Heart Attack

SOME HEARTBURN MEDICATIONS MAY INCREASE THE RISK OF HEART ATTACKS

June 19, 2015 by admin

A recent retrospective study has suggested a link between a class of over the counter heartburn medications and a an increased risk of heart attacks according to Dr. Steven Reisman, the Director of The New York Cardiac Diagnostic Center. This class of medications called proton pump inhibitors (PPI) include Prevacid, Prilosec, and Nexium. They work by potently decreasing the acid in the stomach. Those who are using these medications may have a 16-21% increase in the rate of heart attacks compared to those who have acid reflux and do not take these medications. This study is retrospective and thus may be limited in its ability to establish a cause and effect relationship. It is estimated that approximately 21 million people in the United States use PPI medications yearly.

The mechanism of association with heart attack risk may be related to several possibilities. It is possible that some individuals who have acid reflux “heartburn” may in fact have cardiac related angina or chest pain that independently puts them at risk for a heart attack. In addition, it has also been suggested that these PPI medications may decrease the amount of nitrous oxide in the blood vessel walls causing endothelial dysfunction which may increase the risk of heart attack.

Any individuals on PPI medications should consult their physician to see if this is appropriate according to Dr. Steven Reisman, a Cardiologist in Manhattan. In addition, other causes of heart attack risk should also be evaluated including stress testing and testing for endothelial dysfunction by using EndoPAT testing. Another class of drugs call H2 blockers may be more appropriate in certain patients who have acid reflux.

INDICATIONS FOR THE USE OF ASPIRIN IN THE PREVENTION OF HEART ATTACKS

May 10, 2014 by admin

The Food and Drug Administration (FDA) recently denied a request from Bayer, a manufacturer of aspirin, to expand the use of low-dose aspirin in the prevention of heart attacks, according to Dr. Steven Reisman, a Cardiologist in Manhattan. Previously the FDA in 1998 approved labeling for aspirin and related products in the secondary prevention of cardiovascular events. Secondary prevention includes use in those who have a history of coronary artery disease, previous heart attack, angina, and in those who have undergone revascularization procedures including coronary bypass surgery and angioplasty/stent placement.

In 2003 Bayer applied to the FDA to expand the indications for the use of aspirin for what is called primary prevention. In 2002 the American Heart Association recommended aspirin in primary prevention for those at increased risk for heart disease. The increased risk was defined as a 10 year risk of coronary heart disease greater than or equal to 10%. The goal was the prevention of heart attack.

Aspirin is effective by inhibiting blood clots and also by decreasing inflammation. The risks of aspirin use include allergy, gastrointestinal intolerance, and most importantly bleeding including gastrointestinal and intracerebral. After a review over several years the FDA recently denied the request by Bayer to include primary prevention because it felt the benefits did not outweigh the risks. The FDA noted that with further ongoing studies these recommendations may be expanded at a future date.

Aspirin at a low dose, or “baby” aspirin, is usually recommended at a dose of 81 milligrams per day in the secondary prevention of heart attack. This should only be started after consultation with a physician according to Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center, and a Manhattan Cardiologist. For primary prevention, Dr. Reisman recommends consultation with a Cardiologist to evaluate overall cardiovascular risk and to further define individual risk by non-invasive testing including stress testing, coronary calcium score, and evaluation of plaque buildup in the carotid artery.

Occurrence of Heart Attacks May Be Increased During the December Holiday Season According To Dr. Steven Reisman A New York City Cardiologist.

January 13, 2014 by admin

Some studies have shown that there appears to be an increased incidence of heart attacks around the Christmas and New Year’s season according to Dr. Steven Reisman a Cardiologist in New York City. A heart attack occurs when there is an acute blockage of blood supply and thus oxygen supply in one of the arteries supplying the heart muscle resulting in the death of heart muscle tissue unless this blockage is rapidly opened up and reversed within a few hours of the onset of this symptom. A heart attack can be symptomatic with the development of symptoms such as chest pressure, jaw pain, indigestion like symptoms, shortness of breath, and can also have atypical symptoms such as left arm and back pain. A heart attack can also be without symptoms and then it is known as a “silent” heart attack.

During the holiday season the increase in occurrence of heart attacks is thought to happen because of several reasons. It is well known that cold weather such as strenuous snow shoveling can be a factor constricting blood vessels to the heart and increasing the clotting of blood. Heavy physical exertion can also be a factor in cold weather such as strenuous snow shoveling. In addition, vigorous snow skiing particularly in those who are not in excellent physical shape can also be a related to the increased occurrence of heart attacks. Since the holiday heart attack increase has also been seen in warmer climates, other factors may be at work including psychological factors and also people may delay seeking medical attention even with chest pain because they want to wait until they return home.

According to Dr. Steven Reisman, a Cardiologist in New York City and the Director of the New York Cardiac Diagnostic Center several preventative steps can be taken. Regular exercise is a very important factor especially before skiing or snow shoveling. In addition a heart healthy diet such as a mediterranean diet that includes fiber and omega 3 fatty acid foods is recommended. In particular, no sudden vigorous exercise should be undertaken if the individual is not in shape and one should also wear several layers of warm clothing in cold weather. The prevention of psychological factors such as anger, hostility, and depression is important. It is highly recommended that preventative testing and screening take place before undergoing vacation or vigorous exercise if one is unsure about one’s own risk for heart attack.

Dr Steven Reisman, a New York City Cardiologist and Director of the New York Cardiac Diagnostic Center announces the implementation of a new device for the early detection of risk for heart attack and stroke

January 24, 2013 by admin

Dr. Steven Reisman, a New York City Cardiologist and Director of The New York Cardiac Diagnostic Center announces the recent implementation in his office of a device to measure “endothelial dysfunction” which is a measurement useful in the early detection of risk for heart attack and stroke. The device is call EndoPat and it is a fifteen minute test with the patient lying down and probes put on one finger in each hand to measure the ability of blood vessels to dilate after the inflation of a blood pressure cuff for several minutes.

EndoPat measures reactive hyperemia. Reactive hyperemia is calculated automatically by the device and shows the degree of vascular reactivity. Several recent studies have shown an abnormal test reveals dysfunction which can be an early risk factor for the development of atherosclerosis and “hardening of the arteries” and may also be a contributor to the progression of atherosclerosis.

The measurement of endothelial dysfunction is important in the early determination of risk for atherosclerosis; endothelial dysfunction may even be present before the occurrence of obstructive blockages on other imaging modalities. It is known that the process of atherosclerosis begins early in life and endothelial dysfunction contributes to this disease state and in fact precedes the development of plaque in the blood vessels.

Thus the use of this device to measure endothelial dysfunction or flexibility verses stiffness of the blood vessel is important in individuals early on to identify those who need aggressive life style changes along with risk factor modification in the prevention of both heart attack and stroke. Many interventions such as exercise, weight reduction, a healthy diet, and occasionally medications have been demonstrated to be beneficial in improving endothelial function. EndoPat can also be used to follow the individual’s response to these interventions over time.

EndoPat has been shown to be useful in many groups of patients including those with a family history of coronary artery disease, individuals with chest pain, those with elevated levels of cholesterol or triglycerides, diabetics, those with hypertension, women with chest pain, and also men with erectile dysfunction.

Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center, recommends that EndoPat can also be used in younger and middle age individuals as an early indicator of the need for aggressive attention to life style modification in those who are at increased risk for heart attack and stroke.

ACUTE TRIGGERS FOR CARDIOVASCULAR EVENTS SUCH AS HEART ATTACK AND STROKE

July 3, 2012 by admin

Dr. Steven Reisman, a New York City cardiologist, will discuss the relationship between acute risk factors or acute triggers and the development of a heart attack or stroke. It is well known that there are chronic risk factors for heart disease such as hypertension, hyperlipidemia, diabetes mellitus, smoking, and other factors. There are also acute risk factors that can precipitate a cardiac event. Acute risk factors may result in a rapid increase in blood pressure, vasoconstriction, or even increase in coagulability.

There are several psychological triggers that are known to play a role. These include anger, emotional upset, anxiety, stress in the work place, bereavement, and sexual activity.

An interesting phenomenon has been observed that showed a significant increase in heart attacks at 9 am in the morning. It appears that the act of waking up, when a person who is vulnerable to a heart attack, goes from a supine to an upright position increases the catecholamines in the body. These particular individuals most likely have an underlying plaque that is vulnerable and is more likely to clot in the morning.

There are physical triggers that can include vigorous physical activity along with sexual activity. These factors play a bigger role in those who are sedentary and a lesser role in those who have the habit of exercising on a regular basis.

There are psychological stresses which include an outburst of anger which elevates the risk of heart attack. Also, episodes of anxiety can increase the risk of a heart attack. In addition, depression and frustration may also be associated with increasing the risk of a heart attack.

There are also population stresses that can increase the risk of a heart attack such as earthquakes, war, and even elevated pollution levels and respiratory infection and also floods.

Dr. Steven Reisman, a New York City cardiologist and director of the New York Cardiac Diagnostic Center feels that an initial evaluation with a cardiologist in consultation to evaluate risk of a heart attack along with proper exercise and treatment of psychological stress and prevention of psychological stress is key to helping diminish the risk of heart attack and stroke in these individuals.

DR. STEVEN REISMAN, A MANHATTAN CARDIOLOGIST, REVIEWS THE MARKERS AND RISK FACTORS OF SUDDEN CARDIAC DEATH

March 6, 2012 by admin

Sudden Cardiac Death (SCD) refers to an unexpected death from a cardiovascular cause in an individual with or without pre-existing heart disease according to Dr. Steven Reisman, a Manhattan Cardiologist. This usually is a death occurring within one hour of an acute change in clinical status or an unexpected death that occurred within the previous 24 hours.

In the United States the incidence of sudden cardiac death varies between an 180,000 to 450,000 deaths per year. SCD still accounts for greater than 50 percent of all coronary heart disease (CHD) deaths, and approximately 15-20 percent of all deaths in the United States.

The incidents of SCD increases with age regardless of race or sex. Women, at any age have a lower incidence in SCD than men. Approximately two-thirds of women who present with SCD have no known history of heart disease compared with 50 percent of men.

A variety of risk factors have been proposed for the pathophysiology of SCD. CHD is the most common underlying disease associated with SCD in the western world being responsible for approximately 75 percent of SCD. Cardiomyopathies such as dilated and hypertrophic along with primary electrical disorders are responsible for the remainder. CHD in relation to SCD occurs in three settings including acute myocardial infarction, ischemia without infarction, and structural alteration such as scar formation with ventricular dilatation. The mechanism of SCD in cases without acute myocardial infarction is likely an electrical event due to a ventricular arrhythmia which is a caused by ischemia or other arrhythmogenic stimuli in a chronically diseased heart. It is suggested that approximately 90 percent of deaths that occur within one hour of symptom onset are arrhythmic in nature.

Coronary heart disease or congestive heart failure significantly increases SCD risk of the population. SCD risk factors may be similar to CHD risk factors. Risk factors for sudden cardiac death include smoking, diabetes mellitus, and hypertension. There are certain measurements on the standard resting electrocardiogram that may serve as risk factors for SCD including an elevated resting heart rate, prolonged QT interval and prolonged QRS duration. Some studies have suggested early repolarization as a risk factor for sudden cardiac death.

Certain nutritional patterns may provide protection for the risk of SCD. In some studies consuming fish one to two times per week was associated with approximately a 50 percent reduction in SCD risk. Light to moderate levels of alcohol consumption may be associated with reduced risk of SCD. In some studies it is suggested that an increase in plasma magnesium levels may provide protection for SCD. In addition, a mediterranean diet appears to provide some protection for SCD.

There are certain triggers that may be associated with SCD. There may be a certain diurnal variation to SCD with the greatest incidence occurring in the morning hours from 6am to noon. Certain studies have suggested the highest risk of out of hospital arrest may be on Mondays. These patterns may suggest activity with psychological exposure playing a role in triggering SCD. Although there are long term benefits of exercise, it is also suggested that SCD occurs with a higher than average frequency during or shortly after vigorous exertion. Chronic habitual exertion may result in increase cardiac electrical stability but transient vigorous exercise may have an increased risk for SCD. Both depression and acute mental stress may trigger SCD and acute increases have been seen in situations such as populations experiencing disaster such as earthquake along with life stresses such as the death of a spouse or loss of a job.

The New York Cardiac Diagnostic Center along with Dr. Steven Reisman, a Manhattan Cardiologist, promotes early diagnosis of heart disease and strategies to increase both awareness and prevention of triggers and risk factors related to both coronary heart disease and sudden cardiac death.

DR. STEVEN REISMAN A NEW YORK CITY CARDIOLOGIST, DISCUSSES THAT OBESITY ALONE INCREASES THE RISK OF A FATAL HEART ATTACK

March 3, 2011 by admin

A recent study has suggested that obesity alone can increase the risk of a fatal heart attack even excluding the effect of other risk factors such as hypertension and diabetes. Healthday (2/14 Mozes) has reported that obese men have a dramatically higher risk of dying from a heart attack. In the study of 6,000 middle age men followed for about 15 years, there was an increased risk of fatal heart attack independent of risk factors such as high blood pressure, diabetes, and high cholesterol.

Obese middle-aged men had a 60% increased risk of dying from a heart attack compared to non-obese middle age men after taking out the effect of these risk factors. This suggests that obesity itself may be causing the heart attack. One theory is that obesity may be related to inflammation as a factor in a fatal attack. In addition, obese individuals have larger hearts because of their increase in body size and their hearts may already be “stressed” prior to a heart attack.

Dr. Steven Reisman, Director of the New York Cardiac Diagnostic Center, states that our office advocates an aggressive approach about not only treating traditional risk factors but also obesity with nutrition counseling and also early diagnostic testing to detect heart disease prior to the development of a heart attack.

Heart Attack Risk Increased By Cold Weather

October 15, 2010 by admin

Healthday (8/10, Mozes) reports that a study of patients in the United Kingdom in those admitted
to the hospital for a heart attack revealed that a decrease of just one degree celsius on a single
day gives rise to a cumulative two percent rise in the number of heart attacks in the next twenty-
eight days. This study shows that cold weather increases the risk for having a heart attack in
particular for the elderly and those with a previous history of heart disease. It appears that those
who are taking aspirin were less vulnerable to this increase in risk. The author suggested that
prior research has shown that as temperatures goes down blood pressure may go up and the
blood may become thicker causing the heart to work harder and may also increase the possibility
of blood clotting.

Dr. Steven Reisman, Director of The New York Cardiac Diagnostic Center and a Manhattan
Cardiologist states that the risk of heart attack that is associated with a drop in outdoor
temperature is relatively small compared to the usual cardiovascular risk factors such
as smoking, obesity, high cholesterol, high blood pressure, family history, and diabetes.

U.S Hospitals improving the delivery of urgent care to heart-attack patients

July 14, 2010 by admin

Bloomberg news (7/12/2010) reported that hospitals in the United States are delivering more urgent and faster emergency medical care to heart attack patients which results in increased survival. Bloomberg reported that in 2009 88% of patients with heart attacks received procedures within the recommended 90 minutes of arriving at the hospital compared to only 64.5% in 2007. The original study was published in the Journal of the American College of Cardiology.

According to the American College of Cardiology about 770,000 Americans this year will have their first heart attack. A heart attack is an acute disruption of blood flow to the heart causing the death of the heart tissue. About 38% of those heart attacks will result in death.

These findings showing improved urgent care to these heart attack patients gives hope for increasing survival of heart attack patients brought to the hospital early on. Patients at risk for heart attack include those with cardiac risk factors such as hypertension or high blood pressure, diabetes mellitus, a history of smoking, hyperlipidemia or elevated lipids, a family history of heart disease and obesity. These individuals need early testing to evaluate their risk for heart attack.

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Heart Attack