Q & A
My father died of a heart attack. Although I have no chest pain, are there other symptoms I should pay attention to?
Unfortunately about half of all patients with significant coronary artery disease (CAD) have no angina pectoris, or chest pain. Some have shortness of breath, or sense a strange discomfort in the abdomen or lower teeth (jaw). Some patients have no symptoms at all, especially people diagnosed with diabetes mellitus.
Stress tests are necessary in such patients, but even a stress test will detect only about 80% of cases. If other risks factors such as carotid disease or elevated cholesterol are present then the patient should be checked for CAD.
Genetics (Family History) should not be ignored.
I was diagnosed with an aneurysm in my aorta. What should I do?
If the aneurysm is in the abdomen, and is less than 5cm diameter, we usually just keep an eye on it. Above 5cm we normally advise treatment, either with surgery or with a stent. A stent is usually used in older patients, and can be done while the patient is awake.
Aneurysms commonly occur below the kidneys but may occur elsewhere including in the chest. Careful evaluation and monitoring is required and control of blood pressure is important. When I was at the Cleveland Clinic we showed that the biggest cause of death in patients with aneurysms and PAD is heart attacks. So in addition to watching the aneurysm we need to watch your heart closely. You may require cardiac catheterization to assess your risk for treatment, as well as your long term prognosis.
I have a heart murmur and have started to notice shortness of breath. What is wrong with my aortic valve?
Aortic stenosis (AS) is becoming more common as patients are living longer than before. We see two groups of patients with AS. One group is in their 50’s and 60’s who have a congenital bicuspid aortic valve. In other words they were born with a faulty aortic valve which does not last long enough.
The other group are in their late 70’s or 80’s who have developed calcium deposits in otherwise normal aortic valves.
So we have CONGENITAL BICUSPID AORTIC VALVES and CALCIFIC AORTIC STENOSIS. Both of these conditions are serious life-threatening problems, which fortunately can be successfully treated.
For the younger group (congenital) the valve is replaced, usually with a tissue valve. For the older group the options consist of valve replacement with a tissue valve, or a minimally invasive valve replacement (TAVI) through the groin or a tiny opening under the left breast. Recently the PARTNER-trial was completed and the FDA is currently deciding on the approval of the SAPIEN (Edwards) valve for use in elderly patients who are at high risk for conventional surgery.
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Dr. Lees discusses patient centered comprehensive cardiac care, detection of symptoms, diagnosis, intervention and his complete commitment to patient care.