Atlanta Heart Specialists Practice

Viagra: Life saver or life enhancer?

noreply@blogger.com (Atlanta Heart Specialists) — Thu, 05 Aug 2010 00:00:00 +0000

Sildenafil (Viagra) and other drugs known as phosphodiesterase-5 inhibitors, including Levitra and Cialis have become popular for improving quality of life for many men. They have been very successful in treating erectile dysfunction. As impotence is generally not considered life threatening for most men, these drugs are generally termed ‘lifestyle drugs”. For that reason, they have developed a street market and to some extent have been abused.

Recently, FDA has approved sildenafil (Viagra) to be marketed under a different name called Revatio for treatment of a life threatening disorder called “Pulmonary Hypertension”. This condition implies high blood pressure in the arteries of the lungs, which can subsequently cause heart failure and death. Since then, there have been numerous reports of sildenafil being studied for treatment of various cardiovascular diseases, liver disease and complications of pregnancy.

Although, there is concern about potential complications with the use of medication including heart attacks and vision impairment, there is sufficient evidence that Viagra has transcended impotence and may become valuable for treatment for a wide range of life threatening medical conditions.

Initially, Viagra was developed as a blood pressure medication in the 80s. then it was studied as a heart medication for chest pains. The results were not very encouraging and the drug was to be scrapped until many male subjects reported reversal of their impotence. Since then, it has come a full circle and now is being studied judiciously for many heart related treatments.

So far in addition to impotence, sildenafil (Viagra) has improved symptoms of pulmonary hypertension particularly in children and now is showing a lot of promise in treatment of heart failure. There are studies ongoing in treatment of liver failure and some pregnancy complications. Another potential benefit is for patients who are undergoing heart surgery.

It has also been shown to reduce likelihood of fetal growth restriction by widening the arteries supplying blood to the developing baby.

As potential medicinal uses of Viagra and similar drugs are discovered, it certainly invokes a lot of confidence in prescribing it for men who may be suffering from impotence. I still believe that it is fairly underutilized, as many men may not feel comfortable discussing this issue with their physicians. Some common conditions leading to impotence include diabetes, high blood pressure, high cholesterol and vascular disease ( a condition where cholesterol plaques start to build up in the arteries supplying blood to all the vital organs). In addition, many commonly prescribed blood pressure medications can also lead to this condition. Many physicians screen for impotence in patients with above conditions, but many rely on patients to inform them. In my clinical experience, many men after a certain age expect impotence and do not seek attention. However, most will have underlying causes and further evaluation of impotence can bring to attention more serious maladies (such as heart disease or diabetes) that have not yet manifested. There are certain medical conditions that preclude use of sildenafil , and there are potentially lethal interactions with some medications, most notably nitoglycerine. These issues need to be carefully assessed by your physician

As more uses of sildenafil are discovered, it is absolutely clear that it can certainly be life enhancing and probably life saving as well. A word of caution about use of sildenafil, although it is considered safe and more beneficial than previously thought, it still needs careful monitoring as we gather more information.

Dr Sandeep Chandra

Snoring to a heart attack

noreply@blogger.com (Atlanta Heart Specialists) — Wed, 04 Aug 2010 23:58:00 +0000

Snoring has always been equated with deep restful sleep according to traditional folkore. “Snoring peacefully” has almost gained universal stamp of approval. However, recently there has been a growing awareness of a serious sleep problem that can be very deleterious for our health. This condition is known as “Obstructive Sleep Apnea” and snoring is one of the features of it. There is growing evidence that it can also lead to various heart ailments including heart attacks and abnormal heart rhythms which may lead to death.

Recently, I had written about the importance of sleep and its beneficial effect on the heart. This needs to be furthered qualified. The quality of sleep is very important. Fragmented sleep and obstructed sleep patterns can be very dangerous for the heart and the rest of the body.

Obstructive Sleep Apnea simply stated means, unrecognized difficulty in allowing air into the lungs while sleeping (implying that the muscle tone of the breathing passages may be very relaxed to the point of collapsing during the inbreath.) As the awareness is increasing, it is estimated that up to 4% of the population suffers from it.This includes men (greatest risk), women (slightly lower risk) as well as upto 3% of all children. Most common cause of snoring in children is enlargement of the tonsils and adenoids. In adults, the most common cause is “weighing too much”. Technical term is obesity, which means weighing 20% over your ideal body weight. There are other causes as well which have to do with the architecture of the mouth and throat leading down to the breathing passages.

Although snoring is the most obvious sign of potential sleep apnea, the most damaging part is brief periods of complete cessation of breathing. These episodes can be as brief as 10 seconds and occasionally much longer. This lowers oxygen level to below 90% which is considered dangerous. Normal oxygen levels are 96-100%. It is felt that lowering of the oxygen levels taxes the heart and the brain significantly.

Some of the common signs and consequences of OSA are snoring, usually brought to attention by family members and occasionally neighbors. Most people are not aware that they snore. (although, I have seen several patients who wake up because of their own loud snoring). Typically, people are shocked to find out that they snore. Other features include fatigue daytime sleepiness, morning headaches, sensation of choking, poor memory, difficulty in concentrating, poor performance at work. Usually there is associated high blood pressure, history of depression and hypothyroidism. The only way to truly diagnose this condition is to undergo a sleep study in a qualified lab under the direction of a sleep specialist.

In the event that sleep apnea goes unrecognized, it can lead to several conditions. Initial complications include abnormal heart rhythms, high blood pressure. Over time this can lead to strain on the right side of the heart. Swelling in the legs is a common consequence. Severe consequences include heart failure, heart attacks and strokes.

Typically, in patients with high blood pressure, a fair number will have OSA. Recently, it has also been associated with automobile accidents, most likely due to daytime sleepiness.

The first step to the treatment is awareness and then diagnosis. Subsequently, based on individual assessment, treatment includes weight loss, High pressure oxygen mask (known as CPAP) while sleeping and in some cases, surgery can be corrective. Some general measures we can all take to reduce the likelihood is as follows:

1) Maintain ideal body weight (or as close to it as possible)

2) Exercise – this has not been conclusively proven, but it is felt that exercising does improve muscle tone and swelling in the breathing passages and leads to weight loss

3) Avoid alcohol

4) Avoid sedatives including sleeping pills

5) Comfortable sleeping position with emphasis on proper alignment of the neck while sleeping

Seek evaluation if you develop any of the following signs and symptoms:

1) daytime sleepiness

2) loud snoring with periods of complete stoppage of breath as observed by family members

3) awakening in the middle of the night with a sense of panic

4) palpitations

5) choking sensation upon awakening

6) swelling in the legs

7) unexplained headaches in the morning (excluding hangovers)

8) decreasing memory and ability to concentrate

9) irritability and progressive decline in work performance

Sleep Apnea does occur in various degrees of severity. However, prompt attention to even milder degrees can reduce the risk of a heart attack and a stroke. Even in the absence of sleep apnea, poor sleep patterns can be picked up which after treatment can significantly improve lifestyle and increase daytime energy.

Dr Sandeep Chandra

Taming the Pounding Heart

noreply@blogger.com (Atlanta Heart Specialists) — Wed, 04 Aug 2010 23:57:00 +0000

Typically, the heart beats about seventy times a minute, which in turn is 100,800 times every day. Hopefully, it does it without skipping a beat. However, it is well known that approximately ten million Americans suffer from some form of alteration in rhythm of the heartbeat. This can either be skipped beats, slow beats or fast beats. It is also fairly common to have an irregular beat. Most commonly, these are felt as “Palpitations”.

Collectively, abnormalities in the rhythm or rate of heartbeat is referred to as an “Arrhythmia” Luckily, majority of the arrhythmias are benign, however, some are fairly life threatening and are termed as malignant. There is no correlation between how they are perceived (in terms of discomfort) and their significance. They all need to be evaluated to some extent. Some of the most benign arrhythmias can be most troublesome and very difficult to treat. Some such as “Atrial Fibrillation” although are benign by themselves, can lead to a substrate exposing the patient to a high risk of stroke. Therefore, all palpitations need to be carefully evaluated.

Modern medicine has found it very challenging to offer a reasonable treatment for some very common arrhythmias. Sometimes, the treatment is more dangerous than the actual rhythm disturbance. In the past, a very popular medication was found to be very effective in terminating arrhythmias, and quite frequently, the patient as well.

To this day, there are no ideal anti-arrhythmic agents which combine efficacy without harmful or bothersome side effects. Most commonly, physicians have chosen to treat the life threatening irregularities and generally avoid medications for benign irregularities. This can sometimes expose patients to a very fairly uncomfortable sensation, albeit benign. However recently there has been a lot of natural supplements that have shown potential of being the ideal treatment for some of the benign irregularities. Some of them come close to being the ideal anti-arrhythmic.

In this article, we will review three of the most up and coming supplements. A word of caution, it is ill advised to treat an arrhythmia without having it evaluated by a physician. Not all palpitations are treated the same. With this in mind the first contender is “Fish Oil”.

Fish oil is a very concentrated source Omega 3 Fatty acid. Fish oil has been found to decrease the number of some types of irregular heart beats. It has recently been found to decrease the likelihood from certain n types of dangerous heart rhythms. In a trial done in 1989, it was found that men with previous heart attacks (heart attacks pre-dispose patients to very malignant forms of arrhythmias) who ate fish twice weekly had a 29% reduction in death. There was no decrease in the number of heart attacks but a definite decrease in deaths from heart attacks. It is felt that the benefit may have been related to control of the arrhythmia. In some studies, a 53% reduction in the risk of sudden death has been noted in patients who have had previous heart attacks. Up until now the benefit was only proven in patients with impaired hearts. However, recently there is evidence suggesting that even in people with normal hearts there is a substantial reduction in the risk of sudden death. The question that remains unanswered is whether or not it is effective in patients with less dangerous arrhythmias such as “Atrial Fibrillation”. It is known that people with atrial fibrillation have lower levels of omega-3 fatty acid.

Sources of omega-3 fatty acids are fish oils (most concentrated) as well as flaxseed, walnuts and canola oil. However, only 10% is absorbed when flaxseed etc are used. To achieve heart rhythm benefits, at least 1000-2000 mg of fish oil is needed.

Magnesium, is another supplement which has very beneficial effects. It is also postulated that most arrhythmias have magnesium deficiency as their root cause. The challenge is that there is no way to truly measure levels of magnesium in the heart muscle. Blood levels are a poor indicator. Even when the blood levels are normal, tissue levels can be very depleted. Infact, in a recent study, only 8% of patients had low blood levels of magnesium when in reality 53% tested low at tissue levels. Magnesium is also slowly becoming a very endangered nutritional element. Most common source used to be hard water, but with new water treatment facilities and in-home use of filters converting hard to soft water further eliminates availability of magnesium. A recent World Health Organization study concluded that there is a relationship between hardness of water measured by magnesium and calcium content and the risk of cardiovascular death. Many cardiologists are now routinely recommending to many of their patients to take magnesium supplements. The only side effect known is diarrhea, which can be avoided by spreading the recommended dose of 300-500mg all through the day. Magnesium citrate is possibly the best form of supplementation.

Needless to say there are several other supplements with possible benefits to the heart beat, but Fish Oil and magnesium are the best studied. At present, it is felt that they should be used as adjuncts to what is prescribed by your doctor and not instead of. Also, to keep your heart in rhythm, daily exercise and a non-toxic diet is still your best course of action.

Dr Sandeep Chandra

Healthy mind, for a healthy body

noreply@blogger.com (Atlanta Heart Specialists) — Wed, 04 Aug 2010 23:55:00 +0000

When your back aches, is it truly your back that’s bothering you? This may be the question your physician may start asking very soon. Medicine underwent a major revolution in the 1900s with the advent of “allopathic medicine” which included penicillin and other life saving drugs. To this day, no other medication or surgery has had the same impact that penicillin and aspirin had on mortality. Infact, some of the most expensive and highly marketed drugs have gotten FDA approval by showing statistical improvement in mortality of single digits. Meaning, upto a 1000 patients would need to be treated prior to saving 1 to 10 lives. Any life saved, is worth any price, however it is at the cost of increased risk of side effects and complications to countless others, who may not have benefited nearly as much.

With enhanced awareness of our limitations, physicians subsequently discovered that most of the therapies we offer, are treatments that have to be continued lifelong with no real “cures”. Clearly, there has to be a better answer, or is there a missing link?

For the longest time it was felt that this is it! Take it or leave it. During this period in the 1970s, some physicians recognized that contemporary medicine clearly had a diagnostic and a therapeutic role, however, the missing link was what our predecessors always knew. They focused more on the “mind’s effect on the body”. There have been many cases reported where physician effected amazing cures by strictly talking to the patients! Medical literature from the 1800s, has many excellent therapeutic approaches to maladies, which to this day, are considered untreatable. Majority of these have to do with changing one’s emotional state.

Many leading physicians have started advocating relaxation techniques and mind control as a way to achieving cure from many conditions (some claim all conditions). Dr. Herbert Benson at Harvard studied meditation scientifically and documented reduction in risk of a second heart attack by upto 40%. Many “ultra prevention clinics” have documented cure rates of cancers which have been unheard of in modern science.

Emotional state or your mind is felt to be a culprit in many conditions. Some common ones are as follows:

Back pain
Change in appetite
Chest pain
Constipation or diarrhea
Dry mouth
Extreme tiredness
General aches and pains
Headaches
High blood pressure
Insomnia (trouble sleeping)
Lightheadedness
Palpitations (the feeling that your heart is racing)
Sexual problems
Shortness of breath
Stiff neck
Sweating
Upset stomach
Weight gain or loss

With the recent discovery of the “Broken Heart Syndrome” there is more evidence that links mind to disease states.

“Mind Control” is the process of attuning your mind consciously to a positive source and thereby negating all negative influences in your mind. Negative energy expresses itself as negative thoughts and emotions. It is commonly believed that thoughts are out of your control and are at the mercy of your life circumstance or “an outside force”. Mind Body medicine clearly has demonstrated that emotions we experience and the thoughts we generate our clearly a choice we have exercised. One way of staying healthy is to eliminate all negative emotions and energies in our life. Dr. David Hawkins, in his book “power v/s force” has actually proven scientific correlates of these emotional states.

A distinction needs to be made in “suppressing” negative thoughts v/s eliminating them. Expression of negative thoughts has also been shown to correlate with disease states. Achieving control over your mind, can be a life long effort and will be expanded upon in future articles. Some simple techniques are

· Meditation

· exercise

· yoga

· eliminating negative energy in your surroundings (including people with negative mindsets)

· Breathing exercises such as pranayama

Needless, to say that we have come 360 degrees in our understanding of the human body and have come back to the mind. This does not negate the advances we have experienced in science which can be life extending, however, with little regard for the quality of life. Medicines and surgeries try to accomplish externally, with a lot of impunity, which the mind can achieve literally instantaneously with no impunity. There is still a lot to be discussed, learnt and discovered, but we have entered an era of integrated medicine which has the potential of revolutionizing health care to a level which currently seems incomprehensible.

Dr Sandeep Chandra

Atlanta Heart Specialists

Welcome to Atlanta Heart Specialists

noreply@blogger.com (Atlanta Heart Specialists) — Wed, 07 Apr 2010 16:44:00 +0000

Welcome to the Atlanta Heart Specialists Blog!

Please stay tuned for more information about our practice.