Get Well Wednesday: The Facts On Strokes And Heart Attacks

Since 2009, Dr. Paul Underwood has been a medical director at Boston Scientific, a global company that develops and distributes minimally invasive implantable medical devices such as cardiac stents, pacemakers, defibrillators and heart valves.

He is also the medical director for Close the Gap, a Boston Scientific solution-oriented health equity initiative committed to eliminating cardiovascular health disparities by promoting quality and access to care for all people who may be in need.

Dr. Underwood is the former president of the Association of Black Cardiologists and a fellow of the American College of Cardiology and the Society for Cardiac Angiography and Intervention.

A Morehouse graduate, Dr. Underwood did his medical training at The Mayo Clinic in Rochester, New York and completed his  cardiology training at the Cleveland Clinic with an interventional fellowship at Iowa Heart Center in Des Moines.

The author of over 60 scientific publications, Dr. Underwood received the Certificat De Mérite La Fondation Nationale de’ Action Sociale du Sénégal for his contribution to the establishment of an open heart surgery program in Dakar, Senegal in 1999.

Dr. Underwood answers your questions below: 

Can you guys ask the doctor about interstitial cystitis and what foods you should eat? 

Interstitial cystitis is a relatively new  disorder that has not yet been fully characterized. Some people have noticed that certain foods can make the symptoms appear. Urologists are the doctors that specialize in bladder problems. Besides dietary modifications (see below) there may be other therapies that can cause benefit. First line diet therapy from Wikipedia states:

Diet modification is often recommended as a first-line method of self-treatment for interstitial cystitis, though rigorous controlled studies examining the impact diet has on interstitial cystitis signs and symptoms are currently lacking. Individuals with interstitial cystitis often experience an increase in symptoms when they consume certain foods and beverages. Avoidance of these potential trigger foods and beverages such as caffeine-containing beverages including coffee, tea, and soda, alcoholic beverages, chocolate, citrus fruits, hot peppers, and artificial sweeteners may be helpful in alleviating symptoms. Diet triggers vary between individuals with IC; the best way for a person to discover his or her own triggers is to use an elimination diet. Sensitivity to trigger foods may be reduced if calcium glycerophosphate and/or sodium bicarbonate is consumed. For further information a specialist (Urologist) should be consulted. Another source of healthful information is Black Health Matters. This site is very informative and well worth the visit!

What are the worst foods for you if you have diabetes?

Diabetes is a metabolic problem caused by the body not being able to handle the sugar that is eaten. The goal of diabetes management is to reduce sugar intake to match what the body can handle to keep the excess sugar out of the bloodstream. There are different types of diabetes. The most common type (Type 2) is treated with diet, exercise/weight management (loss) and medications. Foods that have a high ‘glycemic index’ can cause a rapid rise in a person’s blood sugar once they are eaten. This chart categorizes foods by glycemic index. Diabetics are  recommended to eat low glycemic index foods. A Registered Dietician (R.D.) can provide much valuable information on the dietary management of diabetes, referrals to these specialists can be easily made through a primary care provider or a hospital.

I love fried fish and can’t give it up. Is it OK to have fish fried in olive oil on a regular basis?

The ‘Mediterranean diet’ which is loaded with fish, vegetable and olive oil has been shown to be ‘heart healthy’. Certain oils may break down at high temperatures and thus are not recommended for frying. Although the combination of fish and olive oil may be beneficial, the way it is prepared may reduce some of the health benefits. Check ‘heart healthy’ recipes from the Association of Black Cardiologists or the American Heart Association.

Doctor, my grandma was just diagnosed with congestive heart failure this weekend. She has been tight-lipped about her health and isn’t always a believer in ‘science.’ What tips do you have for our family to help support her?

Heart failure can be a scary diagnosis. Fortunately, this condition has received much attention and the management strategies are much better now than they were in the past. Since most people are not aware of the management strategies, they must learn about them after a heart failure diagnosis has been made. There are many resources available for heart failure education.

They typically focus on reducing salt intake, taking appropriate medications at the recommended doses, and knowledge and management of any co-existing conditions that may be contributing the heart failure. Although the treatment for heart failure is fairly well standardized, evaluation by a heart failure specialist (cardiologist) is often recommended. This can be done to confirm the diagnosis, to exclude any contributing factors and to agree on the best course of action.

The referral to a heart failure specialist can be made by a primary care provider. Many health systems also have heart failure teams that assist patients with heart failure management, these are excellent resources to use if they are available.

In this case, you will likely have to do the bulk of the heart failure learning so that you can teach your grandmother and monitor her progress. Black Americans are at greater risk for cardiovascular disease and stroke than White Americans.

A heart attack is a term that typically means ‘myocardial infarction’ or blockage of blood reaching the heart. To some people ‘heart attack,’ particularly ‘massive heart attack’ means sudden cardiac arrest (death). The symptoms of a heart attack are:

·         Chest pain, often radiating to the left jaw or arm (often an oppressive sensation like a squeezing)

·         Shortness of breath

·         Dizziness like you are going to faint

·         Nausea

·         Breaking out in a ‘cold sweat’ (diaphoresis)

·         Undue fatigue

·         Palpitations (fluttering in the heart from an abnormal heart beat)

These symptoms can occur in any combination and should receive prompt medical evaluation in an Emergency Room. If you are having a heart attack, the longer you wait, the more heart damage is being done. The combination of palpitations and dizziness is drastic and requires IMMEDIATE attention-it could be the only warning a person receives for a ‘massive heart attack.’

My mom is a 57-year-old smoker. She has had blood clots in her lungs. Is that from smoking or is it a sign of heart problems?

Smoking makes a person’s blood clot much more easily. People should not smoke! People with blood clots should not smoke!! People who have lung problems, like blood clots, should not smoke!!! Your mother should stop smoking immediately!!!! Although quitting is easier said than done, there have been advances in medical therapy to help people break the habit. Many hospitals have smoking cessation classes and tobacco use (and quitting, perhaps with medication assistance) can be addressed by a primary care provider.

I am a 31-year-old woman, 5’2 and 106 pounds. I don’t smoke and work out regularly. I have frequent PVCs (premature ventricular contractions) and  PACs (premature atrial contractions) sometimes in couplets and triplets.

After some testing, it shows that I have leaky mitral and atrial valves. Are these things related and how serious should I take them? My cardiologist doesn’t seem at all worried or interested. Is this something I need to go deeper into? My mother died at the age of 53 due to heart disease.

Mitral valve problems are commonly seen and often associated with the symptoms you describe. Your doctor apparently believes you have a mild disorder that does not warrant particular treatment at this time. If this is true, then often infective endocarditis prophylaxis (antibiotics before dental work, etc) is recommended. It is also recommended to watch (echocardiogram) the valve every 5 years to assure the condition has not changed. The palpitation can be problematic but the general dictum is that more harm (sometimes fatal) can be done by treating them than not. A cardiologist specializing in heart rhythm disorders is called an electrophysiologist and your cardiologist can refer you to one for evaluation.

Fast Facts on Heart Disease and Strokes:

• Black women (49%) and Black men (44%) have higher rates of heart disease than White men (37%) and White women (32%).¹
• Between the ages of 45 and 64, Black men have a 70% higher risk and Black women have a 50% greater risk of developing heart failure than White men and women.
• The earlier onset of heart failure means higher rates of hospitalization, earlier disability, and higher rates of premature death (death before the age of 65) for Black Americans.
• The annual rate of first heart attacks and first strokes is higher for Black Americans than White Americans.

Source:  American Heart Association

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