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Cholesterol & Dyslipidemia and Managing Multiple Risks


Question:
My question is about hereditary heart disease. I am 39 years old. My father died of a massive heart attack at age 44, his father at age 40, his grandfather at age 38 ... I am the first female in the chain. My overall cholesterol level is high (275) but my HDL is good (96), my LSL is high (159) and my triglycerides are good (85). I run 3-4 times a week and work out with weights, I eat m-a-y-b-e 200 milligrams of cholesterol a WEEK but my father was very fit too, which makes me anxious. Can you give me any advice?

Answer: Given your family history, you should undergo a complete cardiovascular evaluation. This includes a history of other risk factors for coronary heart disease such as smoking, blood pressure and diabetes. Your cholesterol is high...but your HDL (good cholesterol) is great. You probably should be started on a medication to decrease your bad (LDL) cholesterol considering the risk of premature heart attacks. Watch the FAT intake in your diet (no more than 30 % of your total caloric intake, less than 10% in saturated [animal] fats). -JRS



Question: Hi, I am a 27-year-old female with a family history of heart disease. My grandmother died at the age of 52 of a massive heart attack. My grandfather had his first heart attack at the age of 60. One grandparent died of a massive heart attack at 80. About 2weeks ago I started having a pain in my neck that lead down into the middle of my chest. Later, that night I had an enormous pain though my neck, chest through my ribs (on the right side) and through my shoulder. It lasted about 15min. The pressure in my chest lasted 11/2 hours. Since then I have had reoccurring tightness in my neck and chest but without the pain. My heart feels like it is going to pound out of my chest and neck. Not racing just pounding. I have checked my blood pressure during some of these times and they have ranged for 108/62 to 140 over 90. I feel like my blood pressure is all over the place throughout the day. I start feeling like my self and all of a sudden my neck starts my chest then my heart starts pounding and I get really tired. The family doc put me on heartburn meds. I have been taking them for a week and a half I have not noticed any difference. My heart has done the pounding thing without the pressure too, so? Can you give any insight in to what is happening? Thank you for your time.

Answer: I am sure your discomfort is of a great concern. Heart attack is very uncommon in 27-year-old women...however, it is not unheard of. A GI (gastrointestinal) evaluation is the first place to start. However, given your family history of heart attacks, a cardiovascular work up/ history and physical exam is in order. This includes evaluation for risk factors (smoking, diabetes, high cholesterol, high blood pressure). Follow up with your family doctor/ internist. -JRS



Question: My son has been turned down for insurance because he has low cholesterol (or CDT). Since we have never heard of this, could you tell us what is the cause and what is the cure?

Answer: I am sorry that I cannot respond to a question involving an insurance company. I do not know what disease(s) your son may have which could cause an insurer to turn him down for low cholesterol. However low cholesterol can occur in disease states that cause malnutrition such as cancer or AIDS. Also malnutrition can cause low cholesterol. I hope you get a more specific answer from your insurer. -JRS



Question: I am 32 years old and high cholesterol is very prevalent in my family. I have been having numbing/tingling in my fingertips and have already been checked for Diabetes and Carpal Tunnel Syndrome. What are some of the symptoms of High Cholesterol? Thanks

Answer: Unfortunately, there are no symptoms of high cholesterol. With a family history of high cholesterol, you should have your levels tested. In some people xanthalasma (fatty deposits around the eye area) is a sign of high cholesterol. -JRS



Question: I have elevated triglycerides (>700) at one point they were >2450, my cholesterol is always high, usually from 285 as high as 735. I have done all the normal clinical medications to reduce them, but found the statin drugs to be very toxic to my body, they have left me with muscle and joint pain, which is sometimes bad, sometimes not so bad. My actual question is LDL pattern B and also an elevated ApoB level. I know nothing about this, have just started researching, but I do know, I am 49, female, have 4 stents, just got out of the hospital last Thursday, my sister (48) has had 3 severe heart attacks, 5 bypasses and Dr. Bonnie Floyd saved her life, but she has developed congestive heart failure, paroxysmal ventricular tachycardia, and a pacemaker, is totally disabled. I also have a 47-year-old brother who has had either 3 or 4 heart attacks. We all inherited this from my mother's side of the family. Her side has all died the youngest. Do you have anything going on with this kind of stuff, I am curious (and I will ask my Cardiologist, Bonnie Floyd at Medical City) to check out this ApoB and LDL pattern B, I know she knows diet does not change my triglycerides or cholesterol??? Any ideas, suggestions?

Answer: I am sorry your family has to suffer through all of the vascular problems related to your hyperlipidemia. However, it does sound as if you have a lot of confidence in Dr. Floyd. Familial hyperlipidemias are a real dilemma for the patient and the physician. Often combinations of drugs are used to manage the disorder. Exercise can help increase the "good" cholesterol, HDL. There are many studies being conducted to evaluate management strategies as well as basic scientific research. I am sorry to say that I cannot answer your question regarding LDL pattern B or Apolipoprotein B levels. I work in a clinical cardiology practice where research is being conducted and managed by a research team. Most of our studies are clinical studies evaluating drug or device efficacy and safety. Continue your reading about the problem and please address all of your concerns and questions with Dr. Floyd. I am sure she is in a much better position to discuss your particular problem and the appropriate therapies. -JRS



Question: What is considered high cholesterol? Mine tested in the 140's and my statement reads that is elevated, what is considered good or normal and what is considered high?

Answer: Total cholesterol should be less than 200. HDL cholesterol should be above 35 LDL cholesterol should be below 130 I am not sure what your "140" refers to. -JRS



Question: How do I control my high cholesterol?

Answer: Controlling high cholesterol means adapting your life style. 1. Exercise...walk, walk, walk for 20 -30 minutes at least 4 times weekly. 2. Watch what you eat. Decrease the amount of dairy products you eat (use 1% or skim milk products). Eat lean meat, poultry and fish. Grill, bake, roast or poach it. Eat fresh fruits and vegetables. Avoid gravy, fatty foods (bacon, luncheon meats) & chips. 3. Find out from your doctor if you need cholesterol-lowering medications. If you have risk factors for coronary heart disease such as diabetes, high blood pressure, a family history of heart attacks, or smoking you may need cholesterol-lowering medicine. 4. Even if you are prescribed these medications you still need to exercise and watch what you eat. 5. Don't be fooled by labels...low or no cholesterol products do not mean NO FAT. Donuts, pastries & cakes that are advertised as no fat are ALL SUGAR. Read the nutritional label on the food you are about to eat. The American Heart Association cookbook has a lot of very good information in it regarding heart healthy eating. -JRS



Question: Is there a cholesterol connection to cardiovascular disorders?

Answer: Yes (for more information, go to http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm)-JRS



Question: How do you figure risk ratio using HDL, LDL, Triglyceride levels for cholesterol?

Answer: According to the National Cholesterol Education Program (NCEP) Cholesterol / HDLC ratio should be less than 4.5. To calculate: For example if your total cholesterol was 237 and your HDLC was 86, your calculated ratio would be 2.76. You get this number by dividing total cholesterol by HDLC. -JRS



Question: I would like to know how hypothyroidism is related to high cholesterol. I'm 54-55 years old. Does all of this have something to do with menopause? I'm not on any therapy for menopause due to the risk of breast cancer. Could you provide some information on diet (I'm not over weight) so as to avoid taking liperador. My thyroid medication was doubled and I was told that I had high cholesterol.

Answer: Yes, high cholesterol and hypothyroidism are related...so is high cholesterol, hypothyroidism and heart disease. In order to lower your cholesterol without taking drugs such as Lipitor, you should: 1. Take your thyroid medicine as prescribed. 2. Take a walk every day for 20-30 minutes. 3. Avoid food that are high in saturated (animal) fat such as butter, ice cream, milk, junk food / fast food. However, if your physician has suggested Lipitor, you should consider taking it. Medication combined with #1, 2, & 3 can help lower your risk of coronary events. -JRS



Question: I was wondering what your LDL cholesterol reading should be. I am 32 years old and just had my physical. My HDL was 44, LDL 118 and total 174. The nurse told my the LDL was high and should be under 99. I have no history of heart disease and heard that a healthy person should have a reading of HDL 45, LDL below 130 and total below 200. Am I in range of my LDL being okay?

Answer: If you have any risks for heart disease, such as: family history, high blood pressure, smoking or diabetes the LDL should be below 100. -JRS






Chest Pain, Short of Breath, Discomfort


Question:
I am a 45-year-old female; I am overweight by 75 pounds. The other day I had an ache in my chest between the breast and deep that went to both shoulders. Not stabbing, but I could not ignore it. It lasted a couple of hours; I took two aspirin (325mg) each. I have not had the pain since, although I was slightly nauseous with it. I did lie down for an hour or so, until it went away. Is this something I should tell my doctor? I have just started to be treated for menopause, hot flashes, etc.

Answer: Yes, you should discuss this with your doctor. Further evaluation may be warranted. -JRS 137




Question: I had a heart attack two years ago. I have been getting pains either side of my neck, tight chest and breathlessness. I am told this is angina, is it common to suffer with angina after heart attack

Answer: I have heard many people say that after one heart attack you cannot have another one or experience angina attacks. THIS IS NOT TRUE. Angina needs to be controlled by medications, angioplasty or by-pass surgery. Talk to your cardiologist...soon. -JRS



Question: I have constant pain in my forearm and numbness and tingling in my left hand. I have had this for 4 days now. What should I do?

Answer: You should see your doctor. This could be caused by pressure on a nerve or signs of a stroke. -JRS



Question: My 8 year old son has been complaining of heart pains, which appear to be palpitations. Is there something I should be concerned about?

Answer: Your son should be evaluated by his pediatrician.... and then, if necessary, a pediatric cardiologist. -JRS



Question: I am feeling a slight pressure pain that is somewhat on the left side of my chest towards my underarm. It is slightly uncomfortable breathing. This is the first time I have experienced this--it's been only 15 minutes---how do I know if this could be indicative of a heart attack I am 43 year old woman.

Answer: You are not able to tell if it is a heart attack yourself. From your description of the symptoms you need to have this evaluated. -JRS



Question: I have a general question for you: Could you please tell me how to know the difference between experiencing a heart attack versus something like heartburn? Is there anything I can do to differentiate between the two? Thank you.

Answer: Heart attack symptoms may resemble heartburn. The way to differentiate is to: 1. Take a good history of the pain from the patient; including risk factors: family history, cholesterol status, high blood pressure, diabetes, and smoking 2. Look at the EKG 3. Check the cardiac enzymes -JRS



Question: I woke up this morning with indigestion, burning sensation in my chest area, I asked my husband to get me a couple Tums and they seemed to really hit hard, indigestion still there and pain right in the center of my chest bone comes and goes? Pain off and on in-between my shoulders and my right arm seems to go numb every now and then. I had worked out in my yard the last couple of days not really over-worked and last night around eight it just felt like all energy drained out of me and I went to bed, slept pretty good and then woke up with like a indigestion and a headache off and on, I just fell kind of drained. Pain comes and goes? I have had a couple of Angina attacks and test show a value/artery on the back of my heart is smaller and that could cause some problems, I have called my heart Doctor before when I have had these pains and I fell so dumb at times, so maybe I just over did it again? As long as I am basically quiet I seem okay just rung out, if I start bending or doing something then pain comes back again. Is this just another one of Angina attacks?

Answer: What you are experiencing could be angina, indigestion, or musculoskeletal strain. However, since you have a history of coronary artery disease, your symptoms should be investigated… especially because of your "rest pain". Please seek the opinion of your cardiologist. You need to be evaluated to determine the cause of your pain. -JRS



Question: I have pain on my left shoulder and at times a pain in the middle of my chest. I have previously been diagnosed with acid reflux but the pain was only in the middle of my chest then. I bent over the bathtub and I felt water in my throat and tasted acid. This pain I have had for 3 days. I am taking Zantac and it seemed to be better. Could this left shoulder pain be coming from acid reflux?

Answer: Reflux is not too pleasant.... is it? I am glad the Zantac helped. I am not sure what caused your left shoulder pain.... I am not aware of reflux causing this type of discomfort. -JRS



Question: I am having some pain in my chest along with pain in my upper back and a sense of fullness. Can you tell me what this could be?

Answer: Your discomfort could be one of many things. Before I can respond I need more information, such as your age. Do you have high blood pressure, diabetes or high cholesterol? What medical problems are you being treated for? After I get more information I will be better equipped to respond to your question. -JRS



Question: I am a 58-year-old female, with no serious negative genetic background for heart disease, as far as I know. I'm adopted, though, and am not sure of my birth father's background. I do know my mother's. My husband just had bypass surgery a week ago and I am the primary care giver, so this is a very stressful time. I now find I have a heightened concern about a mild burning sensation in the middle of my chest. It feels like it's in my esophagus. The sensation extends from about my Adam's apple to just below my breastbone. It doesn't really hurt. I'm just aware of the sensation. I haven't had any pain, but I read on this site that my symptoms can indicative of heart disease. My only two risk factors are my age and I haven't been exercising regularly. I'm 5'2, weigh 125, and have never smoked. My eating habits are fairly good, in that I'm aware of good/bad fats, don't eat at fast food places, and my good cholesterol count has always offset my bad enough to put me in a very low risk factor category. Another troubling thing, though, is that my blood pressure has always been about 110/70, but the last time it was taken, it was higher. I can't remember the numbers. I also have some mild tingling in my fingertips sometimes, which is fairly new. Do you think I should see a doctor about my symptoms based on my history?

Answer: It would be wise to see a physician. Stress could be the culprit. However cardiac or gastrointestinal problems could cause similar symptoms. -JRS



Question: I am only 35-years-old, but last night I woke up in the middle of the night with severe burning/pain in my chest. I did not feel reflux, but I had burning in my throat. I chewed Gaviscon and took Ranitidine. It took hours, but the pain finally eased up. I had mild discomfort though all day. Should I be overly concerned? My only risk factors are high blood pressure and borderline high cholesterol. I am not overweight, do not smoke, and do not drink.

Answer: It sounds like reflux / esophagitis to me. You should see your primary care provider for evaluation of the symptoms. You may need different drugs than Gaviscon & Zantac. -JRS



Question: I am a 47-year-old white female with a history of high blood pressure, diabetes, anemia and congestive heart failure weighing 220 at 5'7". I am currently taking Labetalol, Lasix, Prinivil, Clonidine, Norvasc, Zocor, Zoloft, Chromagen Forte, Glucophage, Micro K, aspirin and Humulin 70/30. I have trouble breathing just prior to my period each month. Do you have any idea why?

Answer: I am not sure what your get short of breath prior to your menses. Perhaps your blood pressure goes up prior to you period. That could make you more short of breath.... especially if you take an NSAID, such as Motrin (which has been used to decrease menstrual cramps). -JRS



Question: Lately I have noticed that my heart rate goes over 100 beats per minute (bpm). I've seen 109 bpm. It will go down to the 80's at rest sometimes but is consistently in the 90's. I am not a very active person. I am a stay at home mom and housewife. My marriage is solid and I don't have a lot of worries to speak of. It seems to get higher later in the day. I am a 37-year-old female, smoker. I have 2 children aged 17 and 13. The only med I am taking is Valium. I have taken it for quite sometime as a muscle relaxant for neck and shoulder pain caused by an injury from a car accident. I don't take any pain meds accept for Advil or Tylenol. Should I be highly concerned or just get an appointment with my family doctor? Thanks

Answer: Your heart rate is a bit too high. Causes for this could be stress (teenagers can do that), stimulants, such as caffeine, or abnormal thyroid function, lung disease from SMOKING, or low blood count. It needs to be evaluated. -JRS



Question: What should I do? I'm short of breath, weak, fatigued, chilled, no appetite, I can barely walk. Then I get hot. I've taken my abrtrol. I barely can talk; I'm losing my voice. I've seen my cardiologist, and he says my EKG checks out find. He suggest pulmonary specialist. I'm just getting weaker as the day progress. I cry and that just don't help. What should I do? Should I go out to the emergency room, or should I just stick it out?

Answer: You sound as if you feel awful and are at your wit's end. Unfortunately, I have no idea what your problem is. I do not know what the drug is that you said you were taking. In addition I have insufficient information to even try to help you see your way through your angst. I certainly hope you have an internist who is coordinating your care. If you don't, I would suggest that you find one as soon as possible. Good luck, -JRS

Question: Is pain in the center of the chest and back often related to acid reflux due to hiatus hernia problems. The pain often radiates to the jaw on the right side. Could this be a type of pain related to gall bladder?

Answer: To both questions: Yes, the symptoms could be related to acid reflux (GERD), hiatus hernia, or gall bladder disease. However, the symptoms should be further investigated since they could represent other medical problems. -JRS



Question: I am 5' 4" and weigh 150 pounds. I am constantly out of breath or breathing fast. I don't have any medical problems. Can this be from being fat? And, another question... is there a medication for anxiety that won't make you tired or drowsy or sleepy? What other ways can I control it?

Answer: Am I correct to assume that the first question you posed is related to your second question? There are many reasons for feeling short of breath. Lung disease related to cigarette smoking is one of the many causes of shortness of breath. Heart disease is another cause. There is a possibility that your weight may contribute to the problem. You spoke about anxiety. Anxiety can cause shortness of breath and rapid breathing. Medicines for anxiety can cause drowsiness. So, learning to control anxiety without medicines can be helpful. Some people find it helpful to take a walk, listen to music, or do SOMETHING that is pleasant for them, however it would be wise to discuss this further with your family doctor. - JRS



Question: I am a 39-year-old female with High Blood Pressure, I am taking Atonally and Hydrochlorothyazide, and I also smoke. I have been experiencing fatigue, palpitations and a strong pulse beating on the left side of my neck with discomfort in that area. The discomfort sometimes runs down my neck and into my chest and shoulder area. I also get tingling in my arms and legs. It happens a lot when I am lying in bed, my legs sometimes ache. I had blood tests and an EKG done and they were ok. Could it be anxiety?

Answer: Anxiety can cause fatigue, palpitations and chest pain. But, poorly controlled blood pressure can lead to a weakened / overworked heart muscle causing similar symptoms. Address these issues with your physician. You may need to undergo a stress echocardiogram. Also, do your body a big favor and quit smoking. Tobacco abuse significantly increases the risk of heart disease. -JRS




Question: I am 23 years old and for the past 10 months I have been having chest pain. My left arm will sometimes will tingle along with pain in my shoulder. Lately I have been having a lot of abdominal pain. I have seen several doctors including a cardiologist and they all say they can find nothing wrong with my heart. I am at the end of my rope and it makes me very upset. Can you please help me!!!!

Answer: I am sorry to say that I will not be of much help. Since you were evaluated by a cardiologist for your chest pain, arm tingling, and shoulder pain, I could probably assume the pain you are feeling is musculoskeletal. Since you are 23 years old the likelihood of the pain being of cardiac origin is low...unless you smoke, have high blood pressure, are diabetic, have high cholesterol, and have a family history of heart disease. I am unable to respond to your complaints of abdominal pain. Please see your family doctor and talk to him/her about your concerns. A thorough physical examination and discussion about your symptoms is needed. Good Luck. -JRS



Question: I am a 25-year-old female and I have been having chest tightness, shortness of breath and sometimes palpitations for almost a year now and it is becoming more often from about three times a month to almost every day now. It has been bothering me because I feel short of breath most of the time even if I am just in a seated position. I want to know what I could do about it, what specialist I should consult and what tests I should get. I have a history of gastritis and I have pale lips, I was prescribed iron before when I was 12y/o but did not take it because of constipation with iron intake. I had this instance when my boyfriend had a nap placing his head on my upper arm putting pressure on it and as I awoke after 15mins I noticed reddish spots on my arm and got scared. Can you explain to me this symptoms ASAP? Thank you so much.

Answer: From the symptoms you describe, you need to see your family doctor for a full evaluation as soon as possible. Anemia can cause these symptoms. A few simple blood tests and an evaluation of your stool for the presence of occult (invisible) blood should be done. Iron pills can cause constipation. However, it can be prevented by drinking plenty of water, eating fresh fruit and vegetables and taking stool softeners. -JRS



Question: I have a friend who has severe chest pain for about 7-10 days prior to her menstrual cycle. She's been evaluated by a cardiologist who did a heart cath. They said her arteries were clear, but one side of her heart was not getting enough oxygen. Basically, the doctors were rude and acting like she was blowing her chest pain out of proportion. She did have an abnormal EKG both times she was admitted through the ER. When she went for her follow-up, she was scheduled with the wrong doctor. The doctor basically said, "you need to follow-up with the other doctor" and rudely walked out of the room. The next time her appointment was scheduled they messed up the day and time--again. So, she took off work and still was not able to see a doctor. Needless to say, she does not want to try to deal with those doctors. I am talking about severe pain, palpitations, sweating, shortness of breath, tightness in the throat and other symptoms. Do you know if hormones (premenstrual) can cause this? She has pain throughout the month, but it is very severe in the middle of the month and right before her periods. Have you ever heard of anything like that?

Answer: You sound very concerned about your friend's well-being, as a good friend should be. However, your friend needs to address her concerns with her cardiologist. It sounds as if there were many miscommunications with the heart doctors regarding the causes of her symptoms and follow up appointments. This can be frustrating for both the patient and the physican. As to your questions as to whether or not I have heard of severe chest pain occurring constantly throughout the month and then worsening mid-cycle, the answer is no. Constant chest pain is not usually cardiac in nature. However, chest tightness radiating to the throat, sweating, shortness of breath, and palpitations are symptoms consistent with coronary heart disease. However, these symptoms can be related to anxiety. One of your statements confused me. I am not clear what you meant when you said, "the arteries were clear", but one side of her heart was "not getting enough oxygen". This statement is inconsistent with a "clear" catheterization. I think that your friend needs to have a discussion with her doctor to discuss the findings of her catheterization, why the symptoms occur and what should be done to manage the symptoms. - JRS



Question: Thank you for your helpful website. I am a twenty three year old woman. I'm writing because I have had pains in the left side of my chest, over the heart since age nineteen. These days they are very frequent and often I get very dizzy, and need to sit down, or get down on all fours. I have never fainted, but feel lightheaded several times a day. I am also noticing that I'm tired all the time, and I can't sing as long without taking a breath as I used to (I'm a vocal student). I am pretty concerned about the chest pains because they sometimes move down my arm, or into the left side of my neck. I do have a history of gestational diabetes and I once had a swollen liver and spleen due to mono, two years before the pains started, but I have been in good health otherwise. I would like to know if there is reason to be concerned at my age. Thank you for your time.

Answer: You sound concerned.... so your symptoms should be evaluated. Shortness of breath and fatigue are NOT normal in 23 year-old or a 70 year-old. These symptoms need to be evaluated. A complete blood count and thyroid function studies need to be done before looking for cardiac causes of your symptoms. See your doctor. -JRS



Question: I am a 47 year old, white female that is a heavy smoker. For the past two weeks I have been having pain on my right side on the top of the breast that the pain travels over and down my right arm. The pain may last from a couple minutes to about five. I am not sure if I should be concerned or not. Do you have any idea what it could be as I am sure it is not heart related because I have always been told that heart pain is on the left side.

Answer: Heart pain is not always felt on the left side of the chest radiating to the left arm. Heart pain can be felt anywhere from the waist to the neck/jaw area. Some people describe heart pain as a heaviness, tightness, or a squeezing sensation. Heart pain can also cause shortness of breath (which you, as a heavy smoker, could have), nausea, weakness, or sweating. The most important message I can give you is that heart pain and its related symptoms are different for each person. Risk factors for heart disease include a family history of heart attacks, women after their menstrual periods have stopped, diabetes, high cholesterol, high blood pressure, being overweight, and SMOKING. If you have more than one risk factor you should discuss the pain with your family doctor. He/she might suggest a few tests after getting a history of your pain, evaluation of risks for heart disease, and a physical examination. I am certain your doctor will suggest that you do yourself a big favor and stop smoking. - JRS




Cholesterol / Managing Multiple Risks


Question: My question is about hereditary heart disease. I am 39 years old. My father died of a massive heart attack at age 44, his father at age 40, his grandfather at age 38 ... I am the first female in the chain. My overall cholesterol level is high (275) but my HDL is good (96), my LSL is high (159) and my triglycerides are good (85). I run 3-4 times a week and work out with weights, I eat m-a-y-b-e 200 milligrams of cholesterol a WEEK but my father was very fit too, which makes me anxious. Can you give me any advice?

Answer: Given your family history, you should undergo a complete cardiovascular evaluation. This includes a history of other risk factors for coronary heart disease such as smoking, blood pressure and diabetes. Your cholesterol is high...but your HDL (good cholesterol) is great. You probably should be started on a medication to decrease your bad (LDL) cholesterol considering the risk of premature heart attacks. Watch the FAT intake in your diet (no more than 30 % of your total caloric intake, less than 10% in saturated [animal] fats). -JRS



Question: Hi, I am a 27-year-old female with a family history of heart disease. My grandmother died at the age of 52 of a massive heart attack. My grandfather had his first heart attack at the age of 60. One grandparent died of a massive heart attack at 80. About 2weeks ago I started having a pain in my neck that lead down into the middle of my chest. Later, that night I had an enormous pain though my neck, chest through my ribs (on the right side) and through my shoulder. It lasted about 15min. The pressure in my chest lasted 11/2 hours. Since then I have had reoccurring tightness in my neck and chest but without the pain. My heart feels like it is going to pound out of my chest and neck. Not racing just pounding. I have checked my blood pressure during some of these times and they have ranged for 108/62 to 140 over 90. I feel like my blood pressure is all over the place throughout the day. I start feeling like my self and all of a sudden my neck starts my chest then my heart starts pounding and I get really tired. The family doc put me on heartburn meds. I have been taking them for a week and a half I have not noticed any difference. My heart has done the pounding thing without the pressure too, so? Can you give any insight in to what is happening? Thank you for your time.

Answer: I am sure your discomfort is of a great concern. Heart attack is very uncommon in 27-year-old women...however, it is not unheard of. A GI (gastrointestinal) evaluation is the first place to start. However, given your family history of heart attacks, a cardiovascular work up/ history and physical exam is in order. This includes evaluation for risk factors (smoking, diabetes, high cholesterol, high blood pressure). Follow up with your family doctor/ internist. -JRS



Question: My son has been turned down for insurance because he has low cholesterol (or CDT). Since we have never heard of this, could you tell us what is the cause and what is the cure?

Answer: I am sorry that I cannot respond to a question involving an insurance company. I do not know what disease(s) your son may have which could cause an insurer to turn him down for low cholesterol. However low cholesterol can occur in disease states that cause malnutrition such as cancer or AIDS. Also malnutrition can cause low cholesterol. I hope you get a more specific answer from your insurer. -JRS



Question: I am 32 years old and high cholesterol is very prevalent in my family. I have been having numbing/tingling in my fingertips and have already been checked for Diabetes and Carpal Tunnel Syndrome. What are some of the symptoms of High Cholesterol? Thanks

Answer: Unfortunately, there are no symptoms of high cholesterol. With a family history of high cholesterol, you should have your levels tested. In some people xanthalasma (fatty deposits around the eye area) is a sign of high cholesterol. -JRS



Question: I have elevated triglycerides (>700) at one point they were >2450, my cholesterol is always high, usually from 285 as high as 735. I have done all the normal clinical medications to reduce them, but found the statin drugs to be very toxic to my body, they have left me with muscle and joint pain, which is sometimes bad, sometimes not so bad. My actual question is LDL pattern B and also an elevated ApoB level. I know nothing about this, have just started researching, but I do know, I am 49, female, have 4 stents, just got out of the hospital last Thursday, my sister (48) has had 3 severe heart attacks, 5 bypasses and Dr. Bonnie Floyd saved her life, but she has developed congestive heart failure, paroxysmal ventricular tachycardia, and a pacemaker, is totally disabled. I also have a 47-year-old brother who has had either 3 or 4 heart attacks. We all inherited this from my mother's side of the family. Her side has all died the youngest. Do you have anything going on with this kind of stuff, I am curious (and I will ask my Cardiologist, Bonnie Floyd at Medical City) to check out this ApoB and LDL pattern B, I know she knows diet does not change my triglycerides or cholesterol??? Any ideas, suggestions?

Answer: I am sorry your family has to suffer through all of the vascular problems related to your hyperlipidemia. However, it does sound as if you have a lot of confidence in Dr. Floyd. Familial hyperlipidemias are a real dilemma for the patient and the physician. Often combinations of drugs are used to manage the disorder. Exercise can help increase the "good" cholesterol, HDL. There are many studies being conducted to evaluate management strategies as well as basic scientific research. I am sorry to say that I cannot answer your question regarding LDL pattern B or Apolipoprotein B levels. I work in a clinical cardiology practice where research is being conducted and managed by a research team. Most of our studies are clinical studies evaluating drug or device efficacy and safety. Continue your reading about the problem and please address all of your concerns and questions with Dr. Floyd. I am sure she is in a much better position to discuss your particular problem and the appropriate therapies. -JRS



Question: What is considered high cholesterol? Mine tested in the 140's and my statement reads that is elevated, what is considered good or normal and what is considered high?

Answer: Total cholesterol should be less than 200. HDL cholesterol should be above 35 LDL cholesterol should be below 130 I am not sure what your "140" refers to. -JRS 101



Question: How do I control my high cholesterol?

Answer: Controlling high cholesterol means adapting your life style. 1. Exercise...walk, walk, walk for 20 -30 minutes at least 4 times weekly. 2. Watch what you eat. Decrease the amount of dairy products you eat (use 1% or skim milk products). Eat lean meat, poultry and fish. Grill, bake, roast or poach it. Eat fresh fruits and vegetables. Avoid gravy, fatty foods (bacon, luncheon meats) & chips. 3. Find out from your doctor if you need cholesterol-lowering medications. If you have risk factors for coronary heart disease such as diabetes, high blood pressure, a family history of heart attacks, or smoking you may need cholesterol-lowering medicine. 4. Even if you are prescribed these medications you still need to exercise and watch what you eat. 5. Don't be fooled by labels...low or no cholesterol products do not mean NO FAT. Donuts, pastries & cakes that are advertised as no fat are ALL SUGAR. Read the nutritional label on the food you are about to eat. The American Heart Association cookbook has a lot of very good information in it regarding heart healthy eating. -JRS



Question: Is there a cholesterol connection to cardiovascular disorders?

Answer: Yes (for more information, go to http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm) -JRS



Question: How do you figure risk ratio using HDL, LDL, Triglyceride levels for cholesterol?

Answer: According to the National Cholesterol Education Program (NCEP) Cholesterol / HDLC ratio should be less than 4.5. To calculate: For example if your total cholesterol was 237 and your HDLC was 86, your calculated ratio would be 2.76. You get this number by dividing total cholesterol by HDLC. -JRS



Question: I would like to know how hypothyroidism is related to high cholesterol. I'm 54-55 years old. Does all of this have something to do with menopause? I'm not on any therapy for menopause due to the risk of breast cancer. Could you provide some information on diet (I'm not over weight) so as to avoid taking liperador. My thyroid medication was doubled and I was told that I had high cholesterol.

Answer: Yes, high cholesterol and hypothyroidism are related...so is high cholesterol, hypothyroidism and heart disease. In order to lower your cholesterol without taking drugs such as Lipitor, you should: 1. Take your thyroid medicine as prescribed. 2. Take a walk every day for 20-30 minutes. 3. Avoid food that are high in saturated (animal) fat such as butter, ice cream, milk, junk food / fast food. However, if your physician has suggested Lipitor, you should consider taking it. Medication combined with #1, 2, & 3 can help lower your risk of coronary events. -JRS



Question: I was wondering what your LDL cholesterol reading should be. I am 32 years old and just had my physical. My HDL was 44, LDL 118 and total 174. The nurse told my the LDL was high and should be under 99. I have no history of heart disease and heard that a healthy person should have a reading of HDL 45, LDL below 130 and total below 200. Am I in range of my LDL being okay?

Answer: If you have any risks for heart disease, such as: family history, high blood pressure, smoking or diabetes the LDL should be below 100. -JRS




Depression and Heart Disease

Question: I am a 34 yr old female, social worker. Period stopped 2.5yrs ago. Approx. 8 mo after giving birth to first child. Still not having period, also having major weight gain of over 65 lbs. after losing weight from pregnancy.Diagnosed with mild hypothyroidism, Hx. of major depression since age 16, just now received blood test result with majorly increased liver enzymes. I also have extreme fatigue. How could these issues affect my heart? I have no diagnosis of conditions. I have a young child & high stress job and need answers. My cholesterol levels are over 320 with triglycerides usually at 350. Never had these problems previously. my entire body has been disrupted since 6 months after birth of my daughter. Also, separated - now divorced from husband. Also have problems with fluid retention, constipation, all depressive symptoms, am currently on new med Paxil for depression but have been on Wellbutrin for past 7 yrs. Given up on doctors always say it is "stress".

Answer: I am sorry you are not feeling well. What you really need is an evaluation by a good internist....especially with your abnormal lipid and liver function tests. I certainly hope you are receiving mental health care for your high level of stress, history of major depression and recent birth of a child. Good luck, -JRS



Question: Is there some connection between depression and heart problems/high blood pressure in women. From doing some general research on-line I've noticed that there seem to be some similar symptoms. Overweight, non-active, stress. Does one problem/disease often lead to the other? I appreciate your advice in clarifying this. Also, I've heard that women experience different symptoms than men when it comes to heart related problems. Is this true and what are some of the symptoms women should look for.

Answer: Your first question, in essence, answered itself. If a person does not exercise and is overweight, there is a risk of high blood pressure. Exercise can help depression and can decrease blood pressure. Anyone with coronary heart disease can exhibit similar or different symptoms from another person with heart disease. Everyone is different. The best example I can think of is this: Have you ever heard women compare their labors? Have you ever heard two exact stories? Everyone is unique. Some specific symptoms are pressure, heaviness or tightness in the chest area. This discomfort can radiate to the neck, jaw, arms, or back. Other symptoms include: shortness of breath, palpitations, nausea, vomiting, sweating, and dizziness. Men and women are different in their perceptions and descriptions of symptoms. -JRS






Diagnostic Tests

Question: My mother is 63-years-old. She only sees a medical doctor. Over the last year she had to have router cup surgery. Recently she has had excelatored heart rate, blurred vision, sweats, slurred speech, fainting. She had a brain scan, doppler on neck, heart and aorta that showed fine. I think she is going to a heart doctor soon. I keep asking for them to run a blood sugar test on her and they have not done it yet. She also has Glaucoma in her eyes. Do you have any advise on this?

Answer: I can't give you any advice. She needs to continue with the evaluation process with her primary doctor and possibly the cardiologist. None of these symptoms are normal. And, yes these symptoms could have been the result of low blood sugar...however, the symptoms could be caused by more serious problems. It sounds as if your mother's doctor is doing the right things to evaluate her. -JRS



Question: Do heart attacks always show up on some heart tests?

Answer: No -JRS



Question: What does a high potassium level mean?

Answer: Kidney failure, Addison's disease (JFK had it) and certain diuretics can cause high potassium. Severe crushing injury to the tissue can also cause it. Another cause is excessive intake...usually from intravenous administration. Sometimes potassium can appear to be elevated due to poor technique when obtaining the blood sample. -JRS



Question: my mother has to have some tests taken to find out how far her heart disease is progressing and what is causing it. one of the tests is looking for PFTs. could you tell me what that is. thank you, shelia

Answer: PFTs are pulmonary function tests. The test is to evaluate her lung function. Along with other tests it can help determine how much her lungs (disease) may be contributing to her shortness of breath. -JR
S



Question: What does it mean if your platelets are low?

Answer: Thrombocytopenia (low platelet count) can caus e abnormal bleeding because a clot cannot effectively form. The normal platelet count is between 150,000 - 450,000 per microliter. However, if a platelet count is 75,000 it does not mean severe bleeding will occur. Thrombocytopenia is caused by one of three mechanisms: decreased production of platelets in the bone marrow, increased destruction of platelets, and "hiding" of platelets in the spleen. A low platelet count can be related to liver diseases, tumors, leukemia, lymphoma, or it can be caused by some medications. - JRS





Diet

Question: Does alcohol help to lower your cholesterol?

Answer: There is a possibility that red wine may contribute to lowering "bad" cholesterol-JRS




Question: What are the total daily milligrams of cholesterol you should eat? I have very high triglicerides, and can not find a definite answer to this question.

Answer: Concentrate on you FAT intake. No more than 30 % of your calories should be fat...and of that no more than 10% in saturated fat (dairy/meat products). As for your triglycerides.......watch what you eat when your are trying to cut back on fats/cholesterol. A lot of products that are low fat/no cholesterol are mostly sugar (non-complex carbohydrates). These products can raise your triglycerides. Labels are very deceiving. Elevated triglycerides are common in diabetics. -JRS




Question: I was wondering if there are any other ways besides exercise, medication, changes in diet and not smoking that will help people lower their cholesteral.

Answer: Not that I am aware of. Read "Dean Ornish's Program for Reversal of Heart Disease" by Dr. Dean Ornish -JRS



Question: Hi. My name is Robert. I have a little high cholesterol. What is the best way to lower it? I'm starting to diet. I lost about 20lbs. I use to be over 200lbs. I'm staying away from animal fat foods. Is there anything else I should know? I'm 37 yrs old. Thanks so much for listening. -Robert

Answer: Robert, This is a women's heart forum. However, the information regarding cholesterol management is the same for men as it is for women........that is, until more research is done!!!!! You must be congratulated on your weight loss by decreasing your intake of animal fat. However a fat calorie...no matter from which source it comes , is still 9 calories per gram. Some fats, such as olive oil, are better for you than other types of fat (butter, margarine, cream, cheese). Exercise is the best way to increase your "good" cholesterol.....which helps get rid of the "bad"cholesterol. Good luck with your healthful life-style choice. -JRS

 

   

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