiac CT might then be necessary and beneficial if the stress test is inconclusive or borderline in establishing whether or not CAD is present. Additional information obtained in the process can offer insight to a treatment regime and, in the event of a clean bill-of-health; a physician can assist you with wellness and disease prevention support.  

- David Cochran, M.D.
 

2.) Someone told me that women's symptoms for a heart attack is different than for men.  Can you tell me if this is true, and if so, what are the differences?

Women tend to have more "atypical symptoms" with  heart attacks than men do. They might experience tiredness,  shortness of breath, discomfort between shoulder blades, indigestion or just 'not feeling well'. As a result, women tend not to think of them as signals from their heart and ignore them. Studies show that women tend to wait longer to seek help when they have symptoms and they are much sicker when they finally seek care. It is important for women to be aware of the symptoms of heart attack and pay attention to them. Heart Disease is the No.1 killer of women and is preventable. Healthy lifestyle, exercise, and reducing cholesterol can prevent heart disease.

- Lakshmi Parvathaneni, M.D.
 

3.) Why is cardiac rehabilitation important to recovery from a heart attack?

Cardiac rehabilitation is critically important to your recovery from a cardiac event or illness because it provides the education and support to make the lifestyle changes that will help you return to the life you had (and often a better one) before you became ill. Cardiac rehab includes monitored exercise and physical therapy, learning to follow a heart-healthy diet, tobacco cessation, group support and learning how to manage stress. St. Johns' cardiac rehabilitation program includes a family support program for the spouse or support person of the cardiac patient.

St. John's cardiac rehabilitation includes, but is not limited to, the following activities:

• Establishing a progressive exercise program to build fitness and functional capacity.
• Providing educational classes to help adjust to or change the patient's lifestyle and habits, such as smoking cessation and nutrition classes.
• Stress management techniques and techniques to reduce anxiety.
• Counseling and educating the patient with regards to his/her specific heart condition/disease and the best management approach for that condition.
• Preparing the patient to return to work - equipping him/her to meet the physical and psychological demands of the job.

- David Cochran, M.D.